Usefulness and safety of bunazosin hydrochloride in neurogenic bladder after prolonged administration]

Bunazosin hydrochloride (Ea-0643), a selective alpha 1-blocker, was administered to 14 patients with neurogenic bladder over prolonged periods of time in order to determine its efficacy and safety. Subjective symptoms were classified into 4 grades, and their response assessed after 12 weeks of treatment. The proportion of patients showing improvement by at least one grade was 50.0% for retarded urination, 16.7% for prolonged urination, 25.0% for urinary stream condition, 25.0% for abdominal pressure at voiding, and 28.6% for residual urine. Objective symptoms were also assessed after 12 weeks of treatment, and a statistically significant improvement was recognized in the volume of spontaneously voided urine, the maximum and mean flow rates on uroflowmetry. It should be noted that both of those flow rates had improved significantly only 2 weeks into the treatment. The degree of improvement in subjective and objective symptoms and the degree of general improvement were all higher at week 12 than at week 2 of treatment. Current knowledge of the mechanism of action of this drug, coupled with the observations made in this study, suggests that, once it has improved the urodynamics, it exhibits a sustained effect for prolonged periods of treatment. However, further studies are warranted concerning the mechanisms of the pharmacological action of the drug from a pathological viewpoint. The proportion of patients in whom Ea-0643 was judged to be useful at 12 weeks of treatment was 41.7%, but when the assessment of 'slightly useful' was taken into consideration, the usefulness rate rose as high as 91.7%. Stomatitis was observed in only one case as a side effect of this drug.(ABSTRACT TRUNCATED AT 250 WORDS)     

A successful surgical case of acute myocardial infarction in total obstruction of the left main coronary arterial ostium]

Cardiogenic shock due to acute myocardial infarction in an 81-year-old man with total obstruction of the left main coronary arterial ostium was successfully treated with coronary artery bypass grafting. Although this procedure was successful there are some problems in the surgical management of this condition with regard to myocardial protection and preoperative evaluation of poorly visualized left coronary system. It is necessary to infuse first a large volume of high pressure cardioplegic solution and then follow it with another infusion of the solution, through the vein graft, at the regular volume and pressure. Furthermore, the complete revascularization of the left coronary system by vein grafts is recommended.     

Surgical management of the coronary artery to pulmonary artery fistulas; a case of a large ruptured aneurysm

Three patients were treated for coronary artery-pulmonary artery fistula. Each was asymptomatic due to a coronary artery fistula. There was one instance each of myocardial infarction, mitral stenosis and a large closed ruptured aneurysm including a thrombus. All the fistulas were comprised of several small plexiform arranged vessels. The left to right shunt ratio was approximately 8 per cent or less. A surgical operation was performed to close the drainage orifice of the fistulas through pulmonary arteriotomy under cardiopulmonary bypass in two patients while one patient underwent a ligation of a large abnormal vessel to the aneurysm followed by a resection of the aneurysm without cardiopulmonary bypass. A large saccular aneurysm of such fistulas is rare and a rupture of such an aneurysm is even more rare. The surgical management of coronary artery fistulas is also discussed herein.     

Serum level of major basic protein indicates disease activity in atopic dermatitis

We evaluated the serum levels of major basic protein (MBP), assayed using an MBP radioimmunoassay kit. and the effect of an anti-allergic agent, ketotifen, which has strong anti-eosinophil activity, in 56 atopic dermatitis (AD) patients. The serum MBP level was significantly lower (660.11 ± 34.52 ng/ml, P < 0.05) after administration of ketotifen (1 mg twice a day) for 8 weeks than before treatment (774.98 ± 48.64 ng/ml). These findings suggest that serum MBP levels are a useful indicator of AD activity and that anti-allergic agents can have an effect on eosinophil involvement in AD.     

Is there an alternative therapy to cyanoacrylate injection for safe and effective obliteration of bleeding gastric varices？

TO THE EDITOR We read with interest the article entitled “Bleeding gastric varices: Results of endoscopic injection with cyanoacrylate at King Chulalongkorn Memorial Hospital” by Noophun et al[1]. They performed n-butyl-2-cyanoacrylate (CA) injection th…     

Epileptiform EEG Discharges in Healthy Children: Prevalence, Emotional and Behavioral Correlates, and Genetic Influences

Summary: Epileptiform discharges in 8 electrode waking EEGs at rest and during hyperventilation in 1,057 healthy children aged 6–12 years from an elementary school were studied: Epileptiform discharges, detected in 53 children (5.0%), consisted of centrotemporal spikes (37 cases), generalized spike ahd slow wave complexes (10 cases), occipital spikes (2 cases), frontal spikes (1 case), and a combination of multiple spike and slow wave complexes and focal spikes (2 cases). The occurrence of a positive past history of febrile convulsions was higher in children with epileptiform discharges (18.9%) than in those without epileptiform discharges (9.4%). Using the Rutter scales for teachers and parents, we compared the emotional and behavioral problems of children with epileptiform EEG discharges with those of children without epileptiform discharges. No statistically significant differences were noted, indicating that the emotional and behavioral problems existing are most probably coincidental and not directly related to the epileptiform discharges. A genetic basis for generalized epileptiform discharges was postulated because the occurrence of generalized discharges in siblings of probands with generalized discharges was higher (4 of 9, 44.4%) than the prevalence in all subjects. However, the occurrence of centrotemporat spikes in the siblings of probands with centrotemporal spikes was not higher (2/38, 5.3%) and an autosomaldominant genetic factor for centrotemporal spikes in waking EEGs of healthy children could not be confirmed.     

Randomized trial-comparing UFT and FT in the treatment of advanced hepatocellular carcinoma (second report: well controlled study on patients with transcatheter arterial embolization) Osaka Research Society for Liver, Gallbladder and Pancreas]

In a randomized trial Tegafur (FT) or Tegafur.Uracil (UFT) was administrated to 90 patients with advanced hepatocellular carcinoma for whom transcatheter arterial embolization was applied. Efficacy in the reduction of tumor size, subjective symptoms and clinical laboratory findings was comparable in both groups. However, survival rate in the UFT group was significantly higher than in the FT group in only 2 limited subgroups of patients without prior chemotherapy and with tumors found in both lobes of the liver. With respect to adverse effects, complaints about gastrointestinal tract were often noted in the UFT group, but no significant difference was found between the two groups.