Recent progress and future prospect of the prolonged extracorporeal lung assist for respiratory failure

Extracorporeal membrane oxygenation (ECMO) is becoming an accepted therapeutic option for acute respiratory failure in both infants and adults. ECMO has been applied for relatively short-term support and numerous centers have reported satisfactory results with emphasis on patient selection, techniques of cannulation and perfusion, and prevention of complications. To use ECMO for a prolonged support, however, new type of artificial lung and system need to be developed. Most of the membrane oxygenators have the possibility of serum leakage through micropores. To prevent this problem, several dense membrane oxygenators have been developed and clinically used with good gas exchange. A low heparin dosage during ECMO results in reduced bleeding complication. Full systemic heparinization can be avoided during ECMO by using heparin-coated perfusion equipment. Respiratory support by means of pumpless PA-LA extracorporeal membrane oxygenation driven by pulmonary arterial pressure is attractive because of its simplicity and might be suitable for prolonged use. Further studies are necessary to develop an oxygenator for long-term ECMO.     

Dentist's understanding on dental anesthesiology--on the basis of a questionnaire on post-graduation study

We set out a questionnaire for 400 participants of the seminar, to investigate the thoughts of dental practitioners and dentists on duty with regard to the post-graduation study and training in particular, to dental anesthesiology. The results obtained were as follows. 1. Almost all of the dental practitioners felt necessary to receive the post-graduation study and training to brush up their techniques. 2. The dental practitioners felt defective in actual techniques prepared by post-graduation trainings now under way, and they desired a particular training in an actual technique specific to an emergency therapy. 3. Seminars for re-education they desired to attend were those related to anesthesia in majority, followed by prosthetics, maintenance and periodontosis, orthodontics, and surgery, implantodontics, and pedodontics. 4. Major curriculums of anesthesiology they desired to receive were systemic management, resuscitation, how to apply the first-aid medicine, and treatment for shock states. The number of those participants who desired to receive these curriculums was help or above of all members, followed by those in dental psychosomatic disease, treatment for senile patients and acupuncture anesthesia. 5. It was unexpected that those who had been aware of the concept of authorized dental anesthesiologist were confined to 54% of the participants. This led us to consider that clinical dentist should be re-educated regarding the system for authorized anesthesiologist. 6. Major participants answered nothing with regard to the advocated curriculums we questioned, so that it was postulated that none felt unsatisfactory of the advocated curriculums at present.     

Role of interleukin-5 in local accumulation of eosinophils in mouse allergic peritonitis.

The injection of ragweed pollen extracts into the peritoneal cavity of actively immunized mice caused an accumulation of eosinophils in the cavity. We investigated the role of interleukin-5 (IL-5), one of the T-cell-derived factors, in this in vivo local accumulation. Ciclosporin, an immunosuppressant that mainly suppresses T cell functions, dose-dependently inhibited the in vivo local accumulation. Injections of the neutralizing antibody to IL-5 into the cavity decreased the number of the accumulating eosinophils. When the peritoneal cells of the immunized mice were cultured in the presence of the antigen in vitro, IL-5 activity was detected in the culture supernatant. The results indicate that IL-5 plays an important role in the in vivo local accumulation of eosinophils after an antigen challenge.     

Elevated plasma tissue factor antigen level in patients with disseminated intravascular coagulation

The plasma tissue factor (TF) antigen level was measured in patients with disseminated intravascular coagulation (DIC). The plasma TF antigen was detected In normal volunteers, and it was significantly higher in DIC patients than in non-DiC patients. However, in some patients with DiC, the plasma TF antigen level was within the normal range. The plasma TF antigen level in patients with DIC significantly decreased after therapy, but it was not correlated with organ failure or outcome. The plasma TF antigen level in patients with DIC was not correlated with other hemostatic markers. The plasma TF antigen level tended to be higher in DIC patients with nonlymphoid leukemia than in those with lymphoid tumor. TF might be implicated in the occurrence and progression of DIC. © 1994 Wiley-Liss, Inc.     

Diffuse large B-cell lymphoma initially manifested by massive ascites and a small gastric lesion, clinically mimicking primary effusion lymphoma (PEL) in the abdominal cavity: a case report and review of the literature on Japanese PEL patients]

A 50-year-old man was admitted because of increasing massive ascites. While lymphoma cells (diffuse large B-cell lymphoma: DLBCL) were detected in the ascites, pleural effusion, cerebrospinal fluid and bone marrow, no tumor masses other than a submucosal lymphoma lesion in the stomach only 1 cm in diameter were identified. The patient was treated with chemotherapy including rituximab (R-CHOP-ESHAP) and injection of methotrexate and dexamethasone into the medullary cavity as well as radiation to the whole brain, and achieved complete remission 4 months later. The present case suggests that DLBCL can initially manifest as a form of effusion lymphoma with minimum solid tumor component. The distinctive clinical features of Japanese patients with primary effusion lymphoma are also reviewed.     

Demonstration of inguinal hernia by means of peritoneal99mTc-MAA scintigraphy with a load produced by standing in a patient treated by continuous ambulatory peritoneal dialysis

A 45-year-old man receiving continuous ambulatory peritoneal dialysis developed scrotal swelling and edema which was aggravated in the standing position. Physical examination failed to find inguinal hernia and although ultrasonography revealed the patent had processus vaginalias, it failed to prove its continuity to the peritesticular space of the tunica vaginalis. Peritoneal scintigraphy with intraperitoneal instillation of 99mTc-Macroaggregated albumin followed by standing clearly demonstrated the connection. The use of the standing load makes possible faster visualization of a positive finding and more accurate diagnosis than examination in the supine position.     

Surgical treatment of gastric cancer in the aged]

The present status of surgical treatment for gastric cancer in the aged was reviewed. The incidence among the aged in the overall operated patients with gastric cancer has increased yearly and recently has reached approximately 35%. The incidence of early gastric cancer in the aged has increased 40% in recent times. Pulmonary failure and anastomotic leak of the alimentary tract are the most common post-operative complications in the aged; these easily lead to the development of multiple organ failure with high mortality. Precise pre-operative evaluation of functional disorder in each organ and pre-, post-operative nutritional and transfusional support is indispensable to overcome these complications. Surgeons are required to perform appropriate surgical maneuvers with minimum operation time and minimum blood loss with full consideration for the adequate surgical indication in accordance with both the spread of the cancer and the general condition of the aged patient. Mental care to avoid post-operative mental disorders is also crucial.     

Intraoral radiography using dry film

The feasibility of intraoral radiography using an industrial dry film in combination with each of four different kinds of intensifying screens was investigated. The contrast characteristics, resolution, granularity, and the radiographic image quality of normal anatomical features were compared using this technique and conventional periapical film. The physical characteristics of the images obtained using the industrial dry film were markedly inferior to those of the images obtained using the conventional periapical film. However, in studying the diagnostic value of normal anatomical features, there was no significant difference between the two techniques. This finding suggests that the industrial dry film employing an intensifying screen can be used for intraaoral radiography.     

Changes of urinary kallikrein excretion and plasma natriuretic factor in a patient with primary aldosteronism with special reference to adrenal histology

High level of urinary kallikrein excretion was observed in a 23-year-old man with primary aldosteronism. Unilateral adrenalectomy improved the clinical symptoms and normalized the urinary concentration of this vasoactive substance. Although plasma atrial natriuretic factor was not elevated, adrenal surgery lowered its concentration. Coexistence of an adrenal adenoma and lesions of nodular hyperplasia were detected in the removed adrenal gland. We summarize the clinical data of this patient and review the literature.     

Stimulation of phosphoinositol turnover and protein kinase C activation by granulocyte-macrophage colony-stimulating factor in HL-60 cells.

Phosphoinositol turnover, diacylglycerol generation, protein kinase C (PK-C) activity, and intracellular cyclic nucleotides were studied in an established human leukemia cell line, HL-60, in response to one of the hematopoietic cytokines, granulocyte-macrophage colony-stimulating factor (GM-CSF). Continuous exposure of HL-60 cells to GM-CSF induced the cell differentiation that was evaluated by the nitroblue tetrazolium (NBT) reducing activity. GM-CSF also exhibited a proliferative effect on HL-60 cells. GM-CSF at 1 nmol/L, an optimal concentration for cell growth and cell differentiation, induced significant changes in the intracellular inositoltriphosphate (IP3). Diacylglycerol generation was also stimulated by GM-CSF treatment. GM-CSF increased the membrane PK-C activity by 10-fold of the control, whereas no measurable change in cyclic nucleotides was observed. These data indicated that phosphoinositol turnover and the activation of PK-C were included in the GM-CSF signal transducing pathway in HL-60 cell. Phosphoinositol response leading to PK-C activation may act as a trigger signal of cell differentiation by GM-CSF.