Estimation of aldehyde oxidase activity in vivo from conversion ratio of N1-methylnicotinamide to pyridones, and intraspecies variation of the enzyme activity in rats.

The in vivo conversion ratio of N1-methylnicotinamide (NMN) to N1-methyl-2-pyridone-5-carboxamide (2-PY) and N1-methyl-4-pyridone-3-carboxamide (4-PY) as a parameter for the estimation of aldehyde oxidase level in rats was examined. NMN and its pyridones (2-PY and 4-PY) are usually detected in the urine of rats. When we measured the ratio of the amount of pyridones to the total amount of NMN and pyridones (RP value) in the urine of rats, marked intraspecies variations were observed. The variation in RP value among strains was closely related to the differences of liver aldehyde oxidase activity measured with NMN as a substrate. RP values after administration of NMN to different strains of rats confirmed the existence of strain differences of aldehyde oxidase activity in vivo. We demonstrated that measurements of NMN and its pyridones usually excreted in the urine can be used to predict the in vivo level of aldehyde oxidase.     

Management of the system to allow the terminal cancer patients and their families to choose from in-hospital care, outpatient care and home care at Matsuyama Bethel hospital

Hospice ward at Matsuyama Bethel Hospital opened in April 2000. The hospice care has been provided for inpatients and outpatients. We considered a system that should be established to allow patients and their families to choose from in-hospital care, outpatient care and home care. The hospice consultation for outpatients opened in April 2004. The terminal cancer patients who are within 6 months of remaining days were hospitalized to the hospice ward. After making the hospice consultation for outpatients, hospice care services have been provided for terminal cancer patients including those with more than 6 months of remaining days under the coordination of palliative care for outpatients and inpatients.     

Evaluation of TS-1 based treatment and expression of thymidylate synthase and dihydropyrimidine dehydrogenase on oral squamous cell carcinoma

Seventeen oral squamous cell carcinoma (SCC) patients underwent chemotherapy with TS-1 (8 males and 9 females, mean age; 75.1 years, range; 47-102 years). TS-1 permitted five cases of oral chemotherapy on an outpatient basis and 8 cases in elder patients over 80-years of age. Excepting five patients who underwent TS-1 therapy as post-operative adjuvant chemotherapy, the therapeutic efficacy of TS-1 in 12 patients with or without irradiation, surgery or chemotherapy resulted in 3 cases of complete response (CR), 6 cases of partial response (PR), 3 cases of stable disease (SD), with no progressive disease (PD) cases (overall response rate; 75%). SCC samples obtained from biopsy were immunohistochemically stained with anti-TS and DPD polyclonal antibody. Although the statistical significance was not clear, the expression of TS and DPD for CR cases was lower than that for SD cases. TS-1 therapy improved quality of life (QOL) especially in elder patients with oral SCC, and our immunohistochemical results suggested the predictive possibilities of TS and DPD expression in response to TS-1.     

Combined use of paravertebral block and general anesthesia for breast cancer surgery

BACKGROUND: Thoracic paravertebral block (TPVB) is reportedly a useful alternative of general anesthesia (GA) for patients undergoing major breast surgery. To provide surgical anesthesia by TPVB alone, however, demands considerable patient's discomfort during neural block and during surgery. This study was undertaken to investigate if TPVB adds to patient satisfaction when combined with GA for breast cancer surgery. METHODS: In 26 women (ASA I * II) undergoing modified radical mastectomy with axillary dissection, TPVB was performed at T 1 level and 15 ml of 0.5% ropivacaine was injected prior to induction of general anesthesia. After surgery, VAS (visual analogue scale, 0-100 mm) pain scores and postoperative medication were recorded. These data with TPVB were compared with those of 17 patients who had previously undergone similar surgical procedure without TPVB in our hospital. RESULTS: The VAS scores in patients with TPVB were 34 +/- 45 mm (mean +/- SD) on admission to the recovery room and 15 +/- 5 mm next morning. Frequency of postoperative administration of analgesics in patients with TPVB was significantly less than those without TPVB. CONCLUSIONS: Above findings suggest that combined use of TPVB and GA may be a preferable choice of anesthesia for patients undergoing major breast cancer surgery.     

Anesthetic management of a teenage athlete who developed arrhythmia during general anesthesia

A 17-year-old man with fracture of the mandible underwent open fixation under general anesthesia. He was an athlete of the rugby suffering the fracture in a match. His preoperative physical examinations were normal except for I degrees atrioventricular block on electrocardiogram (ECG). During anesthesia, atrioventricular dissociation and frequent premature ventricular contractions were induced by the stimulation of nasotracheal intubation and the administration of atropine for the reversal of muscle relaxation. We thought the cause of the arrhythmia is the athlete's heart which may be vagotonic and may induce vagal reflex or fatal arrhythmia. This case demonstrates that it is necessary to pay attention to chronotropic action associated with the intubation of nasopharynx, the handling of laryngoscope and the usage of drugs for the anesthetic management of the athlete.     

A case of extramedullary plasmacytoma arising from the lacrimal gland: a case report

A rare case of extramedullary plasmacytoma (EMP) arising from the lacrimal gland of a 33-year-old woman is presented. The left lacrimal gland tumor was suspected, and tumorectomy was performed. Histopathological examination with immunostaining revealed it to be positive for IgG and chains, demonstrating monoclonality. However, no abnormality was observed on serum protein electrophoresis, immunofixation, or skeletal survey and bone marrow aspiration, and the tumor was diagnosed as EMP. Postoperative radiation was given to the left orbit by a linear at a dose of 40 Gy. One year and 10 months have passed since the operation, and the patients general condition is good, without local recurrence of tumor, lymph node metastasis, or remote metastasis. The EMP should be considered in the differential diagnosis of lacrimal gland tumor.     

Antimicrobial prophylaxis in orthopedic surgery

Although antimicrobials are effective in preventing postoperative surgical infection, there is substantial room for improvement in their use.     

Once-daily aminoglycoside administration

Once-daily aminoglycoside dosing is effective in treating gram-negative infections, including those associated with bones and joints.     

Correlation between the pituitary size and function in patients with asthenia

To explore the relationship between pituitary morphology and function, we performed mid-sagittal MRI and endocrinological evaluation in 38 patients with asthenia. Six patients were diagnosed as having complete empty sella (ES) and 16 patients partial empty sella (PES). BMI, blood pressure, serum Na, ACTH, cortisol, TSH and T(4) were lower in ES group and PES group than in the group with normal pituitary size. Age in the patients with ES was oldest. Multiple regression analysis revealed that serum cortisol level was independently correlated with the size of the pituitary (beta = 0.586, p = 0.0069). Other variables, including age, BMI, blood pressure, serum Na, ACTH, TSH and T(4), were not correlated with the pituitary size when multivariate analysis was employed. In conclusion, there is a close relationship between the reduction of size of pituitary gland and the degree of adrenocortical dysfunction in asthenic patients. It is suggested that the pituitary-adrenal axis is especially vulnerable in empty sella syndrome, and therefore, meticulous evaluation of the hypophysial adrenal axis is recommended in subjects with reduced pituitary size even in elderly population.