Effects of acromelic acid A on the binding of [3H]glutamic acid and [3H]kainic acid to synaptic membranes and on the depolarization at the frog spinal cord

Triton treatment of synaptic membranes from the frog spinal cord enhanced the specific binding of [3H]glutamic acid compared with non-treated fresh and frozen ones, but not that of [3H]kainic acid. Acromelic acid A specifically inhibited the binding of [3H]kainic acid, and was approximately 100 times more potent than kainic acid. Acromelic acid A and excitatory amino acids caused a depolarization in the ventral root of the frog spinal cord in a dose-dependent manner, and the effect of acromelic acid A was much superior to that of kainic acid or domoic acid. Acromelic acid A is one of the most potent kainic acid agonist at the frog spinal cord.     

The role of serotonin in mucociliary transport system in the ciliated epithelium of frog palatine mucosa

The effects of serotonin (5-hydroxytryptamine, 5-HT) on mucociliary transport and mucus secretion were investigated pharmacologically. The presence of 5-HT in the ciliated epithelium of frog palatine mucosa was examined chromatographically. Mucociliary transport was accelerated by the application of 10^?6 M 5-HT. Mucus secretion was also stimulated significantly by 5-HT (30 mg/kg). 5-HT in the mucosa was detected by a chromatographic technique when a large amount of 5-HT precursor, 5-hydroxytryptophan (5-HTP), was given previously. Phenylhydrazine was used as MAO inhibitor. When phenylhydrazine (20 mg/kg) was given before 5-HTP, 5-HT was markedly concentrated in the mucosa. Radioactive 5-HT was also detected in the mucosa after incubation with [¹⁴C]5-HTP. One hour after systemic administration of [³H]5-HTP, a large number of silver grains appeared in the autoradiograms of some epithelial cells. These results suggest the possibility that epithelial cells with the ability to synthesize 5-HT from 5-HTP exist in ciliated epithelium. A possible functional relationship is proposed between the regulation of mucociliary transport with mucus secretion and 5-HT-containing cells.     

Obstructive sleep apnea syndrome with reversible interventricular septal displacement during sleep: a case report

A case of the obstructive sleep apnea syndrome revealed reversible leftward displacement of the interventricular septum by echocardiography during sleep. A 46-year-old housewife with congenital micrognathia was admitted to our hospital complaining of severe dyspnea and general edema. On admission, she had severe hypoxemia (PaO2 = 35.2 mmHg), pulmonary hypertension (mean pulmonary artery pressure = 70 mmHg) and right heart failure. Her echocardiograms revealed enlargement of the right ventricle with a flattened left ventricle. A sleep study performed after partial resolution of her right heart failure disclosed that severe hypoxemia and pulmonary hypertension (mean pulmonary artery pressure = 70 mmHg) occurred after relatively long periods of apnea. With vigorous inspiratory efforts during sleep apnea, transient enlargement of the right ventricle and leftward displacement of the septum causing the flattened left ventricle were observed echocardiographically. A concomitant decrease in left ventricular inflow velocities was also observed by the pulsed Doppler method. However, these findings immediately returned to normal with the resumption of ventilation. We concluded that these repetitive apneic events due to obstruction of the airway during sleep might accelerate complete eventual pulmonary hypertension and right heart failure.     

The medial genicular artery flap

The anatomical basis and clinical applications of the medial genicular artery flap, which is supplied mainly by the cutaneous perforator of the superior medial genicular artery, are herein described. Based on 10 cadaver dissections, the nutrient artery was found to be consistent and was seen to penetrate the deep fascia within a small triangular area bordered by the medial femoral condyle, the vastus medialis, and the adductor magnus tendon. The distal end of the flap must cover the skin over the medial femoral condyle, and the axis of the flap is along the lower half of the sartorius. The proximal end of the flap can be extended safely beyond the midpoint of the thigh. The medial genicular artery flap is thin and can nicely recontour defects around the knee, with an inconspicuous donor site on the medial aspect of the thigh.     

The characteristics of coronary artery revascularization in aged patients

This study was undertaken in order to clarify the clinical characteristic features and surgical results of coronary artery bypass grafting (CABG) in patients over 65 years of age (group III, n=43). These patients were compared with 2 other groups of patients, one aged between 50 and 59 years (group I, n=88) and another aged between 60 and 64 years (group II, n=54), with respect to mortality, morbidity and late survival. CABG was performed with the saphenous vein under cold K-Mg-cardioplegia with systemic hypothermia. The hospital mortality was 2.3, 3.7, and 4.7 per cent in groups I, II and III, respectively, although no operative mortality was noted in any group. The number of coronary artery lesions increased with age, however, the left ventricular ejection fraction was relatively better preserved in the aged patient than in the younger ones. The 5-year survival rates were 93.4, 95.1 and 96.9 per cent in groups I, II and III, respectively, with most of the late deaths occurring within a year after CABG in each group. In the aged patients, postoperative functional recovery was delayed in the liver and kidney, and postoperative psychosis was not infrequent. The results of this study, indicating a low operative mortality and satisfactory late survival rate, thus strongly support CABG for the aged. Nevertheless, the prevention of postoperative complications is also extremely important for reducing hospital mortality.     

The effects of extreme hemodilutions on the autoregulation of cerebral blood flow, electroencephalogram and cerebral metabolic rate of oxygen in the dog

The effects of profound (hematocrit value, Ht 20%) and extreme (Ht 5%) hemodilutions on the relationship between the mean arterial pressure (MAP) and the cerebral blood flow (CBF) were studied in pentobarbital-anesthetized dogs. A regression line was found between the CBF and Ht values during normotensive hemodilution (MAP 100 torr): CBF (ml/100g X min) = -98.9 log Ht (%) + 195.5 (p less than 0.001). The CBF was increased by hemodilution, but the range of its autoregulation was narrowed, suggesting a progressive susceptibility of CBF to blood pressure with hemodilution. The electroencephalogram (EEG) was not significantly changed by hemodilution within the range of the CBF autoregulation, below which it became slowed. In contrast, the cerebral metabolic rate of oxygen (CMRo2) was decreased by hemodilution even within the range of the CBF autoregulation, while there were no significant differences in CMRo2 values between MAPs of 100 and 40 torr. Thus, the brain function in terms of the EEG seemed to correlate more with the autoregulatory mechanism of the CBF than with the CMRo2 value in the hemodiluted states.     

Resection and reconstruction of sternnum

In case of sternal resection, it is necessary to preserve bone material indispensable for the stability of the anterior chest wall and air tightness of the thoracic cavity, and the support of the chest wall integrity must be restored by some means. Various techniques have been applied to the reconstruction of the chest wall following resection. During the last 10 yers, we have performed reconstructive operation for 6 cases of the chest wall following resection of the sternum in recurrent cases of breast cancer or invaded case of primary breast cancer. In these patients, the chest wall was reconstructed using a rib-latissimus dorsi osteomyocutaneolus flap or a latissimus dorsi myocutaneous flap. The sternum was totally resected in 3 cases, and in all 3 cases, reconstructed using a rib-latissimus dorsi osteomyocutaneous flap. Although postoperative pulmonary function decreased, all cases could be relieved from endotracheal intubation within 17 hours aftr operation, and had no problems in activities of daily living or occurrence of chest flailing or paradoxical movement of the chest. An artificial material (expanded polytetrafluoroethlene patch) was used in only one patient for the reconstruction of the osseous thorax, but this case developed infection during postoperative chemotherapy. After this experience, we used only biological materials for the reconstruction of the chest wall and postoperatively performed radiotherapy and/or chemotherapy on all cases. We have observed no flap infection or detachment since then. One characteristic of using the latissimus dorsi myocutaneous flap is that it is easily elevated and rarely causes serious postoperative esthetic or functional problems. The flap is also easily utilized to reinforce the osseous thorax because ribs immediately below the latissimus dorsi muscle are readily mobilized as a pedicle graft. Reconstruction of the chest wall following resection of the sternum, described in this report, allowed us to perform radiotherapy and/or chemotherapy without serious postoperative complications on the cases relapsing after treatment of breast cance. The 2-year survival rate is 50% and one of these cases survived up to 10 years after resection of the sternum. Thus we prefer to perform resection of the sternum for sternal recurrence of breast cancerif there are no metastatic lesions in other organs.     

A case of fatal benzalkonium chloride poisoning

Five elderly persons with senile dementia accidentally ingested Hoesmin, a 10% aqueous solution of benzalkonium chloride (BAC). The condition of one patient, an 84-year-old woman whose lips and oral cavity became erythematous, gradually deteriorated. Although gastric lavage was performed, the patient died 3 h after ingestion of Hoesmin. Autopsy revealed corrosive changes of the mucosal surfaces of the tongue, pharynx, larynx, esophagus and stomach which may have come in contact with BAC. In addition, BAC was detected in the serum. We conclude that the patient died of BAC poisoning. Fatal BAC poisoning is rare and autopsy findings in only a few cases of BAC poisoning have been reported. Our findings emphasize the risk of oral ingestion of BAC. Received: 11 August 1997 / Received in revised form: 10 December 1997