Effect of middle ear infection upon the pneumatization of the mastoid: An experimental study in pigs

The suppression of the temporal bone's pneumatized cavities is commonly observed in chronic middle ear inflammatory disease, but this fact has not been explained in respect to its etiology, i.e., whether the poorly pneumatized cavity induces chronic middle ear infection or middle ear inflammatory condition suppresses the pneumatization of cellulae. We studied the effect of middle ear infection and eustachian tubal dysfunction in the early stage of life upon the development of pneumatization of the mastoid using 13 pigs, whose mastoid is comparable to that of man. We used two methods, the eustachian tube stenosis test and the tympanic membrane paraffin infusion test. The present study indicated that in six pigs infection of the middle ear in the early stage of life suppressed the normal development of pneumatization of the mastoid bone in pigs.     

The interaction of MCI-154, a calcium sensitizer, and isoflurane on systemic and coronary hemodynamics in chronically instrumented dogs

We conducted this study to determine the interaction of MCI-154, 6-[4-(4'-pyridylamino)phenyl]-4,5-dihydro-3(2H)-pyridazinone hydrochloride, a calcium sensitizer, and isoflurane on myocardial contractility as well as systemic and coronary hemodynamics in chronically instrumented dogs after pharmacological autonomic nervous system activity blockade. MCI-154 increased heart rate and left ventricular function with no change in rate pressure product, pressure work index, and coronary blood flow, with a decrease in coronary vascular resistance (CVR) in the conscious state. Isoflurane decreased heart rate and left ventricular function, with a decrease in rate pressure product and pressure work index. Isoflurane also decreased CVR, but not coronary blood flow. The cardiovascular actions of MCI-154 during isoflurane anesthesia were qualitatively similar to those observed in the conscious state. In contrast to the finding in the conscious state, MCI-154 reversed the decrease in cardiac output and preload recruitable stroke work caused by isoflurane, but these are not significantly different from the effects of isoflurane alone. These results indicate that MCI-154 increases myocardial contractility and decreases CVR without changing calculated myocardial oxygen consumption during both the conscious state and isoflurane anesthesia. IMPLICATIONS: MCI-154, a calcium sensitizer, restores the myocardial contractility depressed by isoflurane and enhances the coronary vasodilating effect of isoflurane in chronically instrumented dogs.     

Implementation of a common clinical path for transurethral resection of prostate (TURP) in multiple hospitals

PURPOSE: To investigate the length of hospitalization and medical charges when a common clinical path for TURP (transurethral resection of prostate) was implemented in multiple hospitals. PATIENTS AND METHODS: This study included 310 patients in 2001 and 298 in 2002, who were diagnosed with benign prostatic hyperplasia and who underwent TURP in seven hospitals in Japan. While the patients were treated according to the managing methods of each hospital in 2001, the patients were managed using a common clinical path in 2002, on which we conferred and established in 2001. We investigated the change of various outcome indicators before and after implementation of the common clinical path. RESULTS: The background of patients and surgical outcome in 2002 were equal to those in 2001, except in incidence of preoperative urinary tract infection, general anesthesia and blood transfusion, and number of surgeons. Implementation of a common clinical path shortened the pre- and postoperative hospital stay, duration of bed rest, administration of antibiotics and Foley catheter indwelling, and reduced the standard deviation of these indicators. The total medical charge decreased from 515,439 to 491,935 yen. However, outcomes were considerably different among the seven hospitals. Multivariate analyses identified the hospitals, cognitive impairment, preoperative indwelling catheter and preoperative variance as the factors affecting preoperative hospital stay, and the hospitals, co-existing disease, blood transfusion, postoperative urinary tract infection and postoperative variance as factors affecting postoperative stay. Based on these analyses, we determined four exclusion criteria against using a common clinical path: 1) patients requiring examination or surgery other than TURP simultaneously, 2) patients whose ADL disturbance, cognitive impairment, past history and/or coexisting disease are expected to affect postoperative convalescence, 3) patients with a preoperative indwelling catheter just before operation, and 4) patients with preoperative urinary tract infection. By excluding 122 (39.4%) and 129 (43.3%) patients fulfilling the above criteria in 2001 and 2002, respectively, there were reduction in the length of pre- and postoperative hospital stay, and the total admission fee. Furthermore, there were decrease in their standard deviations. CONCLUSIONS: A common clinical path was valid for reducing variance of the critical indicators affecting the clinical course of TURP and shortening the pre- and postoperative stay in the multiple hospitals. It is mandatory to establish the standard perioperative management for TURP from the viewpoint of urologists, under the circumstances of the impending introduction of the Diagnosis Procedure Combination (DPC).     

Possible impact of nitric oxide on the antihypertensive effect of captopril and zaprinast

The interaction between the renin-angiotensin system and nitric oxide (NO) is undeniable, but its nature is not fully known. This study investigated the contribution of NO to the acute hypotensive effect of captopril in conscious normotensive rats and the effect on blood pressure of dual administration of captopril and the phosphodiesterase-5 inhibitor zaprinast. In two separate experiments, rats were pretreated with the NO inhibitor L-arginine methyl ester (L-NAME) and with the NO enhancer zaprinast. Pretreatment with L-NAME attenuated and pretreatment with zaprinast potentiated the hypotensive effect of captopril. The hypotensive effect of captoril was not associated with a significant change in the plasma level of cyclic guanosine monophosphate (cGMP). These findings suggest that NO contributes to the blood pressure-lowering effect of captopril. The inability of captopril to alter plasma cGMP levels is not consistent with this view, however, and leads to the conclusion that NO contributes to the acute hypotensive effect of captopril, although the mechanism is not fully understood. Zaprinast potentiates the hypotensive effect of captopril, and an adjustment in dose should be considered when this combination is administered.     

Resting behaviors of captive bottlenose dolphins (Tursiops truncatus)

In order to specify the resting behaviors in captive bottlenose dolphin, we quantitatively analyzed behavior of 16 dolphins in three aquariums in Japan. We observed their behaviors in the low-activity time (0 a.m.-3 a.m.), assuming that the resting behaviors would be most prominent and abundant at this time. We analyzed these behaviors based on the data of their diurnal activity rhythm that we have clarified by measuring swimming speed and breath frequency. The behavior patterns characteristic to the low-activity time could be categorized into the following three types: "bottom-rest" characterized by long immobile stay on the tank bottom, "surface-rest" characterized by long immobile stay at the water surface, and "swim-rest" characterized by slow circle-swim near the bottom along a fixed trajectory. During these behaviors, breath frequency was significantly lower than the daily mean and at least one eye tended to be closed. These three behaviors accounted for 86.6% of the total observation time in the low-activity time. The resting behaviors were often observed even in the high-activity time (0 p.m.-4 p.m.); these three behaviors accounted for 38.5% of the total observation time in the high-activity time. In swim-rest, frequency of sound emission was significantly lower than that of other behaviors with high-speed swimming, and both eyes or one eye, especially the eye facing the inner side of the swimming circle tended to be closed. The eye condition and the periodical change of circle-swim direction or position-exchange observed during swim-rest suggest a relation between this behavior and unihemispheric sleep. The change in the resting behavior observed in the dolphins under nervous situations suggests that the dolphins flexibly change the type and the quantity of the resting behaviors according to the situation.     

Fundamental curriculum in University Education of Medical Technologists: special practice for clinical medicine and biotechnology

This is the summary of my talk about the new concept of education for medical technologists. In Osaka University, the course for laboratory medicine changed from a 3-year to a 4-year training course, and our faculty started a new curriculum of special practice in clinical medicine and biotechnology for first-year undergraduate students from 1997. This special practice in clinical medicine consists of three parts, encompassing learning in the essential divisions of the hospital, bedside learning, and presentation in case conferences. Students visit from time to time to seven divisions, outpatients' clinic, surgical operation room, laboratory for radiological examination, rehabilitation rooms, pharmacy, central storage room for medical records, and the department of medical informatics. The aim of this round practice is to broaden their review of clinical medicine. They also go to the bed side of one patient in the ward for 4 weeks especially for learning about values of laboratory data. They follow up the laboratory data and go with the patient to clinical physiological examinations. Finally, they present their case to all their teachers and class mates in a semi-congress style and are evaluated with scores by the staffs.