Studies on renal dysfunction after intra-arterial hypertensive chemotherapy (CDDP, PEP) for advanced cancer of the uterine cervix--serum.urinary alpha 1-microglobulin, beta 2-microglobulin and urinary lysozyme, albumin]

The present study evaluated the degree of renal impairment caused by intra-arterial hypertensive chemotherapy (CDDP, PEP). In 11 cases of advanced cancer of the uterine cervix, serum and urinary levels of alpha 1-microglobulin (alpha 1-m) and beta 2-microglobulin (beta 2-m), and urinary albumin (Alb) and lysozyme (LZM) were determined before the chemotherapy and 1,2 and 3 weeks after the therapy. Results are summarized as follows: 1. After intra-arterial chemotherapy, the histological classification was Grade I in 1 case (9.1%), Grade IIa in 2 cases (18.2%), and Grade IIb in 8 cases (72.7%). 2. Serum alpha 1-m and beta 2-m levels remained within the normal range after chemotherapy. 3. Urinary alpha 1-m, beta 2-m and LZM levels exceeded the normal limit between 1 and 2 weeks after the therapy, but thereafter they returned to normal. 4. Urinary Alb was significantly increased (p less than 0.05) between 1 and 2 weeks after therapy, but thereafter it returned to normal. These results suggested that intra-arterial chemotherapy (CDDP 100mg and PEP 40 mg in a dose) was effective for advanced cancer of the cervix and that renal disorders including tubular and glomerular impairment, which are the adverse effects of the therapy, were mild and reversible.     

Platelet production, clearance and distribution in patients with idiopathic thrombocytopenic purpura

We have studied 8 normal subjects, and 12 patients with idiopathic thrombocytopenic purpura whose platelet counts ranged from 9 x 10(9)/L to 40 x 10(9)/L. Autologous platelets labeled with 111Intropolone were used for evaluation of mean platelet survival, platelet turnover, platelet sequestration sites, and platelet production (turnover) to clearance (sum of platelet uptake in the liver and the spleen) ratio. Platelet survival correlated directly with platelet counts. There was no significant correlation between the platelet sequestration pattern and platelet count, survival, or turnover. Sum of platelet uptake in the liver and the spleen showed a significant inverse correlation with platelet survival. No significant correlation was found between platelet turnover and platelet count. There was a significant correlation between the platelet production to clearance index when all subjects were analyzed. The distribution of platelet turnover showed considerable individual variation; eight of twelve patients showed platelet turnover less than mean minus 2SD of the control value, but others showed normal range. We conclude that although platelet destruction mechanism in RES shows a primary role of thrombocytopenia, impaired rate of effective thrombopoiesis may also contribute to disease severity in ITP.     

A case report of entrapment of PTCA balloon catheter caused by its rupture

This is a report of a rare case in which an angioplasty balloon catheter became entrapped within the lumen of the coronary artery after the balloon ruptured during percutaneous transluminal coronary angioplasty (PTCA). The patient was a 69-year-old man who underwent elective PTCA of the circumflex coronary artery (Cx) with USCI 2.5 mm new Probe. The inflation failed to dilate the lesion up to 18 bar; at this pressure, balloon rupture was observed. Any attempt to withdraw the balloon catheter across the lesion was not successful, and then the patient was transferred to the operating room for removal of the balloon catheter. After establishing cardiopulmonary bypass, an arteriotomy in the Cx confirmed that the balloon fragment had become entrapped at a sharp edge of calcific stenosis after balloon rupture. The entrapped catheter was successfully removed from the arteriotomy of the Cx, and coronary bypass grafting was performed to the left anterior descending artery which had restenosis after PTCA 3 months ago. The patient had an uneventful postoperative course and was discharged in excellent condition 30 days after surgery. The balloon rupture of PTCA had been considered a minor problem, however, as this case demonstrated, this seemingly benign complication may lead to potentially disastrous consequences.     

Maternal thermal stimulation changes metabolic activity in fetal hypothalamus

To study whether the central nervous system in the perinatal fetal rat can operate during maternal cooling and warming, we examined the 2-deoxy-D-[14C]glucose ([14C]DG) uptake in the fetal brain. Full-term pregnant rats were placed at three different ambient temperatures of 35-37 degrees C, 24-25 degrees C and 0-10 degrees C. Saline containing 20 microCi/100 g of [14C]DG was injected into the superior caval vein in the pregnant rats. Forty-five min after the injection, the mother rats were decapitated and the fetal brains were taken out for autoradiography. The [14C]DG uptake was significantly influenced by maternal thermal stimulation in the hypothalamus and not in other brain regions examined such as the cerebral cortex, the basal ganglia and the limbic nuclei. Glucose utilization in the fetal anterior hypothalamus, paraventricular hypothalamus and dorsomedial hypothalamus significantly increased when the mother rat was exposed to heat compared to when the mother rat was in the thermoneutral condition. During maternal cooling, glucose utilization in the ventromedial hypothalamus and dorsomedial hypothalamus significantly decreased. There was no area activated by cooling and/or inhibited by warming. Compared to a similar study in adult rats (Am. J. Physiol., 248 (1985) R84-92), the present results suggest that although the perinatal fetal brain does not respond to thermal stimulation in terms of glucose utilization as fully as the adults, a few hypothalamic nuclei have already acquired thermal responses, which might be a possible neuronal basis for the thermoregulatory responses just after birth in rats.     

Laboratory and clinical studies on cefpirome in pediatrics

Laboratory and clinical studies on cefpirome (CPR, HR 810), a newly developed cephem antibiotic, were performed. The results obtained are summarized as follows: 1. Absorption and elimination of the drug were examined in a total of 7 children including 3 cases of administered with 20 mg/kg intravenous bolus injection (i.v.), 2 cases with 20 mg/kg drip infusion (d.i.v.) for 60 minutes and 2 cases with 40 mg/kg (d.i.v.) for 60 minutes. Maximum serum levels were attained immediately after i.v. or d.i.v. Cmax's were 233 +/- 7.6, 88.5 +/- 14.5, and 116 +/- 15 micrograms/ml, respectively for the above 3 modes of administration. These values were determined using a bioassay method with Bacillus subtilis ATCC 6633. T 1/2 (beta)'s were 1.18 +/- 0.17, 1.61 +/- 0.28 and 2.68 +/- 0.83 hours, respectively. Cumulative urinary recovery rates were 40.2-69.8% in a period of 0-6 hours after admissions. 2. Clinical efficacies were evaluated in a total of 20 patients with ages ranging from 9 months to 11 years. The treated cases were 6 cases of acute pneumonia, 4 cases of acute bronchitis, 4 cases of acute purulent tonsillitis, 2 cases of acute urinary tract infections, 2 cases of cellulitis, 1 case of purulent lympadenitis and 1 case of acute otitis media. The clinical efficacy rate was 94.7%. Adverse reactions occurred in no patients. Abnormal changes in laboratory test values involved only 1 case with elevated GOT and GPT. CPR was considered to be a safe and useful drug in treating various infectious diseases in children.     

BPPV and variants: improved treatment results with automated, nystagmus-based repositioning.

OBJECTIVE: Although classical benign paroxysmal positional vertigo has generally been resolvable by routine manual repositioning maneuvers, nevertheless resistant cases and variants remain a significant problem. We investigated the efficacy of analyzing and treating positional vertigo with a system that provides unlimited, automated maneuverability of the patient while maintaining constant electronic monitoring of nystagmus. STUDY DESIGN AND SETTING: A power-driven, multi-axial positioning chair combined with ongoing infrared video-oculography was used to manage 986 subjects in a tertiary clinical setting with complaints of positional vertigo. A nystagmus-based strategy and condition-specific protocols were used. RESULTS: Significantly enhanced treatment outcomes were achieved, especially regarding intransigent and variant forms. Pertinent correlations were noted. CONCLUSION: This multi-axial positioning chair combination provided enhanced diagnostic and treatment capabilities for managing positional vertigo, apparently due to improved analytical capability, precision repeatability, and unlimited 360-degree maneuverability. SIGNIFICANCE: This advancement should be considered for tertiary management of complicated labyrinthine lithiasis.     

Chk2 kinase is required for methylglyoxal-induced G2/M cell-cycle checkpoint arrest: implication of cell-cycle checkpoint regulation in diabetic oxidative stress signaling

Methylglyoxal (MG) is a reactive endogenous metabolite that is produced from the process of degradation of triose-phosphates. Under hyperglycemic conditions the rate of MG formation increases as a result of elevated concentrations of precursors. It has been established that MG elicits oxidative stress signaling, leading to the activation of MAP kinases, p38 MAPK and JNK, yet it remains largely unknown about a role of cell-cycle checkpoint regulation in MG-induced signaling. Here, we show that checkpoint kinases, Chk1 and Chk2, as well as their upstream ATM kinase are phosphorylated and activated following MG treatment of cultured cells. This MG-induced activation of Chk1 and Chk2 were inhibited by either aminoguanidine (AG), an inhibitor of production of advanced glycation end products (AGEs) or N-acetyl-l-cysteine (NAC), an anti-oxidant in dose dependent manners, indicating that oxidative stress via AGEs is involved critically in the activation of Chk1 and Chk2 by MG. Furthermore, it was found that cell-cycle synchronized cells exhibited G(2)/M checkpoint arrest following MG treatment, and that siRNA-mediated knock-down of Chk2, but not Chk1, results in a failure of MG-induced G(2)/M arrest. Thus, the results indicate a critical role for Chk2 in MG-induced G(2)/M cell-cycle checkpoint arrest.