Relation of stroke and cardiac indices to serum catecholamines following open heart surgery

Serum catecholamines (epinephrine, dopamine and norepinephrine) were measured two, four and six hours after open heart surgery. The ratios of stroke index (SI) and cardiac index (CI) to catecholamines (CA) were determined. Patients studied consisted of 27 with congenital and 14 with acquired heart disease. Extracorporeal circulation (ECC) time was longer than 90 minutes in 17 and shorter in 24 patients. SI and CI diminished in elder patients with congenital disease (Group Cg-ad), patients with acquired desease (Group Ac) and patients with a longer ECC time (Group L). Therefore, elder age and/or longer ECC time seems to be responsible to the lower indices. However, the ratios of the indices to CA showed that the lower indices indicated the poor response of the myocardium to CA in Group Ac and Group L. The response was larger in Group Cg-ad and the lower indices were related to lower serum CA level. It was concluded, therefore, that the indices of stroke volume and cardiac output had inverse correlation to ECC time, but not to age, namely, prolonged ECC compromised more severely the myocardium and resulted in the poor response of the myocardium to CA. Subsequently, to compensate for the poor response, serum CA levels were elevated probably to maintain due SI and CI in patients with prolonged ECC.     

Secular trends in the incidence,mortality, and survival rate of gastric cancer in a general Japanese population: the Hisayama study

To examine secular trends in the incidence and mortality of gastric cancer in a Japanese community, Hisayama, we established three study-cohorts of Hisayama residents aged ≥40 years in 1961 (1637 subjects), 1974 (2054), and 1988 (2602). Each cohort was followed up for ten years. The age-standardized mortality from gastric cancer significantly decreased from 2.4 per 1000 person-years in the first cohort to 0.8 in the third cohort for men, and from 1.0 to 0.2, respectively, for women (p < 0.01 for trend in both sexes). The five-year survival rate after gastric cancer significantly improved from the first (32.6%) to the third cohort (73.0%, p < 0.01) for men and from 43.2% to 72.3% (p < 0.05), respectively, for women. The age-standardized incidence of cancer in men was not different among the cohorts (4.3 per 1000 person-years in the first, 5.0 in the second, and 4.9 in the third cohort), while it decreased significantly in women (2.0, 1.8, and 1.2, respectively, p < 0.01 for trend). In conclusion, our findings suggest that in a Japanese population, the mortality from gastric cancer declined during the past 40 years, due mainly to the improvement of survival in both sexes and a decrease in the incidence for women.     

Phase I study of weekly nab‐paclitaxel combined with S‐1 in patients with human epidermal growth factor receptor type 2‐negative metastatic breast cancer

We conducted a phase I study of a weekly nab‐paclitaxel and S‐1 combination therapy in patients with human epidermal growth factor receptor type 2‐negative metastatic breast cancer. The primary objective was to estimate the maximum tolerated and recommended doses. Each treatment was repeated every 21 days. Levels 1, 2a, 2b, and 3 were set depending on the S‐1 dose (65 or 80 mg/m²) and nab‐paclitaxel infusion schedule (days 1 and 8 or days 1, 8, and 15). Fifteen patients were enrolled. Dose‐limiting toxicity was observed in one patient at Level 3 (100 mg/m² nab‐paclitaxel on days 1, 8, and 15 with 80 mg/m² S‐1 daily for 14 days, followed by 7 days of rest). Although the maximum tolerated dose was not reached, the recommended dose was determined to be Level 3. Neutropenia was the most frequent grade 3–4 treatment‐related adverse event. For patients with measurable lesions, the response rate was 50.0% and the median time to treatment failure and median progression‐free survival was 13.2 and 21.0 months, respectively. The present results show the feasibility and potential for long‐term administration of this combination therapy.     

Performance of Rapid Diagnostic Tests for Plasmodium ovale Malaria in Japanese Travellers

Background: Rapid diagnostic tests (RDTs) are used widely in the diagnosis of malaria. Although the effectiveness of RDTs for malaria has been described in many previous studies, the low performance of RDT particularly for Plasmodium ovale malaria in traveller has rarely been reported. Methods: This was a retrospective cohort study conducted on Japanese travellers diagnosed with malaria at the National Center for Global Health and Medicine between January 2004 and June 2013. The diagnosis of malaria was confirmed by microscopic examination, RDT, and polymerase chain reaction in all patients. The RDTs used in our study were Binax NOW Malaria (Binax Inc., Scarborough, Maine, USA) (BN) and SD Malaria Antigen Pf/Pan (Standard Diagnostics Inc., Korea) (SDMA). We compared the sensitivity of the RDTs to P. ovale malaria and Plasmodium vivax malaria. Results: A total of 153 cases of malaria were observed, 113 of which were found among Japanese travellers. Nine patients with P. ovale malaria and 17 patients with P. vivax malaria undergoing RDTs were evaluated. The overall sensitivity of RDTs for P. ovale malaria and P. vivax malaria was 22.2% and 94.1%, respectively (P < 0.001). The sensitivity of SDMA for P. ovale malaria and P. vivax malaria was 50% and 100%, respectively. The sensitivity of BN for P. vivax malaria was 90.0%, but it was ineffective in detecting the cases of P. ovale malaria. Conclusions: The sensitivity of RDTs was not high enough to diagnose P. ovale malaria in our study. In order not to overlook P. ovale malaria, therefore, microscopic examination is indispensable.     

Actions and cross-reactivity of antiallergic agents and a calcium channel antagonist on rat peritoneal mast cells. Difference in the action mechanisms and cross-reactivity among the agents.

The actions of the antiallergic agents, disodium chromoglycate (DSCG), tranilast and ketotifen, and of a calcium channel antagonist, nicardipine, and cross-reactivity among the agents were examined by observing the inhibition of 45Ca uptake and histamine release in rat mast cells stimulated by antigen and compound 48/80 (comp. 48/80). 1) All agents inhibited 45Ca uptake and histamine release in mast cells stimulated by antigen. The inhibition of 45Ca uptake by the antiallergic agents paralleled the inhibition of histamine release, while nicardipine inhibition of 45Ca uptake was stronger than its inhibition of histamine release. 2) The action of DSCG on 45Ca uptake and histamine release was significantly decreased in cells stimulated with antigen and phosphatidylserine (PS), while tranilast inhibition of histamine release was not affected by the addition of PS despite a significant decrease in the inhibition of 45Ca uptake. 3) The inhibitory effect of DSCG and tranilast was significantly lower in mast cells stimulated by comp. 48/80 than in the cells stimulated by antigen. 4) Tachyphylaxis was observed in cells re-exposed to DSCG and tranilast following previous exposure to the agents. 5) Cross-reactivity was found between DSCG and tranilast.     

Digital angiotomosynthesis for preoperative evaluation of cerebral arteriovenous malformations and giant aneurysms.

PURPOSETo evaluate the clinical utility of the digital angiotomosynthesis technique for giving additional information regarding critical anatomy of cerebrovascular lesions before surgical intervention.METHODSeven arteriovenous malformations and three giant aneurysms were examined with digital angiotomosynthesis; these images were compared with conventional angiograms.RESULTS1) Detailed recognition of three-dimensional vascular structures of the arteriovenous malformation and giant aneurysm was facilitated by the cine mode of digital angiograms and angiotomograms. 2) Reconstructed angiotomograms could show clear separation of overlapping vessels and demonstrate fine vasculature. 3) Fine feeders, which were difficult to trace on the conventional angiogram, were more easily recognized in all cases of arteriovenous malformation. 4) Small arteries passing in close proximity to the arteriovenous malformation nidus were identifiable. 5) Fine arterial branches, being obscured by big shadows of giant aneurysms on the conventional angiograms, were well identified. 6) The anatomic relationship of bone structures to the giant aneurysm was clearly shown.CONCLUSIONSDigital angiotomosynthesis is helpful for recognizing the three-dimensional and detailed vascular anatomy of arteriovenous malformations and giant aneurysms and provides neurosurgeons with useful information for preoperative evaluation.     

Study on biologic effects of radon and thermal therapy on osteoarthritis.

Radon therapy uses radon (222Rn) gas, which mainly emits alpha-rays and induces a small amount of active oxygen in the body. We first examined the temporal changes in antioxidants, immune, vasoactive, and pain-associated substances in human blood by therapy to elucidate the mechanism of osteoarthritis in which radon therapy is used as a treatment. Results showed that radon inhalation enhanced the antioxidation and immune function, and the findings suggest that radon therapy contributes to the prevention of osteoarthritis related to peroxidation reactions and immune depression. Moreover, the changes in vasoactive and pain-associated substances indicated increases in tissue perfusion brought about by radon therapy, suggesting that radon inhalation plays a role in alleviating pain. PERSPECTIVE: The findings suggest that an appropriate amount of active oxygen is produced in the body after radon inhalation, and this contributes to the alleviation of the symptoms of active oxygen diseases such as osteoarthritis.     

Classification of asthma based on clinical symptoms: asthma type in relation to patient age and age at onset of disease

Seventy-one cases of bronchial asthma were classified into three types: bronchospasm, bronchospasm-hypersecretion and bronchiolar obstruction types. The characteristics of each type were studied in relation to patient age and age at onset of the disease. In the 71 subjects studied, the most frequent type was the bronchospasm type followed by the bronchospasm-hypersecretion type and bronchiolar obstruction type. Intractable asthma was most frequently observed in the bronchiolar obstruction type and least in the bronchospasm type. Most of the patients under 50 years of age showed the bronchospasm type. The bronchospasm-hypersecretion type was characteristically accompanied by blood eosinophilia when the patient age was under 50 years. In the bronchospasm-hypersecretion type, the incidence of intractable asthma was high in patients under 50 years of age, but not remarkable in those over 50. A large proportion of the patients over 50 years of age were of the bronchiolar obstruction type. There was no difference in the incidence of intractable asthma between the two groups classified by age at onset.