Anesthesia for Shy-Drager syndrome; effects of elastic bandage, phenylephrine, and IPPV

A 57-year-old man with Shy-Drager syndrome underwent plastic surgery for decubitus on the buttocks under general anesthesia. Before induction of anesthesia, an elastic bandage was applied to the legs, and its effects were examined by raising the upper body. The fall in mean blood pressure decreased from 49% to 39%, and the symptoms of cerebral hypoxia disappeared. However, the induction of anesthesia with 5 mg diazepam, 0.05 mg fentanyl, and 100 mg thiamylal reduced blood pressure abruptly from 150/88 mmHg to 95/68 mmHg. Continuous infusion of phenylephrine was then started, and blood pressure became stable at around 150/90 mmHg. In this state, IPPV did not reduce the blood pressure in the supine position, and did not intensify its fall when the upper body was raised. Anesthesia was maintained with nitrous oxide 70% in oxygen, fentanyl and pancuronium. During the surgery, ventilation was controlled, and phenylephrine was infused at the rate of 5-15 micrograms.min-1 to maintain systolic blood pressure above 100 mmHg. Phenylephrine was infused during the two postoperative days, because blood pressure fell whenever the patient's posture was changed to prevent pressure on the operative site.     

Microtubules mediate mitochondrial distribution in fission yeast.

The Schizosaccharomyces pombe mutant, ban5-4, displays aberrant mitochondrial distribution. Incubation of this conditional-lethal mutant at the nonpermissive temperature led to aggregated mitochondria that were distributed asymmetrically within the cell. Development of this mitochondrial asymmetry but not mitochondrial aggregation required progression through the cell division cycle. Genetic analysis revealed that ban5-4 is an allele of atb2 encoding alpha 2-tubulin. Consistent with this finding, cells with the cold-sensitive nda3 mutation in beta-tubulin displayed aggregated and asymmetrically distributed mitochondria after incubation at lowered temperatures. These results indicate that microtubules mediate mitochondrial distribution in fission yeast and provide the first genetic evidence for the role of microtubules in mitochondrial movement.     

Speech disturbance following myelography with iohexol: a case report]

Iohexol (Omnipaque) is a non-ionic contrast media for neuroradiology, which causes the neurological complications on rare occasions. A 63-year-old, righthanded female suffered from dysphemia 12 hours after myelography with iohexol via lumbar puncture. The initial cerebral computed tomography scan revealed the generalized contrast media uptake into the cisterns, which was typical to the finding after intrathecal iohexol injection. Although the cerebral magnetic resonance (MR) imaging 7 days after attack also demonstrated no abnormal finding, the electrical encephalogram revealed the sporadic sharp wave activity. Her nonfluent speech deficit had recovered gradually, however, the neurogenic stuttering was still remained. Some literatures previously reported the cases with speech deficits as complications of metrizamide myelography, whereas, a case manifesting as speech disturbance following myelography with iohexol has been not reported. Metrizamide is also a non-ionic agent and had a lower incidence of speech disturbance, which is supposed to be associated with a focal superficial neurotoxic reaction of the cerebrum. Therefore, our unfortunate case suggests that iohexol could rarely cause speech disturbance such as metrizamide.     

Hemolysis and Heat Generation in Six Different Types of Centrifugal Blood Pumps

Abstract: What the most causative factor affecting hemolysis is still controversial. To resolve this problem, we investigated the relationship between hemolysis and heat generation in six types of centrifugal blood pumps (Bio–Pump, Delphin, Capiox, Nikkiso, Isoflow, and Toyobo). The analyzed parameters were index of hemolysis in fresh goat blood, pumping performance, and heat generation in a thermally isolated mock circuit. These parameters were analyzed at a flow rate of 5 L/min by changing the pressure head (100 mm Hg and 500 mm Hg). At 500 mm Hg of pressure head, the Bio–Pump needed the highest rotation number and showed the highest hemolytic rate and heat generation. The index of hemolysis is well correlated to heat generation (r²= 0. 721). Heat may originate from the motor by conduction, hydraulic energy loss, and mechanical friction between the shaft and seal. We strongly suspect that hemolysis was caused by a factor such as mechanical friction which generates heat locally.     

A diagnostic marker of autoimmune chronic active hepatitis: liver plasma membrane antibody in the serum absorbed with particulate fraction of kidney homogenate

The sera absorbed with the particulate fraction of rabbit kidney homogenate (RK) were tested for the antibody against liver plasma membrane (LPM-Ab) by the radiometric assay method. After incubation of the isolated rabbit liver plasma membrane (RLPM) with appropriately diluted serum, IgG bound to RLPM (IgG-RLPM) was determined using 125I-labelled Staphylococcal protein A. IgG-RLPM in each subject tested was expressed in arbitrary units, that is, the multiple of the mean radioactivity associated with RLPM in 35 control subjects. Thus IgG-RLPM was 1.00 (mean) +/- 0.23 (SD) in the control subjects, 1.13 +/- 0.30 in 9 patients with chronic persistent hepatitis (CPH), 1.13 +/- 0.52 in 15 with chronic active hepatitis (CAH), 1.34 +/- 0.38 in 23 with liver cirrhosis (LC) and 3.45 +/- 0.73 in 5 with autoimmune CAH. F(ab')2 fragments from a patient with autoimmune CAH and a control subject decreased IgG-RLPM by 86.4 +/- 6.35 and -5.2 +/- 14.9%, respectively, in four patients with autoimmune CAH. LPM-Ab was detected in 0, 20.0 and 17.4% in the patients with CPH, CAH and LC, respectively. All of the patients with autoimmune CAH were positive for LPM-Ab. The absorption of the sera positive for LPM-Ab with RK decreased IgG-RLPM in various extents. In two of five patients with autoimmune CAH and two of seven patients with CAH or LC, the majority of LPM-Ab was cross-reactive with RK.     

A multi-center double-blind controlled trial of ursodeoxycholic acid for primary biliary cirrhosis

A multi-center double-blind controlled trial of ursodeoxycholic acid (UDCA) for treatment of primary biliary cirrhosis (PBC) was carried out. Twenty two and 23 patients were treated with 600 mg/day UDCA and placebo, respectively, for 24 weeks. In UDCA-treated patients, fall of serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and gamma-glutamyltranspeptidase activities started within 4 weeks after start of the trial and continued throughout the trial period. The serum IgM level fell in 7 UDCA-treated patients examined but not in 10 placebo-treated patients examined. Serum bilirubin concentration showed no significant change at the end of the study in either of UDCA- and placebo-treated group of patients. There was no significant difference between these two groups with respect to the frequency of improvement of pruritus. In UDCA-treated patients, serum bile acid composition changed markedly, though its concentration showed no significant change. The percentage of total bile acid which ursodeoxycholic acid took up increased, whereas those which cholic acid, chenodeoxycholic acid and deoxycholic acid took up were decreased.     

Synthesis and 5-lipoxygenase inhibitory activities of eicosanoid compounds

Ten eicosanoid compounds (3, 6, 9, 11, 12, 15, 18, 21, 23, and 25), methyl (6E,8Z,11Z,14Z)-5-hydroxy-6,8,11,14-eicosatetraenoate (5-HETE, 10), leukotriene A4 (26), and (5S,6E,8E,10E,12RS,14E)-5,12-dihydroxy-6,8,10,14-eicosatetraenoic acid (5,12-diHETE, 27) were prepared and their inhibitory activities against the 5-lipoxygenase from guinea pig polymorphonuclear leukocytes (PMNL) were tested. 5,6-Methanoleukotriene A4 (18) was especially a potent and specific inhibitor of the 5-lipoxygenase without inhibiting the cyclooxygenase and the 12-lipoxygenase. Leukotriene A4, 5-HETE, and 5,12-diHETE also have inhibitory activities against the 5-lipoxygenase at micromolar concentrations, which can regulate the formation of slow-reacting substance of anaphylaxis intracellulary.     

A case report of total removal of infected pacemaker with cardiopulmonary bypass

A successful removal of infected pacemaker with septicemia, pre-DIC state, and pneumonia is reported. A 44-year-old man received transvenous permanent pacemaker implantation through right subclavian region at 42 years of age. Two years and 3 months after implantation an abscess formed around the generator. Since incision and drainage were not effective, the generator was removed after 2 months (another pacemaker was reimplanted at the opposite side), and the initial pacing lead was cut after 3 months of initiation of the infection. But wound healing was not obtained and high fever-up occurred. Arterial blood culture showed septicemia caused by Staphylococcus aureus. He also suffered pre-DIC state and pneumonia. The end of the cut lead had fallen into the right ventricle. After general condition was recovered, the residual lead and the reimplanted pacemaker system were extirpated under cardiopulmonary bypass. And at the same time a new pacemaker system was implanted again. He was in good postoperative course, and he is up and well 8 months after operation.