Long time use of percutaneous cardiopulmonary support after cardiovascular operation; clinical problems from our experience

Result and problems were studied in 12 patients who received percutaneous cardiopulmonary support (PCPS) after cardiac or aortic surgery. Causative diseases included acute myocardial infarction in 7 cases, rupture of the left ventricular septum after infarction, acute mitral valve regurgitation after infarction, rupture of the left ventricular free wall, a stuck valve, and an aortic aneurysm in the thoracicoabdominal region in each 1 case. The time of postoperative PCPS ranged from 2 to 361 hours, and the mean supply flow volume was 1.78 +/- 0.45 l/min/m2. Seven patients could be taken off the treatment or discharged from the hospital (58.3%). The comparison between surviving and non-surviving cases showed a significantly longer assisted circulation time in the latter. An increase of bleeding after surgery was found in all 8 patients who received PCPS for a long period postoperatively. This was assumed to be due to the thrombocytic activation by heparin.     

Inhibitory Effect of a Traditional Chinese Medicine, Juzen-taiho-to, on Progressive Growth of Weakly Malignant Clone Cells Derived from Murine Fibrosarcoma

We have investigated the inhibitory effect of oral administration of Juzen-taiho-to , a Kampo (Chinese herbal) medicine, on progressive growth of a mouse fibrosarcoma. Spontaneously regressive QR-32 tumor cells were able to grow progressively in vivo when coimplanted s.c. with a foreign body, gelatin sponge, whereas QR-32 cells alone gradually grew for over 15 days after inoculation and thereafter regressed for up to 25 days. Oral administration of Juzen-taiho-to (40 mg/day/mouse) for 7 days after inoculation of QR-32 cells with gelatin sponge resulted in significant inhibition of tumor growth and prolongation of the survival of the tumor-bearing mice. This growth-inhibitory effect of Juzen-taiho-to observed on day 25 was dose-dependent over the dose range from 4 to 40 mg/day. Treatment with Juzen-taiho-to for 7 days before tumor inoculation with gelatin sponge also significantly suppressed tumor growth examined on day 25, as did the administration of bismuth subnitrate, which is well known to induce metallothionein, an antioxidant. On the other hand, inoculation of progressed tumor cells (QRsP) resulted in growth without gelatin sponge, leading to death in syngeneic mice. Administration of Juzen-taiho-to for 7 days after inoculation of QRsP cells resulted in a decrease of the tumor growth and prolongation of the survival of mice, but the effect was less than that on the growth of QR-32 regressor tumor after coimplantation with gelatin sponge. These results suggest that the inhibitory effect of Juzen-taiho-to is partly associated with prevention of gelatin sponge-elicited progressive growth, probably mediated by endogenous factors including antioxidant substances, in addition to the augmentation of host-mediated antitumor activity.     

Late onset ataxia phenotype in dentatorubro-pallidoluysian atrophy (DRPLA)

We clinically and genetically studied three patients in a family with dentatorubro-pallidoluysian atrophy (DRPLA). The proband patient had 58/24 CAG repeat alleles of the DRPLA gene (normal ≤ 34 repeats). Cerebellar ataxia first developed in the 6–7^th decades and was the predominant feature for more than 10 years in all three, after which two of them manifested dementia and choreiform movements in the advanced stage. Atrophy of the cerebellum and brain stem an CT or MRI had suggested dominant spinocerebellar ataxia as a diagnosis in their ataxia-predominant stage, with a diagnosis of DRPLA being impossible based on the clinical findings alone. Our experience implies that DRPLA must be taken into account in the differential diagnosis of late onset ataxic disorders, since it can easily be overlooked. Received: 2 April 2001, Received in revised form: 23 July 2001, Accepted: 21 August 2001     

Plasma cell leukemia with lobulated nuclei: One case report

The case of an 80-year-old man with plasma cell leukemia characterized by basophilic cytoplasm, and extensive lobulated nuclei is described. In spite of the peculiar morphologic nuclei, the diagnosis was based on the presence of M protein and Bence Jones protein in the serum and urine, immunophenotypic characteristics, immunoglobulin gene rearrangement, and findings of transmission electron microscopy.     

Anti-invasive and metastatic activities of evodiamine

We have recently reported that evodiamine can suppress in vitro invasion and lung metastasis by colon 26-L5 carcinoma cells. To extend our study, we examine here the anti-invasive and metastatic effects of evodiamine on Lewis lung carcinoma (LLC) and B16-F10 melanoma in addition to colon 26-L5 carcinoma. Critical structures of evodiamine for the activities were also evaluated by comparison with compounds possessing structures similar to that of evodiamine. Evodiamine concentration-dependently inhibited the invasion of B16-F10, LLC and colon 26-L5 cells with IC(50) values of 2.4 micro M, 4.8 micro M and 3.7 micro M, respectively. Pre-treatment of colon 26-L5 cells with evodiamine before inoculation into mice caused significant suppression of the liver metastasis as well as the lung metastasis. Lung metastasis by LLC is also inhibited significantly by pre-exposure to evodiamine. When the anti-migratory activity of evodiamine was compared with that of evodiamine-like compounds, rutaecarpine lacking a methyl group at N-14 and a hydrogen at C-13 b exhibited much less effect than evodiamine. In addition, reserpine, having beta-configurated hydrogen at C-13 b, inhibited tumor cell migration more potently than yohimbine, having alpha-configurated hydrogen at the same position. These results suggest that evodiamine may be useful as a leading compound for agents in tumor metastasis therapy. Also, the presence of a methyl group at N-14 and the configuration of hydrogen at C-13 b may be responsible for the inhibitory activities of evodiamine.     

Consideration of media fill tests for evaluation and control of aseptic processes: a statistical approach to quality criteria

The concept of upper and lower statistical confidence limits has been introduced to the current media fill tests used for the assurance of aseptic operation. Results of media fill tests can be evaluated with rationale and interpreted more clearly by introducing the upper and lower limits for the number of observed positive units. Quality criteria derived by the misuse of statistics should be reconsidered. Media fill tests are one of the most useful methods for the evaluation of aseptic filling processes, and acceptance criteria have been issued in various official compendia. In some official compendia, various combinations of the number of media fills and the number of detected allowable contaminated units have been indicated based on the misuse of statistics. This study has statistically revealed that the larger number of fills allows for the worse average accepted quality. This study has shown that media fill tests can be used for the evaluation of aseptic operation with fully scientific and statistical rationale by evaluating the statistical lower limit for the number of positive units observed. This study proposed that the new criteria should be simply expressed as the process should be in a controlled state and can manufacture product whose sterility can be statistically assured with 95% confidence level.     

PPARgamma activation and adipocyte differentiation induced by AS-6, a prenyl-phenol antidiabetic antibiotic

The prenyl-phenol antibiotics ascochlorin-related compounds, are known to reduce serum cholesterol and triglyceride, suppress hypertension, and ameliorate types-I and II diabetes. However, little is known about the molecular mechanism for these physiological effects. Here we report that the ascochlorin derivative, 4-O-carboxymethyl ascochlorin (AS-6) acts as a potent activator of the nuclear hormone receptor, PPARgamma, although it does not activate the related receptors, PPARalpha, PPARdelta or RARalpha. AS-6 interacts directly with the PPARgamma molecule in vitro, and induces differentiation of the mouse preadipocyte cell line 3T3-L1. Our results suggest that AS-6 is a partial agonist for PPARgamma with a novel chemical structure.     

Stimulation of muscarinic M2 receptors inhibits atrial natriuretic peptide-mediated relaxation in bovine tracheal smooth muscle

The influence of muscarinic M(2) receptors to modulate the relaxant effects of atrial natriuretic peptide (ANP) and sodium nitroprusside (SNP) was investigated in bovine tracheal smooth muscle. In bovine tracheal smooth muscles contracted with methacholine (0.3 micro M), methoctramine (0.03 micro M), a selective muscarinic M(2) receptor antagonist, augmented the relaxant responses to ANP without affecting the responses to SNP and 8-(4-chlorophenylthio)guanosine 3',5'-cyclic monophosphate. Pertussis toxin (PTX; 200 ng/ml for 18 h) augmented the relaxation and accumulation of guanosine 3',5'-cyclic monophosphate produced by ANP. These results suggest that the stimulation of muscarinic M(2) receptors suppresses ANP-induced activation of particulate guanylyl cyclase via a PTX-sensitive G protein.     

Susceptibilities of bacteria isolated from patients with lower respiratory infectious diseases to antibiotics (2000)

From October 2000 to September 2001, we collected the specimen from 410 patients with lower respiratory tract infections in 16 institutions in Japan, and investigated the susceptibilities of isolated bacteria to various anti-bacterial agents and antibiotics and patients' characteristics. Of 499 strains that were isolated from specimen (mainly from sputum) and assumed to be bacteria causing in inflammation, 493 strains were investigated. The breakdown of the isolated bacteria were: Staphylococcus aureus 78, Streptococcus pneumoniae 73, Haemophilus infiuenzae 99, Pseudomonas aeruginosa (non-mucoid) 64, P. aeruginosa (mucoid) 14, Klebsiella pneumoniae 25, Moraxella subgenus Branhamella catarrhalis 21, etc. Of 78 S. aureus strains, those with 4 micrograms/ml or more of MIC of oxacillin (methicillin-resistant S. aureus: MRSA) occupied 53.8%. Vancomycin and arbekacin had the most potent activities against MRSA as observed in 1999. The frequency of S. pneumoniae exhibiting low sensitivity to penicillin (penicillin-intermediate S. pneumoniae: PISP + penicillin-resistant S. pneumoniae: PRSP) was 38.4% being consistent with that in 1999 (34.7%). PRSP accounted for 11.0% of the total, being more than that in 1999 (3.0%). Carbapenems had strong activities against S. pneumoniae. Especially, panipenem inhibited the growth of all 73 strains at 0.125 microgram/ml. Generally, all drugs had strong activities against H. influenzae with MIC80s of 8 micrograms/ml or less. The drug that had the strongest activity against H. infiuenzae was levofloxacin, which inhibited the growth of 94 of the 99 strains at 0.063 microgram/ml. Tobramycin had a strong activity against P. aeruginosa (both mucoid and non-mucoid) with MIC80 of 1 microgram/ml. The mucoid strain was little isolated (14 strains) but the susceptibilities to all drugs were better than the non-mucoid strain. K. pneumoniae showed good susceptibilities to all drugs except ampicillin and the MIC80S were 2 micrograms/ml or less. Particularly, cefpirome, cefozopran, and levofloxacin had strong bactericidal activities against K. pneumoniae with MIC80s of 0.125 microgram/ml, and cefotiam, second-generation cephems, also had a favorable activity being MIC80 of 0.25 microgram/ml. Also, all drugs generally had strong activities against M. (B.) catarrhalis. MIC80s of all drugs were 2 micrograms/ml or less. The drug having the strongest activity was imipenem and levofloxacin inhibiting all 21 strains at 0.063 microgram/ml. Most of the patients with respiratory infection were aged 70 years or older, accounting for approximately a half of the total (44.4%). As for the incidence by the diseases, bacterial pneumonia and chronic bronchitis were the highest, being noted in 38.0% and 31.7% of all the patients, respectively. The bacteria frequently isolated from the patients with bacterial pneumonia were S. aureus (18.3%) and S. pneumoniae (16.1%). In contrast, H. infiuenzae (20.4%) and P. aeruginosa (both mucoid and non-mucoid: 16.7%) were frequently isolated from the patients with chronic bronchitis. Before the drug administration, the bacteria frequently isolated from all the patients were S. pneumoniae (24.3%) and H. infiuenzae (26.7%). The frequency of isolated S. pneumoniae tended to decrease with the increase in the number of administration days while that of isolated H. infiuenzae did not. The frequency of isolated P. aeruginosa tended to increase with the duration of administration. The isolated bacteria were comparable between the patients already treated with penicillins and cephems. In the patients treated with aminoglycosides, macrolides, and quinolones, P. aeruginosa was most frequently isolated (33.3 to 40.0%).