Response of pial vessel diameter and regional cerebral blood flow to CO2 during midazolam administration in cats

Midazolam has been demonstrated to preserve the response of cerebral blood flow to CO2. However, the responsiveness of cerebral vessels or microcirculation during midazolam administration related to alteration of cerebral blood flow has not been explored. The purpose of this study was to examine the effects of midazolam on cerebral microcirculation. Nine cats were paralyzed and mechanically ventilated under nitrous oxide/oxygen anaesthesia. Using the closed cranial window technique and laser Doppler flowmetry, diameter of pial vessels and regional cerebral blood flow (rCBF) were examined on the surface of the cerebral cortex which was perfused by the middle cerebral artery. Before midazolam administration, haemodynamic variables, blood gases, rCBF, and diameter of pial vessels were determined as a control under normocapnia, hypocapnia, and hypercapnia conditions. After midazolam administration, given initially at 0.8 mg kg^-1·min^-1 for 10 min and subsequently at 0.04 mg kg^-1 min"¹ (total dose 10 mg kg^-1'), the same variables were again analyzed. With regard to CO2 responsiveness, an 8.85% increase in rCBF was demonstrated for a Paco2 elevation of 1 kPa before midazolam administration, compared with a 7.47% increase after midazolam administration. With regard to the correlation between C02 response and vessel diameter, arterioles less than 50 μm in diameter were more sensitive than those more than 50 μm in diameter, although there were no significant differences before or after midazolam administration. We conclude that CO2 responsiveness is preserved in terms of rCBF and vessel diameter after high doses of midazolam (10 mg·kg^-1) in cats.     

DNA analysis at p53 locus in carcinomas arising from pleomorphic adenomas of salivary glands: Comparison of molecular study and p53 immunostaining

Where and how frequently p53 abnormalities are involved in the development of pleomorphic adenoma (PA) and its malignant progression to carcinoma was investigated. The presence of p53 gene abnormalities was analyzed in eight patients with carcinoma in pleomorphic adenoma (CPA) by polymerase chain reaction (PCR)-based assays and immunohistochemistry. Normal salivary gland tissue, adenomatous, transitional and carcinomatous areas were microdissected from archival microslides and analyzed for allelic deletions of the p53 gene using two microsatellite markers at the p53 locus; dinucleotide (CA)_n repeat and pentanucleotide (AAAAT)_n repeat. Loss of heterozygosity (LOH) of the p53 gene was detected in 5796 of adenomas, 86% of transitional lesions and 86% of carcinomas. In contrast, overexpression of p53 oncoprotein was noted immunohistochemically in 13% of adenomas, 50% of transitional areas and 75% of carcinomas. All of the tumors with immunoreactivity for p53 oncoprotein demonstrated LOH. Moreover, when LOH was present in adenomatous or transitional areas, the identical LOH was always detected in the corresponding carcinomatous areas in the same CPA tumors. These findings indicate that p53 gene mutation is an early event and occurs frequently at an early stage of precancerous lesions and may be responsible for most cases of malignant transformation of PA.     

DNA analysis at p53 locus in adenoid cystic carcinoma: Comparison of molecular study and p53 immunostaining

Abnormalities of the p53 tumor suppressor gene were investigated in 22 foci from 14 adenoid cystic carcinomas (ACC) by polymerase chain reaction (PCR)-based assays for dinucleotide (CA)_n and pentanucleotide (AAAAT)_n repeat polymorphisms and by immunohistochemical staining for oncoprotein expression. Adenoid cystic carcinomas were divided into lower grade (tubular and cribriform) subtypes and higher grade (trabecular and solid) subtypes. Histologically identified tumor cells were precisely microdissected from archival microslides and were used for molecular analysis. The overall frequency of p53 gene mutations detected by PCR-loss-of-heterozygosity (LOH) analysis was 57% and was higher than the frequency of overexpression of p53 oncoprotein detected by immunostaining (43%). In the molecular analysis of individual histological subtype foci, the number of foci with p53 gene mutation was slgnificantly greater in the higher grade subtype foci than in the lower grade subtype foci and was greatest in solid-type foci (100%). In all six tumors in which histologically different foci were present In the Same tumors, mutations of the p53 gene were detected. When tumor heterogeneity of the p53 gene was present among different histological foci in the same tumors, the mutations were always detected in the higher grade foci. When lower and higher grade foci were present in the same tumors, the identical mutations detected In the lower grade foci were present in the corresponding higher grade foci. These findings indicate that abnormaliies of the p53 gene are involved in carcinogenesis and/or progression of this tumor and, furthermore, suggest that molecular analyses of ACC may provide information of prognostic importance.     

Clinical impact of tamsulosin on generic and symptom-specific quality of life for benign prostatic hyperplasia patients: Using international prostate symptom score and Rand Medical Outcomes Study 36-item Health Survey

AIM: To examine the efficiency of alpha1-blocker treatment on disease-specific and generic quality of life (QOL) in men with clinically diagnosed benign prostatic hyperplasia (BPH), the improvement of QOL scores with International prostate symptom score (I-PSS) and Rand Medical Outcomes Study 36-item Health Survey (SF-36) was prospectively analyzed. METHODS: A total of 68 newly diagnosed patients with symptomatic BPH that satisfied all inclusion and none of the exclusion criteria were prospectively recruited. All patients received 0.2 mg/day of tamsulosin for 12 weeks. All patients underwent pretreatment documentation of lower urinary tract symptoms (LUTS) and assessment of symptom-specific QOL. Symptoms and general health-related QOL (HRQOL) were assessed using the I-PSS and SF-36, respectively. Also, other objective variables, such as prostate volume, maximal urinary flow and postvoid residual urine volume, were evaluated. RESULTS: After 12 weeks, decrease in I-PSS was 27% compared with baseline (from 16.4 +/- 7.18 to 11.9 +/- 7.56). All questionnaires in the I-PSS showed improvement after tamsulosin treatment and the I-PSS QOL score was improved from 4.51 +/- 1.14 to 3.17 +/- 1.38 (P < 0.0001) at 12 weeks after tamsulosin administration. In intragroup comparisons of HRQOL scores with age-gender adjusted SF-36 Japanese national norms, three SF-36 subscales (bodily pain, BP; social function, SF; and mental health, MH) were worse in the BPH group aged over 70 years, while younger BPH groups aged <70 had better mean SF-36 physical function (PF) scores compared with age-gender adjusted Japanese national norms. In the BPH group with a prostatic volume > or =20 mL, three mean SF-36 scales (BP, SF and MH) were significantly improved after tamsulosin treatment. It is noteworthy that these SF-36 subscales were identical to those observed to worsen in the older BPH group compared to Japanese national norms. CONCLUSIONS: Treatment with tamsulosin for symptomatic BPH patients is associated with significant improvement in the generic HRQOL, in addition to disease-specific QOL and symptoms, at 3 months after drug administration. In particularly, for generic HRQOL with SF-36, tamsulosin treatment can efficiently improve three mean SF-36 subscales (BP, SF and MH) that are decreased in older BPH patients.     

HAEMODYNAMIC EFFECTS OF NICARDIPINE HYDROCHLORIDE: Studies during its use to control acute hypertension in anaesthetized patients

Fourteen patients with vascular disease were studied to evaluatethe efficacy of niordipine hydrochloride as a hypotensive agentin the treatment of acute hypertension occurring during anaesthesia.Five patients received a bolus injection of nicardipine hydrochloride0.5 mg. Another nine patients received bolus injections of nicardipine1 and 2 mg. Nicardipine 0.5 mg significantly decreased systemicarterial pressure (by about 24%), systemic vascular resistance(SVR), left ventricular stroke work index (LVSWI) and rate-pressureproduct (RPP). Nicardipine 1 or 2 mg had twice the effect indecreasing arterial pressure as did 0.5 mg, without significantchange in heart rate or right and left ventricular filling pressures.Cardiac index and stroke volume index increased and SVR, pulmonaryvascular resistance, LVSWI and RPP decreased significantly     

Serum α2-macroglobulin–trypsin complex and early recognition of severe acute pancreatitis after endoscopic retrograde pancreatography

Serum α₂-macroglobulin-trypsin complex (α₂M-T) was measured to differentiate the elevation of serum pancreatic enzymes caused by severe acute pancreatitis from simple elevation after endoscopic retrograde pancreatography (ERP). A patient with severe acute pancreatitis demonstrated marked elevation of serum α₂M-T. In patients without severe acute pancreatitis, serum αM-T did not rise in spite of elevated serum pancreatic enzymes. In conclusion, abdominal pain with elevated serum α₂M-T can be an early diagnostic clue to severe acute pancreatitis after ERP.     

Hypersomnia and Periodic Respiration–Presentation of Two Cases* and Comment on the Physio-Pathogenesis of the Pickwickian Syndrome

Two patients with prominent hypersomnia during daytime and frequent, periodic apnea during sleep are reported. The 1st case was without obesity or hypercapnia during waking period. She had ankylosis of the jaw joints. The 2nd case was a typical of the Pickwickian syndrome with marked obesity and hypercapnia in the awake state. Both of the patients showed frequent, periodic apnea lasting 10–48 sec only during sleep. Duration of the apneic period was longest in the paradoxical phase of sleep with rapid eye movements. Return of respiration at the end of the apnea was always just preceded by arousal response in the EEG: K-complex with or without appearance of alpha rhythm. Thus, their nocturnal sleep was constantly fragmented due to the periodic apnea. Stable, deep sleep with high voltage slow waves was much reduced in the 1st case and it was completely absent in the 2nd case. The periodic apnea in the two patients was of obstructive type. Respiratory movement of the thorax accompanied by EMG activity in the inter-costal muscles persisted even during the apneic period. It was confirmed in the 1st case by radiological examination performed during sleep with the use of a television that the base of her tongue dropped down back into the hypopharynx obstructing this completely during apneic period. Tracheotomy and insertion of tracheal canule resulted disappearance of the periodic apnea during sleep and of hypersomnia during daytime. It is concluded from the above findings that hypersomnia in our patients is due to, and is compensating for the sleep disturbance in the night. Physio-pathogenesis of the Pickwickian syndrome are briefly discussed in the light of the present findings with reference to previous works.     

Selective C1q deficiency in a patient with systemic lupus erythematosus

We report a case of systemic lupus erythematosus with selective C1q deficiency. C1q deficiency had been presumed to be a non-hereditary disorder; however, the 10 reported cases in the world literature, and our case, suggest that C1q deficiency could also be an inherited disease.     

A girl having congenital chloride diarrhea treated with spironolactone for seven years

We report on a girl having congenital chloride diarrhea (CCD) who has been followed for 7 years and 6 months sequentially. Dilated intestinal loops, marked enlargement of the abdominal circumference of the fetus and hydramnios were noted by ultrasound examination at 31 weeks of gestation. After delivery by cesarean section for hydramnios, she excreted profuse watery yellow green stools with marked abdominal distension. At 4 months of age, hypochloremia, hyponatremia and a high concentration of chloride in the stool were identified. She was diagnosed as having CCD. Because it was difficult to administer a large volume of potassium chloride (KCl), and sodium chloride (NaCl), we decided to administer spironolactone. After administration of spironolactone, we could generate correct serum electrolytes using less amounts of KCl. At 7 years and 6 months of age, her body size was within normal limits and her intellectual, mental and physical development had been normal. In spite of normal serum electrolytes, blood pH and the presence of chloriduria, secondary hyperaldosteronism was noted. We consider that spironolactone may be useful to decrease the amount of KCl administration in the neonatal period, but frequent measurements of renin, angiotensin and aldosterone would be necessary for adequate control in CCD cases.     

Preoperative needle biopsy and immunohistochemical analysis for gastrointestinal stromal tumor of the rectum mimicking vaginal leiomyoma

Accurate preoperative diagnosis for gastrointestinal stromal tumor (GIST) was obtained using the endoscopic approach in about 50% of the cases. Preoperative assessment is quite important in reproductive women for the treatment of pelvic tumor. We report the first case of GIST of the rectum that was accurately diagnosed with preoperative needle biopsy from the vaginal wall. The case was a 38-year-old woman who presented with a history of genital bleeding. Internal examination revealed a round and elastic mass (7 x 7 cm) in the left pelvic cavity. The biopsy specimen from the left sidewall of the vagina using a manually manipulated biopsy needle showed strong reaction for CD34 and CD117 (c-KIT). The patient underwent low anterior resection of the rectum, tumor resection, and partial resection of the posterior vagina. Preoperative biopsy with vaginal approach might be helpful to make a diagnosis for pelvic tumor of unknown origin and unknown malignant potential.