Suppression of postoperative systemic inflammatory response syndrome with clarithromycin following lung cancer surgery

We examined whether clarithromycin (CAM), a 14-membered macrolide, can control the postoperative systemic inflammatory response syndrome that occurs following lung cancer surgery. In the control group (n = 16), prophylactic antibiotics (flomoxef) were administered for 4-7 days following surgery. In the CAM group (n = 10), 400 mg/day of CAM were administered orally for 14 days prior to surgery and for 7 days following surgery, in addition to the postoperative administration of flomoxef. The incidence and duration of the systemic inflammatory response syndrome in the CAM group (30%, 0.3 days) were significantly lower than those in the control group (81%, 1.6 days). There were no significant differences between the control and CAM groups in both the amount and frequency of nonsteroidal anti-inflammatory drugs following surgery. In conclusion, our study suggests that CAM may suppress the postoperative systemic inflammatory response syndrome in lung cancer patients.     

Quantitative analysis of radioisotope cisternography in the diagnosis of intracranial hypotension

OBJECT: The authors attempted a quantitative analysis of conventional radioisotope cisternography for the purpose of more accurate diagnosis of intracranial hypotension. METHODS: Fifty-seven patients suspected of having intracranial hypotension underwent radioisotope cisternography. Whole-body images were obtained 2.5, 6, and 24 hours after intrathecal injection of 111In-diethylenetriamine pentaacetic acid. Radioactivity in the cerebrospinal fluid (CSF) space was counted during scanning, and radioisotope clearance was studied. Direct signs of radioisotope leakage into the spinal epidural space were found in 25 patients. Most leaks were located in the lumbosacral region. Analysis of the radioisotope clearance curve revealed two different patterns. In patients without a radiographically demonstrated radioisotope leak, absolutely exponential curves were observed (R2 > 0.99). The activity of the radioisotope decreased at a rate of e(-003) to e(-0.107) (mean +/- standard deviation, e(-0.056 +/- 0.018); 32 patients). Clearance in patients with an overt radioisotope leak was not a simple exponential curve; it could be divided into an early rapid phase and a late slow phase. The clearance rate during the first 6 hours was e(-0.219 +/- 0.127) (25 patients) and e(-0.076 +/- 0.021) thereafter. The authors speculated that the early escape of undiluted radioisotope solution through an aberrant CSF outlet, such as a traumatic spinal dural tear, was responsible for this phenomenon. CONCLUSIONS: The quantitative analysis featured in this study seems to be useful in the diagnosis of intracranial hypotension. A small CSF leak below the limit of radioisotope cisternography resolution might be detected using this technique.     

Effect of postoperative chemotherapy on the serum alpha-fetoprotein level in hepatoblastoma

Purpose

It is generally accepted that postoperative chemotherapy does not affect the serum alpha-fetoprotein (AFP) level. The authors report on 3 patients who supposedly showed chemotherapy-related changes in their AFP levels after operation.

Methods

This study included 3 patients with hepatoblastoma (1 case of PRETEXT III and 2 cases of PRETEXT IV).

Results

One patient with PRETEXT III underwent a complete tumor resection, and the postoperative AFP level decreased until it reached the normal range. However, he consistently exhibited a transient, 2- to 3-fold increase in the AFP after each course of chemotherapy for 3 courses. The chemotherapy regimen had to be stopped because of drug-induced encephalopathy, but he has been followed up for 5 years without any evidence of recurrence, and his AFP level has also remained stable and in the normal range. Two patients with PRETEXT IV, who underwent a curative tumor resection, also showed similar chemotherapy-related changes in AFP levels. Both of these cases were observed only after the administration of routine postoperative chemotherapy instead of administering further high-dose chemotherapy. The AFP level remained stable for 17 months and 7 months after the cessation of chemotherapy in 2 cases, respectively.

Conclusions

Regarding the postoperative chemotherapy of hepatoblastoma, we have to pay close attention to both the AFP status during chemotherapy as well as the absolute AFP level.     

Rectal distention inhibits bladder activity via glycinergic and GABAergic mechanisms in rats

PURPOSE: We examined the influence of rectal distention on the spinobulbospinal micturition reflex and the mechanism underlying the inhibition of bladder contraction. MATERIALS AND METHODS: A total of 22 female Sprague-Dawley rats were used in this study. Using urethane anesthesia isovolumetric cystometry was performed before and after distention of the rectum by inflation of a rectal balloon (0 to 3 cm3), followed by the intrathecal injection of strychnine (a glycine receptor antagonist, 0.001 to 10 microg) and/or bicuculline (a gamma-aminobutyric acid(A) receptor antagonist, 0.001 to 1 microg) at the lumbosacral level of the spinal cord. RESULTS: Rectal distention (1.5 to 3.0 cm3) prolonged the interval, decreased the amplitude and shortened the duration of bladder contraction and finally almost abolished bladder activity. After intrathecal injection of strychnine or bicuculline in animals with inhibition of the bladder by rectal distention the interval and duration of bladder contraction returned to baseline but amplitude only recovered to 47% to 54% of the control level. However, simultaneous intrathecal injection of strychnine and bicuculline (0.001 microg each) restored amplitude to the control level. There were no differences between strychnine and bicuculline with respect to their effects on the interval, amplitude and duration of bladder contraction. CONCLUSIONS: An inhibitory rectovesical reflex exists in the lumbosacral cord of rats. The afferent limb of the spinobulbospinal micturition reflex pathway may be additionally and redundantly inhibited by glycinergic and GABAergic mechanisms, while the efferent limb of this pathway may be synergistically inhibited by these mechanisms.     

Prevention of hepatitis B virus recurrence after living donor liver transplantation

The emergence of lamivudine-resistant hepatitis B mutations is a major complication during pretransplantation treatment. The proper time to begin Lamivudine before transplantation is not yet known. Twenty-six patients received preoperative lamivudine treatment followed by combined lamivudine and hepatitis B immunoglobulin after transplantation up to December 2002. The length of preoperative lamivudine treatment ranged from 13 to 200 days (mean, 52 +/- 37 days). Hepatitis B virus-DNA was positive in 22 of 26 (84.6%) patients before preoperative lamivudine prophylaxis and persistently positive among only 4 of 22 patients (18%) who at transplantation did not show a viral mutation. In all patients, hepatitis B virus-DNA became negative immediately after transplantation. At a median follow-up of 34 months, neither a hepatitis B recurrence nor a mutation had occurred in any patient. The ability to schedule the proper time for preoperative lamivudine prophylaxis is an advantage of living donor liver transplantation.     

Anterior fissure of the right liver--the third door of the liver

Background/Purpose Although the anterior segment of the liver has been divided into segments 8 and 5, we have, during surgical or interventional procedures, occasionally encountered patients in whom the right anterior portal vein does not bifurcate into the superior and inferior branches. Thus, the in vivo anatomy of the right liver was reevaluated to clarify the segmental anatomy.Methods We evaluated the hepatic venous and portal ramification patterns, using three-dimensional images reconstructed from computed tomography. In addition, liver volumetry was performed.Results All branches arising from the anterior trunk were divided into two groups: the right ventral portal branches (RVP) and the right dorsal portal branches (RDP), and the anterior fissure vein crossed between the RVP and RDP. The ventral and dorsal regions of the anterior segment were approximately equal from a volumetric point of view.Conclusions The anterior segment seems to be divided into the ventral and dorsal segments by the anterior fissure, and we propose a reclassification of the right liver that divides the right liver into three segments. Dissection of the parenchyma along the anterior fissure makes the third door of the liver open, resulting in the exposing of all Glissonian pedicles of the right liver. The introduction of our segmental anatomy and surgical procedure will allow more systematic and limited liver resections.     

The role of selective COX-2 inhibitors in reactive oxygen species formation in osteosarcoma cells after X-ray irradiation

Selective inhibition of COX-2 is thought to prevent carcinogenesis in some malignant tumors. In this study, in an effort to enhance the effectiveness of osteosarcoma treatment, we investigated the effect of a selective inhibitor of COX-2, with or without irradiation. We also asked whether selective COX-2 inhibitors increase the effect of X-ray irradiation, with regard to reactive oxygen species (ROS) formation in an osteosarcoma cell line. Our results showed that the presence of COX-2 inhibitor without irradiation results in faint spots of ROS formation that do not appear in the absence of COX-2 inhibitor. However, COX-2 inhibitor did not induce ROS formation when combined with irradiation. Thus, radiotherapy with selective COX-2 inhibitions has limitations in the treatment of radioresistant osteosarcoma to obtain the effective achievement, it is indispensable to combine another agent in future studies.     

Hydrogen absorption behavior of beta titanium alloy in acid fluoride solutions

Hydrogen absorption behavior of a beta titanium alloy in acid fluoride solutions has been analyzed by hydrogen thermal desorption. The amount of absorbed hydrogen increased with immersion time in a 2.0% acidulated phosphate fluoride (APF) solution. In the case of an immersion time of 60 h, the amount of absorbed hydrogen exceeded 10000 mass ppm. In contrast, the amount of hydrogen absorbed in the 0.2% APF solution was several times smaller than that in the 2.0% APF solution for the same immersion time. For immersion in a 0.2% APF solution, hydrogen absorption saturated after 48 h. The surface topography and corrosion products on the surface of the specimen immersed in the 2.0% APF solution were different from those in the 0.2% APF solution. During the later stage of immersion, the amount of absorbed hydrogen markedly increased under higher applied stress, although the applied stress did not enhance hydrogen absorption during the early stage of immersion. These results of hydrogen absorption behavior are consistent with the delayed fracture characteristics of the beta titanium alloy.     

Conduction properties of identified neural pathways in the central nervous system of mice in vivo

Various lines of transgenic or knockout mice are now available that have abnormalities in neuron, glial cells or neuron-glial interaction. However, the techniques for quantitative analysis of their pathophysiological functions are still limited. We established an experimental model system to measure the properties of nerve conduction of identified neural pathways in the CNS using anesthetized and immobilized mice. Dorsal column (DC), vestibulospinal/reticulospinal tracts (VRST) and pyramidal tract (PT) were stimulated by inserting stimulating electrodes into the dorsal column nuclei, medial longitudinal fasciculus, and the medullary pyramid, respectively. Volleys were recorded at various segments in the cervical spinal cord with surface electrodes, and their conduction velocities (CVs) and relative refractory periods (RRPs) were measured. The CVs of the DC, VRST and PT were 26.25 +/- 4.96 m/s (n = 7), 51.55 +/- 4.65 m/s (n = 7), 8.89 +/- 1.81 m/s (n = 7), respectively. Data from paired stimulation indicated that the median values of RRPs of the DC, VRST and PT were 10, 2 and 4 ms, respectively, which suggested marked difference among individual tracts. This is the first attempt to measure the conduction properties of the central tracts in mice in vivo. This experimental procedure will give us a physiological measure of CNS functions in normal and genetically manipulated mice and contribute to clarifying the molecular mechanisms and pathophysiology of neurodegenerative diseases such as multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS).