Oxygen pressure measurement during grip exercise reveals exercise intolerance after radial harvest

BACKGROUND: Exercise intolerance of the hand after harvest of the radial artery is not well understood, although mild reductions of blood flow to the hand are reported. To ascertain its prevalence, patient symptoms implying potential exercise intolerance were evaluated by measuring transcutaneous oxygen pressure of the hand during grip exercise. For ascertaining predictive values, we verified ulnar flow reserve measured by Doppler ultrasonography before the harvest of radial artery. METHODS: Forty patients whose radial artery was harvested for coronary bypass graft, were interviewed and tested 1 year after operation, and their preoperative ultrasonographic data compared. RESULTS: Five patients (12.5%) had mild symptoms implying exercise intolerance. Exercise tests revealed severe decreases in tissue oxygenation in 7 patients (17.5%), but in accordance with symptoms (p = 0.0018). Tissue oxygenation in the operated hand was lower than in the nonoperated even in asymptomatic patients (p = 0.0011). Preoperative Doppler echography revealed that ulnar arteries of symptomatic patients were smaller (p = 0.0019) and carried lower blood flows during manual compression of the radial artery (p = 0.0004) compared with those of asymptomatic patients. Smaller ulnar arteries (less than 1.4 mm/m(2)) with poor flow reserves (less than 60 mL x min(-1) x m(-2) during radial compression) appear to indicate risks for exercise intolerance (p = 0.0004). CONCLUSIONS: More than 10% of patients after harvest of radial arteries had mild symptoms implying exercise-intolerance, which accorded with abnormal tissue oxygenation during grip exercise. Work habits of patients should be considered in radial harvest decisions, especially if preoperative Doppler echography indicates lower flow reserves for the ulnar artery.     

Plasma biochemistry values of young beagle dogs

Plasma components of 6 to 12-month-old beagles were examined using a Technicon auto-analyzer. Age-related changes were noted for 8 of the 21 components: the levels of total protein (T. Pro) and iron (Fe) gradually increased while those of alkaline phosphatase (ALP), creatine phosphokinase (CPK) and inorganic phosphorus (Pi) persistently decreased in both sexes. Triglyceride (Trigly) in female dogs, glutamic-pyruvic transaminase (GPT) and urea nitrogen (Urea-N) in male dogs tended to increase. The following thirteen components showed no significant variation during the period of observation: glucose (Glu), lactic dehydrogenase (LDH), albumin (Alb), creatinine (Crea), glutamic-oxaloacetic transaminase (GOT), leucine aminopeptidase (LAP), total bilirubin (T. Bil), amylase (Amy), total cholesterol (T. Chol), sodium (Na), potassium (K), chloride (Cl) and calcium (Ca). Our results generally agree with the reported findings on beagles from various institutions.     

Fibrin glue in the surgical treatment of ranulas

The essential treatment of a ranula is meticulous dissection of the thin wall of the cyst in continuity with the sublingual gland of origin. We have used a technique of fibrin glue injection into the cystic space of the ranula after it had been evacuated by aspiration. The fibrin glue within the cystic cavity prevents collapse of the wall of the cyst during surgery and facilitates and simplifies the surgical procedure by clearly outlining the involved area and by sharply delineating its thin wall.     

Pharmacological evidence for an interaction between constituents (blend effect) of the Japanese-Sino medicine “Keishi-ka-zyutubu-tō” in neuromuscular blockade in diabetic mice

The pharmacological interaction between constituents of Keishi-ka-zyutubu-tō (composed of 7 crude drugs, namely peony, liquorice, jujube, cassia, ginger, Atractylodes lancea, and aconite), a medicine of Japanese-Sino origin, was investigated in in situ sciatic nerve-gastrocnemius muscle preparations using genetically dlabetic KK-CA^y mice. When administered intra-arterially, the drug caused a degree of inhibition of the diabetic neuromuscular junction 280 times greater than normal. The two constituents, peony-liquorice, were only 2.6 times more potent in diabetic muscles. When further combined with peony-liquorice, the potency ratio was increased 4.9 times for cassia, 5.9 times for ginger and 8.7 times for Atractylodes lancea. In combination with the representative compounds contained in the above crude drugs except for jujube, the potency ratio of paeoniflorin (PF) and glycyrrhizin (GLR) was increased 6.6 times for cinnamaldehyde, 6.1 times for [8]-gingerol and 14 times for β-eudesmol in diabetic muscles. Aconite potentiated the blocking effects of peony-liquorice to the same extent in diabetic muscles as in normal muscles. This tendency was also confirmed when mesaconitine was combined with PF-GLR. The single effect of β-eudesmol or [8]-gingerol was 5.2 times or 3.7 times more potent, respectively, on diabetic muscles than on normal muscles. Cinnamaldehyde or mesaconitine demonstrated the same degree of sensitivity in both diabetic and normal muscles. These results indicated that the preferentially more potent neuromuscular blocking effects of Keishi-ka-zyutubu-tō in diabetic muscles were mainly attributable to β-eudesmol, a major component of Atractylodes lancea.     

A case of metastasis of renal cell carcinoma to the abdominal wall 13 years after nephrectomy

A 68-year-old man was admitted to our hospital complaining of a tumor of the left abdominal wall. Thirteen years previously, had undergone a nephrectomy of a right renal cell carcinoma with T2, N0, M0, manifestations stage I. Prior to his second operation, a parenchymal tumor was strongly suspected. The tumor, however, was finally diagnosed pathologically as being a metastatic renal cell carcinoma. Postoperatively, the patient has been well for 21 months without any evidence of recurrence at the time of this report. Long-term follow-up is thought to be essential for cases of renal cell carcinoma with a slow-growing type of metastasis.     

Muscarinic receptor localization and function in rabbit carotid body

Acetylcholine and muscarinic agonists inhibit chemosensory activity in the rabbit carotid sinus nerve (CSN). Because the mechanism of this inhibition is poorly understood, we have investigated the kinetics and distribution of muscarinic receptors in the rabbit carotid body with the specific muscarinic antagonist [3H]quinuclidinylbenzilate ([3H]QNB). Equilibrium binding experiments identified displaceable binding sites (1 microM atropine) with a Kd = 71.46 pM and a Bmax = 9.23 pmol/g tissue. These binding parameters and the pharmacology of the displaceable [3H]QNB binding sites are similar to specific muscarinic receptors identified in numerous other nervous, muscular and glandular tissues. Comparisons of specific binding in normal and chronic CSN-denervated carotid bodies suggest that muscarinic receptors are absent on afferent terminals in the carotid body; however, nearly 50% of the specific [3H]QNB binding is lost following chronic sympathectomy, suggesting the presence of presynaptic muscarinic receptors on the sympathetic innervation supplying the carotid body vasculature. Autoradiographic studies have localized the remainder of [3H]QNB binding sites to lobules of type I and type II parenchymal cells. In separate experiments, the muscarinic agonists, oxotremorine (100 microM) stimulation of the in vitro carotid body. Our data suggest that muscarinic inhibition in the rabbit carotid body is mediated by receptors located on type I cells which are able to modulate the excitatory actions of acetylcholine at nicotinic sites.     

Anesthesia for nephrectomy in a patient suspected of spurious polycythemia

A 46-year-old man suspected of spurious polycythemia received nephrectomy. Spurious polycythemia patients with high blood pressure as a complication have a high possibility of developing cerebral vascular disease. For its prevention, it is important to decrease blood viscosity by phlebotomy and to perform anticoagulation therapy. It is also necessary to deal with these patients as a high-risk group of cerebral vascular disease even if there is no symptoms. We were able to manage this case safely without any complication by aggressive perioperative phlebotomy and anticoagulation therapy.