A case of recurrent biliary cystadenocarcinoma successfully treated with 5FU/CDDP systemic chemotherapy]

We report a case of biliary cystadenocarcinoma which recurred 41 months postoperatively. A 60-year-old woman was admitted for further examination of multiple metastatic tumors and a large amount of ascites. Systemic administration of 5FU and CDDP caused her CEA level to decrease gradually and abdominal computed tomography revealed considerable reduction of the metastatic tumors and ascites. Since her general condition had improved, chemotherapy was continued in the outpatient clinic.     

Peripheral analgesic actions of opioid peptides and morphine analogues

Opiates and opioid peptides were administered in the order of 10(-9)-10(-6) mol peripherally, and their action on pain sensitivity was investigated by the modified formalin test which has two characteristic pain responses (the first and the second phase) in the mouse hindpaw. Opioid peptides (20-500 pmol) had dose-dependent analgesia against both first and second phases, and their action ranked dynorphin greater than [D-Ala2, Met5]-enkephalinamide greater than [Met5]-enkephalin. EKC and morphine (0.4-2.5 nmol) inhibited pain response of the first phase, but produced hyperalgesia in the second phase dose-dependently. Lidocaine hydrochloride had peripheral analgesic action, but was about 500-10000 times weaker than these substances. So, these peripheral analgesic actions have a different mechanism from that of local anesthetic action. N-methyl levallorphan which is thought to be a peripherally selective narcotic antagonist reversed these peripheral analgesic actions at the first and second phases and also prevented the hyperalgesic effects of EKC and morphine at the second phase. Naloxone reversed analgesia at only the first phase. These results suggest that an analgesic mechanism by opioids may exist at the peripheral site as well. Furthermore, it is estimated that a receptor exists which is antagonized by N-methyl levallorphan but not by naloxone and that there is a system of hyperalgesia by EKC and morphine in pain modulation.     

Time course of superoxide generation by leukocytes—The MCLA chemiluminescence system

This study was performed to examine the pattern of Superoxide (O ₂ ^– ·) generation from leukocytes using the O ₂ ^– · specific chemiluminescence (CL) method.Cypridina luciferin analog, 2-methyl-6-(p-methoxyphenyl)-3,7-dihydroimidazo[1,2-alpha]pyrazin-3-one (MCLA) was used as a CL probe. The appropriate conditions of the MCLA method was first determined for the evaluation of the time course of O ₂ ^– · generation by leukocytes. The time course of O ₂ ^– · generation obtained by the MCLA-CL system was compared with that by the luminol-dependent CL, electron spin resonance (ESR)/spin trapping, and cytochromec systems. Following stimulation by three different stimulants (PMA, OZ, FMLP), leukocytes continuously generated O ₂ ^– · for up to 5 h in the MCLA-CL system, irrespective of the kind of stimulation. The curves obtained by generation ceased more rapidly in the luminol-CL, ESR/spin trapping, and cytochromec systems. A 50% activity of the initial value was observed at 70 min in the MCLA-CL system, but 30, 10 and 35 min in the other systems, respectively. The CL or O ₂ ^– · generation value decreased to less than 1% (possible termination) at 300, 90, 120 and 180 min, respectively. With the exception of ESR studies with OZ, the cell viability was not significantly affected in any of the trials. These results indicate that leukocytes can generate O ₂ ^– · much longer than previously estimated and that the MCLA-CL-system is the most suitable system for the measurement of the O ₂ ^– · generation by leukocytes.     

Visual field in hysteria-reliability of visual field by Goldmann perimetry

Four cases with hysterical amblyopia in youngsters under 15-year-old showed the poor reproducibility of visual field, that is, when the same target was moved from the periphery toward the fixation ten times along the same meridian during the same examination, the position of the plotted points were rather variable. The range of variation was measured from the innermost point to the outermost one, after the two first points were omitted because points first detected were usually far from the others. The variation of cases measured by this method was compared with that of normal persons. Results were as follows; 1. in normal person, the mean value of its range was 5.5° in first decade and 4.2° in second to seventh decade; 2. patients with psychogenic visual disturbances showed a variability of 14.2°, and this was significantly different from normal (p < 0.01). These results suggest that this convenient method was helpful for diagnosis of hysteria. It should also be remembered that when we evaluate the visual field, changes under 4° are probably not significant.     

Responses of isolated canine ophthalmic and ciliary arteries to vasoactive substances

The effects of 11 vasoactive substances were compared on the isolated and perfused canine internal and external ophthalmic and ciliary arteries. The vessels were isolated with the optic nerve, and perfused independently with Tyrode solution under a constant flow rate at 37 degrees C and a perfusion pressure of 40-80 mmHg. Drugs used were 5-hydroxytryptamine (5-HT), epinephrine (EPI), norepinephrine (NE), phenylephrine (PHE), prostaglandin F2 alpha (PGF2 alpha), ATP, dopamine (DA), tyramine (TYR), KCl, xylazine (XYL) and clonidine (CLO). Each drug solution was administered by a microinjector into the endothelial side of an artery through a cannula. Responses were obtained as changes in perfusion pressure. Results were as follows: 1) The rank order of potency for inducing a vasoconstriction in external ophthalmic arteries (EOA) was 5-HT greater than or equal to EPI greater than NE greater than PHE much greater than ATP greater than or equal to DA greater than KCl much much greater than TYR, XYL, CLO. Since PGF2 alpha induced only a slight vasoconstriction, it was omitted from the order. 2) In internal ophthalmic arteries (IOA), the responses were similar to those in EOA, although EPI, NE and PHE induced a relatively smaller response. The order was 5-HT greater than EPI = NE greater than PHE much greater than DA = ATP greater than KCl much much greater than TYR, XYL, CLO. 3) In ciliary arteries, the order was EPI greater than NE greater than PHE greater than PGF2 alpha greater than DA greater than ATP greater than KCl much much greater than TYR, XYL, CLO. It was found that 5-HT induced a slight vasoconstriction and the efficacy was low. PGF2 alpha induced a greater response in ciliary arteries than in EOA or IOA. 4) In all three arteries, alpha-2 adrenoceptor agonists, XYL and CLO did not produce significant changes in perfusion pressure. These three arteries might be rich in alpha-1 adrenoceptors but poor in alpha-2 adrenoceptors.     

Use of a Paracorporeal Pneumatic Ventricular Assist Device for Postoperative Cardiogenic Shock in Two Children with Complex Cardiac Lesions

Pneumatic ventricular assist device (VAD) was utilized for cardiogenic shock after intracardiac operation in two children with complex cardiac anomalies based with single ventricle. In the first case (a 10-year-old), after a modified Fontan operation, VAD was placed between the functional left atrium and ascending aorta, serving as a "artificial single ventricle" with neither pumping chamber nor artificial support in the right side of the heart. The systemic circulation was maintained by keeping relatively high central venous pressure. In another child (a 3-year-old) who underwent repair of incompetent atrioventricular valve leaving intracardiac lesions, VAD was placed between the common atrium and ascending aorta, serving as a pump for both pulmonary and systemic circulation with regulation of pulmonary blood flow through an aortopulmonary Gore-Tex shunt. The circulatory assist with VAD was utilized for 5 and 6 days, respectively. Although weaning from the device was not feasible in both patients because of the pulmonary dysfunction, these experience showed the possible use of VAD for cardiogenic shock after surgery in patients with complex cardiac anomalies.     

Anti-arthritic properties of FK506 on collagen-induced arthritis in rats

Objective and design:To determine the effect of FK506 (tacrolimus) on paw inflammation, TNF- expression in joint, and bone and cartilage destruction in type II collagen-induced arthritis (CIA) model in rats.Methods:CIA was induced by immunization of female Lewis rats with an emulsion of bovine type II collagen and incomplete Freunds adjuvant. Paw inflammation was assessed by the increase in paw volume. Tumor necrosis factor (TNF) - expression in hind knee joint was assessed by immunohistochemical analysis. Lesions of bone and cartilage were assessed on the basis of histological change in knee joint, radiographic analysis in hind paw, bone mineral density in femora and proteoglycan contents in the cartilage of femoral heads. FK506 at doses of 1, 1.8 and 3.2 mg/kg or its placebo formulation was orally administered to rats for 28 days from the day after immunization (n = 10). Effect of FK506 was compared with that of vehicle (distilled water).Results:FK506 at a dose of 1.8 mg/kg significantly suppressed paw swelling (p < 0.01) and histological change in knee joint (p < 0.05). Tumor necrosis factor (TNF)- was mainly expressed in the region with a marked infiltration of inflammatory cells in the hind knee joint. FK506 (3.2 mg/kg) markedly reduced TNF- expression. FK506 at a dose of 1.8 mg/kg suppressed radiographic changes in hind paw (p < 0.05) and also recovered the decrease in bone mineral density in the femora (p < 0.05). Proteoglycan contents in the cartilage of femoral heads were determined to evaluate the cartilage destruction more quantitatively and found to significantly decrease in CIA rats. FK506 at a dose of 1.8 mg/kg recovered the loss of proteoglycan contents (p < 0.01).Conclusion:These results show that FK506 is effective in suppressing inflammation, TNF- expression in joint, and damage to bone and cartilage in rat CIA, and may be useful in the treatment of rheumatoid arthritis.     

c-fos overexpression in splenic B cells augments development of marginal zone B cells

Marginal zone (MZ)-B cells participate in very early immune responses and play a pivotal role in the first-line of defense against blood-borne Ags including bacterial LPS. Since splenic B cells from c-fos transgenic (H2-c-fos) mice are hyper-sensitive to LPS stimulation, we examined LPS-sensitivity of MZ-B cells in the spleen of H2-c-fos mice. Here, we show that proliferation of MZ-B cells from H2-c-fos mice stimulated with LPS was larger than that from control mice. Proliferation and IgM production of the H2-c-fos MZ-B cells were also larger than those of splenic follicular (FO)-B cells from the H2-c-fos mice, suggesting that c-fos overexpression augments LPS-sensitivity of MZ-B cells more than that of FO-B cells. Furthermore, the number of MZ-B cells but not that of FO-B cells in the spleen of H2-c-fos mice was two- to three-fold larger than that in control littermates. The number of transitional type II (T2)-B cells in H2-c-fos mice was also larger than that of control littermates. However, the number of transitional type I (T1)-B cells in the spleen of H2-c-fos mice was not larger than that of control mice. Moreover, this c-fos effect on differentiation of MZ-B cells was intrinsic in B cells by the competitive repopulation assay with hematopoietic stem cells of H2-c-fos and control mice. These results suggest that c-fos overexpression in B cells augments differentiation and accumulation of MZ-B cells.