Venodilator effects of adenosine triphosphate and sodium nitroprusside; Comparisons during controlled hypotension

Adenosine triphosphate as well as sodium nitroprusside has been used for hypotensive anesthesia. The purpose of this study was to examine the possibility that two hypotensive drugs may exert different effects on venous capacitance during controlled hypotension. In rats anesthetized with ketamine, mean arterial pressure was lowered to 50mmHg by intravenous infusion of adenosine triphosphate or sodium nitroprusside. Venous capacitance was assessed before and during induced hypotension by measuring the mean circulatory filling pressure (MCFP). MCFP was measured after briefly arresting the circulation by inflating an indwelling balloon in the right atrium. MCFP was lower during adenosine triphosphate-induced as well as sodium nitroprusside-induced hypotension as compared with the respective value at control (P < 0.01 for adenosine triphosphate and sodium nitroprusside). However, the decrease in MCFP by adenosine triphosphate (0.8 ± 0.1mmHg) was less (P < 0.01) than that by sodium nitroprusside (2.3 ± 0.3mmHg). These results suggest that at a comparable level of arterial hypotension venodilator effect of adenosine triphosphate was less than that of sodium nitroprusside. Less venodilatation during adenosine triphosphate-induced hypotension may contribute to the maintenance of cardiac output during hypotensive anesthesia.(Hoka S, Takeshita A, Aishima K et al.: Venodilator effects of adenosine triphosphate and sodium nitroprusside; comparisons during controlled hypotension. J Anesth 1: 144–147, 1987)     

Hormone receptor status and HER2/neu overexpression determined by automated immunostainer on routinely fixed cytologic specimens from breast carcinoma: correlation with histologic sections determinations and diagnostic pitfalls

Although fine-needle aspiration cytology is a routine procedure for the diagnosis of breast carcinoma, cytologic specimens have rarely been used for evaluation of hormone receptor status and HER2/neu overexpression. In order to compare the biological markers on cytology and on histology, routinely fixed smears of 110 primary breast carcinomas were immunostained for estrogen receptor (ER), progesterone receptor (PgR), and HER2/neu by automated immunostainer and the results were compared with the corresponding histologic sections. ER was expressed in 76 of 110 (69%) cases and PgR was expressed in 51 of 110 (46%). Overexpression of HER2/neu was observed in 30 of 110 (27%) cases. Concordance between cytology and histology was 98% for ER, 95% for PgR, and 100% for HER2/neu. There was no false positive result on smears. Diagnostic pitfalls in determination of hormone receptor status on smears included intratumoral heterogeneity and presence of mucin.     

Lipoma-like tumor mass probably arising in the retroperitoneal heterotopic pancreas: a previously undescribed lesion

Heterotopic pancreatic tissue is found in several locations of the body. However, to the best of our knowledge, there have been no reports on heterotopic pancreas in the retroperitoneum. A case of retroperitoneal lipoma-like large tumor mass probably arising in the heterotopic pancreas is reported. A 45-year-old Japanese woman was admitted to hospital because of back pain. Imaging modalities showed an abnormal mass in the retroperitoneum separate from the surrounding organs, including the pancreas and kidney. Histologically, the mass consisted of mature adipose tissue and scattered ductal and acinar elements. Although there was no islet tissue in this fatty mass, the epithelial elements suggested heterotopic pancreatic tissue in origin. The present case is very unusual; however, heterotopic pancreas should be considered in the differential diagnosis of retroperitoneal tumors.     

New techniques: Brachial plexus block by paratracheal anterior approach

A paratracheal anterior technique of brachial plexus block was performed by using 20 mL of 1.5% mepivacaine on 51 patients undergoing elective surgeries on their upper extremities. Time to onset and level of analgesia were measured, and the efficacy of this technique was evaluated. Success rate was 89%, with none of the patients requiring general anesthesia. Analgesia from C4 to T1 dermatomes was achieved in 52% of the patients within the first 15 minutes and 82% in the postoperative period. Complications associated with this technique were minimal. Although 2 patients complained of dyspnea, oxygen saturation by pulse oximeter was maintained within the normal range. Symptoms of clinical toxicity of the local anesthetics and/or tourniquet pain were not observed in any patients. We concluded that brachial plexus block by the paratracheal anterior approach can be effectively applied to produce anesthesia during upper extremity surgery with an excellent success rate and minimal complications. Copyright © 2000 by W.B. Saunders Company     

Establishment of a human leukaemic cell line (CMK) with megakaryocytic characteristics from a Down''s syndrome patient with acute megakaryoblastic leukaemia

A new megakaryoblastic cell line (CMK), which also exhibits erythroid and myeloid markers, was established from a Down's syndrome patient suffering from acute megakaryoblastic leukaemia. The CMK cells were found to be positive in reactions with anti-platelet antibodies (anti-glycoproteins IIb/IIIa and Ib, and Plt-1). Platelet peroxidase (PPO) reactivity was found to be associated with the nuclear envelope and the endoplasmic reticulum but not with the Golgi apparatus. Some cells possessed cytoplasmic granules with the characteristics of alpha-granules and demarcation membranes. Karyotyping revealed near-tetraploidy (modal chromosome number of 95; ranging 87-98) and a translocation der(17)t(11;17), also found in the original leukaemic cells, confirming that the cells were derived from the patient's malignant blasts. The CMK cells were also found to be positive in reaction with anti-glycophorin A antibody, as well as with anti-myeloid antibodies (MY4, MY7 and MY9). Treatment of CMK cells with phorbol ester 12-O-tetradecanoylphorbol-13-acetate (TPA) greatly enhanced the reactivity with anti-platelet antibodies, increased the number of cells in which cytoplasm was dissociated into numerous segments and suppressed the reactivity with anti-glycophorin A. The proliferation of CMK cells was stimulated by interleukin-3 (IL-3) and granulocyte-macrophage colony stimulation factor (GM-CSF). This cell line should be a useful tool for analysing the basis of the afferent association between megakaryoblastic leukaemia and Down's syndrome, as well as for further study of megakaryocytic differentiation.     

Blood group antigens in the intrahepatic biliary tree : II. Type 1 chain N-acetyllactosarnine-related carbohydrate antigens in the proliferated bile ductules

The expression of the carbohydrate antigens related to type 1 chain N-acetyllactosamine (1NAcLc) in the proliferated bile ductules was immunohistochemically examined in liver tissues of 10 cases of chronic hepatitis (CH), 9 of liver cirrhosis (LC) and 8 of alcoholic hepatitis. The ductular expression of the examined blood group antigens was essentially the same among these pathological conditions. The backbone structure, i.e., 1NAcLc (Galβ1 → 3GlcNAcβ1 → 3Galβ1 → 3R), was not detected in the proliferated ductules as in the normal bile ductules. Its fucosylated structures (Le^a, Le^b and type 1 chain H) were more strongly expressed in the proliferated ductules than in the normal ductules. Sialyl-Le^a which was not found in the normal ductules was detected weakly but definitely in the proliferated ductules. Besides proliferated ductules, single or small numbers of epithelial cells expressing the 1NAcLc-related antigens were found intralobularly. This suggests possible migration of biliary epithelial cells into the hepatic lobules. In conclusion, within the proliferated bile ductules (a) synthesis of the 1NAcLc-related antigens is increased compared to the normal ductules, (b) the backbone structure is completely sialylated or fucosylated as in the normal ductules and (c) α1 → 4fucosylation of sialyl-1NAcLc, i.e., sialylLe^a, formation occurs despite its absence in the normal ductules.     

Detection of circulating intercellular adhesion molecule-1 in hepatocellular carcinoma

Serum levels of circulating intercellular adhesion molecule-1 (cICAM-1) were measured in 23 patients with chronic hepatitis (CH), 22 with liver cirrhosis (LC) and 45 with hepatocellular carcinoma (HCC) using an ELISA. Serum samples from all patients showed significantly higher cICAM-1 levels than serum from 50 normal controls. The cICAM-l level was significantly increased in LC or HCC when compared with CH, but no differences were noted between LC and HCC. Levels of cICAM-1 correlated well with serum bilirubin, retention rate of indocyanine green, hyaluronic acid, type IV collagen 7-S and type III procollagen peptide levels but not with tumor size or circulating tumor markers (α-fetoprotein and des-γ-carboxyprothrombin). Our findings indicate that the measurement of cICAM-l is useful for the determination of the severity of liver disease and hepatic fibrosis. HCC tissues obtained from 10 patients were immunohistochemically stained for ICAM-I. Enhanced ICAM-I expression was found on the tumor cell membranes. Sequential measurements of cICAM-1 levels showed that they changed in a similar manner to those of a-fetoprotein during the course of treatment of HCC in a patient with very high pretreatment levels of both markers. These results suggest that HCC cells shed ICAM-1 into the circulation. We conclude that cICAM-1 is not a diagnostic marker for HCC, but may be useful for monitoring the response to treatment.