EFFECTS OF MIDAZOLAM AND FLUNITRAZEPAM ON THE RELEASE OF DOPAMINE FROM RAT STRIATUM MEASURED BY IN VIVO MICRODIALYSIS

We have studied the effects of midazolam and flunitrazepam onextracellular concentrations of dopamine, 3,4-dihydroxypheny/aceticacid (DOPAC) and homovanillic acid (HVA) in rat striatum infreely moving animals using in vivo microdialysis. l.v. injectionsof midazolam 0.075 and 0.15 mg kg^*1 decreased striatal dopamineconcentrations in a dose-dependent manner without affectingthe concentrations of DOPAC and HVA. Flunitrazepam 0.015 and0.03 mg kg-1 also decreased striatal dopamine concentrationsin a dose-related manner, but the reductions in DOPAC and HVAwere not significant. Flumazenil 6 ng kg1 alone did not affectstriatal concentrations of dopamine, DOPAC and HVA, but it preventedthe effects of midazolam and flunitrazepam. Flunitrazepam 10fimol litre' also decreased striatal dopamine release wheninfused through a dialysis probe placed into the striatum, butit failed to affect striatal dopamine release when infused intothe ipsilateral substantia nigra. Central administrations ofmidazolam were effective only when the drug was infused intoboth sites simultaneously (10 and 100 /jrnol litre'7) or givenby intraventricular injection (0.5 and 1 fig). These resultssuggest that midazolam and flunitrazepam affect striatal dopaminerelease in a different manner. (Br. J. Anaesth. 1993; 70: 181–185)     

Treatment of Malignant Tumor in the Head and Neck: --Interdisciplinary Collaboration of Surgery and Radiotherapy--

Although the prime importance in treatment of head and neckcancer is eradication of tumors, due attention should be paidto the conservation of many important structures and functionsin the region. Just to mention a few of these important humanfunctions, there are phonation, digestion and facial expression.Simple surgical procedures specialized by otolaryngologistsare no longer satisfactory. Recently, radiotherapy of head and neck cancer has developedto a superlative degree and chemotherapy to a practical degreealthough much still remains to be satisfied. Our aim was toorganize an interdisciplinary group of specialists in surgery,radiotherapy and regional chemotherapy into a composite attackforce. We aimed at most effective treatment with the least ofside effects. Since 1961, our combined approach to cancer of the head andneck in close collaboration with radiotherapists has yieldedmuch improved results. This has led to an increasing numberof patients with satisfactory rehabilitation.

1. 1. Cancer of the maxilla: Even in the advanced cases combinedsurgery, radiotherapy and regional chemotherapy has led to thepreservation of important structures and functions. Many patientsare now allowed to return to social life and to their previousjobs.
2. 2. Cancer of the nasopharynx: Radiotherapy is the firstchoice.When the effect is less satisfactory, chemotherapy anda window-operationof the palate are performed.
3. 3. Tumorsof the tonsils: The majority of patients suffer fromthe reticulumcell sarcoma. Radiotherapy is the first choice.
4. 4. Cancerof the larynx: A full dose of radiotherapy is thefirst choice.Partial resections are done when indicated.
5. 5. Cancer of thetongue, hypopharynx and esophagus: Radiotherapyis the firstchoice in the majority of cases. Some need plasticsurgery.

     

Clinical research of renal vein control using Hem-o-lok clips in laparoscopic nephrectomy

Control of the renal vein represents a crucial step in laparoscopic nephrectomy. Although endovascular gastrointestinal anastomosis (GIA) staplers have generally been used for renal vein control because of the large diameter of the vessel, Hem-o-lok clips have recently been used for renal artery control. GIA staplers are expensive and can malfunction on rare occasions, resulting in severe complications. We evaluated renal vein control using Hem-o-lok clips (adaptive vascular width 7-16 mm) in laparoscopic nephrectomy. Since April 2004, we have ligated renal arteries using Hem-o-lok clips. From June 2004, this method was applied for renal vein control in 40 laparoscopic nephrectomies. After renal pedicle dissection, renal pedicle ligation was accomplished using extra large (XL) Hem-o-lok clips on both the renal arteries and veins by placing two clips on the patient side and one clip on the specimen side. Ligation times for obtaining renal vein control were compared between XL Hem-o-lok clips and GIA staplers in 40 cases before June 2004. Vascular control using XL Hem-o-lok clips was successful in all 40 cases, without any slipping of clips or uncontrolled bleeding. After renal pedicle dissection, ligation time for achieving renal vein control was 167.0 +/- 48 s (range: 122-295 s) using XL Hem-o-lok clips (mean, three clips) and 68 +/- 24.0 s (range: 54-150 s) using a GIA stapler. XL Hem-o-lok clips allow safe and reliable control of renal veins in laparoscopic nephrectomy. Ligation time is only 100 s longer than using a GIA stapler. In addition, costs are reduced by more than 90% compared to GIA stapling.     

Aβ induces endoplasmic reticulum stress causing possible proteasome impairment via the endoplasmic reticulum–associated degradation pathway

Background: Accumulation of β‐amyloid is a major pathology of Alzheimer’s disease (AD). As in other neurodegenerative diseases, it is also reported that proteasome activity is deteriorated in post‐mortem brains of AD patients. However, the mechanism of proteasomal dysfunction in AD remains unexplained. There is, however, increasing reported evidence that the unfolded protein response (UPR) is involved in AD pathology. Here we show that Aβ causes not only the UPR leading to endoplasmic reticulum (ER) stress mediated cell death, but also proteasomal dysfunction in cultured cells. Methods: Mouse primary cultured neurons and other cultured cells such as HEK 293T or SH‐SY5Y were treated with Aβ or other reagents, such as thapsigargin and lactacystin, to study UPR or proteasome activity. The UPR was investigated using proteins or mRNA expression. To ascertain proteasome activity, we also recruited SH‐SY5Y cells stably transfected with GFP^u. Results: In vitro study showed that UPR, phosphorylation of eIF‐2α and BiP degradation preceded proteasome dysfunction. It is known that the UPR of ER occurs with the assistance of proteasome as ER‐associated protein degradation (ERAD). Conclusion: This evidence, taken together, suggests that Aβ may induce proteasome dysfunction by preceding the UPR through ER‐associated protein degradation.     

Prostatic carcinosarcoma: A case report and review of literature

A unique case of carcinosarcoma of the prostate detected in a 71-year-old man is presented. Pelvic exenteration was performed, and the resected prostatic mass was found to consist of two histologically distinct elements; adenocarcinoma and sarcoma with focal osteosarcomatous element. The patient is still alive with neither metastasis nor recurrence. This is the 42nd case of carcinosarcoma of the prostate to be reported in the literature.     

NEUROMUSCULAR EFFECTS OF I.A. INFUSION OF LIGNOCAINE IN MAN

Neuromuscular effects of lignocaine during and after i.a. infusionwere studied in healthy adult patients, using evoked electromyography.Supramaximal, paired stimuli were applied to the ulnar nervewith variable intervals between the two stimuli. The amplitudeof the hypothenar muscle action potential to the second componentof the paired stimulus (test response) was compared with thatevoked by the first component (conditioning response). Duringand after i.a. infusion of lignocaine, there were marked decreasesof the test response at intervals from 7 to 100 ms after theconditioning stimulus, although the decreases of the conditioningresponse were slight or negligible. The finding of decreasedtest responses coincided with the results obtained with tetanicstimulation such as pronounced fade and only slight post-tetanicpotentiation. Differences between these findings and those foundwith muscle relaxants were compared, and it was concluded thatthe mechanism responsible for these results might be attributedto an effect of lignocaine on the motor nerve terminal.     

Clinical investigation of the ICD-10 subcategories for obsessive-compulsive disorder

Abstract  To examine the validity of ICD-10 subcategories for obsessive-compulsive disorder (OCD), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was applied to 53 OCD patients. The ratios of Y-BOCS compulsions subscore to obsessions subscore were calculated. The group with ratios around one consisted of patients diagnosed in three subcategories (F42.0, F42.1 and F42.2). This suggests that subjective subcategorization such as ICD-10 may be inadequate to differentiate between predominantly obsessive and compulsive patients compared with differentiation by quantitative assessment such as the Y-BOCS ratio. Thus, in selecting the appropriate therapeutic methods, we emphasize the usefulness of quantitative assessment in clinical settings.     

Functional evaluation of one-stage urethroplasty with parameatal foreskin flaps repair of hypospadias using uroflowmetry

BACKGROUND: Uroflowmetry is a simple, accurate and non-invasive test. In the present study, we aimed to determine the role of uroflowmetry in the evaluation of the functional results of one-stage urethroplasty with parameatal foreskin flaps (OUPF) technique. METHODS: Twenty-one children who had undergone OUPF repair at our clinic were selected. Selection criteria were that patients were toilet trained and had no fistula. Uroflowmetry was performed using a rotating disk sensor. The maximum flow rate (Qmax) and average flow rate (Qave) were plotted against body surface related flow rate nomograms. The upper 95% tolerance limits for the 5th, 10th, 15th, 20th and 25th percentiles of the normal population were used for comparison. The flow pattern was classified as bell ring, plateau or intermittent. RESULTS: The median age at the first uroflowmetry was 4.7 years (range 2.5-8.6) and the mean postoperative follow-up period was 25 months (range 1-58). Twelve children had Qmax above the 25th, six between the 5th and 25th and three less than the 5th percentiles of the normal population. A normal bell-shaped flow curve was obtained in 17 (80.6%) of the children. Of the three children with Qmax below the 5th percentile, two children had a plateau flow pattern and were found to have a urethal stricture. Dilation was performed successfully, after which the Qmax returned to the normal range and the symptoms disappeared. CONCLUSION: The OUPF technique provided satisfactory functional results for hypospadias repair. We advocate the use of uroflowmetry for routine postoperative follow-up.