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The effects of ethanol on the simultaneous transport and metabolism of methyl p-hydroxybenzoate (HBM) were investigated in the skin of Yucatan micropig in vitro. It was found that transesterification occurred in the permeation studies involving ethanol. This was confirmed by monitoring the flux of ethyl p-hydroxybenzoate (HBE) into the receptor phase, as well as by monitoring the fluxes of HBM and p-hydroxybenzoic acid (HBA). The apparent flux of total HBM was decreased. The solubility of HBM increased with ethanol concentration, thus, the activity of HBM in ethanol solution became low because we used 10 mM HBM solution for permeation studies. The enhancement factor (E) was calculated to correct the activity. E increased with increasing the flux of ethanol, thus, ethanol may function as an enhancer of HBM transport. The hydrolysis of HBM to HBA was inhibited, whereas transesterification of HBM to HBE was induced at all concentrations of ethanol used (10-40%). The formation of HBE occurred much more readily than that of HBA at all concentrations of ethanol used.

A multicenter study was undertaken in Japan to evaluate the correlation between the percentage of renal uptake of 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) estimated by the count-based gamma camera method and the blood clearance of 99mTc-MAG3. Twenty four centers were enrolled and 172 cases were finally analyzed in this study. The renal clearance of 99mTc-MAG3 (TER) was obtained by using a single blood sample taken at 44 min after injection. Comparison of TER and renal uptake provided a coefficient of correlation of 0.874; suggesting that sufficiently accurate quantification of renal function could be obtained from the renal uptake estimate by the gamma camera method. This study also showed that the comparison of renal function might be feasible among patients under the same protocols, although precise and careful consideration is required in each center.

We report an anesthetic management of a patient with severe vascular occlusion case caused by Aortitis syndrome. The patient, 61 yr-old woman, was scheduled for sigmoidectomy. Her bilateral common carotid arteries and left main coronary artery were totally occluded, but she had been asymptomatic for over thirty years. Epidural anesthesia was chosen to provide pain control, cardiovascular stability, and also to maintain consciousness during operation for cerebral circulatory evaluation. Following intravenous administration of lactated Ringer's solution (about 1000 ml), epidural blockade was maintained with 1 to approximately 1.5% lidocaine and butorphanol. Our findings in this case indicate that it is important for coronary and cerebral perfusion to have normal central venous pressure (preload) and arterial pressure during sympathetic blockade resulting from epidural anesthesia.

A 36-year-old woman was scheduled for Cesarean section under spinal anesthesia. She was a carrier of hepatitis-B-virus and diabetic. She was complaining of low back pain. Spinal anesthesia was performed in the left lateral decubitus position. Because lumbar puncture in the midline was difficult, left paramedian approach was tried. Then she began to complain of right leg pain. Another attempt was made at other site, but her pain was not relieved. After confirming drop of blood-tinged cerebrospinal fluid, 0.3% dibucaine 2.0 ml was injected. Sensory anesthesia was assessed by pin-prick, but anesthesia was not effective. Then epidural catheter was inserted at Th12-L1 using median approach. She received 1.0% lidocaine 15 ml. However, sensory anesthesia was insufficient (Th4-Th12). Therefore O2-N2O was administered in addition to regional anesthesia. After the delivery, she still complained of low back pain. Later examination revealed metastatic bone tumor of L2 from hepatoma. This case suggests that in a patient with such incomplete spinal or epidural anesthesia and neurological finding, vertebral metastatic tumor should be ruled out.

Porcine or human follicular fluid inhibited the spontaneous maturation of isolated hamster oocytes in vitro during the first 1.5 h of culture. Moreover, the presence of 50% follicular fluid combined with 100 microM dbcAMP cooperatively reduced the incidence of germinal vesicle breakdown. The addition of FSH also inhibited the resumption of meiosis, and the presence of LH did not overcome the inhibitory effects of follicular fluid and tended to impede isolated hamster oocyte maturation in vitro.

Thallium-201 has been suggested as a useful diagnostic agent for myocardial scanning. We report herewith the clinical usefulness of Tl-201 as a result of our animal studies with rats as well as clinical trial for human being. After intravenous injection, we killed rats at regular intervals, then measured the activity in each anatomized organ by gamma-well counter and observed the internal distribution and examined autoradiograms with the naked eye. As a result, the accumulation of Tl=201 in the myocardium observed in 5 min after injection, reaching the maximum level in 30 min and gradually decreased hereafter. We performed 22 myocardial clinical scans. In adults we could clearly detect the lesion of myocardial infarction, but in children found it difficult to obtain full sufficient information due to small heart size and high pulse rate. Judging from the foregoing we think it possible to obtain much clearer images by using a data analyzer.

We have been using 99mTc-RBC and 99mTc-HSA for cerebral angiography and measurement of the local cerebral blood volume (LCBV) and cerebral/peripheral hematocrit ratio (alpha). 99mTc-HSA, however, has a problem of poor stability in the blood. We conducted basic and clinical studies on 99mTc-HSA-D, a ready-to-use preparation with good stability in the blood. We measured the regional cerebral circulation dynamics in patients with cerebral diseases in comparison with 99mTc-RBC and 99mTc-HSA. 99mTc-HSA-D and 99mTc-RBC showed more than a 90% retention ratio in the blood 60 min after administration, and good SPECT images were obtained using these two pharmaceuticals. On the contrary, 99mTc-HSA was unstable and its retention ratio was 60s% 60 min after administration. 99mTc-HSA does not provide good SPECT images due to free 99mTcO4- which seems to be liberated from 99mTc-HSA in the body, etc. There were no adverse reactions or abnormal laboratory findings caused by the 99mTc-HSA-D administration in any of the patients. Based on these results, it is surmised that 99mTc-HSA-D is clinically useful for measurement of the cerebral blood volume and cerebral/peripheral hematocrit ratio (alpha).

Increases in afterload cause marked decreases in cardiac output and left ventricular stroke volume in patients with congestive heart failure. We studied the effects of afterload reduction therapy with prostaglandin E1 in three patients with intraoperative heart failure and two patients with low output syndrome after coronary artery bypass grafting. After 120 minutes, mean pulmonary arterial pressure decreased from 25.6 to 17.4 mmHg, pulmonary wedge pressure from 20.0 to 10.2 mmHg and right atrial pressure from 10.2 to 6.8 mmHg. Cardiac index increased from 1.73 to 2.80 l.min-1.m-2. The improvement of peripheral circulatory failure was remarkable and all patients recovered from heart failure. This study suggests that PGE1 is effective for afterload reduction therapy.

It is important to examine the presence of preformed antibodies in hemodialysis patients before renal transplantation, because it causes the graft rejection in organ transplantation. In the 239 hemodialysis patients we analysed 3 preformed antibodies divided TW, BW and BC. Sensitized rate (TW+, BW+ and BC+) was 0% at no blood transfusions (BT), 9.3% at 1-5 BT and 28.9% at 6 more BT. The number of blood transfusions increased the sensitized rate (TW). Sensitized rate (BW+, BC+) was 6.2% at no BT, 9.3% at 1-5BT and 12.0% at 6 more BT, while sensitized rate (BC+) was 33.3% at no BT, 26.7% at 1-5BT and 14.5% at 6 more BT. There was no correlation between the number of blood transfusions and the sensitized rate (BW+, BC+). At one year after the first check, 69.2% of TW positive patients was converted to TW negative and 53.8% of BW positive patients was converted to BW negative each. Further studies of the preformed antibodies are required to assess the clinical course of long surviving patients.

A 32-year-old pregnant woman complained of palpitation and syncope caused by paroxysmal ventricular tachycardia. The electrophysiological study was normal. The evidence that catecholamines were extremely increased in urine suggested that this arrhythmia resulted from imbalance in the autonomic nervous system. Medication by beta-blocking drugs during pregnancy decreased the frequency of ventricular tachycardia. In order to avoid the increase of catecholamines during the delivery, lumbar epidural anesthesia was administered, which resulted in painless vaginal delivery and impeded the attack of ventricular tachycardia. Although the baby was small for date, fortunately he was delivered normally.

The effect of anesthesia and surgery on cell-mediated immunity was investigated in patients with chronic renal failure (CRF) having latent immunological abnormalities compared with patients with normal renal function (NRF) as control. The patient had minor surgery with enflurane anesthesia. During the perioperative period the numbers of peripheral lymphocyte and its subsets were measured by single and two-color analysis, by applying monoclonal antibodies against lymphocyte membrane surface markers. While the number of peripheral lymphocyte was lower in CRF group than in NRF group throughout the whole period, it decreased significantly on the first and third post-operative days in CRF group. No change in peripheral lymphocyte subsets and CD 4/CD 8 ratio was observed except for increase in CD 8 one hour after incision and decrease in CD 8 on the first postoperative day. Significant difference from NRF group was observed neither in peripheral lymphocyte subset nor in CD 4/CD 8 ratio. In minor surgery under enflurane anesthesia no disturbance on immunological system was observed even in the patients with chronic renal failure.

PGE1 has a beneficial effect on cardiac failure with mitral valve regurgitation by decreasing the "after load". An 82-year-old female had a total cystectomy of a bladder tumor. The preoperative standard 12 lead electrocardiogram showed atrial fibrillation and incomplete right bundle branch block. The preoperative echocardiogram showed regurgitation of both mitral valve and tricuspid valve. Under heavy premedication, we intubated with fentanyl and pancuronium bromide, maintained anesthesia with enflurane. After incision, both pulmonary artery pressure and pulmonary capillary wedge pressure increased, and cardiac index decreased. Continuous injection of 100ng.kg-1.min-1 PGE1 made pulmonary artery pressure and pulmonary capillary wedge pressure to decrease, and cardiac index to increase. PaO2, however, decreased apparently. PGE1 was effective for cardiac failure with mitral valve regurgitation associated with pulmonary hypertension. But attention must be given to the decrease in PaO2.