Expression of CC chemokine receptor 3 on human keratinocytes in vivo and in vitro--upregulation by RANTES.

CC chemokines and their ligands, CC chemokine receptors (CCRs), play an important role in the process of inflammation such as trafficking and activating inflammatory cells. CCR3 is known to be a ligand for CC chemokines such as RANTES, eotaxin and monocyte-chemotactic protein-3 (MCP-3). In this study we examined the expression of CCR3 in cultured normal human keratinocytes (KCs). CCR3 protein and mRNA expressions were detected in cultured normal KCs by flow cytometric (FACS) analysis and reverse-transcription-polymerase chain reaction (RT-PCR) analysis. FACS analysis demonstrated that CCR3 expression on KCs was significantly upregulated when the cells were cultured with RANTES, but not with eotaxin, IL-4 or interferon-gamma. RT-PCR analysis revealed that CCR3 mRNA was detectable in normal KCs. We also examined the immunoreactivity of CCR3 in normal skin and inflammatory skin lesions. CCR3 was detected weakly in epidermis of normal skin, while strong immunoreactivity for CCR3 was seen in epidermis of inflammatory skin lesions such as atopic dermatitis. These results suggest that CCR3 is constitutively expressed on KCs and is involved in inflammatory modulation. RANTES may regulate the function of KCs through CCR3.

Suppressive effects of hyaluronic acid on elastase release from rat peritoneal leucocytes.

Effects of hyaluronic acid on the release of elastase from rat peritoneal leucocytes were studied by measuring the leucocyte elastase activity using a synthetic peptide substrate. Leucocyte elastase release was induced by opsonized zymosan, 12-O-tetradecanoyl phorbol-13-acetate (TPA) and N-formyl-L-methionyl-L-leucyl-L-phenylalanine combined with cytochalasin B. Calcium ionophore A23187 potentiated the action of TPA on leucocyte elastase release, whereas hyaluronic acid inhibited leucocyte elastase release regardless of the method of stimulation. Inhibitory effects of hyaluronic acid were dependent on its concentration and molecular weight. Hyaluronic acid of the highest molecular weight (2.0 x 10(6)) indicated a potent inhibitory effect on elastase release. Our present findings suggest that hyaluronic acid may elicit an anti-inflammatory effect by inhibiting leucocyte elastase-dependent pathological processes.

[Acoustic neurinoma presenting with repeated intratumoral hemorrhage. Case report].

A case of acoustic neurinoma with multiple intratumoral hemorrhages is reported. A 56-year-old male noted sudden hearing reduction in his left ear in October of 1985. The diagnosis of a local physician was sudden deafness. About 10 months later, he had two episodes of severe headache without nausea or vomiting. The patient was hospitalized in October of 1986. Neurological examination cerebellar ataxia. cerebellar ataxia. Plain and enhanced computed tomography revealed only an unremarkable low-density area at the left cerebellopontine angle. In contrast, magnetic resonance imaging (MRI) clearly demonstrated a large (3 x 4 x 5 cm), multicystic tumor in the site. On exposure of the tumor at surgery, most of the cysts were found to be filled with a dark red or xanthochromic fluid. The tumor was completely removed following numerous cyst punctures to decrease its volume. There was no evidence of subarachnoid hemorrhage. Histological examination showed a typical acoustic neurinoma. The cyst wall contained numerous telangiectasia-like lesions. The initial symptom of this patient was sudden hearing loss, which is an atypical manifestation of acoustic neurinoma. The massive intratumoral hemorrhage was thought to be caused by telangiectatic lesions in the cyst wall. MRI clearly demonstrated the hemorrhagic cysts within the tumor, especially in the posterior fossa.

[Treatment of aplastic anemia with antilymphocyte globulin, high-dose methylprednisolone and androgen].

Twenty-seven patients with aplastic anemia (20 severe: 7 moderate) were treated with combined immunosuppression consisting of antilymphocyte globulin (ALG: Ahlbulin, Green Cross Co., Osaka, Japan) and high-dose methylprednisolone. Danazol or meptiostane was administered concurrently for at least 3 months. Ten of 27 patients had sustained improvement in hematopoiesis within 3 months of treatment. Three patients with hematological response had a recurrence of pancytopenia 12-36 months after the combined immunosuppressive therapy. Six patients died due to fungal pneumonia (2), hepatic failure (2), interstitial pneumonitis (1) and complication following allogeneic bone marrow transplantation (1). By life table analysis, the survival rate for all patients was 76 +/- 8% at 4 years, with 70 +/- 10% survival rate for patients with severe aplastic anemia and 100% for patients with moderate aplastic anemia. The factors predicting the good response to the therapy were a longer interval from diagnosis to the therapy and higher counts of platelet and reticulocyte at admission.

[Postoperative pain relief for a patient with elective mutism by patient controlled analgesia].

We previously reported that intrathecal (i.t.) administration of morphine reduced postoperative pain in pediatric patients after spinal instrumentation for scoliosis (Cotrel-Dubousset method), and the i.t. administration of morphine before incision produced better pain relief than that given after the surgical procedure. In this study, we evaluated postoperative pain relief in a patient with elective mutism who had been given i.t. morphine 0.15 mg before surgery. The patient was scheduled to undergo patient controlled analgesia (PCA) intravenously with morphine after surgery. The grade of postoperative pain and incidence of side effects were assessed at 1, 2, 6, 12, 24, and 48 h after the operation. The pain was rated by means of a verbal numeric rating scale (0-3) and a visual analog scale (VAS) (0-100mm). The used morphine volume shown on a PCA device was evaluated at scheduled times. No patient developed hemodynamic instability or respiratory depression during the monitoring period. We conclude that PCA can be useful for the patient with elective mutism.

[Continuous total intravenous anesthesia is recommended for wake-up test].

Total intravenous anesthesia (TIVA) has been recommended in view of avoiding air pollution. However, intermittent administration of anesthetic agents has a large disadvantage of delayed emergence time. We reported that continuous TIVA with propofol, ketamine, vecuronium and buprenorphine (PKBp) could bring rapid emergence time. An 8-year old female with spinal scoliosis underwent spinal instrumentation under continuous TIVA. Wake-up test was done twice during surgery smoothly after stopping infusion of anesthetic agents in the cocktail. We conclude that continuous TIVA is one of the most recommended anesthetic methods for wake-up test.

[Anesthetic management by continuous total intravenous anesthesia].

Total intravenous anesthesia (TIVA) is one of the most recommended methods of anesthesia for the prevention of air pollution. But the intermittent administration of anesthetic agents has a disadvantage of elongating emergence time. When inexperienced residents undertake TIVA with larger doses of drugs to stabilize vital signs, it takes long emergence time. Therefore, we suggested a continuous TIVA with propofol, ketamine and vecuronium in combination with butorphanol (PKBt) or buprenorphine (PKBp). In this study, we compared emergence times in the subjects, who underwent general anesthesia with PKBt and PKBp. After induction with propofol (2 mg.kg-1), ketamine (0.5 mg.kg-1), vecuronium (0.1 mg.kg-1) and agonist-antagonist opioids, subjects in each group were maintained with continuous intravenous injection of propofol (2-10 mg.kg-1.h-1), ketamine (240 micrograms.kg-1.h-1) and vecuronium (80 micrograms.kg-1.h-1) in combination with butorphanol (8 micrograms.kg-1.h-1) or buprenorphine (0.4 microgram.kg-1.h-1). The emergence times were designated as Op time (the end of operation to awareness), Pr time (the end of propofol to awareness), and B time (the end of butorphanol or buprenorphine to awareness). The emergence times of Op, Pr and B were not different between the groups. The elderly patients showed longer B time than the younger. The patients with long anesthetic time showed longer B time than the patients with short anesthesia. The patients with general anesthesia combined with epidural anesthesia showed longer B time than the patients with only general anesthesia. But there were no differences in Op time and Pr time. We conclude that the continuous TIVA is useful to reduce emergence time and prevent air pollution.

[Economical benefit of continuous total intravenous anesthesia].

Total intravenous anesthesia (TIVA) has been recommended in view of avoiding air pollution. However, intermittent administration of anesthetic agents has a large disadvantage of delayed emergence. We reported that continuous TIVA with propofol, ketamine, vecuronium and buprenorphine (PKBp) could bring rapid emergence. In this study, we calculated and compared the cost of anesthesia in the subjects who had undergone general anesthesia either with continuous PKBp or nitrous oxide-oxygen-sevoflurane. In group PKBp subjects, after induction with propofol, ketamine, vecuronium and buprenorphine, anesthesia was maintained with continuous intravenous administration of propofol corresponding to the patient's age using twice step down method; ketamine (240 micrograms.kg-1.h-1), vecuronium (80 micrograms.kg-1.h-1) and buprenorphine (0.4 microgram.kg-1.h-1). Group GOS subjects, after the same induction method, received nitrous oxide, sevoflurane and vecuronium. Moreover, the group GOS subjects were divided to two groups; the high flow GOS (N2O:O2:sevoflurane = 4 l:2 l:30 ml) and the low flow GOS (N2O:O2:sevoflurane = 2 l:1 l:15 ml). Continuous PKBp group showed lower cost than the high flow GOS group. The PKBp group showed lower cost than the low flow GOS group except in patients weighing more than 100 kg. Furthermore, we calculated the cost of continuous PKBp anesthesia in Japan, U.S.A. and U.K. The U.S.A. cost of PKBp was higher than the Japanese and the U.K., because the cost of ketamine in U.S.A. is higher than in the other countries. Continuous PKBp is more economical than the high flow GOS, and continuous PKBp in Japan is more economical than in U.S.A.

[A clinical dose finding study of propofol in continuous total intravenous anesthesia].

Total intravenous anesthesia (TIVA) is recommended in view of avoiding air pollution. However, intermittent administration of anesthetic agents has a disadvantage of delayed emergence time. We have suggested continuous TIVA with propofol, ketamine, vecuronium and buprenorphine (PKBp), and reported that the elder or the patients anesthetized for a long time show delayed emergence from continuous TIVA. In this study, after induction with propofol, ketamine, vecuronium and buprenorphine, the subjects were maintained with continuous intravenous administration of propofol corresponding to the age using twice step down method with ketamine (240 micrograms.kg-1.h-1), vecuronium (80 micrograms.kg-1.h-1) and buprenorphine (0.4 microgram.kg-1.h-1). Emergence was evaluated from the 2nd step down of propofol to awareness. There was a linear relationship between the emergence (2nd step down time of propofol to awareness) (Y) and the anesthetic time (X); Y = 0.175X + 3.00. We conclude that the last 1/6 (= 0.175) of anesthetic time is the point to reduce maintenance doses of propofol to achieve more rapid emergence.

[A new method of continuous propofol infusion for total intravenous anesthesia].

Total intravenous anesthesia (TIVA) is recommended to avoid air pollution. However, intermittent administration of anesthetic agents has a large disadvantage of delayed emergence time. We suggested continuous TIVA with propofol, ketamine, vecuronium and buprenorphine (PKBp), and reported that maintenance with continuous intravenous administration of propofol corresponding to the age associated with ketamine (240 micrograms.kg-1.h-1), vecuronium (80 micrograms.kg-1.h-1) and buprenorphine (0.4 microgram.kg-1.h-1) brought rapid emergence and that the last 1/6 of anesthetic time was the point to reduce propofol maintenance dose. In this study, we maintained anesthesia with continuous intravenous administration of propofol using twice step down method every one hour. We conclude that the reduction of propofol maintenance dose for every 1/6 in one hour produces fewer dropout cases.

[Electroencephalographic characteristics during maintenance and emergence from propofol-ketamine-fentanyl anesthesia].

Spectral edge frequency 90 (SEF 90) and relative power in four frequency bands (beta, alpha, theta, delta) of the processed electroencephalogram were recorded in 20 patients undergoing elective gynecological surgery under total intravenous anesthesia (propofol-ketamine-fentanyl) (group PKF, n = 10) or nitrous oxide-oxygen-isoflurane (group GOI, n = 10) anesthesia. During anesthesia, mean SEF 90 and relative beta power increased more significantly in group PKF than in group GOI. At emergence from anesthesia, SEF 90 was 21.8 Hz in group PKF and 20.5 Hz in group GOI. These results suggest that it is difficult to evaluate the depth of anesthesia using pEEG under PKF anesthesia.

[Treatment of hemifacial spasm with botulinum toxin].

We injected botulinum toxin to treat hemifacial spasm, and investigated the effects and the patient's impression of this treatment. Average duration of improvement lasted about 3.5 months in both the initial treatment group and the recurrent group. However the patients in the recurrent group received fewer units of botulinum toxin than those in the initial treatment group. Except for local paralysis that disappeared within a month, there were very few complications. Most patient were satisfied with this treatment. We conclude that the treatment of hemifacial spasm with botulinum toxin is both simple and useful.

[Effect of the type of an epidural catheter on the flow rate of a disposable balloon infuser].

We examined the effects of the bacterial filter and the type of epidural catheter on the flow rate of a disposable balloon infuser. The presence or absence of bacterial filters, and the material of the catheter did not influence the flow rate. On the other hand, the flow rate becomes smaller, as the diameter of the epidural catheter is reduced.

[Continuous total intravenous anesthesia is useful for postoperative pain management].

We compared postoperative pain in two groups. All anesthetic agents were continuously administered intravenously in a continuous PKF (propofol 2-10 mg.kg-1.h-1, ketamine 240 micrograms.kg-1.h-1 and fentanyl 0.4 microgram.kg-1.h-1) group. In a control group, anesthesia was maintained by GOI (N2O-oxygen-isoflurane). Twenty-two patients scheduled for gynecological lower abdominal surgeries were divided into the continuous PKF group (n = 11) and the GOI group (n = 11). Epidural anesthesia was employed in both groups, using local anesthetic agents and fentanyl during surgeries and for 24 hrs postoperatively. To evaluate pain, VAS and Prince Henry Score on rest, cough and movement were taken 2 hrs and 5 hrs postoperatively, and in the morning and afternoon of the 1st as well as 2nd postoperative days. The continuous PKF group showed lower scores than the GOI group. It is a great advantage to use continuous PKF for postoperative pain management, and our data indicate that low dose ketamine may induce pre-emptive analgesia.

[Relief of neuropathic pain with intravenous magnesium].

We investigated the effect of intravenous magnesium, a N-methyl-D-asparate (NMDA) receptor antagonist, in 8 patients suffering from neuropathic pain (post herpetic neuralgia or causalgia etc.). After the nerve block, magnesium sulphate (0.5 mol.l-1) 5 ml was administered intravenously by bolus infusion taking 5 min, followed by continuous infusion of the same dose for one hour. All patients were treated with this therapy once a week. In 4 patients, VAS score decreased 3 points or more when this therapy had been administered 3 to 11 times. In 2 patients, VAS score did not change, and the analgesic effect of magnesium was not certain in other 2 patients. Some patients felt heat sensation immediately after the bolus infusion of Mg, and had a good sleep after this therapy. However, there were not any severe side effects and significant change in HR or BP. We conclude that this therapy with magnesium once a week is safe and effective for relieving neuropathic pain.

[Anaphylactoid shock caused by chlorhexidine gluconate].

We report two cases of anaphylactoid shock caused by chlorhexidine gluconate. Both patients had skin flare, severe hypotension and increased airway pressure during cannulation of an antibacterial IVH catheter containing chlorhexidine gluconate after skin sterilization with chlorhexidine gluconate. In case 1, we did not identify the mechanism and causative drugs. In case 2, an intradermal test to chlorhexidine gluconate was positive 2 months later. Then we confirmed that the anaphylactoid shock was caused by chlorhexidine gluconate. We should bear in mind the risk of anaphylactoid shock when we use chlorhexidine gluconate or the IVH catheter containing the bactericide.

[The relief of postoperative pain by suppositories of buprenorphine or NSAID].

We evaluated the effects of suppositories of buprenorphine (BN) or NSAID (supp.) preoperatively administered for postoperative pain relief in patients who underwent elective gynecological surgeries. Fifty six patients were randomized into four groups: group B; 0.4 mg BN supp., group B+I; 0.4 mg BN supp. and 50 mg indomethacine (IND) supp., group B+D; 0.4 mg BN supp. and 50 mg diclofenac supp., group C; no supp. given as control. They were administered rectally after induction of general anesthesia. In all the supp. groups the patients had good pain relief during the first 24 hrs after the administration of supp. Group B+I seemed to have better pain relief, but, there was no statistical significance among the 3 groups. Nausea and vomiting were observed more frequently in group B and in control group C than in NSAIDs combined groups. The difference in the incidence rates was not significant. In conclusion, the simultaneous administration of BN and IND supp. was considered to be useful for postoperative pain relief without producing major side effects.

[Usefulness of midazolam for premedication before local anesthesia].

The optimal dose and adverse effects of midazolam for premedication were evaluated in 45 patients undergoing local anesthesia. The patients were divided into 3 groups and administered midazolam intramuscularly: group-A 0.075 mg.kg-1, group-B 0.1mg.kg-1, group-C 0.125 mg.kg-1. In this study, concerning sedative and hypnotic effects, the administration of midazolam (0.075-0.1mg.kg-1) showed satisfactory results except in conduction anesthesia of upper extremities (brachial plexus block). However, severe decrease in PaO2 was observed in relatively younger patients. Therefore, it is necessary to observe patients carefully during perioperative period.

[Sixty percent lidocaine tape alleviates pain on injection of propofol after diminishing venipuncture pain].

We evaluated the efficacy of the 60% lidocaine tape in alleviating pain associated with intravenous propofol administration in 71 gynecological patients. Thirty-eight women had the tape applied for 2.5 h before venipuncture, with the remaining patients acting as the control. A 20 gauge cannula was inserted into the cephalic vein. Propofol at room temperature was injected at a rate of 1200 ml.hr-1. The statistical significance of differences was established with the Mann-Whitney's U test and the chi 2 test. The median level of pain intensity resulting from venipuncture among the patients treated with the tape was smaller than that in the control group (16.5, vs 34, P = 0.006). Thereafter, cannulation was successfully achieved with reduced or no pain (VAS at cannulation < or = 25, n = 39), and only 16% of the treatment group complained of pain on injection as compared with 53.8% of the control group (P = 0.02). Moreover, the pain intensity was decreased with lidocaine tape (P = 0.006). The cost of the lidocaine tape is covered by medical insurance for reducing pain on venipuncture. Thus, as the tape also alleviates the pain on injection of propofol through its anesthetic action, it can be a safe, easy and cost-effective method as "it kills two pains with one tape".