Propofol in low doses causes redistribution of body heat in male volunteers.

BACKGROUND AND OBJECTIVE: Cardiovascular and mental stress in dental patients with phobias about dentistry may be reduced by propofol sedation. We tested the hypothesis that even low doses of propofol may have effects on body temperatures in male volunteers. METHODS: Six healthy male volunteers were given propofol over 28 min with the following infusion rates: 8 mg kg(-1) h(-1) for the first 3 min, 4 mg kg(-1) h(-1) for the next 10 min, and 2 mg kg(-1) h(-1) for the final 15 min. Body temperatures were measured at five locations: tympanic membrane, forehead, forearm, dorsum of the hand and fingertip. Thermoregulatory vasoconstriction was evaluated using the forearm minus fingertip temperature gradient. RESULTS: Tympanic membrane and forehead temperatures began to decrease at 10 and 20 min, respectively, after the start of the propofol infusion, and reached a minimum at 30 min (tympanic -0.5 +/- 0.2 degrees C) and 40 min (forehead -0.6 +/- 0.2 degrees C), respectively. Peripheral skin temperatures showed an increase between 10 and 30 min in the forearm and fingertip and between 20 and 30 min in the dorsum of the hand. After 30 min, a decrease in peripheral skin temperatures was observed. The forearm minus fingertip temperature gradient changed from negative to positive after 40 min, and increased continuously thereafter (baseline -0.3 +/- 0.4 degrees C, 90 min: 6.5 +/- 1.6 degrees C). CONCLUSIONS: A low dose of propofol impairs tonic thermoregulatory vasoconstriction and induces heat redistribution from the core to the periphery.

Spatial differences of chemical features of atmospheric deposition between rainy season and winter in the areas facing to the Japan Sea, Japan

Atmospheric deposition was collected using filtrating bulk samplers at 32 sites in the areas facing to the Japan Sea (AFJS) from April 1991 to March 1994. The data were analyzed for winter (January and February) and the rainy season (June and July) when the climate is just the opposite. The AFJS was geographically divided into five areas, that is western Tohoku (WT), Hokuriku (HR), eastern San-in (ES), western San-in (WS) and northern Kyushu (NK). WT, HR and ES receive more precipitation than other regions in winter. H+ depositions increase in winter except NK. This is mainly due to high winter H+ concentrations. In spite of large amounts of precipitation in WT, HR and ES in winter, nss-SO4(2-) concentration was nearly equal to the average throughout Japan. Namely, nss-SO4(2-) depositions in these areas were nearly twice the national mean. In WT, HR and ES, nss-Ca2+ concentrations in winter are lower than the average of the whole country (less than the half). This may be the cause of the lower potentials of neutralization and the higher remaining acid concentrations in WT, HR and ES than NK and WS.

[General anesthesia in a patient with Cornelia de Lange syndrome with restricted opening of the mouth].

Patients with Cornelia de Lange syndrome have many anomalies including micrognathia with a small mouth, a high arched palate, and a short neck, which might make laryngoscopy for tracheal intubation difficult during induction of general anesthesia. General anesthesia was performed in a patient with Cornelia de Lange syndrome, and restricted opening of the mouth, which had not been reported previously, was found during laryngoscopy. The possible causes were thought to be temporo-mandibular joint disorders, contracture of the masseter muscle due to injury by self-destructive tendencies, or elogated coronoid process. The potential difficulty with laryngoscopy should be considered for tracheal intubation in a patient with Cornelia de Lange syndrome.

The effect of ketamine or thiamylal on succinylcholine-induced myoglobinemia under halothane anesthesia in adults.

We studied the effect of intravenous (IV) thiamylal or ketamine on the increases in serum myoglobin, creatine kinase (CK), and potassium induced by succinylcholine under halothane anesthesia. Ninety patients were divided into three groups. In Group O, succinylcholine (1.0 mg/kg) was administered after an the inhaled induction of anesthesia with halothane. In Group T, thiamylal (4.0-5.0 mg/kg), and in Group K, ketamine (1.5-2.0 mg/kg) was injected prior to succinylcholine administration. Anesthesia was maintained with halothane, nitrous oxide, and oxygen. Myoglobin increased in Group O at 60 min to 855 ng/mL (median) and CK to 98.6 IU/L. These increases were significantly higher than those of Group T (110 ng/mL and 66.4 IU/L) and Group K (110 ng/mL and 57.0 IU/L). Potassium increased in Group O only. There was no significant difference between Groups T and K for any of the three values. These results indicate that IV thiamylal and ketamine both suppress the increases of myoglobin, CK, and potassium, and that in cases when succinylcholine is used, both drugs can help to avoid myoglobinemia and limit the increases of CK and potassium.

Primary hepatic neuroendocrine carcinoma with multiple metastases: a case report.

We report a rare case of primary hepatic neuroendocrine cell carcinoma with multiple metastases to the liver, lung, diaphragm, bone, and pancreas. The patient was a 45-year-old man with jaundice and a large hepatic tumor measuring 12 x 16 cm at autopsy. Located in the right lobe, it was hyperechoic and inhomogeneous on US, a diffusely low density mass that contained capsule- and septum-like structures enhanced by contrast medium on CT, an inhomogeneously low intensity mass with much lower intensity foci on T1-weighted MRI, and a diffusely high intensity mass containing small higher and lower intensity foci on T2-weighted MRI. These findings are similar to those of a few previously reported cases, but are not specific to this tumor.

A preliminary study on plasma concentrations of bifemelane, indeloxazine and propentofylline in aged patients with organic brain disorders.

1. Plasma concentrations of cerebral metabolic activating drugs (bifemelane, indeloxazine and propentofylline) were studied in 68 patients (male 25, female 43) with dementia or other organic brain diseases. 2. The variations in plasma concentrations of these drugs were much bigger than expected. Measurements of bifemelane level with time course also disclosed that the concentrations were relatively stable for several months, but they varied very much among patients. 3. These findings suggest that drug monitoring are important in terms of evaluation of drug efficacy and prevention of side effects.

Inhibitory effect of fatty acids on glucose and insulin uptake in the perfused rat hindquarter.

To elucidate the effects of fatty acids on the uptake of glucose and insulin in the muscle, the effects of oleic and palmitic acids on the uptake of glucose and insulin were investigated in perfused hind-quarters of rats. In the absence of insulin, glucose uptake in the hindquarter was slightly, but not significantly, decreased by the addition of oleic and palmitic acids. In the presence of 100 or 500 microU/ml insulin, glucose uptake in the hindquarter (243 +/- 58 or 282 +/- 65 mumol/30 min) was significantly decreased by the addition of 1000 microM oleic acid and 500 microM palmitic acid (175 +/- 50 or 207 +/- 47 mumol/30 min). The decrease in insulin uptake rate, although not significant at 500 microU/ml insulin, is of similar magnitude to the decrease in glucose uptake. In the presence of 1000 microU/ml insulin, glucose and insulin uptake was not significantly altered by the addition of fatty acids. These results indicate that fatty acids directly inhibit the muscular glucose uptake via the decrease in muscular insulin uptake at a physiological concentration of insulin.

Determination of sulphur amino acids by gas chromatography with flame photometric detection.

A selective and sensitive method has been developed for the determination of sulphur amino acids by gas chromatography (GC). Sulphur amino acids were converted into their N(S)-isopropoxycarbonyl methyl ester derivatives and measured by GC with flame photometric detection using a DB-17 capillary column. The derivatives were sufficiently volatile and stable to give single symmetrical peaks. The detection limits of sulphur amino acids were ca. 0.5-1 pmol per injection, and the calibration curves were linear in the range 0.5-10 nmol for each sulphur amino acid. This method was successfully applied to small urine samples without prior clean-up, and sulphur amino acids in these samples could be analysed without any influence from coexisting substances. Overall recoveries of sulphur amino acids added to urine samples were 85-113%. The analytical results of free sulphur amino acid contents in urine samples of normal subjects are presented.

Effects of different doses of thiopentone on the increase in serum myoglobin induced by suxamethonium in children.

We have studied the effects of different doses of thiopentone on the increase in serum myoglobin after administration of suxamethonium during inhalation induction of anaesthesia in children. Forty-three children were anaesthetized with halothane and nitrous oxide in oxygen and allocated to four groups: group S received suxamethonium 1 mg kg-1 to facilitate intubation; group ST2 received thiopentone 2 mg kg-1 and group ST4 received thiopentone 4 mg kg-1, before administration of suxamethonium 1 mg kg-1; group N did not receive thiopentone or suxamethonium. Serum myoglobin and creatine kinase (CK) concentrations were measured until 60 min after the injection of suxamethonium. Both myoglobin and CK concentrations increased in the three groups receiving suxamethonium. There were no significant differences between groups S and ST2, but the myoglobin concentration was less in group ST4 than in groups S and ST2. A significant difference in CK concentration was found only between groups ST2 and ST4 at 60 min. In group N, both values remained reasonably constant. Thiopentone 4 mg kg-1, but not 2 mg kg-1, attenuated the increase. The results indicate that to prevent a marked elevation in serum myoglobin after administration of suxamethonium, thiopentone 4 mg kg-1 should be administered.

Histochemical localization and X-ray microanalysis of calcium in the rat submandibular gland: demonstration of possible sites for microlith induction.

Rapidly frozen and freeze-substituted submandibular glands of young female rats were embedded in Epon and processed for histochemical demonstration of calcium with the glyoxal bis (2-hydroxyanil) (GBHA) staining method. GBHA staining of thick Epon sections revealed discrete calcium reactions of moderate intensity in practically every secretory granule but not in other compartments of the acinar cells. The saliva in the excretory duct was also reactive with GBHA and showed a drastic decrease in staining intensity toward the distal segments of excretory ducts with larger diameters. In addition, the duct saliva contained numerous tiny particles that were highly GBHA reactive. Stromal cells and cells lining the excretory duct were totally free of reactions. In the acinar cells, X-ray analysis detected distinct peaks for calcium in secretory granules and smaller ones in the Golgi apparatus, while they were undetectable in the rough surfaced endoplasmic reticulum (RER), implicating post-RER calcium loading in the secretory pathway. Electron-dense deposits in the duct saliva showed distinct peaks both for calcium and phosphorus, though these appeared in the acinar secretory granules and other cytoplasmic regions lacked phosphorus. Our observations thus demonstrated physiological calcium in the intra- as well as extracellular compartments of the submandibular gland, and further confirmed drastic changes in chemical composition along the synthetic and secretory pathways of the saliva, by both histochemical and X-ray microanalytical methods. GBHA staining of calcium combined with X-ray microanalysis is useful for an evaluation of the physiology and histo-pathological changes of the salivary glands associated with initial phases of microliths as well as sialoliths formation.

[Effect of succinylcholine on serum potassium concentration in children with chronic renal failure].

Serum potassium (K+) levels were measured after intravenous injection of succinylcholine (SCh) in 10 children with chronic renal failure, 10 normal children aged 1 to 10 years and 10 children with chronic renal failure after pretreatment with pancuronium prior to SCh. Arterial blood gas was maintained within normal ranges. The serum K+ level increased significantly during 10 minutes after SCh in normal children. There was no significant difference between serum K+ levels in normal children and those in children with chronic renal failure. Administration of pancuronium in small doses (20 micrograms.kg-1) prior to SCh (1 mg.kg-1) was not effective to prevent serum K+ elevation completely. Our results indicate that the administration of SCh in children with chronic renal failure might be possible without increasing serum potassium level.

Postoperative death of a patient in apparent remission of malignant lymphoma after dissection for squamous cell carcinoma.

A 67-year-old man in apparent remission of malignant lymphoma had squamous cell carcinoma of the left buccal mucosa. The patient underwent partial resection of the mandible, including the excision of the tumor. During the fourth postoperative night the patient suddenly became febrile and had a spiking fever for the next 5 days. His general condition deteriorated afterward, and acute aggravation of malignant lymphoma was suspected. On day 16 disseminated intravascular coagulation was indicated by a decreased platelet count of 3.8 x 10(4), a tendency toward bleeding, and multiple organ failure. The patient died 18 days postoperatively. We alert anesthesiologists and surgeons that surgically treating patients with malignant lymphoma who are receiving immunosuppressive drugs is precarious even though their disease is considered to be in apparent remission.

Parvalbumin-immunoreactive neurons in the cortex in Pick's disease.

Parvalbumin (a calcium-binding protein)-immunoreactive (PV-Ir) neurons in the cerebral cortex were examined in 20 postmortem brains obtained from elderly controls and patients with Pick's disease (PD). The type of PV-Ir neurons and their distribution in control and PD brains were similar. The number of PV-Ir neurons in PD brains did not differ significantly from that in the control brains either. These findings suggested that PV-Ir neurons in the cortex are not affected in PD brains. A significant loss of PV-Ir neurons has already been reported in brains obtained from patients with Alzheimer-type dementia (ATD), and the present results suggest the possibility that the damage of PV-Ir neurons might be comparatively selective for ATD brains.

A study on postmortem stability of vasopressin messenger RNA in rat brain compared with those in total RNA and ribosomal RNA.

Postmortem stability of arginine-vasopressin (AVP) messenger RNA (mRNA) in the rat brain was studied comparing changes with those in the recovered amounts of total RNA and ribosomal RNA (rRNA). The amount of AVP mRNA and rRNA showed a decrease with increasing time interval after death (postmortem time), whereas the amount of total RNA did not alter with postmortem time. The half-life of AVP mRNA in the rat postmortem seemed to be approximately 16 hrs. The analysis of the ratio of AVP mRNA to 18S-rRNA suggested that AVP mRNA was degraded postmortem more rapidly than rRNA. These results suggest that autopsied human brains should be used for AVP mRNA study within a short postmortem time.

[Effects of succinylcholine on serum levels of myoglobin and CK in children under halothane or enflurane anesthesia].

We studied the effects of succinylcholine (SCC) on serum levels of myoglobin (Mb) and CK in children under halothane or enflurane anesthesia. Forty-five children, aged 2 years 11 months to 12 years 6 months were subjected to this study. They were divided into four groups; the two groups were injected with SCC 1 mg.kg-1 intravenously to facilitate tracheal intubation and maintained with halothane (Group SH) or with enflurane (Group SE). The other two groups were intubated without the aid of SCC and maintained with halothane (Group H), or with enflurane (Group E). Mb was analyzed by an antibody radioimmunoassay technique and CK was analyzed by a modified Rosalki's method. While Mb increased in all four groups, the increase was pronounced in the SCC groups (60 min value of Group SH 2192 +/- 639 ng.ml-1, Group SE 1722 +/- 436 ng.ml-1, mean +/- SE), and the increase was significantly smaller in SCC free groups (Group H 40 +/- 12 ng.ml-1, Group E 43 +/- 9 ng.ml-1). The CK value increased only in the SCC groups to 174.1 +/- 32.8 IU.l-1 in Group SH, and to 193.6 +/- 35.7 IU.l-1 in Group SE at 60 min, respectively. These results indicate that increases in Mb and CK values were mainly induced by SCC injection and that SCC might play some roles in development of malignant hyperthermia.

A study of non-isotopic in situ hybridization histochemistry on postmortem changes in vasopressin mRNA in rat brain.

Rat models which stimulated various postmortem conditions were used to determine postmortem changes in the vasopressin mRNA content of the brain. In situ hybridization histochemistry experiments using biotinylated oligonucleotide probes revealed that vasopressin mRNA could be detected in the rat hypothalamic nuclei, even though the rats had been killed and left for 8 h postmortem at room temperature and the brains were then fixed by immersion in 4% paraformaldehyde instead of by transcardial perfusion. However, these signals were greatly reduced in the nuclei if the brains were removed after a 24-h delay. These results suggest that gene expression study of neuropeptides at the cellular level can be performed on postmortem human brains after a short postmortem delay.

An immunohistochemical study of beta-protein in Alzheimer-type dementia brains.

An immunohistochemical study with a polyclonal anti-beta-protein antiserum was performed in order to understand the mechanism of deposition of amyloid fibrils in senile plaques in Alzheimer-type dementia (ATD). Serial cortical sections cut from ATD brains were necessary to investigate the structural correlation between senile plaques and blood vessels. The senile plaques were stained well and a blood vessel or capillary-like structure was found in most of beta-protein-immunoreactive deposits. These findings may suggest an involvement of blood vessels in the formation of at least some of the amyloid deposits in ATD brains.