Neuroprotective mechanisms of lidocaine against in vitro ischemic insult of the rat hippocampal CA1 pyramidal neurons.

To compare neuroprotective effects of lidocaine and procaine against ischemic insult, intracellular recordings were made from rat hippocampal CA1 pyramidal neurons in slice preparations. Superfusion of the slices with oxygen- and glucose-deprived medium (in vitro ischemia) produced a rapid depolarization 6 min from the onset. When oxygen and glucose were reintroduced, the membrane depolarized further until it reached 0 mV, and thereafter the membrane showed no functional recovery. Pretreatment with lidocaine (10 microM), but not procaine (50 microM), restored the membrane potential after the reintroduction of oxygen and glucose. Lidocaine, compared to procaine, significantly inhibited the reduction in both tissue ATP content and flavoprotein fluorescence during and after in vitro ischemia. Under electron microscopy, only lidocaine well preserved the structure of mitochondria in the CA1 pyramidal cell body. Extracellular recordings revealed that procaine reduced the field postsynaptic potential whereas lidocaine augmented it. Both drugs reduced the presynaptic volley dose-dependently. Neither lidocaine nor procaine significantly affected a rapid rise of the intracellular Ca2+ level produced by in vitro ischemia in the CA1 region. All the results suggest that the neuroprotective lidocaine action is due to the protection of the mitochondria to maintain the tissue ATP content during and after in vitro ischemia.

Skin lesions during intravenous hyperalimentation: zinc deficiency.

Of 54 patients who received prolonged intravenous hyperalimentation during the past 4 years, six developed progressive, characteristic skin lesions. These cutaneous manifestations frequently were accompained by abdominal symptoms resembling those of acrodermatitis enteropathica in many respects. In the first four of these six patients, skin eruptions disappeared promptly after the initiation of oral feeding, which led us to assume that these skin manifestations are due to some unknown nutrient deficiency. Our experience in the remaining two patients enabled us to presume the underlying pathology to be zinc deficiency.

Hemangioma of the liver. Diagnosis with combined use of laparoscopy and hepatic arteriography.

A case of hepatic hemangioma is reported in which preoperative diagnosis, with the combined aid of serial selective hepatic arteriography and laparoscopy, was necessary. The patient underwent right hepatic lobectomy after extensive extrahepatic individual ligations with no severe postoperative complications. The combined use of selective hepatic arteriography and laparoscopy is emphasized as essential for the correct diagnosis of hepatic hemangioma.

Copper deficiency with pancytopenia during total parenteral nutrition.

Anemia and neutropenia are commonly observed hematologic changes in patients with copper (Cu) deficiency, but thrombocytopenia is rarely found. A-69-year-old patient with postoperative small-bowel obstruction underwent laparotomy three times. Because of persistent obstruction, nasoduodenal suction was continued and total parenteral nutrition was instituted. Fifteen months after the initiation of total parenteral nutrition, the patient gradually developed pancytopenia (red blood cell count 222 x 10(4)/mm3, neutrophil count 1254/mm3, and platelet count 9.2 x 10(4)/mm3). The serum Cu level was 10 micrograms/dL and the serum ceruloplasmin level was less than 5 mg/dL. After 2 weeks of Cu supplementation in a daily dose of 20 mumol, the serum Cu level increased to 81 micrograms/dL and the serum ceruloplasmin level to 20 mg/dL. Hematologic values showed a dramatic response: red blood cell count increased to 362 x 10(4)/mm3, neutrophil count to 4819/mm3, and platelet count to 22.1 x 10(4)/mm3. The improvement of pancytopenia could be attributed to Cu supplementation. This is the first case report of Cu deficiency with pancytopenia during total parenteral nutrition.

DNA flow cytometric analysis of neuroblastoma: distinction of tetraploidy subset.

Neuroblastoma has several characteristics that differentiate it from other adult malignancies. The ploidy pattern of neuroblastoma has been shown to be related to prognosis. Specifically, a DNA diploidy pattern is associated with a poorer outcome, and an aneuploidy pattern is associated with a better outcome. A tetraploidy pattern has also been identified; however, there is little information regarding this pattern. To examine the properties of neuroblastoma according to these DNA ploidy patterns, the authors performed flow cytometric analysis (retrospectively) for 61 neuroblastoma cases, using paraffin-embedded tissues. Fifty-six of the cases had analyzable results. Calculated DNA indices (DI) ranged from 1.0 to 2.30. The 56 cases were divided into three groups according to DI: diploid (DI = 1.0 to 1.17, n = 19), aneuploid (DI = 1.25 to 1.75, n = 26), and tetraploid (DI = 1.81 to 2.30, n = 11) groups. Compared with the aneuploid group, the diploid group had a stronger correlation with older patient age (> or = 1 year) (P < .01), more advanced clinical stage (III, IV) (P < .01), and poorer prognosis (P < .001). The tetraploid group had properties that were statistically similar to those of the diploid group (P < .05, P < .05, P < .001, respectively). These findings indicate that a subset of DNA tetraploid is present in neuroblastoma, and this subset, which may have clinical and biological characteristics similar to those of the DNA diploid group, should be distinguished from DNA aneuploidy.

Total body fluid volume determination based on urea kinetics in hemofiltration as an index of basal body weight in uremic patients.

Assuming that urea is distributed uniformly within the total body water, urea-space or total body fluid volume was determined in six uremic patients based on urea kinetics in hemofiltration. The total body fluid volume before hemofiltration was 36.0 +/- 3.6 L (61.8 +/- 2.6% BW) and after hemofiltration 32.5 +/- 3.4 L (59.3 +/- 2.8% BW), suggesting that the total body fluid volume was nearly normalized by hemofiltration. It is concluded that urea-space, easily measurable based on urea kinetics during hemofiltration, is useful in evaluating the fluid balance in patients undergoing artificial kidney therapy.

[Retroperitoneal cavernous hemangioma: a case report].

A 55-year-old man was shot at the age of 50. At that time CT revealed a mass near the spleen. Thereafter, CT did not reveal any growth of the mass, but to examine the mass in detail he was hospitalized to our department. The mass was diagnosed as left adrenal cavernous hemangioma, since, on aortography, it was typical cavernous hemangioma and fed mainly from the left inferior phrenic artery. The mass was resected with the spleen, thoracic wall, and part of diaphragma. At the operation the left adrenal gland was identified to be intact. Histopathological diagnosis was retroperitoneal cavernous hemangioma. This is the 19th case of retroperitoneal cavernous hemangioma in the Japanese literature.

[Efficacy of lidocaine tape for venous cannulation in children].

We evaluated whether lidocaine tape (3 X 5 cm, contained 18 mg of lidocaine) could reduce pain caused by venous cannulation in children during anesthetic induction. One hundred and thirty-five children scheduled for elective surgery were randomly assigned to three groups according to the application time of the tape (30 min, 60 min and 120 min). Pain assessment was made by using our pain score (0: no response, 1: slight agitation, 2: strong agitation, at the venous cannulation). The effect of pain reduction (pain score 0 and 1) was found in 81 % of all patients. Especially in the group of 120 min, the effect was remarkable. Only 6.7% of all patients had slight adverse effects including skin redness and itching. In another 25 patients (weighing 3.5-30 kg), plasma concentration of lidocaine were measured 120 min after application of a piece of this tape. Arterial blood was sampled at 30 and 120 min after the tape was removed. Plasma lidocaine levels were always below 0.8 mcg.ml-1 In conclusion, the lidocaine tape may be useful and safely applicable for venous cannulation in children.

[Studies on surfactant replacement therapy in pediatric measles pneumonitis].

Measles pneumonitis, as well as encephalitis, is the most important complication associated with mortality in measles. Many medications including steroids and vitamin A have been applied to pediatric measles pneumonitis. However, the efficacy of such medication has not yet been established. This study is aimed at evaluating the effectiveness of surfactant replacement therapy in pediatric measles pneumonitis. Five patients (aged 1-2 years) with measles pneumonitis were transferred to our emergency center. On the transferred day, Surfactant-TA was administered by intratracheal method. After administration of surfactant, PaO2/FIO2 increased from 63.6 +/- 11.0 (mean +/- SE) to 206.2 +/- 54.1 in an hour and to 163.8 +/- 34.8 in 24. At the same time, the CO2 elimination and the dynamic compliance were improved. Because of these effects, the peak inspiratory pressure employed in mechanical ventilation could be reduced. It is concluded that surfactant replacement therapy can prevent the patients with measles pneumonitis from hypoxemia and ventilation-induced lung injury. However, further study is needed to maintain the improved oxygenation. Recently, it is reported that the effect of exogenous surfactant on oxygenation and activity of pulmonary neutrophils is regulated by the amount and/or concentration of administered surfactant. Therefore, it is an urgent issue to find out the optimum amount and concentration of exogenous surfactant used clinically.

[The efficiency of continuous hemofiltration/hemodialysis for acute respiratory failure complicated with acute renal failure].

Continuous hemofiltration/hemodialysis (CHF/CHD) have emerged as effective modalities in the management of acute renal failure. More recently, these therapies have received attention for non-renal application such as adult respiratory distress syndrome (ARDS) and multiple organ failure. To assess the potential benefits of CHF/CHD in the management of severe impairment of pulmonary gas exchange, we evaluated a series of clinical variables in a group of patients with acute respiratory failure complicated with acute renal failure. In 9 of 15 patients, pulmonary gas exchange was improved. Intrapulmonary shunt (Qs/Qt) and pulmonary vascular resistance were also improved during the therapies. The beneficial effects of the modalities seems to be induced by effective removal of extravascular lung water. However, the fact that the same effects were also observed in a few patients with zero or positive fluid balance may indicate the possibility of elimination of circulating middle-molecular pulmonary toxic mediators. We concluded CHF/CHD are recommendable methods for the management of acutely ill patients with respiratory failure.