Relationship between the administration of nicardipine hydrochloride and the development of delirium in patients on mechanical ventilation.

A history of hypertension is a known risk factor for delirium in patients in intensive care units, but the effect of antihypertensive agents on delirium development is unclear. Nicardipine, a calcium channel blocker, is widely used in ICU as a treatment agent for hypertensive emergency. This study investigated the relationship between the administration of nicardipine hydrochloride and delirium development in patients under mechanical ventilation. We conducted a medical chart review of 103 patients, who were divided into two groups according to the use of nicardipine hydrochloride. The prevalence of delirium was compared with respect to factors such as age, sex, laboratory data, and medical history, by multivariate analysis. 21 patients (20.4 %) were treated with nicardipine hydrochloride in 103 patients. The treatment and non-treatment groups differed significantly in age (72 vs. 65 years) and history of high blood pressure (57% vs. 11%). Multivariate analysis revealed that patients in the treatment group developed delirium significantly less often than those in the non-treatment group (19% vs. 48%). These results suggested that treatment of high blood pressure with nicardipine hydrochloride is a possible method for preventing the development of delirium.

Activated T lymphocytes in cerebrospinal fluid of patients with HTLV-I-associated myelopathy (HAM/TSP).

In order to detect activated T lymphocytes in the cerebrospinal fluid (CSF) of patients with human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP), we studied CSF lymphocytes in untreated patients with HAM/TSP and other neurological diseases (OND). Dual-immunofluorescence staining technique was performed using fluorescence microscopy. No significant difference in the CD4+/CD8+ ratio of CSF lymphocytes was observed between HAM/TSP patients and patients with OND. However, both CD4+ and CD8+ CSF lymphocytes of HAM/TSP patients contained higher percentages of HLA-DR-positive cells than those of patients with OND (P less than 0.05), suggesting that the activated CSF T lymphocytes were composed of both CD4+ and CD8+ subsets in patients with HAM/TSP.

Purification and properties of a membrane-bound phospholipase B from baker's yeast (Saccharomyces cerevisiae).

Phospholipase B bound tightly to the membrane fraction of baker's yeast (Saccharomyces cerevisiae) was purified approximately 226-fold by extraction with sodium deoxycholate (DOC), acetone precipitation, ammonium sulfate fractionation, and column chromatographies on Phenyl-Sepharose CL-4B, DEAE-Sepharose CL-6B, and Sepharose 4B. Only one major activity peak with an apparent molecular weight of 330,000 was detected by gel filtration on Sepharose 4B. However, two glycoprotein bands, one major and one minor, were evident on SDS-polyacrylamide gel electrophoresis in the absence of 2-mercaptoethanol. Isoelectric focusing also revealed two activities, pI 3.4 (major) and pI 3.0 (minor). The purified enzyme had phospholipase B activity (in the presence of DOC) and lysophospholipase activity in a ratio of 1:4.8. Both activities had an optimum pH of 3.5-4.0. Phospholipase B activity was appreciably stimulated only by DOC among bile acids, but lysophospholipase activity was markedly inhibited by them. Both activities were not stimulated by Ca2+ and inhibited by SDS, Triton X-100, Fe3+ and Al3+. The purified enzyme hydrolyzed the acyl ester bonds of phosphatidylcholine sequentially, first the 2-acyl and then the 1-acyl groups. It preferentially hydrolyzed 1-acyl-sn-glycero-3-phosphocholine and, to a lesser degree, 2-acyl-sn-glycero-3-phosphocholine.

Purification and some properties of cyclohexylamine oxidase from a Pseudomonas sp.

Cyclohexylamine oxidase was purified 90-fold from cell-free extracts of Pseudomonas sp. capable of assimilating sodium cyclamate. The purified enzyme was homogeneous in disc electrophoresis, and the molecular weight was found to be approximately 80,000 by gel filtration. The enzyme catalyzed the following reaction: cyclohexylamine+O2+H2O leads to cyclohexanone+NH3+H2O2. The enzyme thus can be classified as an amine oxidase; it utilized oxygen as the ultimate electron acceptor. The pH optimum of the reaction was 6.8 and the apparent Km value for cyclohexylamine was 2.5 X 10(-4) M. The enzyme was highly specific for the deamination of alicyclic primary amines such as cyclohexylamine, but was found to be inactive toward ordinary amines used as substrates for amine oxidases. The enzyme solution was yellow in color and showed a typical flavoprotein spectrum; the addition of cyclohexylamine under anaerobic conditions caused reduction of the flavin in the native enzyme. The flavin of the prosthetic group was identified as FAD by thin layer chromatography. The participation of sulfhydryl groups in the enzymic action was also suggested by the observation that the enzyme activity was inhibited in the presence of PCMB and could be recovered by the addition of glutathione.

Effect of chronic administration of propranolol on lipoprotein composition.

Chronic effects of propranolol on plasma lipids and lipoprotein composition were examined in ten patients who had previous strokes and normal plasma lipids. Although plasma triglyceride and total cholesterol were not affected by propranolol, a slight decrease of free cholesterol and phospholipids and a significant increase of free fatty acids were observed in the eighth week of propranolol treatment. Reciprocal changes were observed in lipoprotein composition; these were an increase in lipids of very low-density lipoprotein and a decrease in lipids of both low-density and high-density lipoproteins. Postheparin lipolytic activity was significantly suppressed by the administration of propranolol. Inhibition of lipoprotein lipase by propranolol was considered to have played a role in the reciprocal changes of lipoprotein composition.

Hypobetalipoproteinemia with abnormal prebetalipoprotein.

A 47-year-old man who had cerebellar ataxia and low plasma lipid and lipoprotein levels is reported. His tendon reflexes were hyperactive and the plantar responses were extensor. There was no acanthocytosis. Total lipids (380 mg/dl), total cholesterol (106 mg/dl), esterified cholesterol (74 mg/dl), triglyceride (58 mg/dl), phospholipids (124 mg/dl) and free fatty acids (303 muequiv./l) were generally decreased. A disturbance of lipid absorption due to a defect of chylomicron formation and hepatic steatosis were also disclosed. On lipoprotein electrophoresis, prebetalipoprotein was very faint and migrated more slowly than normal. Betalipoprotein and alphalipoprotein were moderately reduced in concentration but migrated normally. The concentration of isolated VLDL was only one-tenth of that in normal subjects and it migrated as slow prebetalipoprotein. Although the lipid composition of VLDL was similar to that of normal VLDL, the lack of minor components was disclosed by SDS-PAG electrophoresis. Incorporation of [1-14C]acetate into VLDL lipids was significantly reduced to a greater extent than that of LDL and HDL. From these findings, we discuss the possibility that hypobetalipoproteinemia results from impaired VLDL synthesis.

[Efficacy of leukocytapheresis and low-dose prednisolone treatment in a patient with HTLV-I-associated myelopathy (HAM)].

The patient, a 66-year-old woman, was admitted because of a two year history of slowly progressive gait disturbance. A diagnosis of HTLV-I-associated myelopathy (HAM) was made on the basis of the clinical and serological criteria. Although the ordinary dose of oral prednisolone (PSL) is more than 30 mg in the treatment of HAM, we treated this patient by low-dose (5-10 mg) oral PSL administration. A series of leukocytapheresis performed before the PSL treatment halted the progression of symptoms transiently. Alterations in peripheral blood lymphocyte (PBL) subpopulations and augmented autologous proliferative response of PBLs improved concurrently with the resolution of neurological symptoms after the low-dose PSL treatment. The result suggests that some cases with HAM may respond with PSL treatment in low doses.

[Improvement of Hoffmann external fixation apparatus].

The resurgence of external fixators for the management of skeletal and joint injuries has generated an increasing number of reports. In addition, many types of fixators have been developed in the last ten years. Of these, the Hoffmann external fixator is the most popular one. Is it possible for the patient with a tibial comminuted fracture to walk with the fixator? This study has been pursued to investigate this question and to improve on the fixator. Bone models were made from tubed polyester resin strengthened by glass fiber (elastic module: 9.46 kg/mm2, outside diameter: 35 mm, inside diameter: 30 mm). Each bone model was transfixed by two Steinmann pins (phi: 4.5 mm) with 43 mm between, and a pair of models was framed with two straight bars, with 30 mm from model to bar. The Steinmann pins and straight bars were connected to each attachment. The experiment focused on four main studies: Measurement of the Young's modulus of the Steinmann pin. Compression load test and bending load test framed bone models with each attachment. Observation and measurement of the ground reaction force of ambulation on stilt framed with experimental external fixator. Determination of S-N curve of the Steinmann pin. Results were as follows: The Young's modulus of the Steinmann pin were 1.8 X 10(4) kg/mm2. 0.2% proof of the pin was 110 kg/mm2. The bone models framed with the conventional method were destructed at the universal ball joint at 68 kgf in the compression load test, and 6.8 kgf in the bending load test. The models framed with the conventional method fitted with spring washers at ball joints were not destructed until 203 kgf in compression load, but after several trials the spring washers were crushed. The models fabricated by using a vice with rods and articulation coupling were not damaged until 210 kgf in compression load and were not damaged until 15 kgf in bending load even after several trials. The displacement between the models were 2.8 mm at 80 kgf and 8.5 mm at 210 kgf in compression load. The models fabricated by experimental external fixators were not damaged until 250 kgf in compression load and were not damaged until 30 kgf in bending load, and the displacement between the models were 2.1 mm at 80 kgf and 6.9 mm at 210 kgf in compression load.(ABSTRACT TRUNCATED AT 400 WORDS)

Separation of human serum lipoproteins into three major classes by hydroxyapatite chromatography.

The separation of normolipidemic male serum lipoprotein fraction, prepared by ultracentrifugal flotation, was studied on hydroxyapatite columns. Potassium phosphate buffers in the pH range 5.6-7.4 were evaluated as eluents. The three main classes of the lipoproteins (high density, low density and very low density) can be separated on the Tiselius-type hydroxyapatite (Bio-Gel HTP DNA grade) column by elution with 75, 250 and 300 mM potassium phosphate buffer (pH 7.4), respectively.

Comparative evaluation of KL-6 and surfactant protein D as serum markers for interstitial pneumonia associated with collagen diseases.

Abstract We evaluated the usefulness of serum levels of KL-6 and surfactant protein D (SP-D) as markers of interstitial pneumonia (IP) associated with collagen diseases in 115 patients. KL-6 and SP-D levels in patients with IP (n = 38) were significantly higher than those in patients without IP (n = 77). Moreover, KL-6 and SP-D levels in patients with active IP (n = 8) were significantly higher than those in patients with inactive IP (n = 30). Both KL-6 and SP-D proved useful for the diagnosis of IP associated with collagen diseases and for the evaluation of disease activity. We classified IP into three groups according to the extent of the lesion on computed tomographs of the chest. There was a significant difference among three groups in serum levels of KL-6, but not in serum levels of SP-D. KL-6 proved to be useful as an indicator of the extent of the IP lesions. We monitored changes in KL-6 and SP-D levels in seven of eight patients with active IP. Chronological changes of serum KL-6 and SP-D in patients with active IP were different. In fatal cases in particular, serum levels of SP-D decreased at the terminal stage of IP while levels of KL-6 continued to increase.

A production of monoclonal antibodies by a simple electrofusion technique induced by ac pulses.

A simple and effective technique of electrofusion of the mouse myeloma cells and lymphocytes induced by AC pulses was investigated. Instead of pearl chain formation, we used a mild centrifugation of high-density cell suspensions to enhance the cell-cell contacts. The optimal frequency of the AC field used for cell fusion was 10 kHz. We confirmed the production of monoclonal antibodies against human serum albumin (HSA) by the hybridoma obtained by this method. Under the conditions used in the present work, the efficiency of hybridoma formation is several times higher than those obtained by the chemical method using polyethylene glycol (PEG). Hybridoma colonies were detected in as high as 95% of the wells and 33% of them proved positive against HSA.

Excretion, distribution and metabolism of 1,2,4-trichlorobenzene in rats.

1,2,4-Trichlorobenzene (TCB) labeled with C-14 was given perorally to rats at a dosage of 50 mg/kg for excretion and distribution studies. About 66% and 17% of the oral dose was excreted in the urine and feces, respectively, within 7 days. Trapped radioactivity in the expired air amounted to 2.1% of the dose, but production of labeled carbon dioxide was negligible. Tissue residues were evenly distributed throughout the organs and tissues examined, except for the adipose tissue which consistently had a little higher concentration. The urinary, fecal and expiratory metabolites were identified. Free 2,4,5- and 2,3,5-trichlorophenol (TCP) and their conjugates were mainly detected in the urine. 5- or 6-Sulfhydryl, methylthio, methylsulfoxide and methylsulfone derivatives of TCB were also detected as minor metabolites. Dichlorobenzenes and unchanged TCB were confirmed in the expired air. Reductive dechlroination seems to be catalysed by intestinal microflora enzymes.

A case of prostatic malacoplakia.

Prostatic malacoplakia is an extremely rare disease. We report a case of malacoplakia of the prostate and review the 21 cases previously reported, including 4 in our country and 17 in other countries.

Paroxysmal hypertension in aortitis syndrome.

Three patients with aortitis syndrome ehibited paroxysmal hypertension which seemed to result from baroreceptor dysfunction. All of the patients had signs of active inflammation of aortitis syndrome and stenotic carotid and subclavian arteries. During the attacks, the blood pressure rose to at least 230 mm. Hg systolic and the heart rate exceeded 100. However, with prolonged administration of steroid hormones, the attacks ceased. In two patients with dilated thoracic aortas and aortic regurgitation, the attacks of paroxysmal hypertension occurred without apparent precipitating factors and were followed by anginal pain with marked ST depression. The sympathicotonic state resulting from the disturbance of the baroreceptors was considered to be responsible for the attacks. In another patient, the attacks occurred in the course of treatment with a steroid hormone and were provoked only by voluntary micturition. This post-micturition hypertension was presumed to be an expression of abnormal overshooting following a fall in blood pressure after voiding.

Concentration of activated T lymphocytes in extracorporeal blood circulation for plasma separation.

To investigate whether the proportion of activated T lymphocytes changes in an extracorporeal blood flow, we compared paired samples collected at the inlet and outlet lines of an artificial circuit for plasma separation, using a dual-immunofluorescence flow cytometric technique. In our series of materials from patients with rheumatoid arthritis or systemic lupus erythematosus, the percentages of HLA-DR-positive cells in both CD4+ (P less than 0.01, n = 6) and CD8+ (P less than 0.05, n = 10) subsets were significantly increased in the outlet lines compared with the inlet lines, suggesting that activated T lymphocytes pass through an extracorporeal blood circuit more easily than resting T lymphocytes.

Arthritis in a human T lymphotropic virus type I (HTLV-I) carrier.

The case is described of a 57 year old woman with polyarthritis fulfilling the 1987 revised criteria of the American Rheumatism Association for rheumatoid arthritis, accompanied by clinical carrier state infection of HTLV-I. Anti-HTLV-I IgM antibodies were detected by western blot analysis in her synovial fluid and serum. Atypical lymphocytes with nuclear convolutions were found in synovial fluid and synovial tissue obtained from the affected knee joint, suggesting in situ activation of HTLV-I infected lymphocytes in the affected synovial compartment. The HTLV-I antigens were detected (1.2%) in short term cultured synovial fluid lymphocytes, by indirect immunofluorescence. These findings supported the possibility that HTLV-I has a role in triggering or modifying inflammation in the synovial compartment.