Infusion requirements and reversibility of rocuronium at the corrugator supercilii and adductor pollicis muscles.

BACKGROUND: The aim of this study is to compare the infusion rates required to maintain a constant neuromuscular block and the reversibility of rocuronium at the corrugator supercilii muscle (CSM) and the adductor pollicis muscle (APM). METHODS: We randomly allocated 30 female patients into two groups of 15 patients each to monitor neuromuscular block at either the CSM or the APM. After induction of anaesthesia and laryngeal mask insertion, contraction of the CSM to the facial nerve stimulation or that of the APM to the ulnar nerve stimulation was quantified using an acceleromyograph during 1.0-1.5% end-tidal sevoflurane anaesthesia. All the patients received a bolus of 1 mg/kg rocuronium. When the first twitch (T1) of train-of-four (TOF) recovered to 10% of the control, rocuronium infusion was commenced and maintained at T1 of 10% of the control at the CSM or APM for 120 min. Immediately after rocuronium infusion was discontinued, the time required for 0.04 mg/kg neostigmine-facilitated recovery to a TOF ratio of 0.9 was recorded. RESULTS: Rocuronium infusion dose after a lapse of 120 min was significantly larger in the CSM than in the APM [7.1 (2.3) vs. 4.7 (2.6) microg/kg/min; P=0.001]. The time for facilitated recovery was shorter in the CSM than in the APM [11.4 (3.8) vs. 16.2 (6.0) min; P=0.016]. CONCLUSION: A larger rocuronium infusion dose was required to maintain a constant neuromuscular block at the CSM. Neostigmine-mediated reversal was faster at the CSM.

Epidurally administered mepivacaine delays recovery of train-of-four ratio from vecuronium-induced neuromuscular block.

BACKGROUND: The aim of this study was to examine the efficacy of epidurally administered mepivacaine on recovery from vecuronium-induced neuromuscular block. METHODS: Eighty patients were randomly assigned to one of two study groups. They were either given epidurally a bolus of 0.15 ml kg(-1) of mepivacaine 2%, followed by repetitive injections of 0.1 ml kg(-1) h(-1) throughout the study, or were not given epidurally. General anaesthesia was induced and maintained with fentanyl, propofol and nitrous oxide. Neuromuscular block was induced with vecuronium 0.1 mg kg(-1) and monitored using acceleromyographic train-of-four (TOF) at the adductor pollicis. Patients in each treatment group were randomized to receive neostigmine 0.04 mg kg(-1) at 25% recovery of the first twitch of TOF or to recover spontaneously to a TOF ratio of 0.9. The effect of epidural mepivacaine on speed of spontaneous and facilitated recovery of neuromuscular function was evaluated. RESULTS: The time from administration of vecuronium to spontaneous recovery to a TOF ratio of 0.9 was significantly longer in the epidural mepivacaine group [105.4 (14.2) min] as compared with the control group [78.5 (9.1) min, P < 0.01]. Neostigmine administered at 25% of control in T1 shortened recovery from neuromuscular block, however the time required for facilitated recovery to a TOF ratio of 0.9 in the epidural group was significantly longer than that in the control group [7.6 (1.6) min vs 5.8 (2.1) min, P < 0.01]. CONCLUSIONS: In clinical anaesthesia, it should be recognized that epidurally administered mepivacaine delays considerably the TOF recovery from neuromuscular block.

The human homolog of Saccharomyces cerevisiae Apg7p is a Protein-activating enzyme for multiple substrates including human Apg12p, GATE-16, GABARAP, and MAP-LC3.

Autophagy is a process that involves the bulk degradation of cytoplasmic components by the lysosomal/vacuolar system. In the yeast, Saccharomyces cerevisiae, an autophagosome is formed in the cytosol. The outer membrane of the autophagosome is fused with the vacuole, releasing the inner membrane structure, an autophagic body, into the vacuole. The autophagic body is subsequently degraded by vacuolar hydrolases. Taking advantage of yeast genetics, apg (autophagy-defective) mutants were isolated that are defective in terms of formation of autophagic bodies under nutrient starvation conditions. One of the APG gene products, Apg12p, is covalently attached to Apg5p via the C-terminal Gly of Apg12p as in the case of ubiquitylation, and this conjugation is essential for autophagy. Apg7p is a novel E1 enzyme essential for the Apg12p-conjugation system. In mammalian cells, the human Apg12p homolog (hApg12p) also conjugates with the human Apg5p homolog. In this study, the unique characteristics of hApg7p are shown. A two-hybrid experiment indicated that hApg12p interacts with hApg7p. Site-directed mutagenesis revealed that Cys(572) of hApg7p is an authentic active site cysteine residue essential for the formation of the hApg7p.hApg12p intermediate. Overexpression of hApg7p enhances the formation of the hApg5p.hApg12p conjugate, indicating that hApg7p is an E1-like enzyme essential for the hApg12p conjugation system. Cross-linking experiments and glycerol-gradient centrifugation analysis showed that the mammalian Apg7p homolog forms a homodimer as in yeast Apg7p. Each of three human Apg8p counterparts, i.e. the Golgi-associated ATPase enhancer of 16 kDa, GABA(A) receptor-associated protein, and microtubule-associated protein light chain 3, coimmunoprecipitates with hApg7p and conjugates with mutant hApg7p(C572S) to form a stable intermediate via an ester bond. These results indicate that hApg7p is an authentic protein-activating enzyme for hApg12p and the three Apg8p homologs.

[Extravasation of contrast media in acute subdural hematoma during three-dimensional CT angiography: a case report].

We report a case of acute subdural hematoma in which extravasation of contrast medium was demonstrated using three-dimensional computed tomographic angiography (3D-CTA). An 83-year-old man was found lying down on the floor but he was conscious. Thirty minutes later, he lost consciousness and was transferred to our hospital in a comatose state with right hemiparesis. Plain CT scan showed a left temporoparietal acute subdural hematoma with subarachnoid hemorrhage. CT scan also demonstrated an iso-density area beneath a high-density around the left Sylvian fissure. We performed an emergent 3D-CTA to rule out ruptured aneurysm as the cause of hemorrhage. However, 3D-CTA revealed no cerebral aneurysm, but extravasation of contrast medium from the cortical artery of the left temporal cortex was noted. The patient immediately underwent total evacuation of subdural hematoma by small temporoparietal craniectomy under local anesthesia. We found 3D-CTA to be a useful, less-invasive method for diagnosing the hemorrhagic cause and localizing the bleeding point. It is expected that with more routine use of 3D-CTA in patients with acute subdural hematoma, extravasation of the contrast medium will be seen more frequently. Subdural hematoma with extravasation of contrast medium required emergent surgery, and 3D-CTA findings facilitated the selection of the surgical method according to the bleeding point.

Histopathological aspects of dural arteriovenous fistulas in the transverse-sigmoid sinus region in nine patients.

OBJECTIVE: In recent years, dural arteriovenous fistulas (DAVFs) have been primarily thought to be acquired lesions, formed after sinus thrombosis. The pathogenesis of DAVF, however, is still controversial. We have studied histopathological aspects of DAVFs in resected specimens obtained from nine patients, to obtain clues to the pathogenesis of DAVFs. METHODS: Histological comparison was made among nine DAVF cases and five control cases without venous sinus disease. In addition, the relationship between the clinical course and histological aspects was investigated. RESULTS: The essential abnormality found was a connection between the dural arteries and the dural veins within the venous sinus wall, through small vessels averaging approximately 30 microns in diameter. By using several staining methods, we confirmed that the vessels were part of the venous system; we named these dilated venules "crack-like vessels." CONCLUSIONS: The development of abnormal communications between dural arteries and dural veins (crack-like vessels) is regarded as the essential part of the pathogenesis of DAVFs, and sinus thrombus is not thought to be an essential lesion of DAVFs. It might be postulated that sinus hypertension caused by stenocclusive disease of the venous sinuses triggers the development of fistulous connections between arteries and veins in the dural wall, which may result in increasingly dilated venules and the formation of DAVFs.

Flexible neuroendoscopy for percutaneous treatment of intraventricular lesions in the absence of hydrocephalus.

A procedure with a flexible fiberoptic neuroendoscope was applied to a series of patients with small lesions in the lateral ventricle, not associated with hydrocephalus. The maneuverability of the flexible neuroendoscope allows the surgeon to work in narrow spaces of the lateral ventricle avoiding surgical trauma to surrounding neural structures. The safety and accuracy of this procedure depend upon how available working space is obtained in the undilated ventricles. Both shaft-rotation and tip-flexion of the flexible neuroendoscope are available for adjusting it to the wider axis in each region of the lateral ventricle and for dealing with the intraventricular lesions. Three patients with a small intraventricular lesion, two with arachnoid cysts and one with subependymal hematoma, underwent such a procedure successfully. It is concluded that this neuroendoscopic procedure provides benefits to the treatment of small intraventricular lesions regardless of the size of the cerebral ventricles.

[A long survival case of brain tumor considered as a metastatic tumor].

A case of long survival of brain tumor (well differentiated adenocarcinoma) was reported. A 55-year-old man was admitted in January, 1986, because of a one month history of progressive headache, dizziness and gait disturbance. CT scans revealed an enhancing tumor in contact with the falx in the right frontal lobe. The tumor was totally removed. The histopathological diagnosis was that of a well differentiated adenocarcinoma. The primary site of the adenocarcinoma was not detected. No chemotherapy or radiation therapy was given. Four years and 7 months after surgery CT scans demonstrated a recurrent tumor as a bilaterally expanding falx meningioma. Nearly total removal of the tumor was again performed and diagnosed as adenocarcinoma. Examinations to detect the primary site and other metastatic lesions were negative again. On May 1993, the patient died because of the intracranial dissemination of tumor without extracranial lesions. The period from the first operation to his death was 7 years and 5 months. This is a case of long survival of intracranial cancer, which was considered as a metastatic tumor, though the primary site and other metastatic lesions were not detected. The tumor in this case showed the atypical features of a metastatic adenocarcinoma. For example, the primary and recurrent tumors resembled a parasagital or falx meningioma in shape and they grew slowly. Therefore, there is a possibility that the tumor was actually a primary adenocarcinoma, which might have arisen from the embryologically migrated cells of the mucous membrane or from ectopic epithelial cells.

tsJT16, a cell cycle ts mutant of rat fibroblast defective in early G0/G1 transition, fails to induce G1-cyclin and cdk2 genes after serum stimulation at the nonpermissive temperature.

tsJT16 is a cell-cycle temperature-sensitive (ts) mutant derived from rat fibroblasts whose functional defect appears soon after the growth stimulation from G0 phase. In addition to c-fos, c-myc and ornithine decarboxylase gene, 7 primarily inducible genes, c-jun, KC, JE, 2F1, 2A9, egr-1, and egr-2, were further shown to be expressed after serum stimulation at both permissive and nonpermissive temperatures. However, expression of secondarily inducible genes, cyclin D1 and D3 and cdk2, was ts and was cycloheximide sensitive. Expression of cyclin C was not inhibited by cycloheximide but it was ts. Failure in expression of G1 cyclins and Cdk2 is suggested to be a causal event for inability of growth induction of tsJT16 at the nonpermissive temperature.

A cell cycle ts mutant, tsJT16, is defective in p70 synthesis through protein kinase C-dependent and -independent pathways.

tsJT16 is a G0/G1 ts mutant from the Fischer rat fibroblast line. It has a ts defect in a function operating early after growth stimulation with fetal bovine serum (FBS). A primarily induced gene product, p70, was not synthesized at 40 degrees C after stimulation with serum, while c-fos and c-myc mRNAs accumulated under the same condition. This paper reports that p70 was synthesized following stimulation of G0-arrested cells with platelet-derived growth factor, epidermal growth factor (EGF), and 12-0-tetradecanoylphorbol-13-acetate (TPA) at 34 degrees C, but not at 40 degrees C. However, it was synthesized at both temperatures after addition of A23187. In protein kinase C-deprived cells, peptide growth factors and A23187 induced p70 at 34 degrees C, whereas TPA did not. Fibroblast growth factor and insulin did not induce p70. Induction of c-fos and c-myc occurred at both temperatures after the stimulation with FBS, TPA or A23187. These results indicated that the defect in tsJT16 to induce p70 is likely to be located at the common downstream of protein kinase C-dependent and -independent pathways, but is independent from the pathway of calcium mobilization.

A nuclear labile protein, p70, is expressed exclusively during G0-S transition but not in G1 phase of a cell cycle ts mutant, tsJT16.

tsJT16 is a cell cycle temperature-sensitive (ts) mutant from a Fischer rat cell line. When it is growth-stimulated from G0 phase it enters S phase at the permissive temperature (34 degrees C) but not at the nonpermissive temperature (40 degrees C). It induces a nuclear labile protein, p70, when it is stimulated from G0 phase at 34 degrees C, but not at 40 degrees C. In growing cell cycle it progresses through the S, G2 and M phases at both temperatures but fails to pass through G1 phase at 40 degrees C. Here we described that p70 was synthesized neither in the randomly growing cycle nor in the G1 phase synchronously progressing from M phase. The cells synchronized at early G1 phase by culturing in serum-free medium for 7.5 h from G1/S boundary induced c-fos and c-myc following serum addition, but under the same condition p70 was not synthesized. These results indicate that the synthesis of p70 is not required for progression of the G1 phase of the growing cycle and can be used as an exclusive marker of G0-S transition.

[Cosmetic cranioplasty using the bone chips and Biobond (EDH-adhesive): technical note].

A new and simple cosmetic procedure for the prevention of skin depression produced by burr-holes was presented. A mixture of the bone chips obtained at craniotomy and Biobond in a volume ratio of 7:3 was used to fill the bone defect of the burr-holes in 65 cases. The postoperative appearance was excellent cosmetically. This mixture had good plasticity, and could be formed into any irregular shape desired, and there was no increase in the incidence of infectious complications.

Establishment of a human oligodendroglial cell line.

A human oligodendroglial cell line has been established from a mixed glioma. Over a period of 22 months, the cell consisted of cells with the morphologic features of such a strong perinuclear halo, dichotomous branching, and a tendency to aggregate and float in the medium. In small aggregates, most cells are bipolar. The cell line also continues to synthetize the S-100 protein specific to neural tissue. The response of this cell line to dibutyryl-cyclic AMP is striking, resulting in a remarkable narrowing and elongation of the cell processes. This cell line could be used for studies on glial differentiation and neuron-glia interaction.

Carcinoembryonic antigen (CEA) levels in patients with brain tumours.

Plasma and cerebrospinal fluid CEA determination was done in 97 patients with neurosurgical disorders. Elevated titres were found in 14 of 64 patients with brain tumours. CEA levels were elevated significantly in patients with metastatic brain tumours. Following treatment, the values fell in three patients with ependymoma, medulloblastoma, and unverified brain tumour. This study suggests that CEA levels may be of value in the differential diagnosis of primary and metastatic brain tumours, and useful in the evaluation of patients with brain tumours after treatment. CEA in the cerebrospinal fluid was absent in eight patients with brain tumours.

Angiographic manifestations of intracerebral cavernous hemangioma.

A case of intraventricular cavernous hemangioma is reported, with a review of the literature, especially that dealing with angiography of intracerebral lesions. Dense venous poolings and a localized area of venous stain were observed in this case.

An attempt to detect cell surface antigens in cultured human brain tumors by mixed hemadsorption test. First report.

The mixed hemadsorption test using rabbit anti-human glioma serum was applied to investigate cell surface antigens of nervous tissue tumors, non-nervous tissue tumors, epithelial and mesenchymal cells. Gliomas, neurinomas, and fetal brain cells exhibited a strongly positive reaction. Meningiomas, a metastatic brain tumor originated from the lung and HeLa cells exhibited a moderately positive reaction. No positive reaction was detected in human skin or dural fibroblasts, or in kidney cells even at a high concentration of rabbit anti-human glioma serum.