In open heart surgery uneventful outcomes are aided by hypothermia during the extracorporeal circulation. The hemodynamic effects of catecholamines and α-blockers were investigated in canine models.
Twenty-one mongrel dogs were divided into a normothermic group (n = 5) and a hypothermic group (n= 16). Phenoxybenzamine (POB ; 1mg/Kg), norepinephrine (NE ; 1μg/kg/min), and Dopamine (DOA ; 10μg/kg/min) were administered to each group.
In the normothermic group, (1) NE, after POB administration, significantly increased cardiac output (C.O) and myocardial blood flow (M.B.F). (2) DOA, following POB administration, significantly increased heart rate (H.R) and M.B.F, but decreased mean arterial pressure (m-AP) and total peripheral resistance (T.P.R).
In the hypothermic group, 16 dogs were further divided into three subgroups, POB alone (n = 5), POB + NE (n = 5) and POB + DOA (n = 6). They underwent surface cooling and rewarming. These subgroups were compared with each other at cooling to 25°C, 2022°C, and rewarming to 25°C and 32°C. (1) The PUB + NE group had C.O, stroke volume, M. B.F and M.B.F/C.O ratios significantly higher at each temperature than that of other groups. (2) In the POB + DOA group only the M.B.F was higher than in the POB only group with cooling at 25°C and rewarming at 32°C. (3) In all parameters at 32°C compared with those of pre-cooling in each group, The POB + NE group recovered well to the pre-cooling states.
Based on these results, it was concluded that inotropic agents (especially NE), after POB administration, improved C.O, S.V, M.B.F during hypothermia and rewarming.

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To study the effects of two beta-blocking agents without intrinsic sympathomimetic actions, metoprolol and propranolol, on hemodynamics and the plasma catecholamines, 6 young male volunteers exercised with a bicycle ergometer.
Increases in the heart rate and systolic blood pressure during the exercise were significantly suppressed by both beta-blocking agents. But plasma norepinephrine increased appreciably during exercise following the administration of the beta-blocking agents, although the plasma norepinephrine level at rest remained unchanged. There was a significant positive correlation between the increases in the heart rate and the systolic blood pressure and the increase in the plasma norepinephrine during the exercise, both with and without beta-blocking agents. There was a significant negative correlation between the plasma concentration of the beta-blocking agents and the increase in heart rate during the 50% maximal exercise. There was no obvious difference between the effects of metoprolol and propranolol.
From these results, the author deduced that the effects of the beta-blocking agents may be more potent on the post-synaptic than on the pre-synaptic beta-receptors of the cardiovascular system.

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The infusions of prostaglandin I₂ (PGI₂) into the left atrium, the circumflex branch of the left coronary artery, the common carotid artery or the vertebral artery caused marked depression of the systemic blood pressure and bradycardia in anesthetized open-chest dogs. Although the depressor effect of PGI₂ was almost the same regardless of the infusion sites, the PGI₂-induced bradycardia was more prominent following the infusion into the circumflex branch of the left coronary artery or into the common carotid artery than into the left atrium or into the vertebral artery. The hypotensive effect of PGI₂ was attenuated, while the induced bradycardia was abolished after the vagotomy. From these observations, the author postulated that the bradycardia and hypotension induced by PGI₂ may be mediated by the stimulation of the left ventricular and carotid body chemoreceptors, although a direct relaxation of the vascular smooth muscles may be participating in the hypotensive effect.

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We studied 33 previously untreated adult patients with acute non-lymphocytic leukemia (ANLL) who were treated with induction chemotherapy between January 1979 to December 1981.
Seventeen adult patients with ANLL were treated with DCMP (daunorubicn, ara-c, 6-mercaptopurine, prednisolone) or BHAC-DMP regimen following hypertransfusion (hypertransfusion group) and changes in the peripheral blood and bone marrow cells including the labeling index of leukemic blasts (LI) were studied during the treatment. As controls, 16 adults with ANLL with background factors similar to those of the hypertransfusion group were treated with the same regimen without hypertransfusion (control group). The results were : (1) Both peripheral reticulocyte and marrow erythroblast counts decreased significantly after hypertransfusion, but there were no changes in the counts of peripheral leukocytes, leukemic blasts and platelets or the percentage of leukemic blasts among the nucleated marrow cells. (2) As a whole, no significant change was noted in the LI after hypertransfusion, while in 7 patients (increase group) the LI clearly increased after hypertransfusion due to the rise in the number of labeled large blasts. This suggests an increase in the number of blasts in the S phase. In the remaining 7 patients (non-increase group), the LI decreased or remained unchanged after hypertransfusion. (3) There were no significant differences between the hypertransfusion and control groups in complete remission (CR) rate, the remission duration or the survival period. But the latter two periods tended to be longer in the hypertransfusion group. The CR rate of the increase group tended to be higher than the non-increase group. (4) In the hypertransfusion group, the period from the start of remission induction chemotherapy to reaching the nadir of mature granulocyte and platelet counts tended to be longer than in the control group. (5) In patients achieving CR, the ratio of febrile days to days from the start of chemotherapy to reaching CR and the time period for recovery of platelet counts tended to be lower and shorter, respectively, in the hypertransfusion group than in the control group. This tendency was more evident is the increase group.
From these results, it appears that so-called stem cell competition may exist in human beings. Further study is required to evaluate the significance of hypertransfusion in the treatment of ANLL.

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The role of prostaglandins (PGs) and baroreflex in the pressor response to norepinephrine (NE) were examined in one-kidney, one clip rabbits with renal artery stenosis for 3-day' s duration (3-day clipped rabbits) and in sham operated rabbits with one-kidney without renal artery stenosis.
An exaggerated pressor response to NE, 800ng/kg/min, was observed in the 3-day clipped rabbits, and it was abolished by angiotensin II antagonist, [Sar¹, Ile⁸] angiotensin II (AIIA). Treatment with indomethacin, 10mg/kg, induced hyperresponsiveness to NE in the sham operated rabbits and also produced a further increase in the response in the 3-day clipped rabbits : the enhanced responses with similar levels were not attenuated by AIIA in either group. A subdepressor dose of PG E₂, 800ng/kg/min, abolished the hyperresponsiveness in the 3-day clipped rabbits, while a subdepressor or depressor dose of PG I₂, 10 or 20 ng/kg/min did not. However, the concurrent infusion of AIIA with PG I₂ attenuated the hyperresponsiveness.
Baroreflex, which was calculated from the response of blood pressure and pulse interval to the injection of phenylephrine and nitroglycerin, was not different between the 3-day clipped rabbits and the sham operated rabbits.
These results indicate that the PGs, particularly PG E₂, may be and the baroreflex may not be involved in the enhanced pressor response to NE in the 3-day clipped rabbits, in addition to the altered renin-angiotensin system.

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Dermatophagoides farinae was fractionated by acetone precipitation and with a Sephadex G-200 column. The Df fractions that bind with specific IgG, IgM, IgA antibodies were measuered by ELISA inhibition. The fraction that bind most strongly with specific IgG and IgM antibodies was the Fr I of the Df50d. The fraction that bind most strongly with specific IgA antibodies was the Fr II of the Df50d. There were no significant differences in the IgG antibodies to crude Df, Df50d Fr I, Df80d or in the IgA antibodies to crude Df, Df50d Fr II, Df80d between the serum from hyposensitized asthmatic children and the serum from non-hyposensitized asthmatic children. Fifty percent inhibiting concentration (IC₅₀) of Df50d Fr I and Df80d were measured and the ratio of IC₅₀ Df50d Fr I to IC₅₀ Df80d were compared between 8 hyposensitized asthmatic children and 12 nonhyposensitized asthmatic children. There was a significant difference in the IC₅₀ Df50d Fr I /IC₅₀ Df80d ratio between hyposensitized and non-hyposensitized asthmatic children. Hyposensitized asthmatic children may produce more antibody to this high molecular weight fraction.

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We assessed the functions of both the cardiac and the autonomic nervous system in children with insulin-dependent diabetes mellitus (IDDM) and age-matched control subjects, using noninvasive methods.
The function of the autonomic nervous system was examined by measuring the R-R intervals and the orthostatic blood pressure response. The cardiac function was examined by measuring cardiac output in the lying and standing position. The cardiac output was measured by impedance cardiography. According to the level of glycosylated hemoglobin (HbA₁), the subjects were divided into a well-controlled group (HbA₁ < 10%, N = 17) and a poorly controlled group (HbA₁ > 10%, N = 15).
Both diabetic groups showed a significant elevation of the cardiac output at rest (P <0.05). In the standing position, the poorly controlled group showed a significant decrease in the systolic blood pressure, and a slight increase in the diastolic blood pressure. On the other hand, the levels of CVr-r in the poorly controlled group were significantly lower than those in the normal control as well as the well-controlled group (P <0.01). In addition, the levels of CVr-r in the diabetic group had a significant negative correlation with the HbA₁ values (r =-0.67, P < 0.01).
We conclude that involvement of the autonomic nervous system in IDDM children may develop earlier than that of the cardiac system, which we had not expected.

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The susceptibilities of Pseudomonas aeruginosa to eight kinds of antibiotics (PIPC, CFS, CAZ, AZT, IPM, GM, AMK, NFLX) were investigated. Ninety out of 385 strains were resistant to some kinds of antibiotics. We compared the serotype of these 90 strains with that of 37 random-sampling sensitive ones with the following results.
1) In the sensitive strains, types G and B and non-typable ones were present. But types I, B and G and non-typable ones were present in the resistant strains. Among these GM-resistant strains, type I strains were the most common.
2) A decrease in type I strains and an increase in non-typable strains occurred from 1984 to 1986.
3) Hospital infection was highly suspected, in the GM resistant strains.

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We investigated STD patients who visited our outpatient department or 4 affiliated hospitals for a period from January 1987 to June 1987.
The number of patients was 255 (235 males and only 20 females). The most frequent STD was NGU (nongonococcal urethritis). Next was GU (gonococcal urethritis). A diagnosis of NGU was adopted when Neisseria gonorrhoeae could not be detected by routine stain or culture. Chlamydia trachomatis was detected in 1 (14.3%) of 7 patients with GU, and in 20 (51.3%) of 49 patients with NGU.
Staphylococcus epidermidis was the most frequent species isolated from the urethral smears of the urethritis patients.

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Daily fluctuations of serum sodium valproate (VPA) levels at steady state in polypharmacy were studied by the EMIT method in comparison with those in monopharmacy in 35 patients with epilepsy or convulsant seizures. Serum VPA levels were also determined in 10 patients given VPA alone, 2 or 3 times a day. The lowest values were obtained before the 1st administration in each case (46.8±5.7 or 47.9±6.7 μg/ml), but the highest values were obtained after 2-4 hours in the former (69.2±5 g/ml) and after 6 hours in the later (65. 5 ± 9.8 g/ml). The serum VPA levels and its daily dose with monopharmacy and with polypharmacy were poor correlated Cr=0.34 (p <0.05), Y=1.72X + 43.13 and r =0.35 (p <0.05), Y=1.76X + 27.14).The mean ratio of the serum level to dosage (L/D ratio) was significantly higher with VPA monopharmacy than polypharmacy (p<0.001) with the 3 drugs VPA + phenobarbital (PB) + phenytoin (PHT), 4 drugs (p<0.001) VPA + PB + PHT + carbamazepine (CBZ) and with the 5 drugs (p<0.05) VPA + PB + PHT + CBZ + clonazepam, respectively. But the L/D ratios of VPA monopharmacy and polypharmacy with 2 drugs VPA + CBZ were almost the same.

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1) The isolation frequency of clinical pathogen and their drug-resistances were surveyed by 9 public hospitals in Gunma Prefecture in Japan in 1986. 19682 strains were identified and 13780 strains were examined for 24 kinds of drug-resistances.
2) Among clinical isolates, 49% were Gram-negative rods and 42% were Gram-positive cocci. S. aureus (11.7%), E. coli (10.4%), P. aeruginosa (9.5%), and coagulase-negative staphylococci (9.5%) were the major bacterial species. Isolation frequency of these isolates were different in different clinical sources and in different hospitals.
3) Sixteen kind of species whose isolation frequency was more than 1 % were surveyed for their drug-resistances. There found a tendency of increase in drug-resistant bacteria in Serratia, Pseudomonas and S. aureus. Both the 3 rd-generation cephems and new quinolones were losing their antibacterial effect.

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Some technical improvements were made in heterotopic heart transplantation in the rat.
1 : In the donor operation the small vessel in the fat tissue between the aorta and pulmonary artery must be ligated to prevent post operative bleeding.
2 : In the recipient operation two methods were used to prevent injury to the carotis. One method is to hold the extension of the cuff, and the other is to hold the body of the cuff in a fine mosquito clamp or small clamp on which an appropriate patch is placed.
3 : In the recipient operation three methods were used to keep the jugular vein in its natural position. The first method is to hold the extension of the cuff in a mosquito clamp, the second method is to clamp the jugular vein and the extension of the cuff together, and the third method is to apply two staying sutures, one to the left side one and to the right side of the pulmonary artery of the donor heart.
4 : In the recipient operation, when the venous return is not sufficient and the left auricle begins bulging with blood, the left auricle must be ligated to maintain the transplanted heart in a good position.
5 : When the bleeding of the transplanted heart cannot be controlled conservatively, the heart has to be removed immediately and another donor heart transplanted.
The important point in this operation are summarized below.
An operation is required to prevent thrombosis of the carotis and to secure venous blood return in the transplanted heart.
Acknowledgement : I wish to thank Prof. Sir Roy Calne and the staff of Department of Surgery, University of Cambridge for permitting us to use their laboratories and for kind help in studying organ transplantation in both man and animals.

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The clinical figures and therapeutic treatment of a young male AIDS patient complicated with severe interstitial pneumonitis are described.
The diagnosis was based on clinical symptoms and laboratory tests, including a lowered OKT4/T8 ratio (0.07) and the Western-Blot test. Antibodies to the virus reverse transcriptase (p61p24) had declined strongly, indicating the onset of AIDS. Necessary care taken for preventing the hospital employees from the transmission of the virus infections in the workplace are also described.
A transmissible strain of human immunodeficiency virus (HIV) was isolated from the peripheral blood, and was identified by serological tests and electron microscopy.

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Thyroglossal duct cysts arise from remnants of the embryonic thyroglossal duct between the foramen cecum of the tongue and the thyroid gland. Many cysts occur in the neck midline, but they are rarely found in the oral cavity. We examined the following three interesting cases of thyroglossal duct cyst.
Case 1. A male 1 year and 8 months old with a suspected dermoid cyst located in the left sublingual region. The cyst was lined with pseudostratified ciliated epithelium.
Case 2. A 7-day-old male with a suspected ranula in the right sublingual region. The cyst was lined with pseudostratified ciliated epithelium.
Case 3. A 4-year-old male with a thyroglossal duct cyst in the lingual root. The cyst was lined with stratified squamous epithelium.
Unlike thyroglossal duct cysts in the neck midline, clearly-defined fistula or track was attached to the cyst wall. The simple excision in each of these cases under general anesthesia and the postoperative course were uneventful.
Cases like these are infrequent in infants.

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Three cases of pelvic and ureteral injuries were operated on. Case 1 with a right pelvic injury while working received pyeloplasty by end-to-end anastomosis of the pelvis. Case 2 with a left middle ureteral injury received direct ureteroureterostomy. Case 3 with a left lower ureteral injury received ureterovesical anastomosis with a psoas bladder hitch. The three patients are now in good condition.

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A 64-year-old man was admitted to the surgical ward with the diagnosis of a mediastinal mass. He had a pleomorphic adenoma of left parotis gland remored at 48 years of age.
The tumor was located posterior to the left pulmonary artery, and it was clearly separated from the lung by the parietal pleura.
A histological examination revealed a typical pleomorphic adenoma composed of myxoid stroma and myoepithelial cells. And there was component of bronchial epithelial cells that compressed at the edge of the mass. Therefore, this mediastinal mass is not a metastatic tumor from the neck, but a primary one of teratomatous origin in the mediastinum.
It is the second case of pleomorphic adenoma in the mediastinum as a primary lesion.

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