For the purpose of examining the biochemical modulation function of Leucovorin (LV) on an antitumor effect 5-fluorouracil (5-FU), the following tests were carried out. In order to conduct in vitro (HTCA) and in vivo chemosensitivity tests taken two human tumor xenografts (MC-3, MPC-2). Testing in vivo, the dose was set at LD50x0.8 (single therapy) and LD50x0.6 (combined therapy) for 5-FU. In the cases testing LV, the dose was set at 0.45mg/body. Testing in vitro, the dosage was regulated at μg/ml for 5-FU and at 0.15mg/m l for LV. The antitumor effects of the drugs in vivo were evaluated according to the Battle Columbus Laboratories Protocol. The results of the in vivo were no effects on MC-3. However, 5-FU was evaluated at 41.2% and 5-FU LV at 39.8% on MPC-2. The results of the in vitro were no effects on MC-3. However, 5-FU was evaluated at 51.8% and 5-FU LV at 61.6% on MPC-2. The results of in vivo and in vitro show that in cases using MC-3 and MPC-2, LV did not enhance the antitumor effect of 5-FU. We also investigated the relationship between the antitumor activity of the drugs and their inhibition of thymidylate synthase (T.S) activity in MC-3. There was no correlation between both relation. We conclude that further investigations are necessary to determine the appropriate dose of 5-FU, so that an effective concentration of the drug can be attained at tumor tissue level. Moreover, we need to establish the appropriate time for given the infusion of LV to obtain an adequate enhancement of the antitumor effect of 5-FU.
In this paper, we discuss the results of endoscopic endonasal sinus surgery for diffuse chronic sinusitis characterized by nasal polyposis, especially the effects of postoperative long-term administration of low-dose erythromycin (EM). EM therapy (long-term and low-dose) is now recognized as an effective method for the treatment of panbronchiolitis. Our surgical technique is performed under local anesthesia, and involves removal of the anterior and posterior ethmoidal cells via the middle meatus. We attempt to leave the mucosa of the ethmoid roof intact. Next, sufficient communication between the ethmoid sinus and both the maxillary and frontal sinuses is achieved under endoscopic observation. We analyzed 117 patients in whom diffuse chronic sinusitis was treated by endoscopic endonasal sinus surgery. These initial surgical cases (over 15 years old) have been followed up for more than 9 months postoperatively. The improvement rate in the clinical symptoms (nasal obstruction, nasal discharge, postnasal discharge, etc.), determined by questionnaire, the improvement rate of maxillary sinus lesions, and also the postoperative conditions of the ethmoid sinus, nasofrontal duct, fontanelle and maxillary sinus are analyzed. Furthermore, we compared the results in the EM administration (long-term and low-dose) group (25 cases) with the results in a non-EM administration group (92 cases). We found that the long-term (3 months-6 months) administration of low-dose EM postoperatively achieves significantly better results than conventional endoscopic endonasal sinusectomy without EM. Also, EM was confirmed to be a safe drug.
This report deals with three cases of respiratory complications which were brought on by chronic aspiration in elderly patients with spinal cord injuries. Dysphagia is not usually found in cervical spinal cord injuries. But in three cases of spinal cord injuries who suffered from atelctasis of the lung and pneumonia, miss swallowing of saliva and dysphagia were proved. These patients were older than sixty years. The first case was a 62-year-old male with C5-6 injury. He was once tracheostomized in acute phase because of athlectic lung which was recurred after the stoma was closed. He was tracheostomized again and tracheal cannula was placed. After his admission to our hospital, button type cannula with speech bulb was inserted in his stoma to maintain phonation, but speech bulb was taken out be cause of dyspnea. The saliva was endoscopicaly ovserved to enter trachea. The second case was a 64-year-old male with C3-4 injury, who frequently had athlectasis of the lung and pneumonia. Miss swallowing of saliva was endoscopicaly found and he was tracheostomized. The esophagogram did not show any abnomalities. The third case was a 62-year-old male with C3-4 injury who had lung tuberculosis in the past. Chronic aspiration was proved by methylen blue dye test. He was tracheostomized, but died of pneumonia. Conclusion: The respiratory complication was brought on by chronic aspiration of saliva in the eldely patients with spinal cord injuries.
Sleep apnea syndrome may presents a symptom of excessive daytime sleepiness (EDS), but it is difficult to evaluate the symptom since subjective degree of sleepiness may not correspond to objective one. We measured multiple sleep latency test (MSLT) in five patients with obstructive sleep apnea syndrome (OSAS) before and after the operation, upper airway which is so-called UPPP (uvulopalatopharyngo-plasty) or partial resection of palate (PRP). The postoperative meacurements were carried out within six months of the operation. Mean MSLT score were under 600 seconds in every case before the operation. Postoperative sleepiness score were over 600 seconds in all patients (p<0.05). We stress the importance of objective evaluation of sleepiness before and after operation.
Chronic paranasal sinusitis can be surgically treated either by endonasal surgery, which preserves the mucosa, or radical surgery, which removes it. With the progress in optical instruments in recent years, the former alternative has been rapidly spreading in Japan and abroad. We have mainly used endonasal surgery in our department. The introduction of endoscopy has made the endonasal approach possible for severe paranasal sinusitis, which would otherwise require radical surgery, and diseases such as maxillary mycosis, which mainly affect the maxillary sinus, as well. So far, endonasal surgery has been conducted in 8 patients with maxillary mycosis, 4 males and 4 females. Four months to 4 years and 3 months have passed since surgery in these cases. Symptoms disappeared and the siuns cavity was kept intact in all these cases after surgery. Endonasal surgery is preferable because unlike radical surgery, it is associated with no post-operative local symptoms, achieves healing with intact intranasal structure and is associated with only a few complications such as postoperative maxillary cysts. It is considered particularly useful for maxillary mycosis, in which mucosal damge is slight, because ciliary function can be easily normalized by restoring the ventilation and drainage function.