[Newly developed technics in amalgam repair].
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Biomedical subjects
Publications and source records attributed to H Takami.
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Blood levels of clindamycin-2-phosphate in dog at dosis of 10 mg/kg body weight showed the maximum of 21 mug/ml 30 seconds after one-shot i.v. administration. Continuous infusion of the antibiotic at the infusion speed of 150 and 300 ml/hour/10 kg b.w. with 6 mg/ml solution maintained blood levels of 30 and 170 mug/ml respectively. It may be recommended clinically to use lower concentration than 6 mg/ml to avoid cardiocirculatory disturbances. Four cases of surgical mixed infections with gram-positive cocci, gram-negative bacilli and anaerobes were treated with clindamycin-2-phosphate at a daily dosis of 1,200 mg intravenously and 2 of 4 cases revealed good clinical response. There was none of the haematological, hepatic, nephrontic, cardiocirculatory and allergic side effects.
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Bone Gla protein (BGP) is a vitamin K-dependent protein which is a marker of bone turnover. To determine whether serum BGP is a useful indicator for parathyroidectomy in patients with secondary hyperparathyroidism, we measured serum BGP levels. Thirty-seven patients with secondary hyperparathyroidism who were followed up for more than 1 year after parathyroidectomy were studied. All patients underwent total parathyroidectomy and autotransplantation. Controls were 46 patients who were treated by chronic hemodialysis for more than 3 years. Serum BGP levels (normal: less than 6.5 ng/ml) were markedly increased in 37 patients with parathyroidectomy, ranging from 4.2 ng/ml to 645 ng/ml, with a mean value of 278.8 +/- 159.8 ng/ml (mean +/- standard deviation) versus 65.0 +/- 85.2 ng/ml in the 46 controls (p less than 0.001). Patients with a high BGP level had severe bone and joint pain. Serum BGP in patients with parathyroidectomy was significantly correlated with serum alkaline phosphatase and mPTH (p less than 0.001 for both). The total weight of resected parathyroid tumors was 2,152 +/- 1,368 mg, and tumor weights ranged from 200 mg to 5,600 mg. There was a highly significant correlation between BGP level and tumor weight (r = 0.656, p less than 0.001). The 2 patients who showed BGP levels below 10 ng/ml had tumor weights of only 470 mg and 240 mg, respectively, and revealed no improvement of pain postoperatively, although their mPTH levels were increased. These results suggested that BGP measurement is a sensitive method for detecting increased bone turnover and is possibly useful as an indicator for parathyroidectomy in patients with secondary hyperparathyroidism.
Recent advances in the radiological diagnosis in thyroid neoplasms have been achieved by high-resolution ultrasonography and color-Doppler, and the ultrasound-guided fine-needle aspiration biopsy and ultrasound-guided percutaneous ethanol injection therapy have been developed on the basis of these modalities. Ultrasonography and ultrasound-guided fine-needle aspiration biopsy have made minimally invasive thyroid surgery possible. The surgical procedures are classified into three main categories according to the approach, and each approach has its own advantages and disadvantages. Surgeons have to select the most suitable approach from one of these categories of approaches for each patient with a thyroid neoplasm.
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A 55-year old female patient on long-term hemodialysis began to suffer from pain in her knees and ankles. An ultrasonographic study showed enlargement of all four parathyroid glands. Serum parathyroid hormone and calcium levels were increased. Parathyroidectomy was performed. The right superior gland was enlarged and adherent to surrounding tissues. The other three glands were slightly enlarged. Histologically, the largest gland was a parathyroid carcinoma because capsular and vascular invasion were observed. To our knowledge, there have been only 13 cases of parathyroid carcinomas arising in patients with chronic renal failure reported in the English literature. To evaluate the characteristics of this tumor, we measured nuclear DNA and protein content using stains for HP (hematoporphyrin)/DAPI (4,6-diamidino-2-phenylindole dihydroporphyrin chloride). The nuclear DNA pattern was typically diploid or tetraploid. The cellular protein content was similar to that seen in the controls. The discrepancy between the histology, indicative of malignancy and the cytofluorometrical findings show that it is difficult to determine the prognosis for patients with secondary hyperparathyroidism and parathyroid carcinomas solely from the results of tumor DNA cytometry.
Collagen gel droplet embedded culture drug sensitivity test (CD-DST) was applied to 33 patients with gastric cancer (30 primary tumors, 12 metastatic tumors and 25 biopsy specimens). Evaluable rates by CD-DST were 80% for primary tumors, 75% for metastatic tumors and 72% for biopsy specimens. Chemosensitivities of primary tumors were: 5-fluorouracil 25%, mitomycin C 17%, cisplatin 13%, adriamycin 17%, etoposide 21%. Chemosensitivities of metastatic tumors were lower than those of primary tumors. In 4 out of 6 patients who had measurable lesions, clinical responses to chemotherapy were predictable by CD-DST.
We have established a radioimmunoassay method for calcitonin gene-related peptide (CGRP) to monitor changes in plasma CGRP levels in patients with medullary thyroid carcinoma (MTC). Preoperative plasma CGRP levels (normal level less than 12.7 pg/ml) were as high as 128 pg/ml to 2,010 pg/ml in all five patients with MTC. Ten of 17 postoperative patients with MTC were positive for CGRP. A provocation test was performed in 12 patients with MTC. Plasma CGRP changes roughly paralleled serum calcitonin levels. In particular, in three patients with poorly-differentiated MTC which progressed aggressively, plasma CGRP levels were increased to 1.4 to 2.0 times levels before the test, i.e., lower than the 2.8- to 23.3-fold increase in nine patients with the well-differentiated MTC. These results suggest that CGRP may be a humoral marker of medullary carcinoma and be related to degree of malignancy.
The effect of diltiazem as an adjunct to cardioplegia was examined for cardiac eicosanoid release in 12 patients who received aorto-coronary bypass. The patients were divided into two groups: diltiazem group (No. = 6) (10 mg/L of diltiazem in crystalloid potassium cardioplegia) and control group (No. = 6) (same cardioplegia without diltiazem). The plasma levels of thromboxane B2 and 6 keto PGF1 alpha (metabolites of thromboxane A2 and prostacyclin) in systemic artery and coronary sinus blood were measured during early reperfusion. A significantly larger arterio-venous difference in 6 keto PGF1 alpha concentration was found immediately after aortic clamp release in the diltiazem group (124 +/- 77 vs 12 +/- 47 pg/ml, p less than 0.05). The plasma thromboxane B2/6 keto PGF1 alpha ratio in coronary sinus blood was lower in the diltiazem group immediately after aortic clamp release (0.47 +/- 0.16 vs 0.74 +/- 0.18, p less than 0.05). There was no significant difference in arterio-venous TxB2 concentration between the two groups. In terms of myocardial protective effect evaluated by CPK-MB release, there was no significant difference between the two groups. The results indicated that diltiazem used as an adjunct to cardioplegia enhanced the production of endogenous PGI2 during early reperfusion, although its beneficial effect on myocardial protection was not shown in terms of enzyme leakage.
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