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T Shirai

Publications and source records attributed to T Shirai.

At least 217 records · Page 12Linked to original sources
PubMed1998

The 1.5 GHz electromagnetic near-field used for cellular phones does not promote rat liver carcinogenesis in a medium-term liver bioassay.

We have recently established that local exposure to a 929.2 MHz electromagnetic near-field, used for cellular phones, does not promote rat liver carcinogenesis in a medium-term bioassay system. In the present study, a 1.439 GHz electromagnetic near-field (EMF), another microwave band employed for cellular phones in Japan, was similarly investigated. Time division multiple access (TDMA) signals for the Personal Digital Cellular (PDC) Japanese cellular telephone standard system were directed to rats through a quarter-wavelength monopole antenna. Numerical dosimetry showed that the peak SARs within the liver were 1.91-0.937 W/kg, while the whole-body average specific absorption rates (SARs) were 0.680-0.453 W/kg, when the time-averaged antenna radiation power was 0.33 W. Exposure was for 90 min a day, 5 days a week, over 6 weeks, to male F344 rats given a single dose of diethylnitrosamine (200 mg/kg, i.p.) 2 weeks previously. At week 3, all rats were subjected to a two-thirds partial hepatectomy. At week 8, the experiment was terminated and the animals were killed. Carcinogenic potential was scored by comparing the numbers and areas of the induced glutathione S-transferase placental form (GST-P)-positive foci in the livers of exposed (48) and sham-exposed rats (48). Despite increased serum levels of corticosterone, adrenocorticotropic hormone (ACTH) and melatonin, the numbers and the areas of GST-P-positive foci were not significantly altered by the exposure. These findings clearly indicated that local body exposure to a 1.439 GHz EMF, as in the case of a 929.2 MHz field, has no promoting effect on rat liver carcinogenesis in the present model.

Adrenocorticotropic Hormone↗
PubMed1998

Dose dependence of 1-O-hexyl-2,3,5-trimethylhydroquinone promotion of forestomach carcinogenesis in rats pretreated with N-ethylnitrosourethane.

Post-initiation dose-dependent effects of the chemopreventive antioxidant 1-O-hexyl-2, 3, 5-trimethylhydroquinone (HTHQ), a potent inhibitor of heterocyclic amine-induced mutagenesis and carcinogenesis, on the development of forestomach and tongue tumors were investigated in male F344 rats. Groups of 22 rats were treated with 0.01% ethylnitrosourethane (ENUR) as an initiator in the drinking water for 4 weeks, then placed on diet containing 1.0%, 0.5%, 0.25% or 0.125% HTHQ, or basal diet alone for 36 weeks. Further group of 12 rats each were similarly treated with the different doses of HTHQ or given basal diet alone for 36 weeks without prior ENUR treatment. All animals were killed at week 40. Tongue papillary hyperplasia and papillomas tended to be increased in the groups treated with ENUR followed by 0.5-0.125% HTHQ, though there was no effect at the highest dose, in line with increased bromodeoxyuridine labeling indices. In the forestomach, the incidences of papillomas and carcinomas were also significantly elevated only in the group treated with ENUR followed by 0.125% HTHQ. Without ENUR pretreatment, papillary hyperplasia was found in the 1-0.125% HTHQ groups and the labeling index was also increased, though without clear dose dependence. The results indicate that HTHQ may have very weak or weak promotion potential for tongue and forestomach carcinogenesis, but that both minimum and maximum thresholds for active dose levels may exist.

Animals↗
PubMed1998

Polymorphisms of HLA class II genes in Japanese patients with pemphigus vulgaris.

Pemphigus vulgaris (PV) is an autoimmune disease mediated by autoantibodies that bind to a keratinocyte adhesion molecule, desmoglein-3. The purpose of this study was to identify critical amino acid residues of PV-associated HLA class II genes. Haplotype and allele distributions, along with molecular polymorphisms, of HLA class II genes were analyzed based on the polymerase chain reaction-restriction fragment length polymorphism in 17 Japanese PV patients. Each patient had one or two alleles of DRB1*04 (*0403, *0404, *0406) or DRB1*14 (*1401, *1405, *1406) subtypes. All DRB1*04 and DRB1*14 alleles carried by PV patients with different ethnic backgrounds reported to date, including DRB1*0402, which confers strong susceptibility to PV among Jewish populations, have amino acid residues Phe26, Leu67 or Ile67, and Val86, as well as hydrophilic amino acid residues at positions 70 and 71 of the DRB1 beta chain.

Adult↗
PubMed1998

Earlobe reconstruction using a subcutaneous island pedicle flap after resection of "earlobe keloid".

BACKGROUND: A large keloid of the earlobe is a difficult case in which to obtain a satisfying result by nonsurgical therapies. In this case, surgical resection of keloids should be considered as a first step in therapy. However, it is difficult to reconstruct the earlobe cosmetically after resection of the lesion. OBJECTIVE: To discuss the usefulness of the subcutaneous island pedicle flap in earlobe keloid surgery. METHODS: Five earlobe keloids in five patients (four females and one male) were resected and reconstructed by subcutaneous island pedicle flap. RESULTS: In all patients, there were no keloid recurrences and no adjuvant therapies used during the follow-up periods, which ranged from 10 to 26 months. The reconstructed earlobes were almost symmetrical. CONCLUSION: In the selected cases, use of the subcutaneous island pedicle flap is a viable method to be considered for reconstruction after resection of earlobe keloids.

Adult↗
PubMed1998

Autologous blood donation preceding coronary artery bypass graft operation in a hemodialysis patient.

A 67-year-old male hemodialysis patient with abdominal aortic aneurysm and triple vessel coronary heart disease required autologous blood donation because of his blood type of Rh(-) before cardiovascular surgery. We performed autologous red blood cell and plasma collection by the switch back method with recombinant human erythropoietin therapy during the 5 weeks before the operation. Autologous platelet collection was also made the day before the operation. These autologous blood donations were safely and successfully performed along with hemodialysis. There was some caution taken for these procedures. The ultrafiltration rate had to be adjusted for blood collection or blood transfusion during hemodialysis in order not to disturb fluid balance. It was necessary to monitor the hyperkalemia of the stored autologous packed red blood cells. For platelet collection, blood in the extracorporeal circuit had to be concentrated because of the presence of renal anemia. Coronary artery bypass graft was safely and successfully performed with the autologous blood only.

Aged↗
PubMed1998

[Impact of influenza epidemics and efficacy of vaccination among geriatric inpatients].

To determine the impact of influenza epidemics among geriatric inpatients and to monitor the clinical efficacy of influenza vaccination, the influenza infection rate in non-vaccinated inpatients was determined serologically and the incidence of febrile episodes and death were compared between the vaccinees and non-vaccinees hospitalized in the referred hospital from January through September, 1995. Three influenza subtypes, influenza A/H1N1, A/H3N2, and B, were endemic simultaneously from January to March in 1995. The pattern of incidence of febrile episodes varied for each ward. A total of 123 non-vaccinated inpatients were tested for elevation of serum hemagglutination inhibition titer to the three subtypes of influenza virus. Of these, 58 (47.2%) patients were infected with at least one of the influenza viruses during the epidemic of 1995. No patient with pre-existing HI titer over 128X was infected with any of three types of influenza, indicating that HI titer over 128X is the protective level. The febrile episode frequency was significantly higher in the non-vaccinees than in the vaccinees (49.6% vs. 32.6%), but it was quite comparable in the two groups after the influenza epidemic (34.9% vs. 35.8%). The number of observed deaths from January to September of 1995 was 4 (4.9%) in the vaccinee group and 12 (9.8%) in the non-vaccinee group. These results suggest that influenza epidemics have a striking impact on geriatric inpatients and that influenza vaccination has significant efficacy for the reduction of harmful events associated with influenza infection.

Aged↗
PubMed1998

[Antibody response to a single injection of influenza vaccine among geriatric inpatients vaccinated annually].

To determine the efficacy of a single influenza vaccine administration in the elderly receiving annual influenza vaccination, antibody response to influenza vaccine was compared between once and twice injections in a geriatric cohort. Influenza vaccination had been done for 69 inpatients in the year prior to the study, and was administered twice for 34 of them and once for the other 35 during the study period. Influenza vaccine was injected twice to 77 inpatients who had not received influenza vaccine in the year prior to the study. Hemoagglutination inhibition (HI) antibody titer for influenza A/H1N1, A/H3N2, and B was measured before vaccination, after the first vaccination, after the second vaccination, and after the epidemic period, September 1995 to April 1996. HI antibody titer prior to vaccination was significantly higher in the patients who had received influenza vaccination the previous year. The influenza vaccine induced an increase in HI titer in almost all subjects, and the geometric mean of the HI titer after vaccination in the patients who received vaccine once was comparable to that of the patients injected vaccine twice. The number of patients with HI titers of over 128x increased, and the frequency ranged from 60.0% to 97.1% for the influenza viruses of the three subtypes. The frequency of HI titers over 128x was not significantly different among the three groups. The second vaccination did not increase the number of patients with HI titers over 128x when compared with the number after the first injection in the patients who had received influenza vaccine the previous year. These results suggest that prior vaccination does not diminish the antibody response to influenza vaccine in the elderly. The efficacy of a single influenza vaccination is comparable to that achieved by twice injections in the elderly receiving annual influenza vaccination.

Aged↗
PubMed1998

Action properties of HYI killer toxin from Williopsis saturnus var. saturnus, and antibiotics, aculeacin A and papulacandin B.

The mechanism of the killing and cytocidal effects produced by HYI toxin from Williopsis saturnus var. saturnus, and by the amphiphilic antibiotics aculeacin A and papulacandin B on yeast Saccharomyces bayanus cells was studied. When the yeast cells were treated with these molecules, a discharge of cell materials at the budding position was observed by phase-contrast and scanning electron microscopy. The cytocidal effect of these molecules was most pronounced when the cells were in the logarithmic growth phase. Washing the HYI toxin incubation mixture completely eliminated the killing activity, but in the case of the antibiotics, it only partially reduced the cytocidal activity. Full recovery of the killing activity in the supernatant of the washing solution was observed after HYI toxin incubation, but in the case of the antibiotics, the recovery of cytocidal activity was time-dependent. The activity of membrane beta-1,3-glucan synthase was potently inhibited by HYI toxin, and the concentration of this enzyme in the budding tip was observed. These results suggest that HYI toxin exerts a cytocidal effect on the budding of sensitive yeast cells by inhibiting cell wall synthesis. This mechanism is similar to that of the HM-1 toxin of W. saturnus var. mrakii, and to aculeacin A and papulacandin B, although there are some differences from that of HYI toxin.

Aminoglycosides↗
PubMed1998

Medium-term bioassays for carcinogenicity of chemical mixtures.

Carcinogenic effects of chemical mixtures were examined with a medium-term liver bioassay for carcinogens or a multiorgan medium-term bioassay using male F344 rats. In the medium-term liver bioassay, rats were initially treated with diethylnitrosamine (DEN) at 200 mg/kg body weight, i.p.; after 2 weeks they received chemical mixtures such as 10 different heterocyclic amines at one-tenth or one-hundredth the dose levels used in carcinogenicity studies and the mixtures of 20 different pesticides, each at acceptable daily intake (ADI) levels or a mixture of 100 times ADI levels. All animals were subjected to two-thirds partial hepatectomy at week 3 and were sacrificed at week 8. The number and areas of glutathione S-transferase placental form (GST-P) positive foci (preneoplastic lesions in the liver) were compared between respective groups. When 10 heterocyclic amines were mixed in the diet at one-tenth dose level, clear synergism was observed, but no combined effects were evident with the one-hundredth dose levels. In the pesticide experiment, treatment of rats with the 20-pesticide mixture at the ADI dose level did not enhance GST-P-positive foci. In contrast, a mixture of 100 times the ADI significantly increased those values. In a multiorgan bioassay of 28 weeks, mixtures of 40 high-volume compounds and 20 pesticides (suspected carcinogens) added together at their respective ADI levels did not enhance carcinogenesis in any organs initiated by five different carcinogens (DEN, N-methylnitrosourea, dimethylhydrazine, N-butyl-N-(4-hydroxybutyl)nitrosamine, and dihydroxy-di-n-propylnitrosamine) in combination. The combination effect of low dietary levels of five antioxidants, butylated hydroxyanisole, caffeic acid, sesamol, 4-methoxyphenol, and catechol, were also examined using the multiorgan bioassay. The incidence of forestomach papillomas was significantly increased only in the combination group and the results indicate that combination of the five antioxidants can exert additive/synergistic effects on tumorigenesis in the multiorgan bioassay. These results indicate that chemical mixtures at very low doses did not enhance preneoplastic lesions synergistically but the mixtures at certain doses show synergism in the target organ. The medium-term bioassays are particularly useful tools for this purpose.

Animals↗
PubMed1998

Medium-term bioassays as alternative carcinogenicity test.

A medium-term liver bioassay system for rapid detection of carcinogenic agents using male F344 rats has been developed, in order to bridge the gap between long-term carcinogenicity tests and short-term screening assays. The system is fundamentally based on the two-stage hypothesis of carcinogenesis: initiation with diethylnitrosamine (200 mg/kg bw, i.p.) is followed by test chemical administration during the second, in combination with 2/3 partial hepatectomy. It requires only 8 weeks for animal experimental treatment and a further few weeks for quantitative analysis of immunohistochemically-demonstrated glutathione S-transferase placental form positive hepatic foci. A total of 291 chemicals/substances have already been analyzed in this laboratory and the efficacy of the system for hepatocarcinogens has thereby been well established. This bioassay is particularly useful for dose-response and chemical mixture studies, usually requiring large-scale experiments and also for evaluation of chemopreventive agents. Another bioassay, a medium-term multiorgan bioassay system, using 5 different chemical carcinogens, diethylnitrosamine (DEN), N-methylnitrosourea (MNU), N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN), 1,2-dimethylhydrazine (DMH) and 2,2'-dihydroxy-di-n-propylnitrosamine (DHPN), has also been established for rapid detection of not only hepatocarcinogens, but also other organ-target carcinogens. Rats were initially treated with a single i.p. administration of 100 mg/kg DEN, 4 i.p. administrations of 20 mg/kg MNU, 4 s.c. doses of 40 mg/kg DMH for 2 weeks and then 0.1% DHPN for 2 weeks. Test chemicals are administered after the carcinogens exposure. Animals were sacrificed at the end of week 36, and major organs were examined histologically. Carcinogenic activities of test chemicals were compared between the test chemical treated group and carcinogen exposures group (control group). It is increasingly becoming regarded that these bioassays are useful methods and are appropriate alternative tests systems for carcinogenicity risk assessment. Therefore, 'the International Conference on Harmonization (ICH) of Technical Requirements for the Registration of Pharmaceuticals for Human Use' has proposed that these two bioassays can be used as "additional tests for carcinogenic activity in vivo."

Animals↗
PubMed1998

[A 49-year-old man with progressive bulbar palsy and respiratory failure].

We report a 49-year-old man with progressive bulbar palsy and respiratory failure. He was well until his 48 years of the age (December 1994) when he noted a difficulty in speaking in loud voice. In February, 1995, he noted regurgitation of foods to his nose and difficulty in his speech. He was admitted to our service in May 29, 1995. On admission, he was alert and oriented to all spheres and he was not demented. His higher cerebral functions were normal. In cranial nerves, he showed dysarthria and dysphagia; muscle atrophies were seen in the tongue, the bilateral sternocleidomastoid, supraspinatus, and infraspinatus muscles. Fasciculations were seen in these muscles. He showed no muscle weakness in his limbs except for the upper limb girdle muscles, no ataxia, no reflex abnormalities, nor sensory changes. EMG showed neurogenic changes in the affected muscles. MRI of the brain and the spinal cord was entirely normal. He was discharged for out patient follow-up, however, in October of 1995, he noted difficulty in swallowing solid foods. Gastrostomy was placed and he was discharged to his home. In February 11th of 1996, he was found unresponsive and brought into the ER of our hospital. On admission, he was comatose without spontaneous respiration. BP could not be obtained. He was immediately intubated and artificial ventilation was started. On the following morning, he became alert and he was not demented. He continued to show marked dysarthria and dysphagia; again no weakness was noted in the distal parts of the upper and lower extremities. Laboratory examination showed increase in serum CK to 2,173 IU/L and amylase to 2,032 IU/L. He was extubated on February 15th, however, his spontaneous respiration was not suffice to maintain his blood gas. According to his will, he was not placed on respirator and he died on February 24th, 1996. The patient was discussed in a neurological CPC and the chief discussant arrived at the conclusion that the patient had ALS. Although no upper neuron signs were observed clinically, it is not uncommon to see degeneration in the corticospinal tract in post-mortem examination. The question was what might have been the cause of increase in CK and amylase. Many participants thought that they were secondary to multiple organ failure due to prolonged hypoxic state at his last admission; other possibilities raised included acute myocardial infarction and acute bowel necrosis. Post-mortem examination revealed muscle atrophy in the facial, lingual, cervical, intercostal, and the upper limb girdle areas. The lungs were unremarkable except for old organized pneumonic foci in the right middle and lower lobes. Marked to moderate congestion was seen in many internal organs, however, no other gross abnormality was found. It was thought that respiratory palsy itself was the direct cause of his agonal event. In the spinal cord, the anterior horns showed various degree of neuronal loss and gliosis. No clear evidence of pyramidal tract degeneration was seen at the light microscope level. Lower brain stem motor neurons were markedly reduced. But no Bunina body was found. The substantia nigra showed moderate degree of neuronal loss and extraneuronal neuromelanins. The locus coeruleus showed similar but milder changes. The degree of nigral degeneration appeared to be well beyond those which could be seen in usual ALS patients. The question was whether or not this patient might have been in an early stage of the extended form of ALS.

Amyotrophic Lateral Sclerosis↗
PubMed1998

Prevention by antioxidants of heterocyclic amine-induced carcinogenesis in a rat medium-term liver bioassay: results of extended and combination treatment experiments.

The effects of 1-O-hexyl-2,3,5-trimethylhydroquinone (HTHQ) and other antioxidants on heterocyclic amine (HCA)-induced rat hepatocarcinogenesis were examined in a medium-term liver bioassay. In one study the experimental period was extended for up to 28 weeks to confirm the inhibition of 2-amino-6-methyldipyrido[1,2-a:3',2'-d]imidazole (Glu-P-1)-induction of glutathione-S-transferase placental form (GST-P) positive foci detected earlier in an 8-week experiment. Six-week-old male F344 rats were given a single i.p. injection of diethylnitrosamine (DEN) (200 mg/kg b.w.), and starting 2 weeks later, groups of 20 animals received a diet containing 0.03% Glu-P-1 together with 0.5% HTHQ, Glu-P-1 alone, HTHQ alone or a basal diet alone for 26 weeks. Three weeks after the DEN injection, animals were subjected to partial hepatectomy. The combined incidence of hepatocellular adenomas and carcinomas in the group fed Glu-P-1 alone was 89%, in contrast to 40% with simultaneous HTHQ treatment, and near the control level of 30% without Glu-P-1 and HTHQ. In the second experiment, to assess the effects of HTHQ on HCAs in combination, to mimic the human situation, after DEN initiation groups of 15 rats received diets containing a 0.0155% HCA mixture (0.003% Glu-P-1, 0.0015% 3-amino-1,4-dimethyl-5-H-pyrido[4,3-b]indole (Trp-P-1), 0.004% 2-amino-3-methyl-9H-pyrido[2,3-b]indole (MeAaC), 0.003% 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) and 0.004% 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx), which are all heptocarcinogens) together with 0.5 or 0.125% HTHQ, HCA alone, 0.5 or 0.125% HTHQ alone, or basal diet alone for 6 weeks. The numbers of GST-P positive foci decreased in a dose-dependent manner to 12.2+/-3.1 and 7.2+/-2.4 by the simultaneous treatment with 0.125 and 0.5% HTHQ, respectively, from a value of 17.6+/-3.6 for the HCA mix alone. In a third experiment, after DEN initiation, groups of 15 rats were placed on diets containing 0.02% MeIQx together with 0.25% HTHQ, 0.05% phenylethyl isothiocyanate (PEITC), 1% green tea catechins (GTC) or a mixture of HTHQ, PEITC and GTC, MeIQx alone, antioxidants alone or in combination, or basal diet alone for 6 weeks. These compounds were previously shown to inhibit HCA-associated GST-P positive foci. The numbers of GST-P positive foci in rats treated with MeIQx together with HTHQ (7.7+/-2.6) or antioxidant mixture (0.4+/-2.8) were significantly lower than with MeIQx alone (12.1+/-3.1), but a clear synergistic effect was not demonstrated. These results confirmed the ability of HTHQ to inhibit hepatocarcinogenesis induced by HCAs.

Amines↗
PubMed1998

[An 81-year-old woman with progressive motor disturbance, extrapyramidal features, dementia, and oculomotor palsy].

We report an 81-year-old woman who presented with motor disturbance in her right hand which was followed by parkinsonism, dementia, and supranuclear gaze palsy. She was well until her age of 73 (1989) when she had an onset of difficulty in using her right hand; she did not have weakness. She also developed small step gait. These symptoms had progressively become worse. She was admitted to our hospital in July of 1992 when she was 75 years old. On admission, she was alert and oriented, but she showed some difficulty in recent memory. She did not have aphasia or ideomotor apraxia, but she showed limb-kinetic apraxia in her right hand, ideational apraxia, dressing apraxia, constructional apraxia, tactile agnosia, and left-right disorientation. Alien-hand syndrome was observed in her right hand. Ocular movement was within normal limit for her age. She had oro-lingual dyskinesia. Otherwise, cranial nerves were intact. She walked in small-steps. She had rigidity and fine myoclonic movements in her right upper extremity. Deep reflexes were within normal limits and symmetric. Superficial and deep sensations were intact. Laboratory findings were unremarkable. She was discharged on August 15, 1992 for outpatient follow-up. Her motor and mental symptoms were progressive. By October of 1992, she developed supranuclear vertical gaze palsy, marked rigidity in the neck, and astereognosis. By June 1993, she became unable to walk without support. MRI taken in May of 1994 revealed atrophy of insular cortices, temporal lobe tips and parietal lobes more on the left side; the third ventricle was slightly dilated. She was admitted to another hospital on June 30, 1994. She had become a bed-ridden state with marked dementia and dysphagia. She developed fever on November 5, 1996 and expired on December 16 of the same year. She was discussed in a neurological CPC and the chief discussant arrived at the conclusion that the patient had corticobasal degeneration. Other diagnoses entertained included progressive supranuclear palsy, pallidonigroluysian atrophy, diffuse Lewy body disease, and Pick's disease. But the most of the participants agreed with the chief discussant's diagnosis. Post-mortem examination revealed aspiration pneumonia in the lungs and liver fibrosis apparently due to viral hepatitis. In the central nervous system, frontal and parietal lobes were atrophic more on the left side. Atrophy was accentuated in the superior frontal gyri, precentral and postcentral gyri, and superior and inferior parietal lobuli. Neuronal loss and astrocytosis were seen in these regions with scattered ballooned neurons. The substantia nigra showed marked neuronal loss and gliosis; neuronal loss was also seen in the pars reticulata. The outer and inner segments of globus pallidus and the periacqueductal gray matter showed gliosis, however, no apparent neuronal loss was seen. Putamen, subthalamic nucleus, and the dentate nucleus were preserved. Pathologic changes were consistent with the diagnosis of corticobasal degeneration. It was interesting to note that anti-tau immunostaining and Gallyas staining revealed neuropil threads and astrocytic plaques in the cortical areas, and intracytoplasmic inclusion bodies in the cortical neurons; these inclusions were not stained by Bodian stain. Tuft-shaped astrocytes which may be seen in progressive supranuclear palsy were not observed in this patient. Although corticobasal degeneration and progressive supranuclear palsy share some neurological features in common, this patient showed typical pathologic changes of corticobasal degeneration.

Aged↗
PubMed1998

[Atrial septal defect and severe pulmonary hypertension in an adult who needed nitric oxide inhalation after repair].

A 51-year-old male was diagnosed as having an ostium secundum atrial septal defect with severe pulmonary hypertension. Although pulmonary artery pressure was as high as 96/32 and pulmonary vascular resistance was 14.2 U.m2, he underwent corrective surgery, because pulmonary to systemic blood flow ratio was 2.0. After he regained consciousness in ICU, pulmonary hypertensive crises recurrently occurred and the hemodynamics became quite unstable. Administration of conventional drugs proved to be ineffective. Since inhalation of low dose (3-4 ppm) nitric oxide was started, however, his condition was markedly improved and he recovered uneventfully thereafter. Two years later, pulmonary artery pressure was reduced to 52/28 and pulmonary vascular resistance was 9.9 U.m2. Although good outcome can not be expected in all surgically treated cases, we should refrain from deciding easily that surgery is contraindicated, because no criteria of surgical indication for atrial septal defect with pulmonary hypertension appears to be perfect.

Administration, Inhalation↗