Continuous intravenous infusion of CGS 26303, an endothelin-converting enzyme inhibitor, prevents and reverses cerebral vasospasm after experimental subarachnoid hemorrhage.

OBJECTIVE: Endothelin-mediated vasoconstriction has been implicated in the pathophysiology of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Endothelin-1, the most potent vasoconstrictor peptide of the endothelin family, is synthesized initially as a large prepropeptide that requires multiple steps of post-translational processing for activation. The final step of this processing involves the proteolytic cleavage of a relatively inactive precursor, big endothelin-1, by the metalloprotease endothelin-converting enzyme. Previous findings have demonstrated that intravenous bolus injections of an endothelin-converting enzyme inhibitor (CGS 26303) administered twice daily can prevent and reverse arterial narrowing in a rabbit model of SAH. However, attenuation of vasospastic response was incomplete and required relatively high doses to be effective in reversing vasospasm. Therefore, the present study evaluated an alternative protocol for administration of CGS 26303 to optimize the antispastic influence of this compound. METHODS: Continuous intravenous infusion of CGS 26303 at doses of 2.4, 8.0, or 24.0 mg/kg/d was initiated either 1 hour (prevention paradigm) or 24 hours (reversal paradigm) after experimental SAH in New Zealand White rabbits. All animals were killed by perfusion-fixation 48 hours after SAH. Basilar arteries were then removed and sectioned, and their cross-sectional areas were measured by use of computer-assisted video microscopy. RESULTS: Continuous intravenous infusion of CGS 26303 attenuated SAH-induced cerebral vasospasm in a dose-dependent manner in both the prevention and the reversal groups. These effects achieved statistical significance at all doses as compared with the SAH-only or SAH-plus-vehicle groups. Furthermore, the attenuation of vasospasm after continuous infusion of CGS 26303 was more efficacious than that obtained with bolus injections. CONCLUSION: These findings provide further support for the use of endothelin-converting enzyme inhibition as a therapeutic strategy for reduction of cerebral vasospasm, and they also support the effectiveness of this strategy even when initiated after arterial narrowing has been established. The findings also indicate that continuous intravenous infusion of CGS 26303 is a more effective approach for attenuation of vasospasm than bolus intravenous administration.

Instability in a laser-diode-pumped microchip Nd:YAG laser in a n-ary product scheme.

Dynamical instability, chaotic pulsations, and generalized bistability have been observed in a laser-diode-pumped microchip Nd:YAG laser operating in a double transition scheme in which lasing occurs on two transitions with overlapping gain profiles, F(3/2)(4)(2)? I(11/2)(4)(3) and F(3/2)(4)(1)? I(11/2)(4)(2), and simultaneously involves excited Nd atoms from different sublevels of the upper manifold. The modeling of the experimental results requires rate equations that include cross-gain coupling among oscillating modes that belong to different transitions whose population inversion densities are determined by the Boltzmann distribution.

1.5-mum emissions from laser-diode-pumped Nd-doped microchip solid-state lasers.

1.5-mum emissions from Nd:YAG, Nd:YVO(4), and LiNdP(4) O>(12) microchip lasers pumped by laser diodes have been observed. These coherent emissions are attributed to the effect of high-energy modified lattice vibration owing to the existence of Nd ions as well as to stimulated intracavity Raman scattering enhanced by the microchip configuration. A four-wave mixing process involving two lasing fields and a Stokes field was identified as the generator of new adjacent 1.5-mu;m emission.

Subacute pituitary apoplexy-analysis of 17 cases.

We retrospectively study 17 cases (total cases 197), receiving surgery at Kaohsiung Medical College Hospital, which are proved to be subacute pituitary apoplexy via preoperative computerized tomograms, magnetic resonance imagings, operative findings and pathological proof. Fourteen patients had headache; 15 cases were with visual disturbance including visual defect, blindness. One case was found incidentally to have a cerebral vascular attack. None of these cases received bromocriptine. Preoperative computerized tomograms (CT) aided the initial diagnosis and magnetic resonance imaging (MRI) is preferred for radiological investigation in displaying the metabolic products of hemorrhage within the pituitary tumors. Operative findings revealed xanthochromic fluid with liquid-like tumor debris or chocolate-like content. All these patients received hormone supplement when pituitary apoplexy was highly suspected.

An analysis of intraspinal tumors in south Taiwan.

A series of 120 pathologically verified intraspinal tumors was analyzed for the relative incidence and location of the tumors as well as the distribution of age and sex. These data were compared to series from Taiwan, mainland China, Thailand, Korea, Japan, Iran, India, and countries in the West. The ratio of brain to intraspinal tumors was about 5:1 in Taiwan, higher than those reported in China, Korea, and in the West. The male to female ratio is about six to five. For most tumors, male predominance is noted except for meningioma. The incidence of intraspinal tumors in the order of frequency is nerve sheath cell tumor(NSCT), metastatic tumors, meningioma, glioma, congenital tumors, and vascular tumors. In the East, the incidence of NSCT is about 40%, and meningioma is about 10%. In the West, they are both about 20%. Congenital tumors accounted for only 3.3%. In China, it was about 12% and this is the highest incidence of dysembryoplastic tumors in the world. Glioma has similar incidence (about 10%) in Taiwan, China, Thailand, Japan, and Iran (about 10%), whereas it is about 15% in the West and India. Korea has the highest incidence of glioma, (32.3%). Low incidences of metastatic intraspinal tumors (4.6-5.5%) were noted in China and Japan, but a higher incidence (14.2-24.2%) was seen in Taiwan, Iran, and the West. The most common metastatic tumors in the order of frequency is tumors of unknown origin, lung cancer metastasis, hepatoma, and breast cancer. The high percentage of unknown origin of metastasis may have resulted from loss of follow-up and lack of postmortem studies.