[Anesthetic management of a patient with psoriasis arthropathica].

A 37-year-old woman with psoriasis arthropathica associated with aortic regurgitation underwent replacement of her aortic valve. The serum rheumatic factor was negative. HLA-B 27 was demonstrated in HLA analysis. She experienced a sudden onset of dyspnea and cardiac arrest in the hospital. She was hospitalized and found to have severe aortic regurgitation. She had her aortic valve replaced. We paid attention to management of blood pressure not to trigger cardiac ischemia and of skin lesion not to trigger infection and the worsening of skin condition. There are few reports of HLA-B 27 positive psoriasis arthropathica accompanied by aortic regurgitation. However, the present case may suggest that the cardiac study may be required for HLA-B 27 positive psoriasis arthropathica.

Treatment of primary varicose veins: an assessment of the combination of high saphenous ligation and sclerotherapy.

This study was conducted to determine the optimal treatment for minimizing the recurrence of varicose veins, and to assess the value of the combined treatment of high saphenous ligation and sclerotherapy. A combined total of 967 limbs in 660 patients with primary varicose veins were treated. The treatments comprised: sclerotherapy alone in 81 limbs, high saphenous ligation alone in 3 limbs, a combination of sclerotherapy and high saphenous ligation in 843 limbs, and a combination of sclerotherapy and ligation of incompetent perforating veins in 10 limbs. Recurrent varicose veins appeared from 3 months after the initial treatment in 61 (6.3%) limbs. Saphenous-type recurrence, being the presence of saphenofemoral incompetence (SFI) and/or saphenopopliteal incompetence (SPI), was found in 20 limbs, and further treatment was given. Segmental-type recurrence, being superficial varices without SFI or SPI, was found in 41 limbs, all of which were treated with further sclerotherapy alone. To minimize the recurrence rate of varicose veins, the presence or absence of SFI, SPI, and incompetent perforating veins must be confirmed prior to the initial treatment. It was concluded that the combination of high saphenous ligation and sclerotherapy is effective for patients with SFI and/or SPI, whereas sclerotherapy alone is better for patients without SFI or SPI.

The efficacy of the "BURP" maneuver during a difficult laryngoscopy.

The displacement of the larynx in the three specific directions (a) posteriorly against the cervical vertebrae, (b) superiorly as possible, and (c) slightly laterally to the right have been reported and named the "BURP" maneuver. We evaluated the efficacy of the BURP maneuver in improving visualization of the larynx. Six hundred thirty patients without obvious malformation of the head and neck participated in this study. We divided the degree of visualization of the larynx using laryngoscopy into five grades and compared the visualization of the larynx using the BURP maneuver with that of laryngoscopy with and without simple laryngeal pressure ("Back"). The maneuver of Back and BURP significantly improved the laryngoscopic visualization from initial inspection. The BURP maneuver also significantly improved the visualization compared with the Back maneuver. We concluded that the BURP maneuver improved the visualization of the larynx more easily than simple back pressure on the larynx.

[Predicting the difficulty of laryngoscopy using the distance between the lower border of the mandible and the thyroid notch].

We examined the relationship between the degree of difficulty in visualization of the larynx and the distance from the lower border of the mandible to the thyroid notch (M-T distance). Patients were examined and the M-T distance was measured with their neck fully extended during preoperative period. Difficulty of laryngoscopy was graded as reported previously. Five hundred sixty one patients were assessed, and those with obvious neck and head pathology were excluded. There were 440 cases (78.4%) in grade 1, 116 cases (20.7%) in grade 2 and only 5 cases (0.9%) in grade 3. There were no grade 4 cases. The M-T distance was 5.4 +/- 0.6 cm in grade 1, 4.6 +/- 0.7 cm in grade 2 and 3.6 +/- 0.7 cm in grade 3. These were significantly different with each other (P < 0.05). If the M-T distance is 4.5 cm or less, the difficulty in visualization of laryngoscope increases. Therefore, in the case in which the M-T distance is 4.5 cm or less, we recommend further examination and preparation for difficult laryngoscopy.

Clastogenicity of aporphine alkaloids in vitro.

The chromosomal aberration test using a Chinese hamster lung cell line (CHL) was carried out on 19 aporphine alkaloids including apomorphine with and without rat liver homogenates (S9) mix. Eighteen of 19 alkaloids tested induced chromosomal aberration in the presence or absence of S9 mix. Among the alkaloids tested, anolobine, liriodenine and 4,5-dioxodehydrocrebanine induced chromosomal aberrations at relatively low concentrations and as low as 2.5, 5 and 3.13 micrograms/ml, respectively. Dicentrine, anolobine and 4,5-dioxodehydrocrebanine induced chromosomal aberrations with high frequencies. Apomorphine induced 10% aberrant cells at 12.5 micrograms/ml in the direct method and 12% at 100 micrograms/ml with S9 mix in the S9 method. Liriodenine which was the most potent mutagen for TA100 with S9 mix and roemerine which was the most potent for TA98 with S9 mix in Ames test were also clastogenic with and without S9 mix.

[The influence of heparin administration on the plasma protein binding of lidocaine during epidural anesthesia].

The influence of heparin administration on the protein binding of lidocaine was investigated in this study. Epidural anesthesia was conducted in 20 patients undergoing vasoconstructive surgery, and the changes of lidocaine concentration and its protein binding ratio after heparin administration were estimated. Protein binding ratio of lidocaine decreased rapidly after the commencement of heparin injection until attaining the minimal rate of 50.3 +/- 8.8%, and it then recovered gradually. There was a distinct negative correlation between the reduction in protein binding ratio of lidocaine and the increase of non-esterified fatty acid (NEFA) based on the activated lipoprotein lipase after heparin administration. This reduction of protein binding ratio after heparin was in safety range so that practically no dangerous adverse reaction was seen in these patients. The detailed mechanism was elucidated in an in vitro study. Normal concentration of NEFA (300 microEq.l-1) increased the protein binding ratio of lidocaine, and high concentration of NEFA (1800 microEq.l-1) decreased the ratio on human serum albumin (HSA). Heparin (1.0 unit.ml-1) itself, however, showed no influence for protein binding ratio onto HSA. Concerning alpha 1-acid glycoprotein (AAG), NEFA did not show any influence on the binding ratio, and heparin decreased it little. Consequently, it can be said that the protein binding ratio of lidocaine was mainly affected by NEFA concentration.

[A case of advanced thoracic esophageal cancer with marked response to bleomycin absorbed on activated carbon particles (BLM-CH44), methotrexate, and cisplatin].

A 67-year-old women, who suffered from advanced esophageal cancer with left main bronchus and azygous vein involvement, was treated by combined administration of bleomycin absorbed on activated carbon particles (BLM-CH44, 10 mg/body), methotrexate (30 mg/body i.m.), and cisplatin (75 mg/body i.v.). BLM-CH44 was injected around tumor and total dose of BLM was 120 mg, that of MTX was 180 mg, and that of CDDP was 225 mg. After therapy, the sign of extra-esophageal spread disappeared and a radical operation was performed. Microscopically, the lesion of the esophagus was almost disappeared, and CH44 staining lymph node involvement was completely disappeared.

Mutagenicity of isoquinoline alkaloids, especially of the aporphine type.

The mutagenicity of 44 isoquinoline alkaloids was tested in Salmonella typhimurium TA100 and TA98 in the presence or absence of S9 mix. The alkaloids tested included compounds from the isoquinoline, benzylisoquinoline, bisbenzylisoquinoline, monoterpene isoquinoline, berberine, morphinane, hasubanan, benzo[c]phenanthridine and aporphine groups. Among the alkaloids tested, liriodenine was the most potent mutagen for TA100 and roemerine was the most potent for TA98. A clear structure-mutagenicity relationship was observed in a series of aporphine alkaloids (aporphine, dehydroaporphine, 7-oxoaporphine and 4,5-dioxoaporphine), and 10,11-non-substituted aporphines were suggested to exert their mutagenicity through metabolic activation of the 10,11 positions, possibly as the 10,11-epoxides.

A mutagenic new iridoid in the water extract of catalpae fructus.

A mutagenic principle in the water extract from Catalpae Fructus (originated from Catalpa ovata G. DON) (Bignoniaceae) was isolated and characterized as a new iridoid named catalpin. The iridoid exhibited mutagenic activity towards Salmonella typhimurium strain TA100 in the presence and absence of rat liver homogenate (S9) mix in Ames' test.

Mutagenic activities of gentisin and isogentisin from Gentianae radix (Gentianaceae).

The mutagenic activities of 2 hydroxyxanthones, gentisin and isogentisin, obtained from the methanol extract of Gentianae radix (Gentianaceae) were investigated. The methanol extract of Gentianae radix, which showed mutagenicity in the Ames test in Salmonella typhimurium strain TA100 with S9 mix, was fractionated by column chromatography on Sephadex LH-20, and the fractions were purified by preparative TLC and column chromatography on polyamide. 2 mutagenic materials thus obtained, S1 and S2, each gave a single band on TLC. Identification of S1 and S2 was accomplished by comparing the analytical (mps, elementary analyses) and spectral (UV, IR, mass, NMR) results for S1 and S2 with literature data for gentisin and isogentisin. At doses below 10 micrograms, S1 (gentisin) and S2 (isogentisin) had similar specific mutagenic activities. At doses of over 10 to 50 micrograms, the mutagenic activities of S2 and S1 were 19.1 and 6.94 revertants per microgram respectively. This much lower activity of S1 than S2 may be a result of its poor solubility owing to the presence of the OMe group at C-3. The combined yield of S1 and S2 was about 76 mg (40 mg as S1 and 36 mg as S2), which accounted for 76% of the content of mutagenic compounds (100 mg) estimated roughly from the total mutagenic activity in the extract of the starting materials (100 g).