Ecchymosis and/or haematoma formation after prophylactic administration of subcutaneous enoxaparin in the abdomen or arm of the critically ill patient. / Formación de equimosis y/o hematoma tras la administración profiláctica de enoxaparina subcutánea en abdomen o brazo en pacientes críticos.

INTRODUCTION: Ecchymosis and/or haematoma are the most common adverse events after subcutaneous administration of low molecular weight heparin. There is no strong recommendation as to the puncture site. OBJECTIVE: To evaluate the adverse events, ecchymosis and/or haematoma after the administration of prophylactic subcutaneous enoxaparin in the abdomen vs the arm in the critically ill patient. METHODOLOGY: A randomised, two-arm clinical trial (injection in the abdomen vs the arm), performed between July 2014 and January 2017, in an 18-bed, polyvalent intensive care unit. Patients receiving prophylactic enoxaparin, admitted >72h, with no liver or haematological disorders, a body mass index (BMI) >18.5, not pregnant, of legal age and with no skin lesions which would impede assessment were included. We excluded patients who died or who were transferred to another hospital before completing the evaluation. We gathered demographic and clinical variables, and the onset of ecchymosis and/or haematomas at the injection site after 12, 24, 48 and 72hours. A descriptive analysis was undertaken, with group comparison and logistic regression. The study was approved by the ethics committee with the signed consent of patients/families. RESULTS: 301 cases (11 excluded): 149 were injected in the abdomen vs 141 in the arm. There were no significant differences in demographic and clinical variables, BMI, enoxaparin dose or antiplatelet administration [ecchymosis, abdomen vs arm, n(%): 66(44) vs 72(51), P=.25] [haematoma abdomen vs arm, n(%): 9(6) vs 14(10), P=.2]. Statistical significance was found in the size of the haematomas after 72h: [area of haematoma (mm2) abdomen vs arm, median (IQR): 2(1-5.25) vs 20(5.25-156), P=.027]. CONCLUSIONS: In our patient cohort, prophylactic subcutaneous enoxaparin administered in the abdomen causes fewer haematomas after 72hours, than when administered in the arm. The incidence rate of ecchymosis and haematoma was lower than the published incidence in critically ill patients, although patients receiving anti-platelet agents present a higher risk of injury. No relationship was observed in relation to BMI.

Investigating Serum Uric Acid as a Risk Factor in the Development of Delayed Renal Recovery in Living Kidney Donors.

BACKGROUND: Hyperuricemia has been associated with kidney disease and remains controversial with regard to its gender-specific differences and impact in living kidney donation. METHODS: Between 2006 and 2015, charts of live kidney donors who underwent nephrectomy and had a minimum follow-up of 1 year were reviewed. A total of 291 donors were included and divided based on gender-specific pre-donation serum uric acid (SUA) tertiles. Renal functional outcomes included were estimated glomerular filtration rate (eGFR) at 6-month and 1-year follow-up and percentage of donors with a 1-year eGFR <60 mL/min/1.72 m2. Logistic regression analysis was done. RESULTS: Mean SUA tertiles were 5.8 ± 1.1 mg/dL in males and 4.1 ± 1 mg/dL in females. Females in the highest tertile (SUA >4.5 mg/dL) had lower 6-month (59.9 ± 10.3 vs 66.9 ± 14.1 vs 67.3 ± 12.1; P = .018) and 1-year (60.8 ± 10.6 vs 67.6 ± 10.8 vs 67.8 ± 11.8; P = .021) eGFR and a higher percentage of donors with 1-year eGFR <60 mL/min/1.73 m2 (59.5% vs 31.6% vs 23%; P = .002) compared with donors in the lower SUA tertiles (≤4.5 mg/dL). In males, there were similar eGFRs among SUA tertiles at 6-month and 1-year follow-up. In multivariate analysis, SUA was shown to be a significant predictor of developing stage 3 CKD (eGFR <60 mL/min/1.72 m2), 1 year after donation in females but not in males. CONCLUSIONS: Predonation SUA level is associated with the development of delayed renal recovery (GFR <60 mL/min/1.72 m2) 1 year after donation in females but not in males.

[Validating the Spanish version of the Nursing Activities Score]. / Validación de la versión en castellano del Nursing Activities Score.

INTRODUCTION: Validating workload scores ensures that they are appropriate for the purpose for which they were developed. OBJECTIVE: To validate the Nursing Activities Score (NAS) Spanish version. METHODOLOGY: Observational and prospective study. 1,045 patients who were admitted to a medical-surgical unit and a serious burns unit in 2006 were included. The nurse in charge assessed patient workloads by Nine Equivalent of Nursing Manpower use Score and NAS. To assess the internal consistency of the measurements of NAS, item-test correlations, Cronbach's α and Cronbach's α corrected by omitting each of the items were calculated. The intraobserver and interobserver reliability were assessed with the intraclass correlation coefficient by viewing recordings and Kappa (interobserver reliability) was estimated. For the analysis of internal validity, a factorial principal components analysis was performed. Convergent validity was assessed using the Spearman correlation coefficient values obtained from the Nine Equivalent of Nursing Manpower use Score and Spanish-NAS scales. RESULTS: For internal consistency, 164 questionnaires were analysed and a Cronbach's α of 0.373 was calculated. The intraclass correlation coefficient for intraobserver reliability estimate was 0.837 (95% IC: 0.466-0.950) and 0.662 (95% IC: 0.033-0.882) for interobserver reliability. The estimated kappa was 0.371. For internal validity, exploratory factor analysis showed that the first item explained 58.9% of the variance of the questionnaire. For convergent validity 1006 questionnaires were included and a Spearman correlation coefficient of 0.746 was observed. CONCLUSIONS: The psychometric properties of Spanish-NAS are acceptable.

[Interobserver reliability of the Glasgow coma scale in critically ill patients with neurological and/or neurosurgical disease]. / Fiabilidad interobservador de la escala del coma de Glasgow en pacientes críticos con enfermedad neurológica o neuroquirúrgica.

INTRODUCTION: The Glasgow coma scale (GCS) is a common tool used for neurological assessment of critically ill patients. Despite its widespread use, the GCS has some limitations, as sometimes different observers may value differently the same response. OBJECTIVE: To evaluate the interobserver agreement, among intensive care nurses with a minimum of 3 years experience, both in the overall estimate of GCS and for each of its components. METHODS: Prospective observational study including 110 neurological and/or neurosurgical patients conducted in a critical care unit of 18 beds, from October 2010 until December 2012. Registered variables: Demographic characteristics, reason for admission, overall GCS and its components. The neurological evaluation was conducted by a minimum of 3 nurses. One of them applied an algorithm and consensual assessment technique and all, independently, valued response to stimuli. Interobserver agreement was measured using the intraclass correlation coefficient (ICC) for a confidence interval (CI) of 95%. The study was approved by the Ethics Committee for Clinical Trails. RESULTS: The intraclass correlation coefficient (confident interval) for scale was: Overall GCS: 0.989 (0.985-0.992); ocular response: 0.981 (0.974-0.986); verbal response: 0.971 (0.960-0.979); motor response: 0.987 (0.982-0.991). CONCLUSION: In our cohort of patients we observed a high level of consistency in the application of both the GCS as in each of its components.

Adaptación transcultural al castellano del Nursing Activities Score / Transcultural adaptation into Spanish of the Nursing Activities Score

Introducción La valoración de las cargas de enfermería es práctica habitual en el trabajo diario de los cuidados enfermeros, y normalmente se hace utilizando escalas ajenas al medio hispanoparlante, sin tener en cuenta las características de los distintos entornos que difieren de un país a otro. Entre los instrumentos utilizados para la valoración de las cargas de trabajo en enfermería en unidades de cuidados intensivos, Nursing Activities Score (NAS) ha sido descrito como un instrumento útil para medir dichas cargas en estas unidades. Objetivo Adaptar al castellano el NAS para su uso en unidades de cuidados intensivos. Material y métodos Adaptación por el método de traducción-retraducción del NAS mediante traductores de idioma materno inglés y bilingüe (castellano), y traductores con el castellano como idioma materno y alto nivel de inglés, trabajando los traductores por separado. Se obtuvo una versión única en castellano con la que se realizó una prueba piloto en la Unidad de Cuidados Intensivos y Grandes Quemados del Hospital Universitario de Getafe (Madrid, España) con 30 pacientes y 30 enfermeros durante su turno habitual de trabajo. Se consultó, también, con el autor principal del NAS los ítems que supusieron algún tipo de conflicto. Resultados Entre la escala original y la resultante de las retrotraducciones en inglés se obtuvo una buena correspondencia en el 73% de los ítems y una correspondencia apropiada en el restante 27%; ningún ítem fue considerado con correspondencia mala. Conclusión Se ha obtenido una versión adaptada en castellano del NAS (AU)

Introduction Assessment of nursing workload is a common practice in the daily work of nursing care. This is usually done using scales that were not designed for Spanish-speaking countries, which may not take into account the characteristics of the environments that differ from one country to another. The Nursing Activities Score (NAS) has been described as being a useful tool for measuring nursing workload among the instruments used for this measurement in intensive care units. Objective It was aimed to adapt the NAS into Spanish for its use in Spanish intensive care units. Material and methods The NAS was adapted using translation-back translation method with the participation of both native English speakers who were bilingual in Spanish, and Spanish translators with a high level of English. All of the translators worked individually. A single Spanish version of the scale was obtained, after which a pilot test was made in an Intensive Care Major Burns Unit of the University Hospital of Getafe (Madrid, Spain) with 30 patients and 30 nurses during their regular work shift. We also consulted the primary author of the original description of the NAS regarding items that caused some kind of conflict. Results Between the original scale and the result of the back-translations to English, we obtained agreement ratings of good in 73%, and appropriate in the remaining 27%. No item was considered to have bad correspondence. Conclusion We have developed a Spanish translation of the NAS that appears well matched to the original English version (AU)

[Transcultural adaptation into Spanish of the nursing activities score]. / Adaptación transcultural al castellano del nursing activities score.

INTRODUCTION: Assessment of nursing workload is a common practice in the daily work of nursing care. This is usually done using scales that were not designed for Spanish-speaking countries, which may not take into account the characteristics of the environments that differ from one country to another. The Nursing Activities Score (NAS) has been described as being a useful tool for measuring nursing workload among the instruments used for this measurement in intensive care units. OBJECTIVE: It was aimed to adapt the NAS into Spanish for its use in Spanish intensive care units. MATERIAL AND METHODS: The NAS was adapted using translation-back translation method with the participation of both native English speakers who were bilingual in Spanish, and Spanish translators with a high level of English. All of the translators worked individually. A single Spanish version of the scale was obtained, after which a pilot test was made in an Intensive Care Major Burns Unit of the University Hospital of Getafe (Madrid, Spain) with 30 patients and 30 nurses during their regular work shift. We also consulted the primary author of the original description of the NAS regarding items that caused some kind of conflict. RESULTS: Between the original scale and the result of the back-translations to English, we obtained agreement ratings of good in 73%, and appropriate in the remaining 27%. No item was considered to have bad correspondence. CONCLUSION: We have developed a Spanish translation of the NAS that appears well matched to the original English version.

Percepción de los riesgos de su puesto de trabajo de los médicos internos residentes de un hospital secundario / Occupational risks perception in medical internal residents of a secondary hospital

Introducción. La formación sanitaria especializada (‘residencia’) es un período crucial para el desarrollo profesional posterior. Pretendimos objetivar cuáles son los riesgos que más preocupan a los residentes de nuestro hospital y compararlos con los resultados de la evaluación de riesgos realizada en sus puestos de trabajo para poder plantear estrategias que nos ayuden en nuestra práctica diaria. Sujetos y métodos. Estudio descriptivo en la población de 83 residentes que se incorporaron al hospital durante los años2005-2007. Se obtuvieron los datos de una encuesta, revisando sus historias clínico-laborales y la evaluación de riesgos. Se realizó un análisis descriptivo de estas variables, se compararon los resultados de la encuesta con la evaluación por los técnicos y se analizó la posible asociación de la percepción del riesgo con la especialidad o el año de residencia mediante el programa estadístico Stata. Resultados. Los riesgos más referidos son las radiaciones ionizantes y los psicosociales, seguidos de los biológicos y ergonómicos, aunque varía a lo largo de la residencia. Existen discrepancias muy significativas entre lo que refieren los encuestados y la evaluación de riesgos de los técnicos. Conclusiones. La percepción de los riesgos laborales en los residentes no se corresponde con las condiciones de trabajo objetivadas por los técnicos en la mayoría de los riesgos valorados por diferentes razones. Desarrollar un programa formativo específico para este colectivo les ayudaría a tener un conocimiento más realista. Algunos riesgos requerirían una reevaluación por la parte técnica tomando en consideración la percepción de la situación de riesgo (AU)

Introduction. The medical specialized training ‘residence’ is a critical period for the later professional development. We tried to determine which risks the residents perceive in their activities and to compare them with the risk evaluation developed in their jobsites, to design oriented strategies that help us in daily practice. Subjects and methods. We have implemented a descriptive study whose targeted population was 83 residents who entered in the hospital along the period 2005-2007. Data was obtained through a survey specifically designed and their clinical occupational files –including the risk evaluation–. We have made a descriptive analysis of personal perception and technical evaluation data and verified its relationships with some theoretical determinant factors like year of residence or medical specialty. Results. The risks mainly perceived by residents are: ionizing radiation and psychosocial ones and, secondly, biological and ergonomic risks. We evidence a gap between the survey’s results and the risk evaluation data linked to different factors. Occupational risks perception changes along the years of training residence keeping different trend models (increasing or decreasing the gap) according to different types of risk. Conclusions. In most of situations residents’ occupational risks perception does not correspond directly with their objective work conditions. Developing a formative program specifically addressed to these workers would help them to better recognise and manage. Some risks should be reassessed by technicians taking into account the analyzed group’s perception (AU)

Formación e información en la gestión de la prevención de riesgos laborales para los médicos internos residentes / The role of formation and information in the management of labour risks prevention for the internal

Introducción. La ‘residencia’ o formación sanitaria especializada es un período donde se adquieren conocimientos cruciales en el desarrollo profesional posterior. Pretendemos conocer cómo se desarrolla la actividad preventiva para con los médicos internos residentes (MIR) de nueva incorporación en nuestro Servicio de Prevención y determinar cómo se refleja en su formación en prevención de riesgos laborales. Sujetos y métodos. La población de estudio la constituyen los 83 residentes que ingresaron en los años 2005, 2006 y 2007, realizaron el reconocimiento de inicio en nuestro servicio, y a todos ellos se les remitió el cuestionario. Se realizó un análisis descriptivo con los datos obtenidos de la historia clínico-laboral y dicha encuesta. Se comparó, mediante análisis bivariante, las posibles relaciones entre las diferentes variables. La estimación de prevalencias de las distintas variables estudiadas se realizó con intervalos de confianza del 95%. Para la comparación de proporciones se utilizó la prueba de chi al cuadrado. Resultados. Se obtuvo una muestra efectiva de 45 residentes que contestaron la encuesta (54% de la población de estudio), con un error muestral de ±10% para p > 0,05. Éstos consideran que la cantidad y calidad de la formación recibida es escasa en las diferentes etapas formativas, muy útil (especialmente la del reconocimiento de inicio) y desearían haber recibido más. Conclusiones. Los datos obtenidos han servido como fuente de información para detectar necesidades de formación específica para este colectivo y necesidades de mejora en el contenido y distribución de nuestra historia laboral, donde observamos discrepancias con lo referido en la encuesta (AU)

Introduction. The ‘residence’ or sanitary specialized formation is a period where crucial knowledge is acquired in the professional later development. We try to know how the preventive activity develops for the MIR (internal resident doctors) of new incorporation in our Prevention Service and to determine how it is reflected in their formation in labour risks prevention. Subjects and methods. The population of study is constituted by 83 residents who entered in the year 2005, 2006 and 2007, they realized the recognition of beginning in our Service, and we send the questionnaire. There was realized a descriptive analysis by the information obtained of the clinical-labour history and the above mentioned survey. The possible relations were compared, by means of bivariant analysis, between the different variables. The prevalence estimation of the different studied variables was made by 95% confidence intervals. For the comparison of proportions the square chi was in use. Results. There was obtained an effective sample of 45 residents who answered the survey (54% of the population of study), with a sample mistake of ±10% for p > 0.05. They think that the quantity and quality of received formation is scanty in the different formative stages, very usefully (specially that of the recognition of beginning) and they would want to have received more. Conclusions. The obtained information has served us as source of information to detect needs of specific formation for this group and needs of improvement in the content and distribution of our labor history where we observe discrepancies with recounted in the survey (AU)

P-dichlorobenzene emission rates from moth repellents and leakage rates from cloth storage cases.

UNLABELLED: Emission rates of p-dichlorobenzene (pDCB) from five kinds of commercially available moth repellents and leakage rates from six kinds of commercially available cloth storage cases were measured. The emission rates from moth repellents immediately after purchase (E(max)), which were obtained as the slope of the total emission amount vs. time elapsed, were 0.0033 to 0.035 g/h at 25 degrees C. Moth repellents from different manufacturers differed greatly in emission rates at 0.0033, 0.0060, and 0.011 g/h, even if the moth repellent pieces were of similar shape and initial weight. This is thought to be because emission rates depended on the diffusion resistance of the repellent packing material used by each manufacturer. Therefore, the manufacturer-specific apparent mass transfer coefficients (K) were calculated for each moth repellent from the measured emission rates and a calculated saturated concentration. The apparent mass transfer coefficient K and the concentration gradient between the in-case (inside a cloth storage case) bulk air and the air at the surface of a moth repellent (pDCB tablet) were used for the calculation of the general emission rates. The leakage rates, defined as the air-exchange rate for a cloth storage case, from six cloth storage cases ranged from 0.41 to 78/h. Despite the large difference (more than 100 times) in the leakage rates of the cloth storage cases, the differences in emission rates of pDCB from these cloth storage cases to the indoor environment were small (<30%). This is because the concentration gradients between the in-case bulk air and the air at the surface of a repellent piece were almost the same among the storage cases. This suggests that pDCB emissions from cloth storage cases into the indoor environment should be reduced by making the storage cases more tightly sealable so that the leakage rate is <0.01/h. The results of adsorption tests of pDCB onto woollen clothes showed that the adsorption of pDCB on the clothes was assumed to be very strong and the transfer between the gas phase and the cloth phase in the cloth storage case was assumed to be small. PRACTICAL IMPLICATIONS: The use of pDCB provides benefits such as moth control and deodorizing, but on the other hand, poses potential risks to human health. There is a risk-benefit tradeoff, i.e. a tradeoff between risks of pDCB to human health and benefit of moth control effects. The pDCB concentration in the cloth storage case and in the indoor air can be estimated by using emission rates and the leakage rates obtained in this study. By comparing the concentration to the deterrent efficiency of pDCB, the risk for the use of pDCB moth repellents can be managed.

[Heparin concentration and hemostatic alterations with low systemic heparinization during CPB using heparin-coated circuits].

Extracorporeal circulation with heparin coated circuits allows reduction of systemic heparin. The authors investigated the effects of this method on the hemostatic and fibrinolytic systems and heparin concentration simultaneously. Ten patients undergoing coronary artery bypass surgery were studied. The dose of heparin was 100 IU.kg-1, and the target activated clotting time (ACT) was more than 300 seconds. Blood samples were obtained at the following times; before and after giving heparin, 10 and 40 minutes after the start of extracorporeal circulation, after cross-clamp release, and after giving protamine, and heparin concentration, ACT, thrombin-antithrombin complex (TAT), plasmin alpha 2 plasmin inhibition complex (PIC), and D-dimer were measured. ACT was kept over 300 seconds without additional heparin administration. Heparin concentration was maintained at 1.0 IU.ml-1. However, after release of the aortic cross-clamp, TAT, PIC, D-dimer increased significantly. Despite reduced systemic heparinization, heparin concentration was maintained adequately. Thrombin generation and fibrinolytic activity showed no significant increase until the release of the aortic cross-clamp.

[Anesthetic management for placement of tracheobronchial stents in patients with airway stenosis].

We report the anesthetic management for stents placement in patients with tracheobronchial stenosis. The subjects were 6 patients with lung cancer and one patient with tracheal invasion of esophageal cancer. Anesthesia was induced with propofol, fentanyl and vecuronium, and maintained with propofol and vecuronium. After intubation, tracheostomy was performed. The patients were kept apnic during insertion of stents. Three patients had dynamic stents inserted from tracheostomy site and one orally. Three patients had Dumon stents inserted orally, but the procedure in one patient was cancelled because her stent could not be placed at appropriate position. We recommend the anesthetic management through the tracheostomy site for the placement of Dumon tubes or dynamic stents.

[Problems in clinical use of intraarterial blood gas monitoring system, Paratrend 7].

We evaluated the intraarterial blood gas monitoring system Paratrend 7 in clinical use. One hundred and sixty six sensors used for patients receiving thoracic, open heart or great vessel surgery were tested for one year, prospectively. Sensors were inserted through a 20 G intraarterial cannula into the radial artery before operation and removed when they malfunctioned or seemed to be not necessary for patient management in critical care unit. We encountered several problems such as, initial calibration failure (5/166), impossible sensor insertion (2/166), arterial pressure wave change (5/166), parameter display failure (21/166), and thrombus in the circuit (9/166). Parameter display failure after insertion tended to occur on patient's arm movement imparing the sensor. No serious accident, such as arterial thrombosis was experienced. Some troubles were due to staff's incorrect handling of the apparatus. Training of staffs is indispensable for safe and sufficient utilization of Paratrend 7.

A method of profiling microbial communities based on a most-probable-number assay that uses BIOLOG plates and multiple sole carbon sources.

A new approach to the community-level BIOLOG assay was proposed. This assay, which we call the BIOLOG-MPN assay, is a most-probable-number (MPN) assay that uses BIOLOG plates and multiple sole carbon sources, and the profiles obtained by this assay consist of MPNs estimated for the substrates in the BIOLOG plates. In order to demonstrate the performance of the BIOLOG-MPN assay, it was applied to pure cultures, model bacterial communities that contain two strains in different ratios, and microbial community samples. MPN estimation using BIOLOG plates worked well for the substrates on which utilizers can grow at a sufficiently high rate for color development under the conditions of the assay procedure. Furthermore, the results obtained using model communities showed that the MPNs obtained reflected the mixing ratios of pure cultures in the model communities. The profiles obtained using model communities and community samples were differentiated properly by statistical analyses. The results suggest that the BIOLOG-MPN assay is a promising procedure for obtaining a quantitative picture of the community structure.

FDG PET evaluation of residual masses and regrowth of abdominal lymph node metastases from colon cancer compared with CT during chemotherapy.

Fluorine-18-2-deoxy-2-fluoro-D-glucose (F-18 FDG) PET may be more suitable for follow-up after cancer treatment than other morphologic approaches, because it reflects tumor viability. A patient with abdominal lymph node metastases from colon cancer was followed by CT and F-18 FDG PET during chemotherapy. F-18 FDG PET tumor images changed in accordance with the clinical progress, whereas CT findings were relatively unchanged. This case clearly shows the utility of F-18 FDG PET for follow-up during cancer chemotherapy.

[Application of continuous intra-arterial blood gas monitoring system "Paratrend 7" for pulmonary lavage of a patient with alveolar proteinosis].

We applied a continuous intra-arterial blood gas monitoring system (Paratrend 7) to a patient with pulmonary alveolar proteinosis during pulmonary lavage. Lavage was performed under general anesthesia with one lung ventilation. We inserted the sensor of Patatrend 7 through a 20 G catheter into the radial artery, and monitored pH, PaCO2 and PaO2 continuously throughout the procedure. SpO2 and EtCO2 were also monitored. Saline 1000-1500 ml was instilled and drained repeatedly by volume limited methods. PaO2 values by Paratrend 7 increased during instillation and decreased during drainage of the irrigating fluid. In contrast, PaCO2 value by Paratrend 7 decreased slightly during instillation and increased during drainage. The change of SpO2 was almost the same as that by Paratrend 7, but the response time of pulse oxymetry was a little quicker than Paratrend 7. During the lavage procedure, respiratory and circulatory condition changed very rapidly, and it is necessary to monitor blood gas change intensively. Paratrend 7 is useful as a perioperative monitoring system, but pulse oxymetry might be sufficient during pulmonary lavage considering its cost.

[Prophylactic effect of nicorandil on perioperative coronary spasm].

The prophylactic effect of nicorandil on perioperative coronary spasm (CS) in CABG was examined retrospectively. The subjects were 313 patients who had undergone elective CABG. The patients were divided into two groups a control group receiving single administration of nitroglycerine (N = 196) and a nicorandil group receiving both nitroglycerine and nicorandil (4 mg.h-1-8 mg.h-1) (N = 107). The two groups were compared. The incidence of CS was 14 cases (7.1%) in the control group and 6 cases (5.6%) in the nicorandil group, demonstrating a significant difference. With the dose and the administration method employed in this study, no prophylactic effect of nicorandil on perioperative CS has been demonstrated.

[Anesthesia for bronchial stenosis treated by balloon catheter dilatation].

We experienced three cases of successful balloon catheter dilatation for bronchial stenosis under general anesthesia. There was no problem for two patients, but the third patient planned for stent insertion had bronchiomediastinal fistula. This procedure is generally performed under local anesthesia but more safely done under general anesthesia with muscle relaxants considering operative failure by bucking, pain of patients and prolonged procedure.

Screening the p53 status of human cell lines using a yeast functional assay.

We have screened the p53 status of 156 human cell lines, including 142 tumor cell lines from 27 different tumor types and 14 cell lines from normal tissues by using functional analysis of separated alleles in yeast. This assay enables us to score wild-type p53 expression on the basis of the ability of expressed p53 to transactivate the reporter gene HIS3 via the p53-responsive GAL1 promotor in Saccharomyces cerevisiae. Of 142 tumor cell lines, at least 104 lines (73.2%) were found to express the mutated p53 gene: 94 lines (66.2%) were mutated in both alleles, three lines (2.1%) were heterozygous, and no p53 cDNA was amplified from seven lines (4.9%). Of the 14 cell lines originating from normal tissues, all the transformed or immortalized cell lines expressed mutant p53 only. Yeast cells expressing mutant p53 derived from 94 cell lines were analyzed for temperature-sensitive growth. p53 cDNA from eight cell lines showed p53-dependent temperature-sensitive growth, growing at 30 degrees C but not at 37 degrees C. Four temperature-sensitive p53 mutations were isolated: CAT-->CGT at codon 214 (H214R), TAC-->TGC at codon 234 (Y234C), GTG-->ATG at codon 272 (V272M), and GAG-->AAG (E285K). Functionally wild-type p53 was detected in 38 tumor cell lines (26.8%) and all of the diploid fibroblasts at early and late population doubling levels. These results strongly support the previous findings that p53 inactivation is one of the most frequent genetic events that occurs during carcinogenesis and immortalization.

Oligomerization is not essential for growth suppression by p53 in p53-deficient osteosarcoma Saos-2 cells.

The carboxy-terminal portion of the p53 protein contains the tetramerization domain, and the introduction of multiple missense mutations in this domain disrupts the formation of p53 tetramers, resulting in the production of dimeric or monomeric forms of p53. It has recently been shown that a single missense or nonsense mutation in this domain affects the functional properties of p53 both in yeast and in mammalian cells. In this study, we tested the oligomerization of p53 with mutations in the oligomerization domain, when expressed in a human osteosarcoma cell line, Saos-2, in vivo. We found that single point mutations, including two missense and two nonsense mutations, in the alpha-helix of the oligomerization domain disrupted the oligomerization of p53, but that p53 still retained its ability to inhibit colony formation of cells to some degree. These results suggest that oligomerization and the carboxy-terminal basic domain are not prerequisite for p53-dependent tumor suppression, and this may explain why few of the tumor-derived p53 mutations that have been examined so far are carboxy-terminal mutations.

[Functional screening of p53 status in tumor cells using Saccharomyces cerevisiae].

We have detected both germ-line and somatic p53 mutations in lymphocytes, cell lines and tumor tissues using a functional analysis of p53 tumor suppressor gene based on yeast transcription assay. Through our screening projects of the p53 gene, a number of missense p53 mutations were identified as loss-of-function mutations. This method, previously termed FASAY, is rapid, sensitive, less-expensive and can be automated for screening both somatic and germ-line p53 mutations.