Takao Mitsuno

Present status of clinical studies of Fluosol-DA (20%) in Japan.

Fluosol-DA (20%) is a fine-particle stable emulsion with low toxicity and rapid elimination from the body. Based on comprehensive animal experiments and phase one human studies, Fluosol-DA (20%) has been given clinically to 401 patients in Japan. In 270 of these patients, it was given to treat severe hemorrhage, and in 131, it was given to improve impaired cerebral circulation or for other nonhemorrhagic indications. In these studies, Fluosol-DA (20%) was effective as a blood gas carrier as well as a plasma expander. After infusion of 20 ml of Fluosol-DA (20%) per kilogram of body weight, while maintaining the FIO2 at or near 0.5 or 0.6, PFCs transport an amount of oxygen equivalent to approximately 6.3 +/- 1.4% of the oxygen transported by the hemoglobin phase and approximately 100% of the oxygen transported by plasma. The arteriovenous oxygen difference in the PFC phase was approximately 25 to 30% of that in the hemoglobin phase. Of the oxygen consumed by the tissues, approximately 17% was provided by the PFC phase after treatment with Fluosol-DA (20%). Hemodynamic parameters of patients with hemorrhage were either maintained or recovered to normal levels after Fluosol-DA (20%) infusion. No acute or chronic untoward reactions were observed either early or late after infusion of Fluosol-DA (20%), except for a transient decrease in neutrophils and platelets after the initial administration of a test dose of 1 ml, and these parameters recovered spontaneously in 30 minutes. No abnormal findings that could be attributed to Fluosol-DA (20%) were found in the heart, lungs, liver, spleen, kidneys, bone marrow, endocrine system, or other organs. Organ retention of PFC particles was evaluated in 6 autopsy cases in Japan. Although PFCs were detected in many organs several months after a single Fluosol-DA (20%) injection of 20 ml per kilogram of body weight, PFCs were not found in body tissues of those who were autopsied more than 7 months after its infusion. RES function was slightly depressed for a few days in patients receiving 20 ml of Fluosol-DA (20%) per kilogram of body weight. It was also depressed for several days in rats given 40 ml per kilogram of body weight. Compared with that of control patients, recovery to preoperative levels was slightly delayed in patients receiving Fluosol-DA (20%). Despite this, administration of up to 20 ml of Fluosol-DA (20%) per kilogram of body weight should be safe with respect to the RES function.(ABSTRACT TRUNCATED AT 400 WORDS)

CLINICAL OBSERVATION ON GROWTH PATES OF HUMAN GASTRIC CANCERS

胃癌の逆追跡症例12例について, X線的な胃癌の生長解析を試みた. 胃癌の径生長曲線と壁深達度の分析から, m癌からse癌に至る胃癌の生長過程に, 早期癌および早期癌を思わせる病巣にみられ徐々に癌径を増す早期癌期, 癌径をほとんど増さず主として深部浸潤を示す早期癌を思わせる病巣から進行癌に移行する早期・進行癌移行期および進行癌にみられる急速に癌径を増す進行癌期の性質の異った3時期の存在が観察された. これらの3生長期における平均癌径・面積生長速度および平均癌径倍加時間を測定し, それぞれの測定値を従来の報告例と比較して, m癌からse癌に至る胃癌の生長過程について考察を加えた.

METABOLIC CHANGES AND THEIR CARE OF THE SURGICAL PATIENTS WITH DISEASES OF ALIMENTARY TRACT

消化管切除後の代謝的変化とその対策を術後急性期と慢性期に分け, 臨床例と動物実験の成績より検討し, 以下の成績を得た.消化管手術は侵襲の大きいものが多いこと, 他の疾患にくらべて経口摂取の長い制限のあることを反映して, 代謝抑制が強くかつ長いと思われたが, 積極的な外科栄養管理は術後のcatabolismを相対的に減少させえた.慢性期の代謝的変化はすでに手術時の再建術式によってかなりの部分が決まってしまうので, 可及的術後変化の生じにくい再建術式が必要であるが, 同時に不可避の変化を管理する代謝的対策が必要と思われた.

The experimental study on neurogenic gastro-duodenal ulcer

of ulcerogenic properties in cats. These production were made by electrical stimulation of hypothalamus with pre-treatment of reserpine (1 mg/kg.s.c.). Namely, pre-treatment of reserpine and electric stimulation of anterior hypothalamus formed the perforated duodenum ulcer, mainly. On the contrary, same treatment and stimulation of posterior hypothalamus produced the perforated gastric ulcer greatly. From these experiments, peptic ulcer was separated or divided into 5 types of ulcers. That is, fundic ulcer 1~, multiple ulcer :), pyloric antrum ulcer 3> (kissing and round types), gastro-duodenal ulcer 4) (ulcer was located in boundary between stomach and duodenum), and duodenal ulcer 5~, so on. In the gross-observation of these ulcers, authors have found that the vascular system which is supplied to the gastro-duodenum have some trouble on it. This may be thought that the effects of excessive biogenic amines as serotonin, catecholamines, and histamine may elicited the nervous excitation and then the related tissue resistances to nature was probably diminished. In consequence of vascular disturbance by these amines, the ulcers might be formed in short time. The location of above mentioned ulcers are probably due to displacement and release, brought about by reserpine and probably also by electric stimulatiou with time correlation. From the location of each type of ulcer existence, authers have assumed that the formed-gastric ulcers themselves may have some reasons for peptic ulcer patients. So that, t rea tment of subjects may need to have the well-advised diagnosis or careful observation for them. The differences between gastric and duodenal ulcers may be thought from the vascular and nervous supplies to those organs.

Studies on origin of gastric cancer

Since HAUSER described the pathohistological cri teria for gastric ulcer as a origin of cancer, these studies have been remarkably performed in Japan. These investigators have determined cancer as origin from ulcer in wider point of view, and the reflecting theory has been reformed by the School of IMAI. We report cases here with cri ter ia on the standpoint of affirming cancer originating from ulcer. 1) By histological comparison with 183 cases of cancer including 28 cases of early cancer and 101 ulcerations in 83 cases of gastric ulcer, conventional cri teria might be utilized. 2) The I group of cancer from ulcer by HAUSER exsisted in 2.7%; the II group of cancer

The Future of the Surcical Treatment for Hypertensive Intracerebral Hemorrhage

The surgical treatment for hypertensive intracerebral hemorrhage has been tried for 60 years since Cushings first trial. The results so far obtained, however, were so unsatisfactory that the progress of the treatment is by no means remarkable. Recently the great advancement in surgery has made us possible to get rather good results from this treatment. We operated on 43 cases of the most severe type of intracerebral hemorrhage which, except a few, were condemned hopeless by the conservative treatment . Twenty-four of them recovered well and some of those patients even resumed their work. It is considered that the patients of comparatively less severe type should be operated on actively, as the previous cases of this type showed dramatic recovery after operation. The operation on the cases with hematoma smaller than walnut in size has some difficult problems . Cerebral angiography and echoencephalography are contributable to decide the surgical indication. Especially, the hematoma echo in echogram , proposed by us for the first time, has been proved very important for local diagnosis of hematoma. Among the methods of operation, the most ideal is the trephination with total evacuation of hematoma using trephine of 4 cm in diameter . If nerve adhesive is developed and the cut nerve fibres are connected with it, hemiplegia will easily be improved after the internal capsula hematoma has been evacuated. Postoperative care should be done concentrating on an early recovery of cerebral function, the prevention of lung complication and the treatment of gastroduodenal bleeding, to which gastric cooling is effective and its active application will be recommended in future . Thus, the surgical treatment for hypertensive intracerebral hemorrhage is believed to advance as the better results will be expected with the progress in diagnostic technique, the establishment of surgical indication, and proper postoperative care.