Pulmonary tuberculosis with chemotherapy related liver dysfunction

A retrospective study of the hepatotoxicity of antituberculous drugs was undertaken to establish preventive measures for elevated transaminases by analyzing its clinical courses. Four hundred and forty six patients with normal liver function on admission were enrolled in this study. More than 50% of total 113 cases who showed abnormalities of transaminases were aggravated up to 4th week after administration of drugs, and 80% up to 8th week. The initial values of elevated transaminases did not relate to recovery rate, and could tolerate the additional administration of drugs. However, cases with higher peak values and exacerbation in transaminases showed a tendency of delayed normalization. These results indicate that the chronological observation of transaminases is useful to determine whether or not the antituberculous drugs should be discontinued when hepatic dysfunction occurs. Moreover, they suggest that patients with severe pulmonary tuberculosis may continue chemotherapy with the same regimen under careful observation of liver function even when their transaminase values exceed 100.     

The treatment of affective disorder with carbamazepine: prophylactic synergism of lithium and carbamazepine combination.

1. In order to examine the prophylactic interaction between lithium and carbamazepine (CBZ), 18 patients who had been treated prophylactically with a combination of lithium and CBZ (combination therapy), lithium alone (Li-therapy), or CBZ alone (CBZ-therapy) were investigated in terms of episode occurrence. 2. The results revealed that the duration of symptoms and the frequency of hospitalization per year were significantly lower in the combination therapy than in both the Li-therapy and the CBZ-therapy. 3. In 7 out of 18 patients, the best prophylactic effect was obtained during combination therapy and none of the parameters measured was definitely inferior to those measured during the two single therapies. 4. During combination therapy, serum lithium level was significantly lower than during Li-therapy in the CBZ responders, and the combination of the two drugs enabled the required concentrations of lithium to be decreased. 5. It was concluded that synergistic action and a decrease in required concentrations of lithium can be expected with the combined use of lithium and CBZ, especially in responders to CBZ.     

Intensity of exposure to asbestos in metropolitan Kure City as estimated by autopsied cases.

In this study, the intensity of exposure to asbestos was evaluated in the residents of Kure City, the site of the Japanese naval shipyard, Kure. The number of asbestos bodies was counted in 728 autopsied cases from those treated surgically in Kure Kyosai Hospital. Five grams of lung tissue was lysed, and the number of asbestos bodies was counted with the use of light microscopic examination. By this method, the number of asbestos bodies detected in men was significantly higher than that in women. There was a peak between 60 and 70 years of age. The number of asbestos bodies in exposed cadavers in Kure City exceeded greatly that found in other districts of Japan. By this criterion, 58 of 109 patients with lung cancer had asbestos exposure, and 39 had a high exposure to asbestos. All 13 patients with malignant mesothelioma had a high exposure to asbestos. Excess asbestos exposure also was found in a large proportion of patients with gastric cancer, colon cancer, and acute leukemia. The crocidolite type of asbestos was detected frequently in patients of malignant mesothelioma or leukemia, and the chrysotile form was found in those with lung cancer.     

Application of new intraurethral stent for higher risk patients with benign prostatic hypertrophy]

We reviewed our experience of the application of a new urethral stent (PROSTAKATH) for 8 patients with prostatic outflow obstruction from December 1989 to March 1990. 6 patients had required the Foley catheter for several months because of chronic urinary retention. 2 were dys-uric patients having a higher bladder residual urine volume. All were in a high risk group for surgery. 7 out of the 8 patients were treated successfully. The stent was not placed in one. All 7 patients in whom the urethral stent was placed voided freely after placement of the stent. Bladder residual urine was not detected by the ultrasound sonography except in one patient. The urethral stent used in this study was a spring-like spiral with an outside diameter of 21 Fr, it is made of gold-plated stainless steel. Under local anesthesia, it can be easily inserted using a 6-7 Fr. ureteral catheter as a guide wire under ultrasonic scanning guidance. During the follow-up period of 5-8 months, 1 patient had an episode of migration of the stent to the bladder 2 months later, which was removed endoscopically, and a new stent was placed. Side effects were observed in 2 patients; one complained of strong discomfort and the other suffered from urge incontinence. Both symptoms were ameliorated during the follow-up period. We conclude that the urethral stent is an effective device as a non-invasive treatment of prostatic outflow obstruction.     

Ultrasonic Doppler assessment of hemodynamics in gradual carotid ligation

Hemodynamic changes were examined with an ultrasonic Doppler flowmeter and with a sound-spectrograph in 5 patients with internal carotid giant aneurysms or with recurrent laryngeal cancer undergoing gradual carotid occlusion. The ultrasonic Doppler technique was useful for preoperative assessment of intracranial cross-filling and as a practical guide for the graded reduction of blood flow in the carotid artery. The degree of flow increase in the contralateral carotid artery when the ipsilateral carotid artery was totally occluded was greater in postoperative gradual occlusion than in intraoperative rapid occlusion. In one patient with bilateral internal carotid artery giant aneurysms, whose left internal carotid artery had already been ligated at its origin, gradual occlusion of the right internal carotid artery was performed after the bilateral superficial temporal artery-middle cerebral artery (STA-MCA) anastomoses. Flow in the donor artery of the right STA-MCA anastomosis developed with increasing occlusion of the right internal carotid artery.