Okayama University Medical School

This study demonstrates that an adrenergic mechanism plays an important role in producing the delayed cerebral vasospasm which follows subarachnoid hemorrhage. Results were as follows: 1. Experimental subarachnoid hemorrhage (SAH) was produced by injection of fresh arterial blood into the cisterna magna in cats. The cerebral vasospasm was shown angiographically to be biphasic in nature: immediate constriction lasting 1 h and marked prolonged spasm occurring between the 3rd and 5th day after SAH. The amount of noradrenaline (NA) and dopamine-beta-hydroxylase (DBH) activity decreased over a period of 24 h both within the wall of the basilar artery and in the locus ceruleus and then gradually increased, reaching a maximum on the 3rd day after SAH. 2. Topical application of spasmogenic substances (NA and blood) produced a marked constriction of the hypersensitive basilar artery on the 3rd day after SAH. 3. 6-Hydroxydopamine (6-OHDA) injection into the cisterna magna produced prolonged vasocilatation. The dilated vessel responded with mild transient constriction after the topical application of NA or fresh blood. DBH activity and NA concentration in the vessels, locus ceruleus and medial hypothalamus decreased markedly on the 3rd day after the cisternal injection of 6-OHDA. 4. Various spasmogenic substances (i.e. serotonin, NA, prostaglandins and methemoglobin) were measured in a mixture of equal volume of CSF and blood in cats. ONly the serotonin in the mixed fluid produced vasoconstriction. Spasmogenic substances decreased markedly in the mixed fluid incubated for 3 days at 37 degrees C, and none of these substances apart from methemoglobin was present in a concentration sufficient to produce constriction of vessels. 5. These results suggest that early spasm is induced by serotonin around the arteries of the cranial base, and delayed spasm might be caused by hyperreaction of cerebral vessels to spasmogenic substances such as methemoglobin, during the accumulation of excess NA in the cerebral vessel wall.

Primary mass culture of isolated cells from adult rat livers by the trypsin-perfusion method uas carried out to investigate cytological and biochemical properties of primary cultured cells. Two main types of cells were found in the course of primary culture of isolated hepatic cells. One was a group of polygonal cells with granular cytoplasm, which appeared to arrange themselves in cords and clusters 3 to 4 days postinoculation and then gradually decreased in number. These cells seemed to be associated with expression of liver specific functions such as higher tyrosine aminotransferase levels and transient increases in albumin production. Another type of cells was relatively small in size and had clear cytoplasm, which grew out rapidly in place of the polygonal cells and proliferated also in subculture. alpha-Fetoprotein was detected in the cultured media of the proliferating clear cells. These results suggest that the polygonal cells and the clear cells may correspond to the mature hepatocytes and the hepatocytic stem cells in vivo, respectively.

We report the first case in Japan, i.e., the first case among oriental subject of Farber's disease. This is a rare disorder of lipid metabolism in infancy subsequent to a genetically-determined defect in ceramide degradation. Main features are characterized clinically by hoarseness, joint swelling, subcutaneous nodules and retarded psychomotor development. Lipid analysis and pathological investigation on the material obtained from a subcutaneous nodule confirmed clearly the presence of ceramide and intracytoplasmic inclusion bodies characteristic for Farber's disease. In this case, we experienced also corneal opacity and striking abnormalities in electroencephalogram, which have apparently not been noticed in the 17 cases hitherto reported.

A case of liver hemangioma complicated by intravascular coagulopathy is presented because of the rarity of the association. Hemangioma of the liver was suspected by palpation of the liver tumor, scintigraphy and x-ray examination, and confirmed by selective hepatic arteriography in combination with exploratory laparotomy. Intravascular coagulopathy was established by demonstrating secondary fibrinolysis and consumption of platelets and coagulation factors. Unconjugated hyperbilirubinemia due to micro-angiopathic hemolytic anemia was also present. The clinical course of the clotting abnormalities was basically a chronic one with an occasional acute or subacute defibrination process associated with further enlargement of the hepatic tumor. These provide sufficient evidence that the intravascular coagulopathy was closely related with the hemangioma in the liver. Neither ligation of a presumed nutritional artery of the hemangioma nor radiation therapy caused any demonstrable reduction in the tumor size.

Effects of propranolol on ischemic segmental function were studied in anesthetized open-chest dogs. Two segment-length gauges were used for measuring the regional myocardial function: one was sutured on to the left ventricular surface perfused by the anterior descending coronary artery (ischemic zone) and the other was on to that perfused by the circumflex coronary artery (normal zone). A bolus of propranolol (0.5 mg/kg) was injected into the right femoral vein. Five min later, the left anterior descending coronary artery (LAD) was completely occluded for one mine and thereafter released. Then a second coronary occlusion for 20 min was performed; an interval of 20 min was allowed between two occlusions. Propranolol, in the ischemic segment, apparently decreased the extent of paradoxical lengthening in the late systole following one min LAD occlusion, and facilitated improvement of segmental function after release of the occlusion. Moreover, the extent of abnormal stretching induced by 20 min occlusion during early systole, was also reduced by propranolol pretreatment. In contrast, compensatory increase in shortening by the normal segment was disturbed by propranolol. These results suggest that propranolol might exert a favourable influence on the segmental myocardial function during either transient or maintained myocardial ischemia.

The enzymatic conversion of azathioprine to 6-mercaptopurine was detected at pH 6.5 with rat liver supernatants, although the non-enzymatic reaction predominated at pH 7.0 and 7.5. Glutathione S-transferase may catalize this conversion. Activities of the enzyme in liver with both zathioprine and 1,2-dichloro-4-nitrobenzene as substrate decreased upon carbon tetrachloride-induced hepatic injury. These results may explain an ineffectiveness of azathioprine in patients with severe hepatic damage.

The biological specificity of the endotoxin receptor on platelet membranes was examined. The binding indices of platelets in experimental endotoxemia which was induced by intravenous administration of endotoxin (Lipopolysaccharide of E. coli, Difco) to rabbits were found to be 30% of the control at 60 min after the injection. The result suggests that the endotoxin receptor of platelets was already occupied. The binding indices of human platelets were measured after pretreatment with pharmacologically active substances which were assumed to effect platelet activity. The binding of LPS to platelets showed competitive inhibition at pharmacologically effective doses, but other substances merely inhibited platelet activity. One interpretation is that there is a common receptor on platelet cell membranes for lipopolysaccharide of E. coli and endotoxin. The sensitivity to endotoxin in vivo and binding indices of platelets were examined in rabbits and guinea pigs since their response to endotoxin is almost opposite with regard to sensitivity. The binding indices of platelets from rabbits and guinea pigs showed a positive correlation with the endotoxin sensitivity. Those findings indicate that platelets play a key role in vivo in the clinical course of endotoxemia.

The intestinal mucosal barrier of rabbits was damaged by carrageenan-induced ulceration of the colon, superior mesenteric artery occlusion (SMAO) and hemorrhagic shock and the values of Endotoxin (lipopolysaccharide, LPS) were determined by radioimmunoassay and the concentration of lysozyme (LZM) by the turbidimetric method. As a result, endotoxemia was observed in 13 out of 15 carrageenan rabbits, and in all of the SMAO and hemorrhagic shocked rabbits. Serum LZM concentration rose with time in all cases. As to the correlation of LPS and LZM, they changed almost in parallel in carrageenan rabbits, SMAO and hemorrhagic shock. LPS value and LZM concentration in blood were also determined in LPS injected rabbits. It was confirmed that injected LPS increased the LZM concentration of blood. On the basis of these results, it can be concluded that destruction of intestinal mucosal barrier permits an invasion of LPS into blood and then releases LZM into the blood stream.,/p>

This research was performed to establish a cell line from experimental bladder tumor and to discuss the biological characteristics of the cell line so established. Tissue cultures of epithelial cells were derived from a rat bladder cancer induced by BBN. The cells showed loss of contact inhibition and the phenomenon of piling up after several subcultures. Colonial cloning was used. The population doubling time of the wild strain and the colonial clones was about 30 h. The chromosomal mode ranged from triploid to tetraploid to tetraploid. Plating efficiency was well below 20%. Intraperitoneal backtransplantation into newborn Wister rats resulted in tumors in all cases. These tumors, in some parts, resembled primary transitional cell carcinoma. The major tumor cell groups, however, showed marked keratinization and the picture of squamous cell carcinoma. The nucleus/cytoplasm ratio and the numbers of nuclei, free ribosomes and intracytoplasmic microfibrils were increased. Dense microvillus arrangements characterized the electron microscopic picture. During the mitotic phase, the cells became large and globular whereas the microvilli were relatively short and were gathered profusely over the whole surface. Cells in the gap 1-synthetic phase developed lamellipodia and pseudpodia-like cytoplasmic processes and were polygonal in shape. Microvilli were present in the central part containing the nucleus, but their numbers were somewhat decreased and their height increased (scanning electron microscopy).

A new instrument for visual field examination with binocular fixation is described. The binocular vision was dissociated with polarizing plates. Only the point of fixation was visible to both eyes while the testing chart (Amsler chart) was visible to one eye in the use of this apparatus. The examination was done with both the patient's eyes open. With the use of this apparatus, not only was the visual line fixed steadily in order to detect various changes of the central visual field due to maculopathy or optic neuropathy and these changes were detected accurately and quickly, but also suppression scotoma associated with amblyopia or squint could be detected quantitatively.

Levamisole, an agent acting upon depressed cellular immunity, enhancing and normalizing it and consequently showing antitumor activity in the cancer-bearing body, was administered to patients with gastrointestinal cancer at a daily dose of 150 mg for three consecutive days every other week, starting as a rule, three days before operation. The patients were evaluated for survival. Of the 143 patients (66 with curative resection, 40 with noncurative resection and 37 without resection) who received levamisole therapy for one month or more, 57 survived postoperatively six months and of 44 treated 37 survived one year. In this study, 185 patients with gastrointestinal cancer were used for comparison purposes. The six-month survival rate was 100% (23/23) in the levamisole treated group and 95.3% (102/107) in the control group after curative resection (p greater than 0.5), 100% (23/23) and 90.5% (49/54) after noncurative resection (p less than 0.01), and 72.5% (8/11) and 33.3% (9/24), respectively, in non-resectable patients (p less than 0.01). The one-year survival rate was 100% (21/21) and 95.3% (102/107) after curative resection (p greater than 0.5), 77.8% (14/18) and 59.3% (32/54) after noncurative resection (0.05 less than p less than 0.1), and 40% (2/5) and 8.3% (2/24) in non-resectable patients (0.05 less than p than 0.1) in the levamisole group and in the control group, respectively. The difference in survival in survival rates between levamisole-treated and control groups was most prominent in the non-resectable patients followed by those undergoing noncurative resection and curative resection.

With the parameters of a flow-volume and a volume-time curve, the discriminant analysis of bronchial asthma is described. The subjects were classified into three groups (healthy adults, mild asthmatic patients and moderates ones). The difference of the mean vectors of the parameters of the three groups was made clear by the selection methods of the discriminant analysis between any two of the groups both with 6 parameters (%FVC, FEV1.0%, peak flow rate (PF), flow rate at 50% of FVC (V50), flow rate at 25% of FVC (V25), and V50/V25) and with 8 (6 parameters mentioned above and V75, V10). Forced expiratory volume in 1 second percent (FEV1.0%) or V50 was selected at the first step with 6 parameters, and V75 was selected at the first step with 8 parameters. Probabilities of misclassification with 8 parameters were lower than those with 6 ones and the probability of misclassification at the discriminant analysis between healthy adults and mild asthmatic patients with 8 parameters was 15.75% at the final step.

Enzyme deviations in injured livers were studied by analyzing isozyme patterns of phosphorylase using a newly developed electrophoretic method, which separates six molecular species of this enzyme, i.e. M,FM,F,L,L', and FL'. In hepatic injuries caused by CCl4 and galactosamine intoxications of rats, F appeared in early stages and L' (and FL') in later stages of the injuries with a concurrent decrease or loss of L, which is a sole isozyme component of adult liver. In injured livers of patients with hepatitis and cirrhosis of the liver, increases in FL' activity were also found. Appearance of F was found only in hepatocellular carcinoma. The results obtained with phosphorylase isozyme analysis support the idea that an undifferentiated gene expression takes place in the injured livers of non-malignant hepatic disorders.

Malignant fibrous histiocytoma of soft part is rather common but malignant fibrous histiocytoma of the bone is rarely encountered clinically. Authors present five cases of malignant fibrous histiocytoma with skeletal involvement and discuss their clinical course, x-ray findings and histological features. This tumor has marked tendency for local recurrence and metastasis. Other bone tumors such as giant cell tumor, aneurysmal bone cyst, non ossifying fibroma, osteosarcoma, fibrosarcoma of bone and metastatic cancer can be excluded by several characteristic findings observed in x-rays as well as histopathological features. All information on the patient should be carefully analysed, because it is difficult to decide whether bone involvement is primary or secondary. Four out of five cases definitely originated within the bone.

In urine of diabetics, a significantly great inhibitory activity of glyceraldehyde 3-phosphate dehydrogenase (GAP-Dehyd) was observed compared with that of normal subjects. The 0.2 ml of urine from 41 patients with diabetes mellitus inhibited 0.5 units of GAP-Dehyd by 27.2 +/- 3.0% (mean +/- S.E.M.), while that from 17 normal volunteers inhibited only by 9.0 +/- 1.0% (P less than 0.05). This inhibitory substance was extracted by 90% ethanol from diabetic urine and partially purified by anion exchange chromatography using Dowex-1 (HCOO type). The molecular weight of this substance was confirmed to be 100--300 daltons by an analysis on Biogel P-4 gel filtration chromatography. And analysis by thin layer chromatography using silicagel plate showed that this inhibitor was a ninhydrin reactive substance which has not been reported previously. From the above facts, it was assumed that the inhibitory substance of GAP-Dehyd in urine of diabetics was a new acidic compound of low molecular weight containing an amino residue in the molecule.

Micromethods for estimation of bilirubin uridine diphosphate-glucuronyl and -xylosyl transferases in liver are described. With these methods, a liver specimen as small as 10 mg is sufficient for assay of either enzyme activity and 15 mg is sufficient for assay of both enzymes. Normal values for livers with minimal elevation of SGOT and minimal histological change were 0.260-0.400 U/g protein for glucuronyl transferase and 0.142-0.302 U/g protein for xylosyl transferase.

The case of a patient with repeated attacks of collapse induced by sublingual isosorbide dinitrate is reported. The patient was an 81 year-old female who was admitted to Yura Hospital because of attacks of precordial pain. Several minutes after the sublingual administration of isosorbide dinitrate (10 mg) for an anginal attack, she developed a sensation of general weakness, and thereafter because unconscious. Arterial blood pressure fell and became unmeasurable. Electrocardiograms recorded during the syncopal attack showed sinus tachycardia and significant elevation of ST-segment in right precordial leads. In response to a drip infusion of noradrenaline, arterial blood pressure returned to normal with recovery of consciousness. Two similar syncopal attacks induced by sublingual isosorbide dinitrate occurred in the next three days. These attacks were not due to augmentation of the vagal reflex. Decrease of venous return probably was the primary etiological factor.

Ninety-nine gastric cancer patients initially received levamisole at a daily dose of 150 mg for three consecutive days before operation. This therapy was repeated fortnightly (3-day administration followed by 11-day withdrawal period) for more than one month as long as possible and the survival rate up to 18 months was compared with thas of control patients. The 18 month survival rate of advanced Stage IV patients was significantly higher in patients receiving levamisole than that of control patients. The effects of levamisole in cases of advanced cancer have been discussed in relation to the literature available.

In view of comparatively-high incidence of papillary, well or moderately-well differentiated, transitional cell carcinomas in urology, and of frequent recurrence of carcinomas after appropriate procedures, we have undertaken the correlative study on urinary cytology with cystoscopy, pathology and the amount of fibrinogen and degradation products of fibrinogen and fibrin (FDP). Cytopathologically, 191 cases were confirmed histologically for cancers out of 442 cases studied cytologically; among these 442 classes IV and V were found in 136 cases, and 99 of 136 cases (72.8%) had cancers. Admittedly, we were unable to suspect tumors cytologically in 24.5% of the cases. As to histological gradings and cytology, 48.7% of classes I and II in well differentiated were found against 52.9% and 57.1% of classes IV and V in moderately-well and poorly differentiated carcinomas, respectively. Urinary FDP assay was quite promising; out of 19 cases with both positive cytology and FDP, 18 (94.7% had carcinomas histologically, whereas 12 of 56 cases (21.4%) with both negative cytology and FDP bore cancers. Subsequently, several proposals for improving the diagnostic accuracy were discussed. We concluded the importance of accumulating more cases by combining several diagnostic procedures, especially among well and moderately-well differentiated carcinomas.

Electron microscope observation of cultured human leukemic B cell, T cell and null cell lines and reverse transcriptase assay of the culture supernatants were all negative for the presence of C-type virus. Bat cell line, which propagates primate C-type viruses well, was cocultivated with the human leukemic cell lines, in the hope of amplification of virus if present. Three weeks after mixed culture, the culture supernatants were again examined for reverse transcriptase activity and the cells were tested for syncytia formation by cocultivation with rat XC, human KC and RSb cell lines. All these tests, except for the positive control using a simian sarcoma virus, were negative, suggesting that no C-type was produced from these human leukemic cell lines.