Experimental observation of plastic deformation areas, using an acoustic microscope

Novel techniques are described for the observation of plastic deformation areas by using an acoustic microscope. On a test piece subjected to plastic deformation, an area was found that had an abnormal contrast in the crystal grain and a pointed end at the V notch. Calculation of the propagation velocity of the surface acoustic wave (SAW) showed a difference of several percent between this area and the rest of the test piece. It has been presumed that this difference reflects the local plastic deformation, and that the abnormal contrast area corresponds to the image of the two-dimensionally distributed plastic deformation area of metals.

Measurement of a damaged layer thickness with reflection acoustic microscope

An acoustic microscope was used for determining the frequency dependence of surface acoustic wave (SAW) velocity on a specimen whose silicon single-crystal surface was machined under various conditions. Consequently, thickness of the damaged layers could be estimated from the curvature points of frequency dispersion curves of the SAW velocity. It was revealed that thicknesses of the damaged layers can be estimated through rough approximation by about one-half the wavelength determined by the frequency at curvature points. From specimens possessing two damaged layers, frequency dispersion curves with two curvature lines can be obtained. From the curvature point at high frequencies the thickness of the top damaged layer can be determined. On the other hand, from the curvature point at low frequencies, the thickness of the inner damaged layer can also be determined. By choosing an acoustic lens as the condition for exciting SAWs, images can be observed while varying the frequency. From observation results obtained with this method, the distribution in the depth direction can be clarified.

[Chemotherapy of renal cell carcinoma: experimental study and clinical effect]

In vitro sensitivity tests of 6 antineoplastic agents (mitomycin C, bleomycin, adriamycin, Vinblastine , cis-dichlorodiamine platinum, ACNU) were carried out on cultured cell line (OUR-10) established from human renal cell carcinoma and the results were compared with clinical results of 16 cases of renal cell carcinoma treated in our clinic. The effect of these drugs was estimated from the cell growth curve and DNA histogram determined by flow cytometry. All these drugs showed a concentration dependent effect. However, the usefulness of these drugs was not recognized in 10 clinical cases of advanced tumors.

The effect of sustained stellate ganglion stimulation on left ventricular contractility in the dog

Although a progressive reduction in left ventricular contractility during sustained left stellate ganglion stimulation has been well documented, there have been no reports on the contractile state after nerve stimulation. Left ventricular contractility after cessation of 60 min of electrical (10 V. 10 Hz. 1 msec) left stellate ganglion stimulation has been assessed in open chest dogs. Before and 15 min after stimulation, left ventricular contractility was evaluated by the end-systolic pressure-segment length relationship using ultrasonic crystals during a stepwise aortic constriction to increase left ventricular afterload. Restimulation of the left stellate ganglion was also performed 15 min after cessation of the first stimulation. After sustained left stellate ganglion stimulation, the end-systolic points shifted to the right from the control and the slope of multiple pressure-segment length coordinates significantly decreased (102.5 +/- 16.1 to 76.5 +/- 10.2 mmHg/mm, mean +/- S.E., p less than 0.05, n = 5), indicating a depression of left ventricular contractility. Increased left ventricular dP/dt max and norepinephrine level in the coronary sinus gradually returned to near base line during 60 min of stimulation. These reduced responses lasted for at least 15 min after cessation of stimulation. The myocardial norepinephrine content was reduced to 0.59 +/- 0.08 (mean +/- S.E.) ng/mg wet tissue from 0.90 +/- 0.15 of the control level (p less than 0.05). These data suggested that left ventricular contractility decreased after sustained cardiac sympathetic nerve stimulation, probably due to norepinephrine reduction in the myocardium.

Renal transplant blood flow evaluation by ultrasonic duplex scanning

The transplant blood flow was measured renal transplantation by ultrasonic duplex scanner composed of pulsed Doppler flowmeter and real-time B-mode linear scanner in 32 patients. The blood flow information could be obtained from anywhere of interest within the renal transplant. Then blood flow in 3 regions including renal hilum, central echoes and renal parenchyma were measured. The parenchymal peripheral blood flow was not always similar to the hilar central blood flow. Parenchymal blood flow was the most correlated with graft function and decreased remarkably during acute rejection episode. This method enabled detection of occurrence of acute rejection in the course of post-cadaver transplant ATN. Prolongation of delta t (acceleration time) in Doppler spectrogram from parenchyma was also reliable evidence for the deterioration of graft function. Ultrasonic duplex scanning is a useful method in managing post-transplantation patients because intrarenal hemodynamics can be evaluated by this method.

[Studies involving 11 cases of early gastric cancer with a widespread lymph node metastasis]

Over the past 10 years, we have experienced 11 cases of early gastric cancer limited to the mucosa and submucosa, with a widespread lymph node metastasis over the perigastric node. These cases represented 3.8% of all the early gastric cancer cases treated at our hospital during this period. The average age of these patients was 49.1 years, and consisted of 7 males and 4 females. Of these 11 cases, 10 cases (90.9%) were, macroscopically, the depressed type. Histologically, 7 cases (63.6%) were poorly differentiated carcinoma. Curative resections were possible in 8 cases (72.7%). The cumulative 5-year survival rate was poorer than for other types of early gastric cancer, and amounted to 66.7% in cases that were curative, and 0% for non-curative cases.

[Treatment of primary gastric lymphoma and factors that influence the prognosis]

Twenty-two cases of primary gastric lymphoma have been clinicopathologically reviewed and factors influences the prognosis were examined. An increased tumor size of more than 10 cm, an increased tumoral penetration, a lymph node involvement, and stage IV classification decreased the survival rates. All patients given stage I classification have remained alive without having received chemotherapy. The survivors of stages III & IV amounted to only three patients who were treated by surgery and systemic chemotherapy. A radical operation is the choice of treatment for a gastric lymphoma but aggressive chemotherapy should be supplemented for advanced cases.

Defective interleukin-1 production in a familial monocyte disorder with a combined abnormality of mobility and phagocytosis-killing

Monocytes in a familial monocyte disorder, a recently recognized primary immunodeficiency syndrome, with impaired phagocytic functions were studied for their ability to produce interleukin 1 (IL-1) as well as the surface property. Monocytes from two children (siblings) with the disorder possessed CD11b, CD13, CD14, CD33, Ia and LFA-1/Mac-1/p150,95 beta subunit antigens as determined by flow cytometry. Electron microscopic cytochemistry showed that the monocytes had surface glycoproteins reactive with four representative lectins. The IL-1 production by monocytes was assayed in the two patients and compared with that in six children with primary immunodeficiency syndromes and some monocyte abnormalities; three had congenital neutropenia, two had hyper-IgE syndrome, and one had defective monocyte chemotaxis. Monocyte culture supernatants were prepared with stimulation by lipopolysaccharide or silica, and their IL-1 activity was measured by the mouse thymocyte-proliferation assay. The patients' monocytes were defective in IL-1 production: the values were less than 1.0% of the control monocyte values (n = 12) and were in contrast with those of congenital neutropenia monocytes of 186.2% to 204.3%. These results demonstrate a familial monocyte disorder which is characteristic among the immunodeficiency syndromes with regard to the defective IL-1 production and the impaired phagocytic functions.

[Measurement of nerve conduction velocity of the dorsal nerve of the penis]

Tests for evaluating the function of the nervous system in patients with erectile impotence have been performed indirectly with the measurement of nerve conduction velocity in the extremities and other neurological procedures, since it has been technically difficult to measure the nerve conduction velocity of the dorsal nerve of the penis. Calculation of the nerve conduction velocity of the dorsal nerve of penis from values of the bulbocavernosus reflex latency was not reliable and the development of a technique to measure accurately the nerve conduction velocity of the dorsal nerve of penis has been awaited. Ten impotent men were studied, and a precise description was made about the procedure of measuring the orthodromic nerve conduction velocity of the dorsal nerve of the penis. The dorsal nerve of the penis was stretched optimally with a weight of 300 g, and its conduction velocity reached the maximal value. This new methodology is of use in the evaluation of erectile impotence.

Right ventricular aneurysm due to congenital muscular defect in an adult

A large right ventricular aneurysm was detected by an echocardiographic examination in a 50-year-old woman presenting with weakness, collapse and hypotension. At surgery, another smaller aneurysm, arising from the anterior infundibulum of the right ventricle, was found in addition to the large one. Both were resected. Histological studies on the resected specimen revealed that much of the myocardium was replaced by adipose tissue. As far as we know this is the first reported case in Japan in which two congenital aneurysms arose from the right ventricle as a result of muscular defect.

[A case of early gastric cancer forming a large abdominal tumor from a lymph node metastasis]

A 37-year-old male was admitted to our hospital because of an abdominal tumor, about the size of a fist, located anterior to the pancreas head. This tumor oppressed the antrum of the stomach to the left, and an operation was performed, the tumor being diagnosed as a leiomyosarcoma of the stomach, determined from image findings. After histopathological examination, however the tumor proved to be an adenocarcinoma. An early gastric cancer was found at the anterior wall of the antrum during the operation, and the tumor was thought to be a metastatic lymph node. Lymph node metastasis also was observed at the root of the mesentery.

[Complication during the period of anuria after cadaveric transplantation--with special reference to wound bleeding]

Some period of anuria is usually expected after cadaveric renal transplantation, and hemodialysis is necessary during the period. Postoperative bleeding in the anuric period is not uncommon and usually can be easily controlled with adequate conservative treatment. However, it becomes uncontrollable in some cases and causes a series of serious complications. Out of 22 patients having undergone cadaveric renal transplantation in our hospital, six patients had postoperative bleeding. On investigation of these cases, we found that not only a hemorrhagic tendency due to uremia but also hemodialysis is a risk factor of bleeding in the wound.

[Effect of valve replacement on left ventricular function in chronic aortic regurgitation]

To ascertain the optimal time for surgery in chronic aortic regurgitation (AR), 66 patients with and without surgical correction were reviewed from the standpoint of left ventricular (LV) function based on their serial echocardiographic studies. Aggravation of the clinical status was usually associated with enlarged LV dimension, decreased %fractional shortening (%FS), and increased LV end-systolic meridional stress (sigma m). Fourteen patients developed congestive heart failure during follow-up periods of up to five years, and most of their echocardiographic findings showed %FS less than 27%, and LV end-systolic dimension (LVD) greater than 50 mm. Thirty-two patients underwent surgery. Preoperatively, sigma m and %FS were closely correlated, including cases whose %FS was decreased. This linear regression equation became steeper with dobutamine administration; however, in patients, whose mean preoperative LVD value exceeded 50 mm, the %FS remained depressed (delta FS less than 6%) and sigma m did not significantly decrease during dobutamine administration. Marked or moderate resolution of LV dilatation and hypertrophy was observed in all patients postoperatively. Compared to patients with preoperative %FS greater than or equal to 27%, much more time was required for recovery of patients with %FS less than 27%, though their %FS and their exercise capacity improved within two years of surgery. Immediate postoperative recovery was observed in cases with excellent preoperative response to dobutamine (delta FS greater than or equal to 6%). However, in patients with severely depressed preoperative %FS less than 20%, postoperative improvement was not so marked and the surgical results were unsatisfactory. From these results, we concluded that the optimal time for surgery for AR is when %FS = 27% and LVDs = 50 mm.

[Results of treatment of primary malignant tumor of the small intestine]

The results of treatment of 40 cases of primary malignant tumor of the small intestine are reported. The malignant tumors included 14 leiomyosarcoma, 12 malignant lymphoma and 14 adenocarcinoma. Our standard treatment for these tumors was segmental resection of the small intestine with its mesentery including the regional lymph nodes and we used additional adjuvant chemotherapy for some cases of malignant lymphoma and adenocarcinoma. Curative resection was performed in 57.1% of leiomyosarcoma, 50.0% of malignant lymphoma and 61.5% of adenocarcinoma. Cumulative 5-year survival rates were leiomyosarcoma 21.4%, malignant lymphoma 53.0% and adenocarcinoma 43.3% respectively. Serosal infiltration, lymph node metastasis and operative curability proved to be the prognostic factors. In particular, the 5-year survival rate of patients on whom curative resection could be performed was significantly better for each tumor type than that of patients for whom this was not possible, the figures being leiomyosarcoma 40.0%, malignant lymphoma 83.3% and adenocarcinoma 83.3%.

The degree of increment in plasma catecholamines in patients with mitral stenosis by mild exercise

Although sympathetic excitation during mild exercise may readily occur in patients with mitral stenosis (MS), the degree of increment in plasma catecholamines has not been fully investigated. We imposed mild ergometric exercise (50 watts, 300 kg/min for 5 minutes) on five patients with mild MS (mitral valve area greater than or equal to 1.0 cm2) and eight with severe MS (mitral valve area less than 1.0 cm2) while they were undergoing cardiac catheterization. In patients with severe MS, total plasma catecholamine levels during exercise were remarkably higher (2821 +/- 783 [SEM] pg/ml) than in those with mild MS (957 +/- 113 pg/ml, p less than 0.05) and in seven control subjects (612 +/- 75 pg/ml, p less than 0.05). This marked increment could not be predicted by heart rate response, which did not differ between severe and mild MS (166 +/- 5 vs 153 +/- 10 bpm). In contrast with catecholamine change, the cardiac index in severe MS showed a very small increment. Results suggest that mild daily exercise can remarkably increase plasma catecholamine levels in severe MS, and this may accelerate various complications of this disorder.

[A case of a perforation indicative of early gastric cancer with various macroscopic findings and a collective review of the relevant Japanese literature]

A case of perforated early gastric cancer and a collective review of the relevant Japanese literature is reported. A 83-year-old woman with free air discovered by an abdominal X-ray, was referred to our hospital. On operating, a perforated ulcer was found within and lesions, indicative of a IIc + III type early gastric cancer. Macroscopically, there was an elevated lesion at the antrum of the stomach as well. Histologically, these lesions were connected and moderately differentiated adenocarcinoma. Another lesion was also found at the anterior wall and diagnosed as IIb type gastric cancer.