Ruptured aneurysm of an azygos anterior cerebral artery

A ruptured saccular aneurysm of the azygos pericallosal artery was found and clipped successfully in a woman of 47 years. Aneurysm of an azygos pericallosal artery is extremely rare.

Injury to the spinal cord produced by acupuncture needle

An unusual case of injury to the upper cervical spinal cord is reported. A 62-year-old woman had been treated with acupuncture for stiffness of the muscles of her neck four to five years before she developed gradually progressive hypalgesia and hypothermesthesia over the right half of her body. Radiological examination and CT scan revealed the broken tip of an acupuncture needle between the first and second cervical vertebrae. The needle was removed. There was a moderate recovery of sensation.

A synthesis of dihydrostreptomycin

A key protected streptidine derivative (3) useful for the synthesis of antibiotics of streptomycin series was prepared by hydrolysis of an acylated dihydrostreptomycin (DHSM) derivative (2), and it was condensed with a protected dihydrostreptobiosaminyl chloride (5) to give two condensation products (6 and 7). By deblocking, 6 was led to DHSM and 7 to a biologically inactive isomer (8) of DHSM. From the PMR spectrum of 4-O-mesyl derivative (4) of 3, the benzyloxycarbonyl and acetyl groups were concluded to be attached to the end nitrogens of the guanidine groups.

Psychotropic agents. 3. 4-(4-Substituted piperidinyl)-1-(4-fluorophenyl)-1-butanones with potent neuroleptic activity

A series of 1-(4-fluorophenyl)-4-(1-piperidinyl)-1-butanones substituted with benzimidazole, benzotriazole, or quinoxaline at the 4 position of the piperidine ring was synthesized and subjected to neuroleptic tests. Neuroleptic activities of several compounds were comparable to those of haloperidol. In particular, 4-[4-(2,3-dihydro-2-thioxo-1H-benzimidazol-1-yl)-1-piperidinyl]-1-(4-fluorophenyl)-1-butanone (10) was characterized by having a potent neuroleptic activity with less liability to the extrapyramidal side effect.

Pancreatitis-like isoamylase pattern in normal persons

On the assumption that a rise in the pancreatic type isoamylases may not necessarily indicate underlying pancreatitis, genetic studies of human serum and urinary amylase isoenzymes have been performed with the use of electrophoresis. Although the preponderant increase in the two principal pancreatic isoamylases Amylase-1 and 2 has been accepted to be a specific index of pancreatic involvement, 1.68% of normal persons had Amylase-2 with an elevated amylase activity (named "Dominant Amylase-2") up to the same levels as the major isoenzymes. Results of pancreozymin-secretin test and other laboratory findings of these persons with Dominant Amylase-2 were all within normal ranges. Pedigree studies confirmed an autosomal dominant mode of inheritance for this variant. The important of serial determination and pedigree investigations has been shown to distinguish normal persons having Dominant Amylase-2 from patients with pancreatitis without elevated amylase activity. The existence of an inherited trait of pancreatitis-like isoamylase pattern in healthy individuals must be born in mind before coming to a conclusion when amylase isoenzymes are used for clinical medicine, though preponderance of the pancreatic type isoenzymes in serum and urine has been revealed to be a characteristic finding in pancreatitis. Knowledge of amylase genetic polymorphism provides a scientific basis for amylase isoenzyme interpretation.

Clinical evaluation of the pancreatitis-like isoamylase pattern in normal persons

Amylase isoenzyme analysis of serum and urine has been performed in 4001 normal persons and 500 patients with various disease using electrophoresis on thin layer polyacrylamide gel. Although elevation of amylase activity in amylase-1 and 2 has been reported to be the specific findings in patients with pancreatitis, 1.69% of normal persons had an elevated Amylase-2(named "Dominant Amylase-2") up to the same levels as major isoenzymes (Amylase-1 and 3), along with Amylase-1. Pedigree study confirmed an autosomal dominant mode of inheritance for Dominant Amylase-2. Knowledge of the genetic polymorphism is of importance in clinical assessment of amylase isoenzymes in patients having an elevated Amylase-2 suggestive of pancreatitis. Predominance of the pancreatic components in serum and urine has been revealed to be a specific index of pancreatic involvement. However, the existecne of an inherited trait of pancreatitis-like isoamylase pattern in healthy individuals must be borne in mind. On the basis of the present study, it may be concluded that a rise in the pancreatic type isoenzymes may not necessarily indicate underlying pancreatitis, especially in the absence of elevated amylase and lipase levels.

Frequency of intrahepatic arteriovenous fistula as a sequela to percutaneous needle puncture of the liver

Incidence of intrahepatic arteriovenous fistula after needle biopsy of the liver, percutaneous transhepatic cholangiography, and transhepatic catheterization of an intrahepatic bile duct or portal vein, was determined by studying the hepatic arteriograms obtained within 1 month of the transhepatic procedure. An arteriovenous fistula, mostly arterioportal, occurred in 5 (5.4%) of the 93 patients after biopsy, in 3 (3.8%) of 79 after percutaneous transhepatic cholangiography, and in 7 (26.2%) of 26 after catheterization. None of the fistulae was so large and close to the porta hepatis as to cause portal hypertension. In 1 patient with an intrahepatic bile duct carcinoma, the long track of a 0.7-mm caliber needle became a fistula draining arterial blood into the parenchyma. In another, an aneurysm was found after biopsy and percutaneous transhepatic cholangiography. The possibility of spontaneous closure of small fistulae is discussed.

[Effect of caerulein on pancreatic endocrine and exocrine secretion from the perfused rat pancreas (author's transl)]

Several investigations in vivo and in vitro have shown that gastro-intestinal hormones stimulate insulin secretion. However, the reports on the insulinotropic activity of pancreozymin are contradictory. The conflicting results are probably due to the fact that pure native preparation of this hormone has not been obtained in "physiologic" doses. In the present study this problem has been investigated by exposing rat pancreas to caerulein in vitro. Caerulein, an active decapeptide isolated from the skin of the Australian amphibia Hyla caerulea, resembles pancreozymin in chemical structure, including C-terminus. This active polypeptide of nonmammalian origin has been shown to possess all the biological activities of pancreozymin. The present investigation was undertaken to evaluate the significance of the interactions of exocrine and endocrine pancreas using perfused rat pancreas in vitro. Biphasic insulin release was demonstrated with caerulein at concentrations higher than 1 ng/ml. Insulin response of the first phase was proportional to the dose up to 1 microgram/ml. The second phase of insulin release was, however, almost constant, regardless of the concentrations of caerulein. Release of glucagon was stimulated by the same concentrations of caerulein which stimulated insulin release. Maximal response of the pancreatic amylase and pancretic juice output were observed with 1 ng/ml of caerulein. With higher doses, significantly less secretory responses were observed. The dissociation of the response to caerulein between endocrine and exocrine pancreas was found.

Relation of electrophoretic pattern of amylase isoenzymes to severity of pancreatic disease

Serum and urinary amylase isoenzymes were studied in an attempt to evaluate the usefulness of isoamylase analysis in the diagnosis of pancreatic diseases. The amylase in human serum and urine was separated into 4 to 5 distinct isoenzymes, which have mobilities consistent with those of the pancreatic isoamylases (Amylase-1, -2, -4 and -6) and the salivary isoamylases (Amylase-3, -5 and -7). The normal isoamylase pattern was Amylase-1, -2, -3 and -5. Amylase-4 and -6 could not be found in normal serum and urine. Amylase activity in Amylase-1 and/or -2 increased remarkably, having the normal isoamylase pattern, in the patients with elevated serum amylase activity after stimulation with pancreozymin-secretin or after endoscopic retrograde cholangiopancreatography. However, in the patients with acute pancreatitis, salivary type isoamylases disappeared and only the pancreatic type components were identified. It seems that the appearance of Amylase-4 and disappearance of the salivary components indicate severe pancreatic inflammation and that the apparent specificity of this isoenzyme pattern affords a mean for conforming the diagnosis of acute pancreatitis. However, the occurrence of an inherited trait in the pancreatic isoamylases of healthy individuals suggests that a rise in the pancreatic components may not necessarily indicate pancreatic disorders.

The nature and origin of hyperamylasemia following open-heart surgery with extracorporeal circulation

The nature of the postoperative hyperamylasemia in 27 patients undergoing open-heart surgery was investigated. An increase in serum amylase activity was found in 56% of the patients. Isoamylase analysis revealed that the rise was in the salivary-type isoamylase in all of these patients. Since the level of serum amylase activity was increased in the postoperative state with prolongation of extracorporeal circulation, it is conceivable that cellular hypoxia due to inadequate tissue perfusion may cause disturbances in cellular metabolism with a release of intracellular amylase. The finding of the salivary-type amylase in normal lung tissue, transient salivary-type hyperamylasemia in acute respiratory distress and increased amylase activity of the salivary-type in serum specimens from the left atrium compared to those from the right ventricle suggest that the origin of the amylase responsible for the transient postoperative hyperamylasemia in the salivary-type is due to the amylase released from lung tissues under hypoxia during and after operation.

Amylase in the lung

Although elevated amylase levels in serum, pleural fluid, and extracts of tumor tissue in primary lung cancer have been reported, electrophoretic and column-chromatographic studies have not revealed the ectopic production of amylase but have merely shown an increase of amylase activity of chiefly the salivary type in these materials. The present study was designed to make clear the nature of the amylase or amylase-like substance in the serum, pleural fluid and tumor extracts, and to determine whether amylase might be produced ectopically in tumor tissues. Our data not only confirmed that the hyperamylasemia in some cases of primary lung cancer was due to an increase in salivary type isoamylases, but also showed that the same isoamylase pattern occurs in serum, pleural fluids, and diseased lung tissue of patients with pneumonia. However, the elution pattern of amylase in these materials in column-chromatography on Sephadex G-75 Superfine was different from that of salivary amylase. On the basis of our observations, it seems reasonable to conclude that the salivary type hyperamylasemia in some cases of primary lung cancer may be due to an increase in the amylase contained in normal lung tissues, resulting from activation and release into the blood stream by some inflammatory process. However, ectopic production of amylase was demonstrated in one particular case of primary lung cancer in which a high amylase content and a peculiar isoamylase were found both in the primary and metastatic lesions.

Angiographic demonstration of intrahepatic arterio-portal anastomoses in hepatocellular carcinoma

Hepatic angiograms of 114 patients with hepatocellular carcinoma (HCC) were studied, particularly changes in the portal vein branches. Arterio-portal shunts of varying sizes, evidenced by opacification of intrahepatic portal branches, were seen in 72 cases (63.2%), with retrograde opacification of the portal vein trunk in 29 (25.4%). At least four types of shunts were found: (a) through a tumor thrombus in the portal branch, (b) in a retrograde direction via a peripheral tumor nodule, (c) through a small tumor invading or amputating an artery, and (d) through a tumor located near a major portal vein branch and supplied by a large, coiling artery. Postmortem angiography of the liver in 50 patients with HCC suggests that arterio-portal shunts are the result of the special vasculature in HCC and are highly diagnostic when accompanied by other angiographic changes.

3H-thymidine autoradiography of CSF cells in primary reticulum cell sarcoma of the brain

CSF cells in a case of primary reticulum cell sarcoma of the brain with diffuse subarachnoid spreading were examined by 3H-thymidine autoradiography. Immediately after lumbar puncture, the CSF withdrawn was incubated at 37 degrees C for 1 hr with an admixture of 3H-thymidine at a rate of 1 muCi/ml CSF. The cells were collected by centrifugation and the microautoradiographic procedure was performed. The labeling index (L.I.) of the total CSF cells was 10.5%, and when non-neoplastic cells, i.e. polymorphonuclear leukocytes, small lymphocytes, monocytes etc., were excluded, the real L.I. of the tumor cells in the CSF was supposed to be more than 14.4%. Referring to the results of various brain tumors reported in the literature, this belongs to the highest labeling group. The high L.I. of the tumor cells in this case was well consistent with the extremely rapid clinical course. It should be stressed that the examination of CSF cells by 3H-thymidine autoradiography in cases of brain tumors could be one of the valuable methods indicating the DNA synthesis of the tumor cells, which is an important parameter of malignancy.

On the relationship between the frequency of two types of lethal-mutation and x-ray doses in Drosophila

The dose-frequency relationship for each of 2 types of lethal mutations, fractional- and whole-lethal, was obtained using X-rays on Drosophila melanogaster. The results show that fractional-lethal mutations are induced by X-rays, and also that the proportion of fractional-lethal mutations in the total of mutations tends to decrease with increasing doses, namely, 61% at o R, 47% at 500 R, 37% at 1000 R and 20% at 2000 R. The same tendency is observed with visible mutations. In order to consider the problems related to the above results, the relationship between the true frequency and the observed frequency of the induced lethal mutations is discussed, taking into consideration the existence of the ostensible whole-lethal and the ostensible normal.