[Unusual postoperative hemorrhage in a patient with ruptured aneurysm and hemophilia B]

A case of ruptured cerebral aneurysm with hemophilia B is reported, and discussion is made concerning the management of mild type hemophilia in surgical operations. A 41-year-old male came to our hospital with complaints of severe headache, vomiting, and transient consciousness disturbance. His dentist said the patient had a mild bleeding tendency when he was 30 years old, however no postoperative hemorrhage was repeated in appendectomy in his childhood. He also had had no episodes of spontaneous bleeding. CT scan on admission showed subarachnoid hemorrhage, and angiography revealed a ruptured aneurysm at the trifurcation of the left middle cerebral artery. His coagulation screening tests (bleeding time, clotting time, prothrombin time, and activated partial thromboplastin time) were normal. An aneurysmal neck clipping was carried out, and operators did not detect any bleeding tendency during the surgery. CT scan on the next day showed no remarkable finding. On the third postoperative day, right hemiparesis occurred. Left putaminal hemorrhage took place. His coagulation tests and FDP were also normal. The hematoma was partially evacuated. After the second operation his condition was good, and rehabilitation program started. On the 15th hospital day his consciousness deteriorated suddenly, and CT scan showed a massive epidural hematoma on the left. His prothrombin time elongated mildly, but other tests were normal. Coagulation factors VIII and IX were examined and the factor IX was 22.5% of control. He was thought to be a patient with mild type hemophilia B. Despite a third operation for hematoma removal he died on the 20th hospital day. Mild type hemophilia B does not bleed spontaneously.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationships of urinary metallothionein with other indicators of renal dysfunction in people living in a cadmium-polluted area in Japan

An epidemiologic investigation was carried out to study the significance of urinary excretion of metallothionein (MT) in people aged 50 years and over living in a cadmium (Cd)-polluted area in Japan. The urinary level of MT was compared with various parameters (age, urinary alpha 1-microglobulin (alpha 1-MG), beta 2-microglobulin (beta 2-MG), total protein, Cd, copper (Cu), and zinc (Zn), and relative clearances to creatinine of alpha 1-MG, beta 2-MG, phosphate and uric acid). It was found that the urinary excretion of MT is closely associated with Cd and the indices of renal dysfunction listed above. This observation was more remarkable in women than men. When subjects with signs of renal dysfunction were compared as a group to those with normal renal functions, the excreted amount of MT in the former is significantly greater. The results support the notion that the urinary excretion of MT reflects not only Cd exposure levels but also renal dysfunction caused by long-term Cd exposure.

Postnatal development of biliary and pancreatic exocrine secretion in piglets

1. The secretory responses of bile and exocrine pancreas were studied in various aged piglets. 2. At 3 days old the bile and exocrine pancreas could be reacted by various stimulations. The response by secretin was the same as that in the 28 day old. 3. Protein concentration in pancreatic juice by CCK-8 increased steeply after 6 days old, but the ratio of amylase to protein rose abruptly at 28 days old. 4. These findings indicate that (1) the secretory capacity of bile and pancreatic juice developed predominantly at an early period of postnatal life; (2) the formation of bile acids and pancreatic digestive enzymes developed gradually during the suckling period.

High-performance liquid chromatography-inductively coupled plasma profiles of cadmium, zinc, sulphur, and other elements in rat liver supernatants after cadmium injection

The distribution of cadmium, zinc, sulphur and other elements in the liver supernatants of rats and their variation with time following a single intraperitoneal injection of cadmium chloride were characterized by high-performance liquid chromatography (HPLC) coupled with an inductively coupled plasma. Cadmium that was bound to high-molecular-weight-proteins before the induction of metallothionein was analysed more easily using an Asahipak GS-520 column, whereas the distributions of other elements and of cadmium bound to metallothionein were better characterized on a TSK G3000SW column. Cadmium bound primarily to a distinct high-molecular-weight protein before the induction of metallothionein. After the injection its distribution shifted with time to metallothionein. An atomic emission spectrometer, employing an inductively coupled argon plasma and a vacuum UV monochromator was effectively used as a multi-element specific detector for HPLC.

Malignant lymphoepithelial lesion

A case of undifferentiated carcinoma arising from benign lymphoepithelial lesion (BLEL) of the parotid gland was studied by light and electron microscopy. Histopathologically, the carcinoma was composed of pleomorphic anaplastic cells showing an undifferentiated type among abundant lymphoid tissue forming germinal center. Among the prominent lymphoid tissue, epithelial hyperplasia, dysplasia, and squamous metaplasia of the duct epithelium were found. Dysplastic epithelium revealed a transition with carcinomatous component in some areas. On the electron microscopic observation, the tumor cells were poorly differentiated, possessing desmosomes and intracytoplasmic filaments. The patient is alive and well 2 months after resection of the tumor, but has a high titer of serum Epstein-Barr virus capsid antigen in IgG. Eighty five cases of the malignant lymphoepithelial lesion (MLEL) including the present case are summarized.

Acute brain swelling during evacuation of subdural hematoma caused by delayed contralateral extradural hematoma: report of two cases

Two patients experienced severe brain swelling during the evacuation of acute subdural hematomas. Postoperative computed tomographic (CT) scans revealed delayed extradural hematomas on the sides opposite the subdural hematomas. Extradural bleeding occurred in the area of the fractured skull. One patient improved neurologically after evacuation of the extradural hematoma, and the other was not operated because he was moribund. Drilling exploratory burr holes in the fractured area may have been a better strategy than awaiting a postoperative CT scan. The reduction of intracranial pressure after the removal of subdural hematoma was postulated to be the most important factor contributing to the formation of the extradural hematoma.

Multi-component analysis of urine of dogs with liver diseases by high-performance liquid chromatography

Components of the urine of normal dogs and dogs with liver diseases were analysed by high-performance liquid chromatography (HPLC) using a macroreticular anion-exchange resin with UV detection. The dogs with liver diseases were experimentally prepared by either Eck fistula by portal-caval anastomosis, dimethylnitrosamine-induced liver failure or total hepatectomy by operation. Eighteen chromatographic peaks were numbered and the cross-correlation coefficient of the intensities of every pair of peaks was computed. There were high correlations between several pairs of peaks according to the types and degrees of the hepatic failures, whereas no significant correlation was observed for the peak pairs of normal urine samples. The results showed that HPLC analysis of urine is useful in the diagnosis of the physiological state in liver dysfunction.

Environmental and injected cadmium are sequestered by two major isoforms of basal copper, zinc-metallothionein in gibel (Carassius auratus langsdorfi) liver

Gibels were exposed to cadmium in their aquarium at a concentration of 10 micrograms Cd/l for up to 39 weeks. Distributions of cadmium, copper and zinc in the liver soluble fraction were determined along with sulfur by high performance liquid chromatography-inductively coupled argon plasma-atomic emission spectrometry. Cadmium was sequestered by the two major isoforms of gibel metallothionein as in the case of cadmium injected intraperitoneally into gibel. Several peaks with cadmium, copper, zinc and sulfur were observed other than the two major isoforms and their relative ratios were different between the control and cadmium-exposed fishes.

Detection of sulfur-containing compounds in control and cadmium-exposed rat organs by high-performance liquid chromatography--vacuum-ultraviolet inductively coupled plasma-atomic emission spectrometry (HPLC-ICP)

Sulfur-containing compounds in biological samples were separated by high-performance gel permeation chromatography and detected with a vacuum-ultraviolet inductively coupled plasma-atomic emission spectrometer. Distribution profiles of sulfur in the supernatants of liver, kidney, spleen, lung, and pancreas of control and cadmium-exposed rats were determined along with cadmium, copper, iron, phosphorus, and zinc profiles. Changes in sulfur distribution were induced by cadmium exposure not only in the metallothionein fraction, but also in the high-molecular-weight protein fraction, indicating the effect of cadmium exposure on diverse endogenous sulfur-containing compounds. Glutathione and taurine also were detected simultaneously as distinct peaks.

Mercaptalbumin as a selective cadmium-binding protein in rat serum

Cadmium-binding proteins in blood serum were determined on a gel permeation column by high-performance liquid chromatography-inductively coupled argon plasma-atomic emission spectrometry. Cadmium chloride was administered iv to female rats of the Wistar strain in a single dose of 0.4 mg Cd/kg body wt and the rats were killed 1, 2, 3, 5, 10, 20, and 30 min after the injection. The blood serum was separated on an Asahipak GS-520 column and cadmium concentration in the eluate was monitored continuously along with sulfur, zinc, copper, iron, and phosphorus concentrations. Cadmium was selectively bound to mercaptalbumin and the metal was eliminated from blood serum within 30 min in a biphasic mode. Addition in vitro of cadmium chloride into fresh blood serum revealed that cadmium is bound selectively to mercaptalbumin up to approximately 14 micrograms Cd/ml serum. Excess cadmium in blood serum was found in the lower molecular weight fraction. Nonmercaptalbumin produced by oxidative disulfide bond formation between albumin and glutathione or cysteine was not able to bind cadmium. Sulfur and other element profiles were helpful in characterizing metal-binding proteins.

Urinary alpha 1-microglobulin as an indicator protein of renal tubular dysfunction caused by environmental cadmium exposure

An epidemiologic investigation was carried out to clarify the significance of the urinary excretion of alpha 1-microglobulin (alpha 1-MG) in people aged 50 years and over living in a Cd-polluted area in Japan. Approximately 80% of the population participated in the health examination. The urinary and serum levels and the relative clearance of alpha 1-MG to creatinine clearance were compared with various parameters (age, urinary beta 2-microglobulin (beta 2-MG), total protein, Cd, Cu and Zn, serum beta 2-MG, creatinine and blood urea nitrogen and relative clearances of alpha 1-MG, beta 2-MG, inorganic phosphate and uric acid). It was found that the urinary excretion of alpha 1-MG is closely associated with the urinary Cd and Cu and with the indices of renal dysfunction listed above. These results suggest that the urinary alpha 1-MG level markedly reflects a degree of proximal tubular dysfunction and that it may be useful as one of the screening measures for proximal tubular dysfunction caused by environmental Cd exposure.

[Cerebral venous thrombosis associated with the use of oral contraceptives]

The entity of cerebrovascular diseases associated with the use of oral contraceptives is well known but quite rare in Japan in contrast to Western countries. We recently encountered a 38 years old female with cerebral venous thrombosis considered to be caused by oral contraception. This patient took oral contraceptives for 17 days following therapeutic abortion, and was transferred to our hospital because of disturbed consciousness. CT scans disclosed a right temporo-occipital subcortical hemorrhagic infarction and bilateral thalamic infarction. Cerebral angiograms showed non-filling of cortical veins in the same area. The internal cerebral vein, vein of Galen and right transverse sinus were not visualized either. The hematoma and necrotic tissue were removed to avoid farther neurological deterioration. The brain was swollen and hyperemic, and thrombosed cortical veins were clearly recognized at operation. Twelve cases, including ours, of cerebrovascular diseases associated with oral contraception were reported up to now in Japan, and only 3 of them were diagnosed objectively as venous or sinus thrombosis. The average age of these 12 cases was 34 years old and many of them experienced abortion or therapeutic abortion. There was no relationship between the dose of estrogen and the onset of cerebrovascular diseases. We believe that the onset of this pathological state is based on gynecological hypercoagulable state, and the oral contraception may play a role of a trigger. Oral contraception should be contraindicated in patients with gynecological hypercoagulable state, hypertension and/or smoking habit.

[Systemic chemotherapy with high-dose cisplatin and sodium thiosulfate rescue]

Intravenous bolus injection of an 80- to 120-mg/m2 dose of cisplatin followed by "rescue" with sodium thiosulfate (STS) was tried in the treatment of 7 patients with advanced tumor. STS was given continuously i.v. six hours after cisplatin injection, combined with methylprednisolone and metoclopramide as antiemetics. Four patients were evaluable, consisting of one CR, one PR and two NC. Severe nausea and emesis occurred in two patients and irreversible renal dysfunction occurred in one. The clinical use of the STS rescue regimen was discussed in conjunction with our basic investigation of "STS-rescue" in an animal model.

Intracerebellar hemorrhage due to cerebellar hemangioblastoma

A rare case of a bleeding from a cerebellar hemangioblastoma is described. The tumor was diagnosed preoperatively with a computed tomography scan and a vertebral angiogram. The characteristic computed tomography scan findings and probable mechanism of bleeding are discussed.

Cell cycle-dependent heat sensitization of murine granulocyte-macrophage progenitor cells in regenerating marrow

The response of murine granulocyte-macrophage progenitor cells to hyperthermia was examined using normal and regenerating marrow. Hyperthermic exposure was given in vitro at 41-44 degrees C for periods of up to 60 min, and the results were compared between the 2 groups. Although almost no difference in percentage of survival was observed between them at 41 degrees C, murine granulocyte-macrophage progenitor cells of regenerating marrow showed markedly increased thermal sensitivity at and above 42 degrees C in comparison with that of normal marrow. Hydroxyurea suicide experiments revealed that the proportion of in vitro colony-forming units in the DNA-synthetic phase of the cell cycle [S phase] was greatly increased in regenerating marrow [66 +/- 4% (SD)] as compared with that in normal marrow [18 +/- 8%]. These data indicate that heat sensitization of hemopoietic cells occurs because of cell cycle effects, when they apparently mean the relative proportion of cells in S phase.

[Pancreas head carcinoma associated with situs inversus viscerum totalis]

The patient was a seventy seven years old male whose chief complaint was jaundice. Chest and abdomen roentgenogram showed situs inversus viscerum totalis. Echographically, pancreas head tumor was showed. Stenosis of inferior bile duct and dilatation of main pancreatic duct were showed by percutaneous transhepatic cholangiography and endoscopic retrograde cholangio pancreaticography. So, pancreas head carcinoma associated with situs inversus viscerum totalis was diagnosed. Pancreaticoduodenectomy and modified Child method was undergone. At the time of operation, liver was recognized left side of abdomen. The tumor was diagnosed well or moderately differentiated papillotubular adenocarcinoma by pathological study. This unusual combination of situs inversus viscerum totalis and pancreas head carcinoma was reported.

Parathyroid hormone concentration in the serum of people with cadmium-induced renal damage

Serum parathyroid hormone (PTH) and renal functions were measured in thirty subjects with cadmium-induced renal damage and in the same number of control subjects. The negative correlations between PTH and creatinine clearance (Ccr) and between PTH and percentage renal phosphorus reabsorption (% TRP) were significant in the cadmium (Cd)-exposed group. Serum PTH concentrations were clearly high in two cases of the cadmium-exposed group. Their renal functions decreased severely compared with those of the other Cd-exposed people. The present study indicates that chronic cadmium intoxication could cause increased secretions of PTH, which may be related to cadmium-induced bone damage.

Immunoelectron microscopic (IEM) studies on glutaraldehyde-fixed renal specimen

Immunofluorescent microscopy (IF) has become an essential tool in the routine diagnosis of renal pathology. It is thought that glomerular IF patterns represent different forms of immunologically mediated glomerular lesions. However, in order to preserve antigenicity IF is usually done on frozen, unfixed specimen by light microscopy and it is difficult to locate target macromolecules in tissue with precision. In order to establish the precise location of such macromolecules in glomeruli in relation to the ultrastructure, we undertook an immunoelectron microscopic (IEM) study on renal biopsies. Percutaneously biopsied tiny specimen was fixed in glutaraldehyde and processed with protease. Using peroxidase-labeled antisera, a direct IEM was done. With this technique, target macromolecules corresponded well not only to electron-dense deposits but also to IF patterns. In one case of membranous nephropathy, immunoglobulin (Ig) was found to be outside of the glomerular basement membrane (GBM), while IgA was seen to be inside the GBM. For this same case, a similar localization of immunoglobulins was not revealed by IF. In conclusion, IEM is a useful technique that can broaden our knowledge of pathogenic mechanisms in glomerular disease.

Copper and zinc levels in serum and urine of cadmium-exposed people with special reference to renal tubular damage

Urinary copper and zinc concentrations and their serum levels were determined in women environmentally exposed to cadmium, including "itai-itai" disease patients and suspected patients, for evaluating the effect of cadmium exposure on metabolism of such essential metals as copper and zinc in human beings. Copper concentrations in the urine of cadmium-exposed women, especially "itai-itai" patients and suspected patients, were much higher than those of nonexposed women. Zinc concentrations in the urine of cadmium-exposed women, however, were not different from those of nonexposed women. Zinc levels in the serum of the "itai-itai" patients were somewhat lower than those of the nonexposed women. On the other hand, serum copper was almost equal in the cadmium-exposed and the nonexposed women. The correlation coefficient between beta 2-microglobulin amounts and copper concentrations in the urine of all women examined was as high as 0.95. It is concluded that exposure to cadmium will cause an increase in the excretion of copper in urine, which is attributable to renal tubular damage due to the cadmium exposure, and that urinary zinc excretion is not increased by cadmium exposure, even in the patients who suffer from severe renal tubular damage.

Urinary metallothionein as a new index of renal dysfunction in "Itai-Itai" disease patients and other Japanese women environmentally exposed to cadmium

The significance of elevated excretion of metallothionein in urine of women living in cadmium-polluted areas of Japan was studied with respect to renal dysfunction. The relationships between the concentrations of metallothionein in urine and those of other non-specific urinary indices of renal dysfunction, i.e., total protein, glucose, beta 2-microglobulin, retinol-binding protein, alpha-amino nitrogen and proline were examined. In addition, the relationships between urinary metallothionein and urinary cadmium and copper were also evaluated. It was found that the logarithm of the metallothionein concentration in urine was significantly correlated with the logarithm of the concentrations of each of the above parameters. When subjects with signs of renal dysfunction, including "itai'itai" disease patients and patients suspected of the disease, were compared with subjects with normal renal functions, as a group, the former excreted significantly higher concentrations of metallothionein in their urine than the latter. The results suggest that the elevated excretion of metallothionein is not only an index of excessive cadmium exposure, but also of renal dysfunction caused by chronic exposure to this metal.

[Studies on the biological effects of low level lead exposures. Part 2. Biochemical responses and subjective symptoms in female lead workers (author's transl)]

Females painters of ceramic works were examined for parameters of biochemical lead poisoning such as erythrocyte ALAD, free erythrocyte protoporphyrin (FEP), ALA and coproporphyrin (CP) in the urine as well as parameters of lead absorption such as lead concentration in the blood and urine (PbB and PbU). Results were compared with those of male painters. At the same time, subjective symptoms were questioned in both male and female painters. Under the lead exposure levels of these painters (PbB 5-50 microgram/dl, PbU 10-200 microgram/l), FEP alone, among the four biochemical tests for lead poisoning, showed a different behaviour between the male and female painters. Among female painters, significant higher incidence of the symptom of "tiredness" was recognized when the PbB level became more than 20 microgram/dl and significant higher incidence of the "history of abortion" was seen as the PbU level became more than 60 microgram/l. However, any relationship between subjective symptoms and PbB or PbU level was not recognized among male painters. These results suggest that female painters are more susceptible to lead exposure than male painters.