[Study of the changes in portal hemodynamics after endoscopic injection sclerotherapy with reference to the variceal recurrence]

Endoscopic injection sclerotherapy (EIS) combined with percutaneous transhepatic obliteration was performed in 63 cirrhotic patients with esophageal varices. In all patients, esophageal varices were completely disappeared after EIS. To investigate risk factors for recurrence of esophageal varices after EIS, hemodynamic changes in the portal system before and after EIS were studied by portal vein catheterization and ultrasonography. In patients in whom portal pressure rose after EIS, recurrence of varices was observed in high incidence (p < 0.05). Furthermore, variceal recurrence appeared frequently in patients with progressive splenomegaly after EIS (p < 0.05). During post-EIS course, new appearance or increase in size of non-variceal portosystemic collaterals was detected by ultrasonography in 22% of the patients. In these patients, variceal recurrence rate was low (p = 0.09). In patients with shunts around the splenic hilum, variceal recurrence rate was lower compared with the patients with paraumbilical vein (p < 0.05). Prognostic factors for variceal recurrence were analysed using multiple regression model. It was suggested that the absence of non-variceal portosystemic collaterals was the most risky factor. In conclusion, observation of portal hemodynamics is considered to be useful for the long-term management of patients with esophageal varices treated with EIS.

Gene therapy in Japan: current trends

The Japanese government took significant steps in making decisions about a newly developing clinical application of gene therapy when, on April 15, 1993, the Government officially accepted the Guidelines for Clinical Research on Gene Therapy submitted by the Health Science Council of the Ministry of Health and Welfare of Japan to the Minister.

Autonomous decision making and Japanese tradition

Crucial problems exist in understanding Japanese traditional customs with regard to autonomous decision making by patients in Japan. These problems are difficult to comprehend because they seem, by western standards, to defy logic. Questions that baffle those outside the Japanese tradition, include: Why do many Japanese patients hesitate to make medical treatment and care decisions for themselves without consulting family, close friends, or someone viewed as being in a superior position? Why do many Japanese physicians fail to disclose the truth directly to the patient, instead customarily conveying information to family members, despite the doctors' awareness of their legal obligation to protect the patient's privacy? Why do many Japanese physicians continue to question whether patients should be told the truth at all? What perpetuates Japan's widespread, but often unnoticed, neglect of the individual's right to self-determination in healthcare decision making?

Different cellular patterns associated with hepatitis C virus reactivation, cytomegalovirus infection, and acute rejection in liver transplant patients monitored with transplant aspiration cytology

Fine-needle aspiration biopsy (FNAB) is a routine diagnostic tool used for the monitoring of the graft during the first postoperative weeks after liver transplantation. The cellular pattern of acute liver rejection is typical in transplant aspiration cytology (TAC), documented and published by several authors. The lymphoid response associated with various viral infections may, however, provide differential diagnostic problems in the cytological monitoring. In this study, we have investigated in detail the cellular pattern of lymphoid response associated with hepatitis C virus (HCV) reactivation, and compared it with the pattern of cytomegalovirus (CMV) infection and with the typical diagnostic findings of acute cellular rejection. HCV reactivation was associated with rather mild total inflammation in the graft (4.5 +/- 1.5 CIU at the peak). The inflammatory infiltrate consisted mainly of small lymphocytes (3.1 +/- 0.2 CIU at the peak), with only occasional activated cells and without lymphoid blast response. No lymphoid activation was seen in the blood. CMV infection was associated with a mild immune response (3.9 +/- 0.4 CIU at the peak) recorded as a slight lymphoid activation and occasional blast cells both in blood and in the graft together with lymphocytosis in the graft (2.4 +/- 0.7 CIU at the peak). The typical findings of acute rejection were easily distinguished from the cellular pictures of both viral infections. The rejections were lymphoid blast (3.6 +/- 3.4 CIU at the peak) and activated lymphocyte (3.5 +/- 2.6 at the peak), dominated by a high peak of total inflammation (9.3 +/- 7.0 CIU). No blast cells and only a few activated cells were seen in the blood during rejection episodes. Thus, the cellular patterns of HCV reactivation and CMV infection differed slightly from each other, but significantly from that of acute liver allograft rejection monitored with the FNAB cytology.

End-to-side neurorrhaphy with removal of the epineurial sheath: an experimental study in rats

Terminolateral neurorrhaphies were used up to the beginning of this century. After that, they were no longer reported. We tested the efficacy of a new type of end-to-side neurorrhaphy. A group of 20 rats had the peroneal nerve sectioned, and the distal ending was sutured to the lateral face of the tibial nerve after removing a small epineural window. All experiments were made on the right side, the left one remaining untouched in half the animals of each group. The other half was denervated by sectioning and inverting the endings of the peroneal nerves. In this way, tibial cranial muscles were either normal or denervated on the left side and reinnervated through end-to-side neurorrhaphies on the right side. After 7.8 months, the animals were subjected to electrophysiologic tests, sacrificed, and the nerves and muscles were taken for histologic examination. A response of the tibial cranial muscle was obtained in 90 percent of the animals. The distal ending of the peroneal nerve showed an average of 861 nerve fibers. The average areas of the reinnervated tibial cranial muscles were (microns 2) 1617.81 for M2n (when the contralateral side was normal) and 1579.19 for M2d (when the contralateral was denervated). We conclude that the terminolateral neurorrhaphy is functional, conducting electrical stimuli and allowing the passage of axons from the lateral surface of a healthy nerve, to reconstitute the distal segment of a sectioned nerve. The absence of an incision on the axons of the donor nerve was no impediment to axonal regeneration or to the passage of electrical stimuli. The results demonstrate the possibility of using end-to-side and terminolateral neurorrhaphies for reconstituting neural lesions when only a distal end is available; the reinnervation can be obtained from the lateral face of a healthy nerve.

Corticostriatal and corticotectal projections from visual cortical areas 17, 18 and 18a in the pigmented rat

Regions of the visual cortex and the deep layers of the superior colliculus (SC) have been suggested to be functionally linked via an 'indirect' pathway through the basal ganglia. The present report demonstrates projections from the striate (area 17) and extrastriate (areas 18 and 18a) visual cortex in Long-Evans hooded rats to the striatum (ST) and SC with anterograde (biocytin) and retrograde (WGA-HRP and fluorescent dyes) tracers. Biocytin injections into each cortical area produced markedly different patterns of labeling in ST and SC. Injections into area 17 resulted in a dense labeling in the superficial layers of SC, with little labeling present in the deep layers of SC or ST. In contrast, injections into area 18a, which produced marked labeling in the deep layers of SC with moderate in the superficial layers, resulted in dense labeling in the caudal two-thirds of the dorsal region of ST; injections into area 18 produced numerous terminals mainly in the deep layers of SC and in the rostral two-thirds of the dorsal aspect of ST. WGA-HRP injections into ST resulted in numerous retrogradely labeled pyramidal neurons in areas 18 and 18a, but only a few labeled neurons were observed in area 17. Corticostriatal neurons in extrastriate visual cortex were distributed predominantly in layer V, with smaller numbers in layers II and III, whereas corticotectal neurons were located only in layer V of both the striate and extrastriate visual cortex. Although corticostriatal and corticotectal neurons were intermingled in layer V, no double-labeled neurons were observed following injections of different fluorescent dyes into ST and SC. It appears, therefore, that: 1) the major source of visual input to both ST and the deep layers of SC in the rat arises not from the primary visual cortex but from extrastriate visual areas; and that 2) the projections from the extrastriate visual area to ST and SC originate from different populations of corticofugal neurons.

Comparison of inhibition of Escherichia coli topoisomerase IV by quinolones with DNA gyrase inhibition

In order to examine the inhibitory activities of quinolones against topoisomerase IV, both subunits of this enzyme, ParC and ParE, were purified from Escherichia coli. The specific activity of topoisomerase IV decatenation was found to be more than five times greater than that of topoisomerase IV relaxation. Thus, the decatenation activity of topoisomerase IV seems the most relevant activity for use in studies of drug inhibition of this enzyme. Although topoisomerase IV was less sensitive to quinolones than DNA gyrase, the 50% inhibitory concentrations for decatenation were significantly lower than those for type I topoisomerases. Moreover, there was a positive correlation between the inhibitory activity against topoisomerase IV decatenation and that for DNA gyrase supercoiling. These results imply that topoisomerase IV could be a target for the quinolones in intact bacteria and that quinolones could inhibit not only supercoiling of DNA gyrase but also decatenation of topoisomerase IV when high concentrations of drug exist in bacterial cells.

A serine protease in soybean seeds that acts specifically on the native alpha subunit of beta-conglycinin

A proteolytic activity directed against the alpha subunit of beta-conglycinin was detected in resting mature seeds of the soybean [Glycine max (L.) Merrill] cultivar Keburi. The relationship between pH and activity and the effect of protease inhibitors revealed that the enzyme was a neutral/alkaline serine protease. The proteolysis of the alpha subunit of beta-conglycinin yielded a specific product with a molecular weight of about 47,000, as determined by SDS-PAGE, but the enzyme had no activity against the beta subunit. The amino acid composition, the molecular weight and the amino-terminal amino acid sequence of the proteolytic product revealed that the action of the enzyme on the alpha subunit was specific, with cleavage occurring only at the R126-R127 peptide bond of the alpha subunit. These characteristics of the protease indicate that the enzyme is a novel protease that has not previously been recognized in soybean seeds.

[Relation between nuclear DNA content and lymph node metastasis in submucosal early gastric cancer]

To investigate a possible relation between the nuclear DNA content and lymph node metastasis of submucosal early gastric cancer, DNA content was analyzed for 46 patients with lymph node metastasis and 67 patients without nodal metastasis. DNA aneuploidy was found in 20 (43.5%) of 46 patients with lymph node metastasis and in 31 (46.3%) of 67 patients without it. There was no statistical difference in the incidence of aneuploidy between the 2 groups. Among the cases with DNA diploidy, the mean value of S phase fraction was 6.82% in patients with lymph node metastasis and 5.65% in those without metastasis. The mean value of S phase fraction was significantly higher in patients with nodal involvement (p < 0.05). Furthermore, among the cases with DNA aneuploidy, the mean value of G2/M phase fraction was 11.03% in patients with lymph node metastasis and 7.54% in patients without metastasis. The mean value of G2/M phase fraction was significantly higher in patients with nodal involvement (p < 0.05). These findings suggest the significant value of the S and G2/M phase fraction for the prediction of lymph node metastasis in patients with submucosal early gastric cancer.

Effects of various forms of progestin on the endometrium of the estrogen-primed, ovariectomized rat

Progestin supplementation has been advocated in estrogen treatment for postmenopausal women to avoid proliferation of the endometrium. In this study we investigated the morphologic and biochemical effects of progestins on the endometrium of estrogen primed, ovariectomized rats. As the progestin derivatives, Allylestenol (AE), Norethisterone (NE), Danazol (DZ), Dydrogesterone (DG), Medroxyprogesterone acetate (MPA) and Cyproterone acetate (CPA), and as a anti-estrogen compound, Tamoxifen (TMX), were applied. To evaluate the effects of these different compounds on the endometrium, histologic studies and measurement of estrogen receptor concentrations were performed. When 19-nortestosterone groups, AE, DZ and NE, were orally administered to the conjugated equine estrogen (CE) treated, ovariectomized rats, the histologic pattern of the endometrium revealed rather a marked inhibition of hyperplasia induced by CE than a progestational response. Two of 3 of 17 alpha-hydroxyprogesterone groups, DG and MPA, provided slightly endometrial protection against the hyperplastic response, but another one, CPA, did not have any inhibitory effect on the estrogenic stimulation of the endometrium. TMX was not capable of suppressing the endometrial hyperplasia caused by CE administration. The average plasma concentrations of estradiol (E2) were 82.0 +/- 27.0 pg/ml (Mean +/- SD) after CE administration and there were no significant differences among these groups. Estrogen receptor concentrations of endometrium of progestins or antiestrogen added groups were not changed, when compared with the CE alone group. There was also no relationship between the estrogen receptor concentrations and the histologic findings in the endometrium. This discrepancy may be chiefly due to the low dose of the progestins as compared with the CE dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Induction of interleukin-2 receptor alpha chain expression of immature acute myelocytic leukemia cells

Leukemic cells from 27 adult patients with acute myelocytic leukemia (AML) were investigated to determine the cell surface inducibility of interleukin-2 receptor (IL-2R) in in vitro culture with and without interleukin-1 beta (IL-1 beta). IL-2R alpha chain (IL-2R alpha) was induced on leukemic cells in 11 of 27 cases. Most of the cases could induce IL-2R alpha spontaneously without IL-1 beta, while the IL-2R beta chain (IL-2R beta) did not appear on leukemic cells from any of the cases tested. AML cases expressing CD7 or HLA-DR antigen could induce IL-2R alpha more frequently than any other type of AML. Among interleukin-3 (IL-3), granulocyte-macrophage colony stimulating factor (GM-CSF) and G-CSF, IL-3 showed a more prominent effect on DNA synthesis in IL-2R alpha inducible cases than in its uninducible cases. These results suggest that IL-2R alpha but not IL-2R beta was easily inducible on AML cells with immature characteristics.

Effect of reduction of inhaled corticosteroid on bronchial hypersensitivity in asthmatics

We retrospectively assessed the effect of reduction of beclomethasone dipropionate (BDP) inhaler (BDI) on bronchial hypersensitivity in asthmatics whose respiratory threshold of histamine (RT-Hist) once reached a normal level of > or = 10 mg/ml with BDI treatment. In a study period of 1988-1992, 19 out of 44 patients had their RT-Hist of > or = 10 mg/ml, and the reduction of BDI was undertaken in 10 cases. Cessation of bronchodilators did not result in the increase of bronchial hypersensitivity in patients undergoing BDI treatment without the dosage change. When BDI was reduced from 8 puffs/day to 4 puffs/day, the RT-Hist did not drop below 5 mg/ml in 6 out of 8 patients (success rate = 75%). When BDI was reduced from 4 puffsday to 2 puffs/day, the success rate was 37.5% (3/8). Cessation of BDI was unsuccessful in 3 patients (0/3). Conversely, the RT-Hist did not drop below 10 mg/ml in all six cases whose BDI was not reduced. This preliminary study suggested that cessation of BDP would be very difficult in most asthmatics, although its reduction would be successful in some cases.

Two end-to-side neurorrhaphies and nerve graft with removal of the epineural sheath: experimental study in rats

We have studied a new type of end-to-side nerve repair in rats. The healthy (donor) nerve was not divided but an epineural window was created. In our experiment, a nerve graft bridged the tibial nerve to the distal end of the divided peroneal nerve. Electrophysiological studies showed electrical impulses conducted through both end-to-side nerve junctions. Histological studies demonstrated axons leaving the lateral surface of the healthy (donor) nerve. Based on these observations, we suggest that end-to-side neurorrhaphy from a healthy nerve may bridge a neural deficit.

Social environment affects synaptic structure in the glomerulus of the accessory olfactory bulb of the hamster

The accessory olfactory bulb (AOB) is the primary center of the vomeronasal chemosensory system. The effects of differential rearing on the numerical density and size of synapse as well as neuronal size were examined in the AOB of adult hamster. At 30 days from birth, male littermates were assigned to one of three experimental conditions. (1) the IC (isolated condition), where a male animal was housed alone, (2) the NC (neighbor condition), where one male was separated from two females by wire shields, and (3) the SC (social condition), where two males and two females were housed together. After 2 months of differential rearing, the AOBs of male littermates from each experimental set were prepared for morphological examination. The lengths of synaptic contact zones and the density of synapses in the glomeruli of the AOB as well as the area of somata of mitral/tufted cells were measured with an image analyzer. The synaptic contact zone was longer in the SC compared with both the IC and the NC while there was no difference in the synaptic density among the three groups. The somal area of mitral/tufted cells was larger in both the SC and the NC compared with the IC. These results indicate that the exposure to different rearing conditions induces differential morphological changes in both synapses and somata in the AOB of adult hamster.

[Clinical examination and therapies of hydronephrosis after radical hysterectomy]

We investigated postoperative hydronephrosis in 50 patients (100 ureter) undergoing radical hysterectomy for uterine cervical cancer from Jan. 1989 to Dec. 1991 at Department of Obstetrics and Gynecology in Nagasaki University Hospital. The incidence of hydronephrosis was 68.1% of patients, and hydronephrosis was seen significantly more frequently and was of a higher grade on the right kidney than the left. After one year, hydronephrosis disappeared in 59.1% of patients (65.1% of right kidney, 88.2% of left kidney), and only 2 of 93 kidney have worsened. In cases without hydronephrosis, hydronephrosis developed in only 3 of 31 kidney after one year due to local recurrence or nodule metastasis of the original disease. We compared therapeutic effects of 3 methods (ureteral stent, PNS, no treatment). But there was no significant difference between these methods, we could not determine which was the best treatment. And we observed that indwelling ureteral stent might interrupt spontaneous healing of ureter. Radiotherapy didn't significant influence hydronephrosis after radical hysterectomy; Therefore, we suggest that, in patients with hydronephrosis without other severe urological complications after radical hysterectomy, clinical course should be observed for at least one year, first and them some treatments should be applied if cases worsen gradually than before.

Clinical features of adult-relapse asthma in comparison with those of child-onset asthma and adult-onset asthma

Clinical features of adult-relapse asthma (group B, n = 15) were compared with those of child-onset asthma (group A, n = 18) and adult-onset asthma (group C, n = 34) in terms of allergic component and bronchial hypersensitivity. The percentage of patients with high levels of serum IgE (> 300 U/ml) in groups A, B, and C was 83%, 73%, and 50%, respectively, and the percentage of patients with positive IgE RAST for house dust was 87.5%, 78.6%, and 46.7%, and that for mite was 93.3%, 92.9%, and 58.6% in groups A, B, and C, respectively. The histamine concentration of PC20 for the bronchial hypersensitivity test in groups A, B, and C was 196 micrograms/ml, 500 micrograms/ml, and 724 micrograms/ml, respectively. Thus, the adult-relapse asthma was closer to the child-onset asthma type in allergic state and closer to the adult-onset asthma type in bronchial hypersensitivity state. The classification employed here seemed to provide some merits in delineating the features of adulthood asthma.

[A clinical study on asthmatic patients who were readmitted after a short period of discharge]

We conducted a clinical study on asthmatic patients who were readmitted within three months of discharge. During twelve years (1979-1991), the number of patients who were readmitted within three months was 139 cases (209 episodes) in our department. Patients with respiratory diseases made up 53% of the subjects. Among patients with pulmonary disease who were readmitted within three months, the number of patients with lung cancer was 25 cases and that with bronchial asthma 24 cases. Within a month period, the number of readmitted patients with bronchial asthma was the largest 59% (19 cases) and the number of patients with lung cancer came second (4 cases). As for the characteristics of these asthmatic patients, the intrinsic type (15 cases), those with a history of over one year of the disease (20 cases), and those with steroid dependency (10 cases) were most commonly observed. Readmission occurred frequently between October and April. Readmission occurred frequently because of asthmatic attacks due to infection of reduction of steroid. Among asthmatic patients who were readmitted within one month, the disease severity was mild to moderate in 11 out of 19 patients, but there was a tendency for this to become intractable thereafter. It is impossible to prevent all patients from seeling readmission within a short period of discharge. However, we think the doctor's careful education of the patients is an important factor to reduce the early readmission rate of asthmatic patients.

[Late malfunction of the Björk-Shiley valve prosthesis due to Delrin disc defacement]

A 55-year-old woman eighteen years after mitral valvular replacement with Delrin disc Björk-Shiley valve prosthesis underwent a reoperation of prosthetic valve replacement for the prosthetic malfunction due to disc defacement. The patient suffered from faintness and vertigo at rest. An echocardiographic examination showed a moderate mitral insufficiency with a normal disc movement. Precise examination on the removed prosthesis revealed accelerated defacement of disc margin which made the ring-disc clearance up to 0.35 mm and strut-shaped groove formation on the inlet surface of the disc occluder. These findings suggested a pronouncedly earlier disc wear than predicted by Björk and co-workers. We concluded, therefore, that a patient undergone a valve replacement with Delrin disc Björk-Shiley valve should be examined periodically by echocardiography even though being without any symptoms.

[A case report of BWG syndrome in an elderly patient performed with mitral valve replacement 11 years after single CABG]

A 46-year-old female who had undergone single CABG for BWG syndrome 11 years ago was referred to our hospital for paroxysmal atrial fibrillation. The roentgenogram showed slightly cardiomegaly and the enlargement of LA. Ischemic changes of ECG appeared at I, aVL, V5, V6, as inverted T wave, and low voltage R wave at V1-V4, but non Q wave. The thallium-201 emission computed tomogram at exercise revealed poor perfusion at apical region without redistribution pattern. Catheterization showed mitral regurgitation (grade III), big right coronary artery (RCA) arising from aorta, rich collateral to poor left coronary artery (LCA), and bypass graft was obstructed. The proximal end of LCA was closed, and didn't arise from both pulmonary artery and ascending aorta. In this cases, MVR only without re-CABG to LCA was selected and performed. Postoperative course was uneventful. The result of this case suggested that MVR was an effective surgical procedure for MR of BWG syndrome in the adult case and it was better to add CABG to LCA as much as possible if the ischemic region was large.