Close associations between prevalences of dominantly inherited spinocerebellar ataxias with CAG-repeat expansions and frequencies of large normal CAG alleles in Japanese and Caucasian populations

To test the hypothesis that the frequencies of normal alleles (ANs) with a relatively large number of CAG repeats (large ANs) are related to the prevalences of the dominant spinocerebellar ataxias (SCAs)-SCA types 1, 2, 3 (Machado-Joseph disease), 6, and dentatorubral-pallidoluysian atrophy (DRPLA)-we investigated the relative prevalences of these diseases in 202 Japanese and 177 Caucasian families and distributions of the number of CAG repeats of ANs at these disease loci in normal individuals in each population. The relative prevalences of SCA1 and SCA2 were significantly higher in Caucasian pedigrees (15% and 14%, respectively) than in Japanese pedigrees (3% and 5%, respectively), corresponding to the observation that the frequencies of large ANs of SCA1 (alleles >30 repeats) and of SCA2 (alleles >22 repeats) were significantly higher in Caucasians than in Japanese. The relative prevalences of MJD/SCA3, SCA6, and DRPLA were significantly higher in Japanese pedigrees (43%, 11%, and 20%, respectively) than in Caucasian pedigrees (30%, 5%, and 0%, respectively), corresponding to the observation that the frequencies of large ANs of MJD/SCA3 (>27 repeats), SCA6 (>13 repeats), and DRPLA (>17 repeats) were significantly higher in Japanese than in Caucasians. The close correlations of the relative prevalences of the dominant SCAs with the distributions of large ANs strongly support the assumption that large ANs contribute to generation of expanded alleles (AEs) and the relative prevalences of the dominant SCAs.

Estrogen-dependent production of erythropoietin in uterus and its implication in uterine angiogenesis

Although erythropoietin (Epo) has been shown to possess in vitro angiogenic activity, its physiological significance has not been demonstrated. Normally angiogenesis does not occur actively in adults but an exception is the female reproductive organ. In the uterine endometrium, angiogenesis takes place actively for supporting the endometrial growth that occurs during transition from the diestrus to estrous stage. This transition is under control of 17beta-estradiol (E2), an ovarian hormone, and can be mimicked by injection of E2 to ovariectomized (OVX) mouse. Thus, the uterus is a pertinent site to examine the Epo function in angiogenesis. We found that Epo protein and its mRNA were produced in an E2-dependent manner, when the uterus from OVX mouse was cultured in vitro. The de novo protein synthesis was not needed for E2 induction of Epo mRNA. Administration of E2 to OVX mouse induced a rapid and transient increase in Epo mRNA in the uterus. Injection of Epo into the OVX mouse uterine cavity promoted blood vessel formation in the endometrium. Furthermore, injection of the soluble Epo receptor capable of binding with Epo into the uterine cavity of non-OVX mouse in diestrus stage inhibited the endometrial transition to proestrus stage, whereas heat-inactivated soluble Epo receptor allowed the transition to occur. These results, combined with our finding that the endothelial cells in uterine endometrium express Epo receptor, strongly suggest that Epo is an important factor for the E2-dependent cyclical angiogenesis in uterus.

Expression of vascular endothelial growth factor gene and its receptor (flt-1) gene in urinary bladder cancer

We investigated expression of the vascular endothelial growth factor (VEGF) gene and its receptor gene (flt-1) in 30 patients with transitional cell carcinoma (TCC) of the urinary bladder by Northern blot hybridization analysis. The VEGF transcript was observed in all of the tumors and the normal mucosae. Of the 20 tumors in which a comparative study was done, eight (40.0%) overexpressed the gene with a tumor versus normal ratio of equal to and greater than 3.0. Invasive TCCs expressed significantly more VEGF gene than superficial TCCs. Cytoplasm of tumor cells was positively stained by immunohistochemistry with an anti-VEGF monoclonal antibody, while the intratumoral endothelial cells and the vascular smooth muscle cells were weakly positive for the staining. TCCs, normal mucosae and human umbilical endothelial cells expressed flt-1 gene, while leucocytes from peripheral blood did not. The expression level of flt-1 gene significantly correlated with that of the VEGF gene in the tumor. These results indicate that the VEGF gene is frequently overexpressed in TCC of the urinary bladder, especially in muscle invasive tumors, and that a paracrine system including VEGF and flt-1 exists between the TCC cells and the adjacent endothelial cells so as to regulate the angiogenesis in this tumor.

Determination of provitamin A of green leafy vegetables by high performance liquid chromatography and open column chromatography

The purpose of study was to determine the provitamin A value through beta-carotene analysis of five Brazilian leafy vegetables: carrot leaves (Daucus carota L.), beet leaves (Beta vulgaris L.) "serralha" (Sonchus oleracea L.), mint (Mentha piperita LL.) and celery leaves (Aplum graveolens. L.). Two analysis methods were used: open-column chromatography (OCC) and high performance liquid chromatography (HPLC). Two analysis methods were used: open-column chromatography (OCC) and high performance liquid chromatography (HPLC). Recovery tests were done for both methods and 92% of recovery was obtained for OCC and for HPLC 102%. The provitamin A value obtained for these leaves, using OCC were: 491 RE/100 g for carrot, 1097 for beet, 1390 for "serralha", 1016 for mint and 911 for celery. The results obtained using HPLC were 495 RE/100 g for carrot leaves, 1095 for beet leaves, 1472 for "serralha" leaves, 940 for mint leaves and 908 for celery leaves. We concluded that both methods presented good recoveries, are similar for determination of provitamin A in the leaves and they can be used for routine analysis. These five leaves can be as an inexpensive and easily obtained sources of provitamin A in Brazil.

In vivo evidence that erythropoietin protects neurons from ischemic damage

Erythropoietin (EPO) produced by the kidney and the liver (in fetuses) stimulates erythropoiesis. In the central nervous system, neurons express EPO receptor (EPOR) and astrocytes produce EPO. EPO has been shown to protect primary cultured neurons from N-methyl-D-aspartate (NMDA) receptor-mediated glutamate toxicity. Here we report in vivo evidence that EPO protects neurons against ischemia-induced cell death. Infusion of EPO into the lateral ventricles of gerbils prevented ischemia-induced learning disability and rescued hippocampal CA1 neurons from lethal ischemic damage. The neuroprotective action of exogenous EPO was also confirmed by counting synapses in the hippocampal CA1 region. Infusion of soluble EPOR (an extracellular domain capable of binding with the ligand) into animals given a mild ischemic treatment that did not produce neuronal damage, caused neuronal degeneration and impaired learning ability, whereas infusion of the heat-denatured soluble EPOR was not detrimental, demonstrating that the endogenous brain EPO is crucial for neuronal survival. The presence of EPO in neuron cultures did not repress a NMDA receptor-mediated increase in intracellular Ca2+, but rescued the neurons from NO-induced death. Taken together EPO may exert its neuroprotective effect by reducing the NO-mediated formation of free radicals or antagonizing their toxicity.

Correlation between initial potentials on a signal-averaged P-wave and indice of electrophysiologic measurements in the right atrium

The aim of this study was to determine whether initial potentials of the P-wave on a signal-averaged electrocardiogram (SAE) during sinus rhythm reflect indices of electrophysiologic measurements in the high lateral right atrium. A total of 67 patients underwent P-wave signal averaging during electrophysiologic testing. The correlation between root mean square voltages for the initial 10 and 20 msec of the P-wave on the SAE and indices of electrophysiologic measurements, sinus node recovery time (SRT) and sinoatrial conduction time (SACT), obtained from programmed stimuli, was evaluated. It was found that the initial potentials of the P-wave on the SAE correlated negatively with SRT and SACT (-0.37 < or = r < or = -0.30). It was concluded that the initial potentials correlated with indices of electrophysiologic measurements, although the statistical significance was weak.

Functional outcome after hip fracture in Japan

One thousand one hundred sixty-nine elderly Japanese patients who sustained a hip fracture were observed prospectively. Ninety-two percent had operative fracture treatment. Hospital length of stay averaged 67 days; 81% of patients were discharged to their place of residence where they resided before sustaining the fracture. Mortality rates at 120 days, 1 year, and 2 years after injury were 6%, 11%, and 19%, respectively. At 1-year followup, ambulatory status was recovered to that of the level experienced before injury in 67% of patients.

Establishment and characterization of a new human extrahepatic bile duct carcinoma cell line (ICBD-1)

A new human extrahepatic bile duct carcinoma cell line (ICBD-1) was established from surgically resected tumor of a 71-year-old Japanese male patient. ICBD-1 cells proliferate in a layer with a population doubling time of 31.5 h and secrete tissue polypeptide antigen. ICBD-1 cells have a tetraploid pattern with a DNA index of 1.83 and chromosome counts showed equally distribution in a range from 65 to 69. IC50 values for ICBD-1 cells were 200 ng/ml for adriamycin, 400 ng/ml for mitomycin C, 2 microg/ml for cisplatin and 300 ng/ml for 5-fluorouracil. ICBD-1 cells were successfully transplanted to male nude mice, inducing progressive tumor growth. Histologically, nude mouse tumors were less differentiated than the original human tumor. Tumor cells showed alveolar structures with thin fibrous stroma, classified as poorly-differentiated adenocarcinoma. ICBD-1 is the fourth established cell line that originate from extrahepatic bile duct carcinoma and it will be applicable for the experimental studies of this disease.

Embryonal carcinoma P19 cells produce erythropoietin constitutively but express lactate dehydrogenase in an oxygen-dependent manner

Embryonic stem cells and embryonal carcinoma P19 cells produce erythropoietin (Epo) in an oxygen-independent manner, although lactate dehydrogenase A (LDHA) is hypoxia-inducible. To explore this paradox, we studied the operation of cis-acting sequences from these genes in P19 and Hep3B cells. The Epo gene promoter and 3' enhancer from P19 cells conveyed hypoxia-inducible responses in Hep3B cells but not in P19 cells. Together with DNA sequencing and the normal transcription start site of P19 Epo gene, this excluded the possibility that the noninducibility of Epo gene in P19 cells was due to mutation in these sequences or unusual initiation of transcription. In contrast, reporter constructs containing LDHA enhancer and promoter were hypoxia inducible in P19 and Hep3B cells, and mutation of a hypoxia- inducible factor 1 (HIF-1) binding site abolished the hypoxic inducibility in both cells, indicating that HIF-1 activation operates normally in P19 cells. Neither forced expression of hepatocyte nuclear factor 4 in P19 cells nor deletion of its binding site from the Epo enhancer was effective in restoring Epo enhancer function. P19 cells may lack an unidentified regulator(s) required for interaction of the Epo enhancer with Epo and LDHA promoters.

Synthesis of human erythropoietin in vivo in the oviduct of laying hens by localized in vivo gene transfer using electroporation

In order to synthesize human erythropoietin protein in the oviduct of laying hens, localized in vivo gene transfer was attempted by using electroporation. In Experiment 1, transcriptional activities were compared by using four viral and cellular promoters, i.e., the 1.35-kbp long ovalbumin promoter, SV40 early promoter, Rous sarcoma virus long terminal repeat (RSV LTR), and the miw promoter, which is a hybrid of RSV LTR and chicken beta-actin promoter. These promoters were fused immediately upstream to the chloramphenicol acetyltransferase reporter gene. The results of chloramphenicol acetyltransferase activity showed that the miw promoter was the strongest, followed by SV40, RSV LTR, and the ovalbumin promoter in decreasing order. The intensity of the miw promoter was 250 times as high as that of the ovalbumin promoter. In Experiment 2, plasmid DNA containing the human erythropoietin gene, driven either by the ovalbumin promoter or the miw promoter, was transfected in vivo, and the production of human erythropoietin protein was detected by ELISA. The results indicated that the synthesis of human erythropoietin protein was attained in the chicken oviduct, and its concentration was higher when driven by the miw promoter than the ovalbumin promoter.

[Radiation therapy for non-small cell lung cancer with postoperative intrathoracic recurrence]

We reviewed patients with intrathoracic recurrence of non-small cell lung cancer after surgery, with reference to the feasibility of radiotherapy. The series consisted of 46 patients (39 males and 7 females) treated by radiotherapy from 1982 to 1995. Histology included squamous cell carcinoma (28 patients), adenocarcinoma (17), and large cell carcinoma (1). Clinical stage by UICC classification (1987) was as follows: stage I(2 patients), stage II(1), stage IIIa(13), stage IIIb(23), and stage IV(7). Recurrences were noted in bronchial stump (18 patients) and surgical scar (4). Metastases occurred in hilar-mediastinal lymphnodes (15), lung fields (7), and pleuropericardium (2). The mean interval from surgery to recurrence was 27 months. Delivered dose ranged from 45 to 80 Gy, and 19 patients received combined chemotherapy. Therapeutic results were as follows: complete response in 16 patients, partial response in 27, no response in 12 and progressive disease in 1, Overall 2- and 5-year survival rates were 17% and 11%, respectively, and 10 months in MST. On univariate analysis, significant prognostic factors were sex, stage at recurrence, recurrence pattern, performance status and initial response to radiotherapy, while multivariate analysis showed sex and initial response. From these data, we are encouraged by effective radiotherapy for postoperative intrathoracic recurrence of non-small cell lung cancer, especially in patients with stump or lymphnode recurrence.

Assessment of the expression of p53, MIB-1 (Ki-67 antigen), and argyrophilic nucleolar organizer regions in carcinoma of the extrahepatic bile duct

BACKGROUND

The authors retrospectively examined the predictive value of p53, MIB-1, and the argyrophilic nucleolar organizer regions (AgNOR) and examined the relationships among them in carcinoma of the extrahepatic bile duct (EHBD).

METHODS

Formalin fixed, paraffin embedded specimens from 54 patients with EHBD carcinoma were immunostained with MIB-1 against the Ki-67 nuclear antigen and p53 by the avidin-biotin peroxidase complex method, using the antigen retrieval technique of heating tissue sections in a microwave oven. The AgNOR proteins were localized at the optical level, as shown by a one-step silver staining technique.

RESULTS

MIB-1 and AgNOR were closely associated with lymph node metastasis (P < 0.01). The cumulative survival rate for patients with a low MIB-1 labeling index (LI) (< 29%) was significantly better than that for patients with a high MIB-1 LI (> or = 29%) in cases of EHBD carcinoma (P < 0.05), but MIB-1 was not an independent prognostic factor in multivariate analysis. The results indicated that AgNOR and p53 overexpression had no prognostic value. The authors detected p53 in 24 of the 54 EHBD carcinomas (44.4%). There was a significant correlation between MIB-1 and AgNOR (P < 0.01). The authors found that neither MIB-1 nor AgNOR correlated with p53 overexpression.

CONCLUSIONS

MIB-1 and AgNOR proved to be useful predictors of lymph node metastasis. The results of this study indicated that MIB-1 and AgNOR might be markers of the progression of EHBD carcinoma.

Developmental characteristics of temporal control of movement in preschool and school children of different ages

The purpose of this study was to investigate the temporal control of repetitive tapping in children, ages 3 to 11 (N = 99). The subjects tapped in synchrony with an auditory pulse (synchronizing phase) at nine different tempos (interpulse intervals of 370, 420, 500, 540, 620, 720, 850, 1000, and 1300 msec.) and were then asked to maintain the same tapping tempo without the aid of an auditory pulse (continuing phase). The time difference between the onset of the pulse and the tap in the synchronizing phase and intertap interval in the continuing phase were measured. Both the time difference between the timing pulse and the tap, and variation of intertap intervals were smallest at the tempo of 500 msec. for all age groups. The variation of the intertap interval at slower tempos was greater than that at fast tempos in all age groups. This suggests that the accurate interval (tempo) of all the subjects was around 500 to 600 msec. At slower tempos, the intertap interval had a tendency to become slightly shorter with time and converged at intertap interval 500 to 600 msec. It is suggested that the preferred tempo was superior to the prescribed tempo in the continuing phase for younger subjects. Differing patterns of response in the movement sequence were observed between younger and older subjects in the movement sequence. The changes in temporal control over the age groups are thought to appear at between 5 and 7 years of age.

Immunohistochemical detection of proliferating cell nuclear antigen and p53 expression in carcinoma of the extrahepatic bile duct

We used an immunohistochemical method to determine the concentrations of p53 and proliferating cell nuclear antigen (PCNA) to evaluate their usefulness as a predictor of malignancy and examined the relationship between PCNA and p53 in carcinomas of the extrahepatic bile duct (EHBD). Paraffin-embedded specimens from 46 patients were immunostained for PCNA and p53 using PC10 and DO7 monoclonal antibodies, respectively. The PCNA labeling index (LI) was closely associated with the stages of the tumor and depth of invasion (p < 0.05). The cumulative survival rate of patients with a low PCNA LI (LI < 47%) was found to be significantly better than that of patients with a high PCNA LI (LI > or = 47%) in all cases and patients with advanced cancer by univariate analysis (p < 0.05), but PCNA LI was not an independent prognostic factor in multivariate analysis. We detected p53 in 37% of the EHBD cancers. We also found that p53 positivity was not related to the percentage of PCNA-labelled cells or survival. The results suggest that PCNA immunoreactivity may be a useful predictor of malignancy in patients with EHBD carcinomas.

[Evaluation of intra-arterial infusion chemotherapy for liver metastasis from gastric cancer]

We evaluated the result of intra-arterial infusion chemotherapy on liver metastasis from gastric cancer. Of 92 cases of metastatic liver tumor, 17 cases received intra-arterial infusion chemotherapy after primary resection. For comparison, we assigned the 17 cases to two groups according to the infused agents. One group was treated with the combination therapy of 5-FU, epirubicin and MMC (FEM group: n = 7), and another with other antineoplastic agents (non-FEM group: n = 10). In the FEM group, the response rate, 1-year survival rate and 50% survival period were 33.3%, 51.4%, 430 days, respectively, while those of the non-FEM group were 10.0%, 10.0%. 147 days. Although there was no significant difference (p = 0.0951), improvements in survival rate and survival period were observed. This implies the possibility that intra-arterial infusion chemotherapy, especially the combination therapy of FEM, is an effective treatment for liver metastasis from gastric cancer.

[Influence of fluid replacement on serum magnesium concentration and proper magnesium supplementation during general anesthesia]

We have studied the influence of fluid replacement on serum magnesium (Mg2+) concentrations, and studied proper Mg2+ supplementation during general anesthesia. Thirty eight patients undergoing elective surgery randomly received: Mg(2+)-free acetated Ringer solution (Group I, n = 15), acetated Ringer solution containing 0.5 mmol.l-1 of Mg2+ (Group II, n = 6), 1.0 mmol.l-1 of Mg2+ (Group III, n = 7), 2.0 mmol.l-1 of Mg2+ (Group IV, n = 6), or 4.0 mmol.l-1 of Mg2+ (Group V, n = 4). Measurements were made on serum and urine Mg2+ concentrations during anesthesia. In Group I, the serum Mg2+ concentrations decreased in correspondence with the water balance. It is suggested that dilution due to the fluid replacement induced the reduction in serum Mg2+ concentrations since the observed urine Mg2+ concentrations were negligible. In Group II-V, the reduction in serum Mg2+ concentrations was inhibited by Mg2+ supplementation, and the serum Mg2+ concentrations remained unchanged in Group IV. We conclude the Mg2+ supplementation is required during anesthesia when a large amount of fluid is infused.

[Complication due to arterial infusion chemotherapy for liver metastasis from colorectal cancer]

OBJECTIVES

Arterial infusion chemotherapy is considered to be an extremely effective treatment for liver metastasis from colorectal cancer in terms of its tumor reduction and preventing recurrence in residual liver after resection. However, there still remain some unclear points as to the influence on hepatic artery and bile duct when this treatment is used over the long term. We report some conclusions obtained by examining cases of hepatic arterial occlusion (stenosis) and biliary complication who received this treatment.

MATERIALS AND METHODS

Thirty-six cases who received this treatment over 3 months were the objects of this study, with the aim of direct effect against metastatic focus (21 cases) and prevention of recurrence in residual liver (15 cases). The ages were from 27 to 81; 22 cases were male and 14 were female. Indwelling routes of catheter were gastroduodenal artery (GDA) in 28 cases and femoral artery (FA) in 8 cases. Intermittent high-dose infusion (WHF: 5-FU 1,000 mg/m2/5 hrs qw) was adopted as the method.

RESULTS

Hepatic arterial occlusion or stenosis was observed in 12 cases (GDA: 10; FA: 2). There seemed to be no correlation with the total dosage of 5-FU or the number of administrations. Even when hepatic arterial occlusion or stenosis occurred, no change was observed in liver function, and there no death was caused by this. However, CT showed a low-density area followed by atrophy in the right lobe in one case with right hepatic arterial stenosis, despite normal portal blood flow. Of the 6 cases which developed obstructive jaundice, 4 were due to the increase of metastatic focus or lymph nodes, and 1 case without dilatation of bile duct died from suspected sclerosing cholangitis. In this case, ALP had been increasing since 1 month before the onset of jaundice. Another case which developed biloma accompanied by the increase of serum bilirubin improved by discontinuance of chemotherapy.

CONCLUSION

Since arterial infusion chemotherapy for liver metastasis from colorectal cancer causes hepatic arterial occlusion (stenosis) at a high rate, early detection of abnormalities by liver function test and imaging diagnosis which leads to early treatment is important.

Release of opioid peptides, gluten exorphins by the action of pancreatic elastase

The release of opioid peptides, gluten exorphins A, which have been isolated from the pepsin-thermolysin digest of wheat gluten, with gastrointestinal proteases was examined. High levels of gluten exorphin A5 (Gly-Tyr-Tyr-Pro-Thr) immunoreactive materials were detected in the pepsin-pancreatic elastase digest by a competitive ELISA. From this digest, gluten exorphin A5, B5 and B4 were isolated. This means that these peptides are released in the gastrointestinal tracts after ingestion of wheat gluten. The yield of gluten exorphin A5 in the pepsin-elastase digest was larger than that in the pepsin-thermolysin digest. The gluten exorphin A5 sequence is found 15 times in the primary structure of the high molecular weight glutenin. The region from which gluten exorphin A5 was released by the action of pancreatic elastase was identified using synthetic fragment peptides.

Chronic exertional compartment syndrome in lower legs: localization and follow-up with thallium-201 SPECT imaging

The purpose of this study was to ascertain whether 201Tl SPECT imaging of the leg is useful in precise localization of the ischemic compartment involved in chronic exertional compartment syndrome (CECS).

METHODS

Imaging and quantitative analyses of postexercise 201Tl SPECT leg examinations were retrospectively performed in nine patients with clinically diagnosed CECS and eight control subjects. Imaging and quantitative criteria for the ischemic compartment were decreased 201Tl perfusion less than the lower limits of normal, which were defined as 2 s.d. below the mean percentage uptake of the control subjects. The SPECT imaging results were compared with those of quantitative analysis, postoperative SPECT images and clinical diagnoses.

RESULTS

Postexercise normal legs had nonuniform 201Tl distribution in both legs and in the four compartments. Lower limits of normal mean percentage 201Tl uptake were about 60% for the anterior compartment and about 50% for the other three compartments. Redistribution was observed in 67% of normal compartments in the control subjects. The SPECT images demonstrated 16 ischemic compartments in eight of the nine patients. The SPECT results were consistent with those of quantitative analysis. There were discrepancies between the clinical and SPECT diagnoses in six legs (33% of the 18 legs) of five patients. Postoperative SPECT demonstrated 201Tl perfusion was improved in all involved compartments for that fasciotomy was performed.

CONCLUSION

Thallium-201 SPECT imaging of the legs can easily provide precise localization of the ischemic compartment, which is demonstrated as decreased 201Tl distribution on the stress image. This technique is promising for the screening and follow-up of CECS.

Survival in long-term haemodialysis patients: results from the annual survey of the Japanese Society for Dialysis Therapy

The prognosis for haemodialysis patients is reported to be more favourable in Japan than in Europe or North America. Consequently, evaluation of the death predictors for haemodialysis patients in Japan is of considerable interest outside Japan. The Patient Registration Committee of the Japanese Society for Dialysis Therapy annually surveys the individual patient case mix, laboratory data and important events occurring in the previous years. Thus, using case mix data and laboratory data (including Kt/V and protein catabolic rate) from the 1993 questionnaire survey and the individual patients' life/death statistics from the 1994 questionnaire survey, a logistic regression analysis was conducted on 53867 patients. The analysis indicated that important death risk predictors were: (i) advanced age, (ii) occurrence of diabetes mellitus, (iii) male sex, (iv) Kt/V lower than 1.8, (v) haemodialysis time less than 5 h, (vi) protein catabolic rate less than 0.9 g/kg/day, and (vii) percentage body weight decrease less than 4% and more than 8% during the first haemodialysis session of the week.

Use of the body surface recovery time for detection of coronary artery disease

We explored the relationship between body surface recovery time (RT), the interval between the QRS onset and the time of maximum derivative in the T-wave on a 16 precordial lead system electrocardiogram (ECG), and monophasic action potential (MAP) duration of the left ventricular endocardium in 9 patients in whom electrophysiologic testing was indicated. The usefulness of RT measurement on body surface ECG for the detection of coronary artery disease was evaluated in 98 patients who had chest pain. The RT located in the right clavicular or upper sternal area showed a very high positive correlation (r = 0.91, p < 0.001) with MAP duration from the left ventricular endocardium and showed specific shortening in patients with one-vessel disease of the left anterior descending coronary artery. With a criterion of the RT located in the right clavicular or upper sternal area corrected by Bazett's formula < 380 msec1/2, a sensitivity of 81% and a specificity of 80% were achieved for detection of one-vessel disease of the left anterior descending coronary artery.

Current status of renal replacement therapy in Japan: results of the annual survey of the Japanese Society for Dialysis Therapy

Beginning in 1966, the Patient Registration Committee of the Japanese Society for Dialysis Therapy has conducted a survey once a year on renal replacement therapy in Japan. As of 1983, the survey covered the life/death of patients in the survey years, as well as the case mix of individual patients. In 1990 several laboratory variables were added to the survey items. The present report summarizes the data from the 1993 and 1994 surveys. The Committee mailed out questionnaire forms at the end of the survey year to the heads of all dialysis facilities. Survey forms were returned from 99.6% of the dialysis facilities in the 1993 survey, and from 99.8% of the facilities in the 1994 survey. Some 143709 patients were treated by renal replacement therapy in 1994 (7509 were treated by CAPD, and 131016 by extracorporeal haemopurification). The gross mortality rate was 9.5% in the same year. The mean values of the laboratory variables among 88693 patients undergoing thrice weekly haemodialysis were as follows in 1993: Kt/V, 1.31 +/- 0.30; protein catabolic rate, 1.04 +/- 0.30 g/kg/day; haemodialysis time, 4.12 +/- 0.50 h. In 1994, the variables were: predialysis serum creatinine concentration, 11.54 +/- 2.85 mg/dl; predialysis serum albumin concentration, 3.91 +/- 0.55 g/dl; predialysis haematocrit, 28.69 +/- 4.36%.