[Studies on the biological effects of low level lead exposures. Part 1. Estimation of usefulness of some biochemical tests as parameters for occupational lead exposures (author's transl)]

Male painters of ceramic works were examined for parameters of biochemical lead poisoning such as erythrocyte ALAD, free erythrocyte protoporphyrin (FEP), and coproporphyrin (CP) in urine as well as parameters of lead absorption such as lead concentration in blood and urine (PbB & PbU) in order to estimate the usefulness of those biochemical tests for occupational lead exposures. Under the lead exposure level of these painters (PbB 5-50 microgram/l), log ALAD and log FEP showed good linear correlations with PbB, while ALAU and CPU showed significant but lesser correlations with it. The log ALAD showed a good linear correlation with log PbU, log FEP, and ALAU fairly good ones, CPU a significant but lesser correlation with it. ALAD and FEP were equally the most sensitive tests for increasing PbB or PbU. ALAU was the next most sensitive test and CPU was the least sensitive. From the view point of sensitiveness and obvious meaning as a test for lead poisoning, FEP is the most desirable test for occupational lead exposures.

Elevated urinary excretion of metallothionein due to environmental cadmium exposure

Metallothionein, a low molecular weight cadmium-binding protein, has been determined for the first time in urine of "itai-itai" disease patients and other Japanese women environmentally exposed to cadmium. On a group basis, the urinary metallothionein levels of "itai-itai" disease patients and suspected patients were significantly higher than that of women living in a cadmium-polluted area. Women living in a non-polluted area excreted significantly less metallothionein than women living in a cadmium-polluted area. A similar trend was observed for urinary beta 2-microglobulin, a nonspecific index of renal tubular dysfunction. However, mean levels of urinary cadmium in the "itai-itai" disease patients, suspected patients and women living in the cadmium-polluted area were similar. It is suggested that if, in addition to beta 2-microglobulin and cadmium, metallothionein is used as another index of cadmium exposure, monitoring of renal tubular dysfunction caused by cadmium may be more effectively carried out.

Small ventricles detected by CT-scanning in epileptic patients

Relatively young 119 cases of generalized epilepsy and 99 controls of an identical age were selected. The bicaudate CVI was measured and the results were as follows: 1) In our cases, the mean of bicaudate CVI showed a smaller value than those of Hahn's in both epilepsy and control groups. 2) When the value of bicaudate CVI was set up below the point of 8.5 as "excessively small ventricle," the incidence rate of "excessively small ventricle" was 9% in the control group and 31% in the epilepsy group. The data showed higher incidences of small ventricles in the epilepsy group, and that the younger females have a tendency to have higher incidences of small ventricles. 3) To make clear the reason for the higher incidences of small ventricles in epilepsy, the small ventricle group and the non-small ventricle group in epilepsy were compared with each other from the points of the clinical course, EEG findings and frequency of attacks. No correlation or difference between them was found. Further investigation will be needed to make clear the etiology of small ventricles in epilepsy. However, it could be said at the present stage that not so many atrophic changes were observed in the younger patients of generalized epilepsy.

A study of the relationship between cadmium concentrations in urine and renal effects of cadmium

The relationship between urinary cadmium concentration expressed as microgram/g creatinine and renal effects of cadmium exposure was studied in 542 inhabitants over 20 years of age who lived in the Jinzu River basin which is polluted by cadmium. Cadmium concentration in urine was employed as the index of cadmium exposure. Total protein with glucose, beta 2-microglobulin, retinol binding protein, and proline served as indices of renal effects. The prevalent rate of high beta 2-microglobulin excretion was the highest among these indices both in men and women. Prevalence rates of indices of renal effects increased proportionally with increasing cadmium concentrations in urine and probit linear regression lines could be calculated between them. The urinary cadmium concentrations corresponding to 1% prevalence rates of indices of the renal effects were calculated by the regression line. For beta 2-microglobulin, 3.2 microgram Cd/g creatinine and 5.2 microgram Cd/g creatinine were obtained in men and women, respectively. This method may be useful for evaluating the risk of renal damage of exposed inhabitants.

[Surgical treatment of the thoracic arterio-venous malformation with intraspinal and extraspinal niduses (author's transl)]

Recent advances in the technique of selective spinal angiography and microsurgery have provided us remarkable progress in diagnosis and treatment of spinal arteriovenous malformation. Although in some cases total extirpation is still difficult, various attempts have been performed for complete cure. In this paper, the authors reported a case of 6-year-old girl who complained of the progressive gait disturbance. In this case we found the thoracic AVM which had niduses not only in the intraspinal canal but also in the extraspinal space. Transthoracic ligature was performed in this case. That is, through a thoracotomy with rib resection on the right side, the enlarged anomalous feeding artery, i.e., intercostal artery with its branches, from which Adamkiewicz's artery should be derived was ligated and clipped. And the result was good. In Japan, we have never had a report of such surgical method for AVM. Besides such a case is very rare that the AVM had nidus extending to both intra- and extra-spinal canal space. So we discussed the treatment against such an AVM with the investigations of literatures. Further follow-up study for this case will be reported later. The paper was read by the authors at the 53rd Kyushu region meeting of Japan Neurological Society (February 28, 1976, Kagoshima).

A morphological study on vascular changes in the surgically resected tissues of temporal lobe epilepsy-with a special reference to the etiology

(1) Twenty-one out of 23 cases surgically resected specimens of TLE presented the common histological findings; sclerotic changes of the tissues. And the other two cases encountered the small tumors which might be called "cryptic". (2) Since circulatory disturbance is generally accepted to explain the cause of TLE we reexamined vascular behaviors in detail and found the quantitative and qualitative abnormaltities which reached the high rate of 71% (17 out of 21 cases) except two cases of small tumors. Moreover, it is remarkably noteworthy that these vascular changes adjoin the sclerosed parenchymal tissue. (3) It may be said that vascular changes have exerted some influences on the formation of inferomedial temporal sclerosis from the standpoint of the histological findings, though they are alone not fully sufficient to explain the etiology of TLE.

[Familial occurrence of pituitary adenoma (author's transl)]

The familial occurrence of brain tumors are exceedingly rare except in cases with phacomatosis. We encountered pituitary adenomas in two sisters of a family, so far presenting no evidence of multiple endocrine adenomatosis (MEA). Case 1, K. O. a 26-year-old woman was admitted to our Hospital on September 10, 1970 with visual acuity and field disturbance, irregular menstruation and acromegaly. Neurological examination: Her visual acuity was Vd 0.6 and Vs 0.3, visual field was bitemporal hemianopsia, and ther was papilledema bilaterally. She had left exophthalmos and left abducens palsy. Roentgenogram of the skull, brain scanning, cerebral angiogram, pneumoencephalogram suggested the presence of a pituitary tumor. On Sep. 17, 1970, through a left frontotemporal craniotomy the tumor was removed subtotally. The pathological diagnosis was pituitary adenoma (chromophobe). Case 2, M. T. a 31-year-old woman, sister of case 1, was admitted to the Hospital on September 19, 1973, with mild headache, left visual field disturbance and amenorrhea. She had a child, and a past history of pulmonary tbc. Neurological examination: Her visual acuity was Vd 1.2 and Vs 0.03, and visual field of the right eye was temporal lower quandrant anopsia. There was optic nerve atrophy in the left eye. Plain X-ray craniogram, brain scanning, cerebral angiogram and pheumoencephalogram suggested the presence of a pituitary tumor. On Sep. 28, 1973, a right frontal craniotomy was performed. The tumor tissue with capsule was removed subtotally. The pathological diagnosis was pituitary adenoma (mixed type). In the literatures about familial brain tumors with histological diagnosis, glioma and glioblastoma are common, meningioma is relatively rare. Pituitary adenoma with no evidence of MEA is exceedingly rare. The two sisters presented in this paper, have no evidence of hyperparathyroidism, pancreas adenoma and peptic ulcer. So, we consider, at present, these cases should not be field in MEA.