[Clinical study of the hypogastric plexus preserving operation for Y-prosthesis replacement for abdominal aneurysm--operative technique for avoiding postoperative sexual disorders]

We studied the effect of the hypogastric plexus preserving operation for Y-prosthesis replacement in abdominal aneurysm. The hypogastric plexus preserving operation was performed for avoiding postoperative sexual disorders such as the impotence and the abnormalities of ejaculation. With wide abrasion of retroperitoneum as usually, postoperative abnormalities of ejaculation occurred in 70% and postoperative impotence occurred in 50% of cases undergoing Y-prosthesis replacement. More reliable nerve preserving operation was the minimum abrasion of retroperitoneum and the aorta had not to he abrased at the origin of the inferior mesenteric artery, bifurcation of the aorta and the common iliac artery. Then with this nerve preserving operation, abnormalities of ejaculation occurred in 30% (p < 0.05) of cases and impotence occurred in 20% of cases. The results indicate that sexual dysfunction may he prevented to minimize by the nerve preserving operation.

Morphology and analysis of the development of the human temporomandibular joint and masticatory muscle

The calcification levels of the mandible and the temporal bone of human fetuses, which ranged from 12 to 32 weeks of gestation, were systematically investigated with a soft X-ray analyzer linked to an image analyzer. The profile of the condylar process (head) revealed high levels of calcification, in contrast to that in the mandibular fossa of the temporal bone. The basal portion of the condylar process and the mandibular notch exhibited moderate calcification from 12 weeks of gestation. The weight and the cross-sectional areas of the muscle and the muscle fibers in masticatory muscles (masseter, temporal, medial, and lateral pterygoid muscles) are all increased gradually during development from 12 to 32 weeks of gestation. These changes in calcification and in cross-sectional area of muscle suggest that muscle development may be related to bone calcification during formation of the mandible.

Production of two novel monoclonal antibodies against human renal glomeruli and their application to the immunohistochemical investigation of crescentic glomerulonephritis

Two monoclonal antibodies (MAbs) against human renal glomeruli, HEP1 and HBM1, were produced using isolated human glomeruli as an antigen. Immunohistochemical and immunoelectron microscopic analyses revealed that the recognition site of HEP1 is the cell surface of the visceral glomerular epithelial cells. HEP1 showed no reaction in the renal interstitium or in other tissues. HBM1 recognized an antigen present in the basal lamina of the renal glomeruli, Bowman's capsule, and partly in the basement membrane of renal tubules, but it was not reactive with the mesangial matrix or renal interstitium. The isotype of both MAbs was IgG1, k. The molecular weights of their corresponding antigens were 127-177 and 220 kD, respectively. Besides human tissues, HEP1 also showed cross-reactions with antigens in the visceral glomerular epithelial cells of various animals other than mice. HBM1 recognized human antigen only. Using both MAbs, eight cases of crescentic glomerulonephritis were examined immunohistochemically. As a result, it was demonstrated that the crescents may not be formed by visceral glomerular epithelial cells. From this study, these two MAbs appear to be useful markers for the evaluation of renal glomerular disorders.

Effect of lifetime cigarette consumption on time domain spirogram indices

A cross-sectional analysis on the dose-related change in time domain spirogram indices induced by lifetime cigarette consumption was conducted to examine the ability of those indices to detect early changes in the lung periphery in comparison with conventional spirometric indices. The subjects were asymptomatic healthy male workers from three occupational cohorts including asbestos workers and welders. They were asked to perform the forced expiration maneuver at least three times to obtain reliable results. A total of 893 subjects were enrolled in the study, and 484 of them who were aged 30 years or more and were free from chronic respiratory symptoms and abnormalities in chest radiography and spirometry, were analyzed. Although conventional indices, such as forced expiratory volume in one second and maximal midexpiratory flow, were not significantly different between smokers and nonsmokers, the standard deviation of transit times and of time constant distribution in smokers were significantly elevated compared with nonsmokers. Furthermore a dose-related change according to lifetime cigarette consumption was observed in those indices. We conclude that time domain spirogram indices, especially the standard deviation of time constant distribution, would be more useful than conventional indices in detecting early changes in the lung periphery.

Timing for administration of an antihypertensive drug in the treatment of essential hypertension

To find the best timing for administration of long-acting antihypertensive drugs, we gave nitrendipine, a calcium antagonist of the dihydropyridine group, once a day to six hospitalized and drug-free patients with essential hypertension, changing the time of administration and studying the effects on the circadian rhythm of blood pressure. After control values of 24-hour blood pressure variations were taken with patients on placebo, a 10-mg tablet of nitrendipine was given for 3 days on three occasions--at 6 AM on awakening, at 8:30 AM after breakfast, and at 6 PM after supper; 24-hour blood pressure values for each period were recorded on the third day. The 24-hour blood pressure values during the control period showed a biphasic circadian rhythm, with higher values during wakefulness and lower values during sleep. The control period was also characterized by a rapid rise in blood pressure on awakening, the so-called morning surge of blood pressure, and a gradual decline during sleep at night. Although the morning surge was not completely suppressed by nitrendipine given after breakfast, it was diminished by the drug given on awakening or after supper; the latter brought a deeper decline in blood pressure during sleep compared with other times. The average of 24-hour blood pressure values obtained by nitrendipine given on awakening was the lowest among the three occasions. Thus, administration of long-acting calcium antagonists with a rapid onset of action on awakening in the early morning seems to be a more rational and beneficial alternative than the conventional administration after breakfast.(ABSTRACT TRUNCATED AT 250 WORDS)

Contents of lecithin and choline in crude drugs

The determination of lecithin and choline in crude drugs was established by a combination of high performance liquid chromatography (HPLC) with electrochemical detector (ECD) and enzyme reaction. Lecithin in crude drugs extracted with a mixture of chloroform-methanol (2:1) at room temperature was hydrolyzed by phospholipase D. The hydrolyzate was injected to HPLC, and choline was separated from impurities by reverse phase column. The choline was converted to betaine and hydrogen peroxide by passing through column packed with immobilized choline oxidase. This hydrogen peroxide was detected by ECD. The peak area of hydrogen peroxide derived from lecithin was proportional to the concentration of lecithin from 0.10 to 1.52 microgram/ml. Choline in crude drugs was extracted with ethanol under reflux and determined under the same HPLC conditions as lecithin. The peak area of hydrogen peroxide derived from choline was proportional to the concentration of choline from 0.01 to 0.45 microgram/ml. The contents of lecithin and choline in 31 kinds of crude drugs were determined by these established methods. The results showed that Cervi Parvum Cornu, Kokurozin, Foenigraeci Semen and Psoraleae Semen contained more lecithin than other crude drugs, while Angelicae Radix, Foenigraeci Semen, Psoraleae Semen, and especially Hippocampus were found to contain more choline than other crude drugs.

[Clinical study of anti-phospholipid antibody in patients with sarcoidosis]

Serum antibodies against five types of phospholipids were measured by enzyme-linked immunosorbent assay (ELISA) in 55 patients with sarcoidosis. In 21 cases (38%), either IgG antibodies or IgM antibodies were detected. These antibodies were thought to mainly be infective type. This positive rate was significantly higher than that (7%) of the control group (70 cases) (p < 0.01). As to the immunoglobulin classes, 5 cases had IgG antibodies only, 11 cases had IgM antibodies only, and 5 cases had both IgG and IgM antibodies. No correlation was observed between the occurrence of anti-phospholipid antibodies (APL-Ab) and disease activity of sarcoidosis. Significant correlations were found between the occurrence of APL-Ab and skin lesions, many extrathoracic organ lesions and the persistence of abnormal chest X-ray findings for over 2 years and 5 years. From these data, it is suggested that the presence of APL-Ab is associated with prolonged disease activity of sarcoidosis.

Therapeutic effect of a CDDP-epirubicin-Lipiodol emulsion on advanced hepatocellular carcinoma

Prior injection of an anticancer agent and Lipiodol mixture is a key point for the treatment of hepatocellular carcinoma (HCC). We therefore prepared a new, improved emulsion of Lipiodol containing a high dose of cis-diamminedichloroplatinum (CDDP) and epirubicin by replacing the ionic contrast medium (Urografin 67) with a nonionic contrast medium (Iopamidol; Iopamiron 300) and adding phosphatidyl choline. This CDDP-epirubicin-Lipiodol emulsion (CELE) was examined pharmacologically and chemically with the following results. The size of these particles is less than 10 microns (diameter) for up to 24 h; the release of 28%-34% of the CDDP and 80%-90% of the epirubicin was estimated in the dissolution test, and 85% of the CDDP and 35% of the epirubicin was retained in the organs in the moment calculation. CELE was injected into 58 HCC patients via a celiac angiographic catheter. In 36 of these patients, the CELE injection was followed by transcatheter arterial embolization (TAE) therapy. Following the administration of CELE as one-shot injection therapy for stage IV HCC, the 1-year survival rate was 59% and the 2-year survival rate was 27%. Moreover, in patients (stage II, 12; stage III, 8; stage IV, 16) who received CELE and subsequently underwent TAE therapy, the 1-year survival rate was 90% and the 2-year survival rate was 67%. The nonionic contrast medium with Lipiodol forms finer emulsified particles, and these particles are more capable of penetrating into the tumor. In addition, the greater pharmacological stability of these particles provides a slow-release effect and prolonged stability of their shape. Finally, theoretically, the use of two major anticancer agents such as CDDP and epirubicin showed a greater clinical effect in the treatment of HCC than either our earlier suspension or a single anticancer agent.

Mathematical model of cardiovascular mechanics for diagnostic analysis and treatment of heart failure: Part 1. Model description and theoretical analysis

The planning of drug therapy for heart failure should involve both the diagnostic analysis of the patient's defective state and a prediction of the drug effects on the identified state. We have devised a mathematical model of cardiovascular system mechanics, on which both quantitative diagnosis and evaluation of drug effects can be made. The model was composed of systemic and pulmonary circulatory networks including the dynamics of the left and right ventricles. The model of the ventricles can represent both systolic and diastolic problems in heart failure through the parameters of ventricular contractility and diastolic stiffness. Each vascular network was composed of arterial and venous resistances and total vascular capacitance. Patient's ventricular and vascular parameters were estimated simultaneously from the clinically measurable haemodynamic variables based on the model. Despite the simplicity of the model, the results showed good agreement with clinical and experimental data. The clinically significant haemodynamic classification of heart failure by Forrester et al. (Forrester et al., 1977) was simulated well by the model. This model provides a useful basis for analysing pathophysiological states in heart failure and evaluating drug effects on the disease.

Comparison of indirect haemagglutination test, gel-diffusion precipitin test, and enzyme-linked immunosorbent assay for detection of serum antibodies to Pasteurella multocida in naturally and experimentally infected rabbits

Enzyme-linked immunosorbent assay (ELISA), gel-diffusion precipitin test (GDPT), and indirect haemagglutination test (IHAT) were evaluated for the detection of antibodies to Pasteurella multocida in both naturally and experimentally infected rabbits. A total of 285 rabbit serum samples from 7 rabbit colonies were tested by ELISA, GDPT, and IHAT, and nasal cultures were taken coincidentally to use as the standard in the serological tests. There was better correlation (98.0%) between the results of ELISA and positive nasal culture than between the GDPT (86.3%) or IHAT (23.5%) and positive nasal culture. In addition, ELISA and GDPT were positive in 26 (11.1%) and 21 (9.0%) of 234 serum samples from nasal culture negative rabbits, respectively. In experimentally infected rabbits, antibodies detected by the ELISA and GDPT began to rise one to 3 weeks post-inoculation. IHAT did not detect antibodies. These results are discussed in terms of value to serodiagnosis of rabbit pasteurellosis.

Clinical evaluation of serum ornithine carbamoyltransferase by enzyme-linked immunosorbent assay in patients with liver diseases

We developed a sensitive enzyme-linked immunosorbent assay (ELISA) for serum ornithine carbamoyltransferase (OCT) protein, and examined serum OCT concentrations in patients with various liver diseases. OCT concentrations were markedly elevated in cases of hepatic encephalopathy, 'acute on chronic', and those with the acute phase of acute hepatitis, moderately in chronic hepatitis, liver cirrhosis, hepatocellular carcinoma, primary biliary cirrhosis, and slightly in those with a fatty liver. High percentages (92-98%) of patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma had higher than normal concentrations of serum OCT protein. There was a close correlation with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities and moderate correlations with those of mitochondrial AST, glutamate dehydrogenase and gamma-glutamyltranspeptidase. The OCT/ALT ratio was higher in patients with liver cirrhosis than in those with chronic hepatitis (p < 0.001), and was still higher in cases of hepatocellular carcinoma (p < 0.05). In 2 patients with 'acute on chronic' disease, OCT concentrations decreased similarly with or more rapidly than AST or ALT activities after admission. In 2 patients with hepatic encephalopathy, the OCT concentrations changed similarly with AST and ALT activities. This OCT ELISA system will aid in diagnosing various liver diseases and in the follow-up of the patients, and the OCT/ALT ratio may serve for a differential diagnosis of liver diseases.

Variation of the jaw-opening reflex during spontaneous mastication in rabbits

To understand the modulation of periodontal mechanoreceptor activity on mastication, the jaw-opening reflex (JOR) evoked by electrical stimulation of the inferior alveolar nerve (IAN) was studied during chewing in freely behaving rabbits. Spontaneous chewing movements were intact from the IAN stimulation below two times the threshold (T) which was measured at rest. As the stimulus intensity was increased to more than 2.5 T, the amplitude of the masseter activity decreased or it was abolished; however, the chewing rhythm was still maintained up to 3.0 T. When the low-threshold primary afferents were tested while the rabbit chewed pellets rhythmically, the amplitude in the JOR was inhibited below the prior control level. The inhibitory effect on the JOR was larger in the opening phase than that in the closing phase. In conclusion, the JOR was tonically depressed during the masticatory cycle and the inhibition of the JOR was rhythmically modulated in a phase-linked manner that was larger in the opening phase than in the closing phase.

[Pseudocoarctation of the aorta associated with aortic valve regurgitation: a case report]

We reported a case of pseudocoarctation of the aorta associated with severe aortic regurgitation. A 63-year-old male admitted with congestive heart failure due to aortic regurgitation. The blood pressure was 170/60 mmHg in the right arm and the systolic pressure was 132 mmHg in the right leg. To and fro murmur and diastolic grade IV/VI blowing murmur was heard along the lower left sternal border. Aortogram demonstrated marked buckling of the descending aorta at the origin of the left subclavian artery without collateral circulation and bicuspid aortic valve with severe aortic regurgitation. His pressure gradient across the pseudocoarctation was 40 mmHg in the preoperative catheterization. We performed an aortic valve replacement (AVR) without further surgical treatment. The pressure gradient was reduced to 10 mmHg and his symptom improved after AVR. These results suggested that pseudocoarctation of the aorta may require no surgical treatment in some case associated with aortic valve regurgitation because of improvement of high pressure gradient across it by AVR alone.

Multidisciplinary treatment of head and neck cancer using BCG, OK-432, and GE-132 as biologic response modifiers

Since 1979, we have performed multidisciplinary treatment using intensive immunotherapy with biologic response modifiers (BRM) in combination with surgical treatment of oral cancer. Chemotherapy and radiotherapy were also included as part of the therapy. A historic control study was performed. Adjuvant therapy was administered by standardized methods, and the distribution of patients at various stages was similar between groups. The immunotherapy group showed a shorter treatment period, lower rates of recurrence, metastases, and side effects, greater histologic effects at the end of the first treatment, and a higher survival rate than the nonimmunotherapy group. Immunologically, immunotherapy tended to promote positive immune reactions and inhibit negative immune reactions.

Age distribution of the melancholic type of personality (typus melancholicus) in outpatients with major depression: a comparison with a population without a history of depression

We investigated the age distribution of the typus melancholicus (TM) score, measured by Kasahara's scale, in 119 outpatients with major depression and in 600 workers without a history of depression. In the patient group, the score was, regardless of age, always constant at a high level. The TM score for the control group increased with aging and was in most age groups significantly lower than that for the patient group. This result suggests that a higher TM score on the scale would be a risk factor and a possible trait marker of major depression.

Renal impairment and intraglomerular mononuclear phagocytes in cholesterol-fed rabbits

Morphological and immunohistochemical studies using the anti-macrophage monoclonal antibody RbM2 were performed in cholesterol-fed rabbits. From the beginning of the experiment, the levels of lipoproteins showed the pattern of familial type III hyperlipoproteinemia patients, and glomerular endothelial and mesangial cells had lipid deposits. By the 3rd week, RbM2-positive cells appeared in the capillary lumina. These cells became larger and increased in number after the 8th week. Although they had become very large and had increased noticeably by the 20th week, few sclerotic glomeruli were observed. We could hardly detect any proliferation of or foamy changes in the mesangial cells, and monocyte/macrophages showed no proliferative capacity within the glomeruli. These findings suggest that hyperlipidemia alone did not cause proliferation or foam transformation of the mesangial cells. The glomerular macrophages, probably derived from circulating monocytes, did not induce a glomerular injury under the short-term hyperlipidemic conditions of these experiments.

Arrangement and innervation of the glutei medius and minimus and the piriformis: a morphological analysis

In order to examine the relationships between the positional arrangement and supplying nerves of the glutei medius and minimus and the piriformis, we investigated 49 pelvic halves of 28 cadavers. The superior gluteal nerve ran on the ventral surface of the piriformis in 44 cases (89.8%) (Type A), and some branches of the nerve perforated the piriformis in five cases (10.2%) (Type B). Based on the detailed findings of the innervation of the three muscles, the piriformis is chiefly composed of the caudal element of the gluteus medius (Type A) and in some cases the caudal element of the gluteus minimus as well (Type B).

Histopathologic findings of lung vessels in five children with primary pulmonary hypertension

A histopathologic study was carried out on pulmonary vessels of lung tissues from 5 children with primary pulmonary hypertension (PPH), in whom diagnosis was made on the basis of cardiac catheterization. Histological sections of lung were obtained in 4 patients by open lung biopsy and in one patient by closed needle necropsy soon after death. In all cases the vascular diseases were classified as grade 6 of the Heath-Edwards. Morphologic studies of small pulmonary arteries revealed medial hypertrophy (41.0%), intimal cellular proliferation (2.5%), intimal fibroelastic proliferation (36.9%) and medial destructive changes (19.6%) such as dilatation lesions, plexiform lesions, arteritis, or fibrinoid necrosis. Index of pulmonary vascular disease (IPVD) was 1.6 to 3.4 (mean 2.5). The advancement of these pulmonary changes sufficiently explains the extremely poor prognosis of children with PPH.

Effect of glycyrrhizin, cyclosporin A, and tumor necrosis factor alpha on infection of U-937 and MRC-5 cells by human cytomegalovirus

Reactivation of latent or persistent human cytomegalovirus (HCMV) infection of monocytes or macrophages occurs under immunosuppressive conditions. We investigated the effect of glycyrrhizin (GL), cyclosporin A (CsA), and tumor necrosis factor-alpha (TNF-alpha) on the viral DNA synthesis and antigen expression of HCMV in U-937 and MRC-5 cells. Although GL inhibited the viral antigen expression of HCMV in human monocytic cell line U-937 and human embryonic lung cell line MRC-5 in the study, as determined by flow cytometry and immunofluorescence assay, immediate early HCMV DNA was detected by the polymerase chain reaction. CsA or TNF had no inhibitory effect on HCMV in U-937 or MRC-5 cells. The HCMV infection model with U-937 or MRC-5 cells is of use for clarifying not only the mechanism of persistent infection but also the anti-HCMV effect of chemical agents.

Enhancement of the mutagenicity of amino acid pyrolysates by phthalate esters

The ability of phthalic acid, phthalic acid anhydride, and various phthalate esters to enhance the mutagenicity of many amino acid pyrolysates was observed with the Ames test (Salmonella typhimurium TA98), but not the SOS Chromotest. Phthalate enhancement of the mutagenicity of 4-nitroquinoline-1-oxide, 2-nitrofluorene, and benzo[a]pyrene was not observed with either test. The mutagenicity-enhancing ability may be related to the induction of enzymes such as P450IIB, that metabolize amino acid pyrolysates. By quantitative structure activity relationship (QSAR) analysis, a good correlation was observed between the mutagenicity-enhancing activity of phthalates and their octanol-water partition coefficients.

Origin, course and distribution of the superior gluteal nerve

Ten pelvic halves of six Japanese male cadavers were dissected in order to obtain precise anatomical knowledge of the course and distribution of the superior gluteal nerve. The more anterior parts of the glutei medius and minimus, innervated by branches of the superior gluteal nerve, were revealed to originate more cranially, and the tensor fasciae latae was innervated by the cranialmost element of the nerve. Based on these findings, it might be proposed that the course and distribution of the superior gluteal nerve are directly influenced by the anterior rotation of the gluteus medius.

Determination of 17-hydroxycorticosteroids in dialysate solution as a measure of adrenocortical function in hemodialysis patients

Dialysate contents of 17-hydroxycorticosteroids (17-OHCS) in hemodialysis patients were studied as a potential measure of adrenocortical function. Dialysate 17-OHCS contents after a 2-day interval of hemodialysis in 15 hemodialysis patients were determined. Dialysate 17-OHCS increased after intravenous injection of cortisol the evening prior to hemodialysis (n = 4). Dialysate 17-OHCS content was suppressed, as was plasma cortisol, after a standard dexamethasone (Dex) suppression test (n = 1). Their plasma cortisol was suppressible or nonsuppressible by an overnight Dex suppression test, as reported previously. However, basal dialysate 17-OHCS contents were not different between them, indicating that the nonsuppressible patients with overnight Dex seem not to have hypercortisolism. We conclude that determination of dialysate 17-OHCS seems a useful noninvasive technique for the evaluation of adrenocortical function in hemodialysis patients.