Arterial chemoembolization of hepatocellular carcinoma with mitomycin C microcapsules

Chemoembolization by selective intra-arterial infusion of mitomycin C in microcapsule form exerts potential therapeutic effects through infarction and prolonged activity. Of 20 patients with inoperable hepatocellular carcinoma (HCC) treated with one or more courses via a hepatic arterial catheter, a change in tumor size could be measured in 16. Measurable tumor regression amounting to greater than 50% was shown in 6 patients (38%), 25-50% in 3 (19%), and less than or equal to 25% in 6 (38%), while tumor increased in 1. Serum alpha-fetoprotein, which was greater than 300 ng/ml before treatment in 13 patients, clearly fell after treatment in 10 (77%). The survival rate at 3, 6, and 12 months after treatment was 75%, 65%, and 24%, respectively, for all patients, and 92%, 85%, and 38% in 11 patients without a tumor cast in the portal vein or its major branches. Systemic toxicity was mild, and all patients tolerated treatment well. These results indicate that chemoembolization with mitomycin C microcapsules is a useful palliative measure for treatment of inoperable HCC.

Clinical study of eighty-six cases of idiopathic portal hypertension and comparison with cirrhosis with splenomegaly

The clinical features of 86 cases of idiopathic portal hypertension, the equivalent of hepatoportal sclerosis in the United States and of noncirrhotic portal fibrosis in India, are presented. This disease is characterized by overt splenomegaly with pancytopenia, portal hypertension, and relatively mild abnormalities in liver function tests. Although differential diagnosis from liver cirrhosis is not always easy, liver histology, laparoscopy, portography, hepatic venography, and measurement of wedged hepatic vein pressure are useful in diagnosis. Prognosis is relatively benign if variceal bleeding is controlled or prevented, and the disease does not progress to cirrhosis. The etiology is still undetermined, but the liver pathology characterized by occlusive changes of the intrahepatic portal radicles, portal and periportal fibrosis, and irregularly distributed parenchymal atrophies suggests some sort of portal venopathy that causes decreased portal perfusion of peripheral liver parenchyma. These patients with idiopathic portal hypertension were compared with 63 cases of cirrhosis with splenomegaly and 80 cases of cirrhosis without splenomegaly. There was some similarity in hematologic findings between idiopathic portal hypertension and cirrhosis with splenomegaly, but the basic disease process seemed distinctly different. The cause of marked splenomegaly does not seem to be simply congestion, and remains an enigma.

Role of portal and splenic vein shunts and impaired hepatic extraction in the elevated serum bile acids in liver cirrhosis

To study the mechanism for the elevation of serum bile acids in liver cirrhosis, bile acid concentrations were measured in the portal, superior mesenteric, and splenic veins, using percutaneous transhepatic catheterization, and compared with those of peripheral veins in 41 patients with mild to moderately advanced cirrhosis. The demonstrated gradient of bile acid concentration was superior mesenteric vein greater than portal vein greater than peripheral vein nearly equal to splenic vein, suggesting that the superior mesenteric vein is the main route of transport for the intestinally absorbed bile acids. Bile acid concentrations in peripheral vein were correlated with the measured portal and splenic vein shunt indexes. The ursodeoxycholic acid oral tolerance test carried out in 10 patients during portal vein catheterization demonstrated that hepatic extraction of this bile acid was correlated with indocyanine green clearance and that it was inversely correlated with portal vein shunt index. These findings are consistent with the view that distorted hepatic blood flow has a significant role in elevating serum bile acid, at least in patients with moderately advanced liver cirrhosis.

Polymorphism of human liver alcohol dehydrogenase: identification of ADH2 2-1 and ADH2 2-2 phenotypes in the Japanese by isoelectric focusing

Liver homogenate-supernatants from most Japanese exhibit an "atypical" pH optimum for ethanol oxidation at pH 8.8 instead of 10.5, the "typical" pH-activity optimum. It has been proposed that atypical livers contain alcohol dehydrogenase isozymes with beta 2 subunits while typical livers contain isozymes with beta 1 subunits, both produced by the ADH2 gene. Because it is difficult to differentiate the atypical ADH2 2-2 phenotype from the ADH2 2-1 phenotype by starch gel electrophoresis, an agarose isoelectric focusing procedure was developed that clearly separated the atypical Japanese livers into two groups, A1 and A2. The beta beta isozymes in A1 and A2 livers were purified. Type A1 livers contained a single beta beta isozyme with an atypical pH-rate profile; it was designated beta 2 beta 2. Three beta beta isozymes were isolated from A2 livers, two of which corresponded to beta 1 beta 1 and beta 2 beta 2. A third, absent from the typical and the atypical A1 livers, had an intermediate mobility; it was designated beta 2 beta 1. Type A1 livers are, therefore, the homozygous ADH2 2-2 phenotype, and type A2 livers, the heterozygous ADH2 2-1 phenotype. The ADH2 2-2 phenotype was found in 53% of 194 Japanese livers, and the ADH2 2-1 phenotype, in 31%. Accordingly, the frequency of ADH2(2) was 0.68.

Renal tubular disturbances induced by tributyl-tin oxide in guinea pigs: a secondary Fanconi syndrome

Painting of tributyl-tin oxide on the skin induced a secondary Fanconi syndrome in guinea pigs. In the urine of these animals, excretion of sodium, chloride, phosphate, glucose and many kinds of amino acids increased and reached a maximum between day 40 and 50. In sera, the concentrations of phosphate and certain amino acids were low due to excessive loss into urine. Histological examination of the kidney revealed damage to the tubular epithelium with no glomerular change. It was also found that cytochrome P-450 in the kidney and 1-25-dihydroxy vitamin D in serum were reduced in the tin-treated animals. It is most likely that tributyl-tin oxide caused a secondary Fanconi syndrome as defined by renal tubular disturbances represented by glucosuria, generalized amino aciduria, phosphaturia, and hypophosphatemia.

Noninvasive evaluation of the ratio of pulmonary to systemic flow in atrial septal defect by duplex Doppler echocardiography

The ratio of pulmonary to systemic flow (Qp/Qs) was noninvasively evaluated by duplex Doppler echocardiography in 22 patients with atrial septal defects (ASDs). Right and left ventricular stroke volumes (RSV, LSV) were determined from the recordings of ejection blood flow velocity and diameter at the level of the pulmonary and aortic orifices in each ventricular outflow tract. The ratio RSV/LSV, determined by the duplex Doppler echocardiography, was compared with Qp/Qs by oximetry. The RSV/LSV for 10 normal subjects was 0.99 +/- 0.05 (mean +/- SD), whereas the RSV/LSV for patients with ASD, 2.26 +/- 0.63, was significantly higher than that for normal subjects (p less than .01). In patients with ASD, a fairly good correlation was found between RSV/LSV and Qp/Qs (r = .92, p less than .01; y = 1.11x - 0.30), and this high correlation was found even in patients with complications such as pulmonary hypertension, mitral and tricuspid regurgitation, Eisenmenger complex, and ventricular septal defect. We also found that semilunar valve regurgitation modified the value of RSV/LSV in accordance with the degree of regurgitation. These findings indicate that, with a few limitations, the Doppler index RSV/LSV is clinically useful in the estimation of the magnitude of the shunt flow in patients with ASD and that the limitations could be overcome by additional Doppler examination.

Towards a classification of E. coli ribosomal proteins: a hypothetical 'small ribosome' as a primitive protein-synthesizing apparatus

Homologies were searched among the published primary sequences of 51 E. coli ribosomal proteins, partly by 'eye' and partly by computer-assisted methods. By employing Moore and Goodman's alignment statistics for evaluating homology levels, 33 out of these 51 ribosomal proteins has been classified into 9 homology groups, some of which being yet tentative and remaining to be further analyzed. Taking it into consideration that most ribosomal protein genes are clustered at str-stc region, rif region and several other regions, these results strongly suggest that most or all of the contemporary ribosomal proteins must have evolved by repeated gene duplications of very few (or only one) primitive ancestral ribosomal protein gene(s). Thus it is most reasonable to propose that 'a small ribosome' consisting of very few (or only one) ribosomal protein(s) must have existed as a primitive protein-synthesizing apparatus.

Prognosis of primary hepatocellular carcinoma

Prognosis of 600 consecutive patients with hepatocellular carcinoma was analyzed in relation to treatment. They were divided into three stages based on four parameters of advanced disease: ascites, tumor greater than 50% of the two-dimensional size of the liver, serum albumin below 3 gm per dl, and serum bilirubin above 3 mg per dl. Stage I had none of these signs; Stage II one or two signs, and Stage III three or all signs. Of 600 patients, 98 had resection, 333 had nonsurgical treatment (158 treated by intraarterial chemotherapy, 94 systemic chemotherapy, 77 transcatheter embolization, and 4 others) and 169 no treatment. The median survival of untreated patients was only 1.6 months from diagnosis, and no untreated Stage III patient lived more than 3 months; there was a median survival of 0.7 month. Surgically treated patients lived significantly longer than nonsurgical patients of comparable stages; median survival was 19.6 months in the former and 2.8 months in the latter. Whereas Stage I patients did fairly well without treatment, chemotherapy significantly prolonged survival of patients of Stages II and III. These results suggest that early diagnosis and hepatic resection improve prognosis in patients with hepatocellular carcinoma in the areas where this cancer frequently emerges unicentrically. In view of the generally poor prognosis, liver transplantation is recommended when resection is not possible or indicated, and before extrahepatic metastasis occurs.

Domain structures and molecular evolution of class I and class II major histocompatibility gene complex (MHC) products deduced from amino acid and nucleotide sequence homologies

Domain structures of class I and class II MHC products were analyzed from a viewpoint of amino acid and nucleotide sequence homologies. Alignment statistics revealed that class I (transplantation) antigen H chains consist of four mutually homologous domains, and that class II (HLA-DR) antigen beta and alpha chains are both composed of three mutually homologous ones. The N-terminal three and two domains of class I and class II (both beta and alpha) gene products, respectively, all of which being approximately 90 residues long, were concluded to be homologous to beta2-microglobulin (beta2M). The membrane-embedded C-terminal shorter domains of these MHC products were also found to be homologous to one another and to the third domain of class I H chains. Class I H chains were found to be more closely related to class II alpha chains than to class II beta chains. Based on these findings, an exon duplication history from a common ancestral gene encoding a beta2M-like primodial protein of one-domain-length up to the contemporary MHC products was proposed.

Enumeration of circulating ferritin-secreting cells by a reverse hemolytic plaque assay

In the present study, we tried to detect ferritin-secreting cells (FSC) as plaque-forming cells using a reverse hemolytic plaque assay and thereby to evaluate some of the cellular aspects of ferritin dynamics associated with various hematological disorders. Healthy adult males had 433 FSC and adult females had 244 FSC in 1 X 10(5) peripheral blood mononuclear cells (PBM). The mean numbers of FSC in 1 X 10(5) lymphocyte-enriched fraction were 120 in males and 53 in females, and those in 1 X 10(5) monocyte-enriched fraction were 932 in males and 668 in females. These results indicate that monocytes contain about 8-13 times as many FSC as lymphocytes. Each fraction of PBM from patients with iron deficiency anemia contains only about half as many FSC as those of normal individuals. Whereas, in states of increased iron storage such as seen in sideroblastic anemia, aplastic anemia and myelofibrosis, the mean numbers of FSC are markedly increased to about 4-8 times in PBM, about 11-20 times in lymphocytes and about 3-7 times in monocytes, compared with each counterpart of the normal individuals.

Aneurysm of the intrahepatic branch of the portal vein. Report of two cases

Two patients in whom real-time ultrasonography and percutaneous transhepatic portography or the venous phase of the arteriogram of the superior mesenteric artery demonstrated a localized saccular dilation of a peripheral branch of the portal vein are described. One patient subsequently died, and autopsy confirmed the diagnosis. A hypoechoic lesion continuous with a branch of the portal vein seems to be the characteristic sonographic picture. Radiologic evidence for portal vein aneurysm was obtained in only 2 of 300 patients with portal hypertension in whom percutaneous transhepatic portography was performed, and in 2 of 3000 patients who visited our unit and in whom ultrasonography for the liver was performed. Thus, aneurysm of the intrahepatic portal vein does occur, but very rarely.

The lateral thigh fascio-cutaneous flap in the repair of ischial and trochanteric defects

We have recently designed and developed a lateral thigh fascio-cutaneous flap based on the first perforating artery. This artery supplies the distal part of the gluteus maximus muscle and continues to supply the fascia, subcutaneous tissues and skin over the lateral aspect of the thigh. We describe the use of this fascio-cutaneous flap in the repair of ischial and trochanteric defects.

Purification and some properties of a new Ca2+-binding protein (TCBP-10) present in tetrahymena cilium

A new Ca2+-binding protein, different from calmodulin, has been detected in the cilium and cell body of Tetrahymena. This protein, designated as TCBP-10, has been purified from the cells to homogeneity. TCBP-10 is an acidic protein (pI = 4.5) which shows a Ca2+-dependent mobility shift in alkali-glycerol-polyacrylamide gel electrophoresis. The protein is resistant to heat and trichloroacetic acid. The molecular weight of the protein is 10,000 by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and 22,000 by Sephadex G-50 gel filtration, suggesting that the native form of the protein is a dimer. The protein has a molar extinction coefficient of 6,500 at 282 nm. Equilibrium dialysis experiments revealed that the protein binds 1 mol of Ca2+/mol of protein with a dissociation constant of 27 microM. The protein contains a relatively large quantity of acidic amino acids, single residues of cysteine, histidine, and tryptophan, and no methionine. These properties are similar to those of some low molecular weight Ca2+-binding proteins belonging to the calmodulin family. Thus, the cilium of Tetrahymena contains a second Ca2+-binding protein in addition to calmodulin. We consider that TCBP-10 and calmodulin may play important cooperative roles in the Ca2+-regulation of ciliary movement in Tetrahymena.

How to investigate cholestasis: utility of ultrasound as the first imaging study

In modern gastroenterology, ultrasonography, particularly the real-time modality, is one of the most important diagnostic procedures, and the value of ultrasound in the diagnosis of cholestasis, and obstructive jaundice in particular, is indisputable. Although sector-type real-time ultrasonography has certain merits, for a routine examination, the linear scan is much more practical. It should be the first imaging investigation in patients with jaundice, along with the routine hematologic and biochemical tests. In obstructive jaundice, these studies are followed by ERC or PTC, and a definitive diagnosis is possible in the large majority of patients. Such a diagnosis very rarely requires correction at surgery.

[Treatment of multiple myeloma. High-dose intermittent administration of cyclophosphamide and prednisolone--follow up study of 10 years period]

Twenty patients with plasma cell myeloma were treated with high-dose (10 mg/kg) intermittent administration of cyclophosphamide for remission induction and maintenance therapy. High-dose intermittent administration of glucocorticosteroid hormone was also performed usually in parallel with large-dose of cyclophosphamide. A significant objective response was obtained in 12 of 20 patients (60.0%). The median survival was 32 months in all cases; 47 months in the responding cases. The response rate was not affected by the class of M-protein, the type of light-chain and/or the presence of bone lesions. All responders were on the 3rd stage. High-dose intermittent administration of cyclophosphamide was evaluated as very useful since it showed equivalent effects obtained by combination chemotherapy regimens, hardly producing bone marrow suppression.

An unusual portal-systemic shunt, most likely through a patent ductus venosus. A case report

A 46-yr-old man with cirrhosis presented with mental confusion, headache, and nausea. Colloid liver scintigraphy showed a defect in the hilar area, and portograms after superior mesenteric arteriography demonstrated varicose veins in the same area. Computed tomography revealed a sausage-shaped low-density channel connecting the hepatic hilum and the inferior vena cava, and bolus injection contrast enhancement demonstrated transit of contrast medium from the portal vein directly into the inferior vena cava through this channel. Real-time ultrasound demonstrated a large conduit contiguous from the portal vein to the inferior vena cava through and behind the liver. The catheter introduced into the inferior vena cava opacified a large opening of this shunt below the right and left hepatic vein openings. Measurements of blood pressure, ammonia, and PaO2 clearly indicated that portal vein blood was being shunted through this channel. These findings are highly suggestive of a portosystemic shunt through a patent ductus venosus.

Structural relationship between barley (Hordeum vulgare) trypsin inhibitor and castor-bean (Ricinus communis) storage protein

A significant sequence homology was found between barley (Hordeum vulgare) trypsin inhibitor and castor-bean (Ricinus communis) seed glutamine-rich storage protein. This appears to suggest a divergent evolution of the two different classes of seed proteins and to support a view that plant proteinase inhibitors may also act as storage proteins.

Purification and properties of two binding proteins for branched-chain amino acids in Salmonella typhimurium

Two leucine-binding proteins isolated from osmotic shock fluid of Salmonella typhimurium LT2 were purified by DEAE-cellulose and DEAE-Sephadex A-50 chromatography, and subsequent isoelectric focusing. These purified binding proteins could be crystallized by adding 2-methyl-2,4-pentanediol. One of the binding proteins, designated as LIVT-binding protein, binds L-leucine, L-isoleucine, L-valine, and L-threonine, while the other, L-binding protein, binds only L-leucine. The level of LIVT-binding protein in the shock fluid was about three-fold higher than that of L-binding protein. The molecular weight of the LIVT-binding protein was estimated to be 35,000 by gel filtration, and 39,000 by gel electrophoresis. The isoelectric point was pH 4.94. The dissociation constants of this protein for leucine, isoleucine, and valine were 0.43, 0.15, and 0.89 microM, respectively. For the L-binding protein, molecular weights of 34,000 (gel filtration), and 38,000 (gel electrophoresis) were obtained. The isoelectric point was pH 4.74. The dissociation constant of this protein for leucine was 0.54 microM. The LIVT-binding protein was more heat-stable than the L-binding protein. These two binding proteins showed an antigenic similarity, they could cross-react with each other's antiserum. This similarity was also found between the binding proteins of Salmonella typhimurium and Escherichia coli K-12. Both LIVT- and L-binding proteins in a regulatory mutant, KA2313, were found to be about three-fold the levels in the wild-type strain.

Arterioportal shunts on dynamic computed tomography

Thirty-two patients, 20 with hepatocellular carcinoma and 12 with liver cirrhosis, were examined by dynamic computed tomography (CT) using intravenous bolus injection of contrast medium and by celiac angiography. Dynamic CT disclosed arterioportal shunting in four cases of hepatocellular carcinoma and in one of cirrhosis. In three of the former, the arterioportal shunt was adjacent to a mass lesion on CT, suggesting tumor invasion into the portal branch. In one with hepatocellular carcinoma, the shunt was remote from the mass. In the case with cirrhosis, there was no mass. In these last two cases, the shunt might have been caused by prior percutaneous needle puncture. In another case of hepatocellular carcinoma, celiac angiography but not CT demonstrated an arterioportal shunt. Thus, dynamic CT was diagnostic in five of six cases of arteriographically demonstrated arterioportal shunts.

Decrease of urinary prostaglandin E2 and prostaglandin F2 alpha excretion by nonsteroidal anti-inflammatory drugs in rats. Relationship to anti-inflammatory activity

An analytical method for measuring in vivo inhibition of prostaglandin (PG) synthesis by nonsteroidal anti-inflammatory drugs was developed for estimation of urinary prostaglandin levels in rats. Drugs were administered orally to rats (Wistar, male, 200-250 g), and water (2.5 ml/100 g body weight) was given 1 hr after drug administration to yield a constant volume of urine. Urine was collected for 4 hr after drug administration, and urinary PGE2 and PGF2 alpha were determined by radioimmunoassay. The urine volume in the 4-hr period was 5.0 +/- 0.30 ml per rat, and prostaglandin contents in the 4-hr urine were 4.56 +/- 0.56 ng PGE2 and 1.31 +/- 0.24 ng PGF2 alpha per rat in the no-drug control group. Administration of nonsteroidal anti-inflammatory drugs decreased the urinary PGE2 and PGF2 alpha dose dependently. The activities of ten typical nonsteroidal anti-inflammatory drugs in reducing urinary PGE2 excretion were compared with their anti-inflammatory activities in rats. A close correlation (r = 0.98, P less than 0.001) between the dose required for 50% reduction of urinary PGE2 excretion and the dose required for 50% inhibition of carrageenin edema was found for each drug. These drugs were also tested for their inhibitory effects on PGE2 biosynthesis in a cultured system of mouse 3T6 fibroblast cells and on prostaglandin synthesizing system in bovine seminal vesicle microsomes. No close correlation was observed between anti-inflammatory activities and inhibition of prostaglandin biosynthesis in vitro.

Further characterization of a brain high molecular weight actin-binding protein (BABP): interaction with brain actin and ultrastructural studies

Crude actomyosin fraction from porcine brain contained a large amount of high molecular weight actin-binding protein (BABP). The molar ratio of BABP to actin (BABP/actin) in the fraction was estimated to be 0.22. From this fraction, BABP and actin were solubilized with a molar ratio of 0.25, suggesting the existence of an interaction between BABP and brain actin. BABP was finally purified to 90% purity. The purified BABP was negatively stained and observed by electron microscopy; it appeared to be a slender, flexible, two-stranded molecule whose contour length was about 200 nm. The structure was very similar to those of fodrin and other high molecular weight actin-binding proteins such as filamin, spectrin, and ABP. Lattice cage-like structures composed of BABP molecules were occasionally observed at high BABP concentrations. The addition of BABP to actin filaments resulted in the appearance of many branching, filamentous bundles. The electron microscopic observations suggested that a single BABP molecule could crosslink actin filaments, that is, one BABP molecule has two actin binding sites.

[Echocardiography evaluation of operative procedures for rheumatic aortic valvular diseases]

It is well known that in patients with markedly retracted aortic cusps of rheumatic origin, valve replacement is mandatory because valve repair including commissurotomy and slicing often increase the degree of aortic regurgitation. The degree of the induced regurgitation is considered to be dependent on the retraction of aortic cusps. Therefore, the preoperative evaluation of the severity of retraction is necessary when determining the type of operative procedures. The purpose of this study is to investigate the parameters indicating the degree of cusp retraction by two-dimensional echocardiography. The diameter of the aortic root (R) and the depths from the aortic root to the bottom of the Valsalva sinus (S) and the aortic cusp (C) were measured in nine cases with aortic valvular disease, in which four underwent valve repair and five valve replacement. The control consisted of 20 healthy subjects. The results were as follows: The C/R ratio exhibited a significant correlation with the degree of retraction of aortic cusps, and was considered to be a useful parameter for the determination of the type of operative procedures for aortic valvular disease. It was suggested that in cases with the C/R ratio of 0.5 or more, both commissurotomy and slicing of cusps were effective for improvement of valvular function, while in cases with the ratio less than 0.5, only valve replacement was effective. The diameter of the aortic valve ring between the inner echoes of both the anterior and posterior walls measured by echocardiography was correlated well with the result obtained at operation.

Effects of intra- and extrahepatic portal systemic shunts on insulin metabolism

To study the effects of intra- and extrahepatic portal-systemic shunts on insulin degradation, 11 patients with liver cirrhosis and 7 noncirrhotic patients with liver disease were studied with percutaneous transhepatic catheterization. Insulin levels in portal and peripheral blood were measured simultaneously for 1-2 hr after intravenous administration of glucose. The degrees of intra- and extrahepatic portal-systemic shunting were measured with this technique using 131I-macroaggregated albumin and 99mTc-macroaggregated albumin. The amount of insulin secreted and insulin degraded were assessed from the areas under blood concentration curves for portal and peripheral blood. Insulin degradation was significantly reduced in cirrhotics compared to noncirrhotics with liver disease, although there was no difference in the amount of insulin secreted between these two groups. It was also correlated significantly with the degree of intrahepatic shunting but not with the degree of extrahepatic shunting. These results suggest that intrahepatic shunting plays an important role in the reduction of insulin degradation in cirrhosis.

Domain structures of cell surface glycopeptides encoded by class I and class II beta genes of the major histocompatibility complex

Published sequence data of MHC genes, cDNAs and MHC products were analyzed for their sequence homologies. Alignment statistics revealed that class I gene products consist of four mutually homologous domains, and that class II beta gene products is composed of three mutually homologous domains. Not only extracellular domains but also newly discovered C-terminal shorter domains of class I and class II beta gene products were found to have evolved from a one-domain-long beta 2-microglobulin-like protein by repeated exon duplications and splittings.

Evidence for the homology of hexose 6-phosphate dehydrogenase and glucose 6-phosphate dehydrogenase: comparison of the amino acid compositions

Amino acid compositions of hexose 6-phosphate dehydrogenase and glucose 6-phosphate dehydrogenase from crucian carp and rat, and that of sea-urchin glucose 6-phosphate dehydrogenase were compared in order to ascertain if they are homologous enzymes. The results demonstrated that the overall amino acid compositions of the two enzymes remarkably resemble each other, and that the composition divergence (D = 0.038) of the crucian carp enzymes is in the range of those for homologous proteins so far reported. These findings strongly support our previous prediction that the two enzymes have diverged from a common ancestral molecule.

Differentiation of benign monoclonal gammopathy and smouldering multiple myeloma from frank myeloma

Circulating immunoglobulin (Ig) secreting cells of each type of the different Ig classes were enumerated using a reverse haemolytic plaque assay in nine subjects with the pre-clinical phase of IgG myeloma (six with benign monoclonal gammopathy and three with smouldering multiple myeloma). A shift in the ratio of IgG kappa to IgG lambda secreting cells without a significant increase in the total number of IgG secreting cells, that is the number of IgG kappa plus IgG lambda secreting cells, was a constant feature noted in every subject.

[Clinical experience of cefoxitin in the treatment of infections complicated by intractable blood disorders]

A total of 19 patients who had local or systemic infections with a variety of difficult-to-treat blood disorders were treated with cefoxitin (CFX). The following findings were obtained. 1. Fifteen out of 19 patients' responses were judged "excellent" or "good" with an overall cure rate of 78.9%. 2. As to the side effects of CFX, transient elevations in S-GOT, S-GPT were observed in 3 patients, urine protein in 2 patients, and hematuria in 1 patient. However, these abnormalities cannot be solely attributed to CFX because these patients were treated with either antitumor agents or aminoglycosides, and some had undergone blood transfusions. 3. CFX should be considered for the treatment of severe infections because it is well tolerated, has a broad spectrum of antibacterial activity against both Gram-positive and Gram-negative pathogens and is highly resistant to beta-lactamases.

Immunofluorescence of phenobarbital inducible cytochrome P-450 in the hepatic lobule of normal and phenobarbital-treated rats

The localization of the form of cytochrome P-450 that is induced by phenobarbital was studied by direct immunofluorescence in the hepatocytes of rats pretreated with phenobarbital in comparison with saline-treated rats. Specific fluorescence was seen in the hepatocyte cytoplasm in saline- and phenobarbital-treated rats; a more concentrated halo of fluorescence was detected surrounding the nuclei in the centrilobular zones after phenobarbital treatment. In the saline-treated rats, fluorescence was barely discernible but slightly more intense in the centrilobular than perilobular zones. In phenobarbital-treated rats, fluorescence was much more intense, with a similar but much greater difference between the centrilobular and perilobular zones. The tissue distribution and induction site of this component of the cytochrome P-450-dependent microsomal system may be relevant to the site of drug toxicity and the development of chemical carcinogenesis.

Spontaneous reversal of portal blood flow demonstrated by percutaneous transhepatic catheterization: report of two cases

Two patients are described in whom percutaneous transhepatic catheterization of the portal vein for a hemodynamic study demonstrated a continuous reversed blood flow in the portal vein, entering into a large collateral. The measurements made of blood pressure in the superior mesenteric, splenic, and left gastric veins, and of ammonia, immunoreactive insulin, and C-peptide in blood taken from these and peripheral veins all indicated reversed portal vein blood flow. The evidence for retrograde portal vein blood flow was obtained in only 2 of 203 patients with cirrhosis in whom portal hemodynamics were studied by the same procedure. Thus, spontaneous reversal of portal vein blood flow does occur, but very rarely.

Reconstructive surgery for acquired valve disease

There has been a continuing controversy between reconstructive valve surgery and replacement. In this paper, an analysis of clinical and hemodynamic late results of the patients undergoing open mitral commissurotomy (OMC, 135 patients), repair of mitral regurgitation (MAP, 32 patients), and combined valvuloplasty (62 patients) was presented. 1) OMC: The 10-year actuarial survival rate was 86.5% postoperatively. None of the patients required reoperation in this series. Clinical and hemodynamic improvements mainly depended upon the anatomical severity of a stenosed mitral valve. 2) MAP: The 10-year actuarial survival rate was 94% postoperatively. Especially, good to excellent results were obtained in the patients with mitral regurgitation due to ruptured chordae or dilated annulus. 3) Combined valvuloplasty: The 10-year actuarial survival rates postoperatively were 90% in OMC + tricuspid annuloplasty group (31 patients), 100% in MAP + tricuspid annuloplasty group (7 patients), and 87.2% in OMC + aortic commissurotomy group (24 patients). The reconstructive valve surgery provides very small operative risk, very low late mortality and morbidity. Therefore, it should be the treatment of choice for most of the patients with symptomatic valve disease.