[Support to the immune system by Venoglobulin I in hemodialized patients]

With the advance of hemodialysis, it has become apparent that immunity, especially cellular, is lowered in patients on maintenance hemodialysis. We administered Venoglobulin I (VGI) to the patients on maintenance hemodialysis to study the change in the immune system and the episodes of infection. VGI was administered to twelve cases, eight males and four females, and their mean period of hemodialysis was three years. Administration of VGI started in February 1981 an mean duration of administration was 7.8 months. As a rule, 2.5g of VGI was administered every 20 days. Counts of white blood cells, lymphocytes, T cells and B cells were measured every two months. The cases were divided into two groups according to the duration of hemodialysis: Group A, less than a year and Group B, more than a year and a month. Results and conclusions 1) VGI increases the lymphocytes and T cell counts in Group B to suggest the improvement of cellular immunity. 2) In Group A, lymphocytes and T cell counts were decreased because the effects of VGI were overcome by the effect of hemodialysis to distort the immune system. 3) The magnitude of effects of VGI was proportional to the period of administration. The effect appeared at least within eight months, and once it appeared, it kept stable level. 4) There had been no episodes of infection during the period of study. 5) With these results, it was indicated that administration of VGI to the patients on maintenance hemodialysis was useful because VGI could support their lowered cellular immunity to some extent.

Active and inactive renin after captopril (SQ 14225) administration in hypertensive patients

The changes in active and inactive renin after oral administration of captopril (SQ 14225) were studied in 29 hypertensive patients. Inactive renin was calculated as plasma renin activity (PRA) after cold storage (total renin) minus PRA before cold storage (active renin). The patients were divided into 2 groups, responders and non-responders, according to the response of active renin to captopril. In 9 responders, the active renin increased markedly, while the inactive renin decreased. On the other hand, in 20 non-responders, both renin activities increased only slightly. Total renin increased markedly in responders; it increased in much smaller degree but significantly in non-responders. These data suggest that captopril promotes the conversion of inactive renin to active one and augments the renin release as a whole.

Evaluation of the chronotropic property of captopril in hypertensive patients

Captopril was administered (50 mg orally) to 88 untreated hypertensive patients (70 with essential hypertension, eight with renal arterial disease, 10 with renal parenchymal disease) and to 25 hypertensive patients treated with sympatholytic or beta-blocking agent (20 with essential hypertension, five with renal arterial disease). In the former group, captopril caused a decrease in heart rate (HR) in 18 patients and an increase in only two. As a whole, captopril caused significant decreases in blood pressure without increase in HR. Significant negative correlation was observed between change in HR and plasma renin activity obtained before captopril administration (n = 79, r = -0.425, p less than 0.0001). Hypotensive and chronotropic effects of captopril were almost identical in untreated and treated patients. Hypotensive effects caused by captopril and nifedipine (20 mg orally) were almost identical. Nifedipine caused reflex tachycardia, while captopril caused slight bradycardia. Absence of compensatory tachycardia appears to be related to reduction of endogenous angiotensin II by captopril.U

Prostaglandin E synthesis in the kidney in renin subgroups of essential hypertension

To assess the pathophysiological role of renal prostaglandin E (PGE) in renin subgroups of essential hypertension, urinary excretion of PGE before (24 hours urine) and after the administration of furosemide (1 mg/kg, iv) and 2 hours upright posture was estimated in 66 essential hypertensives, classified into high, normal and low renin subgroups. In each renin subgroup, the administration of furosemide and 2 hours upright posture induced marked increases in urinary excretion of PGE and sodium, and in plasma renin activity. However, there were no significant differences in basal values of urinary excretion of PGE among the 3 subgroups, nor in the values after the administration of furosemide and 2 hours upright posture. The present data do not support the hypothesis that the difference in renin level in essential hypertensives is dependent on the synthesis of renal PGE.

[Multihospital randomized study on the adjuvant chemotherapy with mitomycin-C and Futraful for gastric cancer V. Estimation of 5-year survival rate]

The addition of Futraful to MMC therapy of gastric carcinoma was evaluated. Nationwide 297 institutions participated in a randomized controlled study and cumulative five-year survival rate was calculated. A total of 1,673 cases was studied. These were divided in two groups: Group A, without Futraful, and Group B, with Futraful. Futraful was administered postoperatively for 3 months. The MMC treatment was done by moderate intermittent administration (Method I) or by large dose administration (Method II). Futraful improved survival rates regardless of the method of MMC treatment. Especially, Group B' (more than 60 g of Futraful) showed significantly better results in patients with metastases and positive serosal invasion in both methods, and beta type infiltration in Method I. Furthermore the Group B' patients had higher survival than Group A patients in Method II for patients in stage III and gamma type infiltration. Method II, a large dose MMC, plus Futraful was suggestive of particular effectiveness in preventing peritoneal metastases in curatively resected cases.

[Phase II study on peplomycin for esophageal cancer]

For the purpose of verifying the effectiveness of peplomycin, one of the derivatives of bleomycin, against carcinoma of the esophagus and the safety of it, the analysis of the data for total 113 cases collected from 25 institutions in Japan was made. The results are as follows. It was effective in 19 out of 74 evaluable cases of carcinoma of the esophagus (25.7%). In case of treatment with peplomycin alone, it was effective in 6 out of 39 cases (15.4%). In case of the combination treatment with peplomycin and some other therapy, it was effective in 13 out of 35 cases (37.1%). As for the side effects, the incidence of fever was the highest in both the cases of peplomycin alone and the combination treatment such as 39.6% and 37.0%, respectively. Anorexia, nausea, vomiting, respiratory symptoms and tiredness were found in relatively many cases. In the clinical laboratory tests, the vital capacity after the treatment tended to be lower than that before the treatment, but there was little change in the hematological tests, pulmonary function test and renal function test.

[Effect of postoperative long-term chemotherapy of stomach cancer using mitomycin C and futraful--the secondary study (1)]

The Cooperative Study Group of Surgical Adjuvant Chemotherapy for Gastric Cancer in Japan with the participation of 334 institutes nation-wide had conducted the secondary study in order to investigate the usefulness of futraful in long term treatment, based on the results obtained by the primary study. The following method was taken for the study and patients were randomly divided into three groups: A group-given a high dose of MMC immediately after operation; B group-given futraful for one year after MMC administration; C group-given futraful alone for long-term. The number of eligible cases for data analysis was 3,o30. Side effects observed during the long term treatment with futraful were considered to be minor. Although the occurrence of hematocytopenia was slightly frequent because of possible increase of influence by the concomitant use of MMC, no tendency of hepatic disorders and any subjective side effects to be strengthened by MMC combination was observed at all. As for 2-year survival, an elevated survival was found in the group of concomitant use of MMC and futraful; Especially, a significantly high survival was found in the cases of stage III and n (+) . ps (+). Furthermore, the survival was elevated in proportion to the increase of total dosage of futraful. This suggested the usefulness of futraful for long term treatment.

Establishment of an experimental model of human hepatoblastoma

Establishment of xenografts or cell culture lines in which the alpha-fetoprotein (AFP) characteristic of clinical hepatoblastoma persists have been difficult. The serially transplantable strain (HB-3) of highly AFP-producing hepatoblastoma was successfully established in nude mice. And a highly AFP producing cell line (c-HB-3) is easily obtained by HB-3. This strain and line give us an ideal experimental model of hepatoblastoma in vivo and in vitro.

Effect of acute water loading on urinary excretion of prostaglandin E in hypertensive patients

To assess the relationship or urine flow to the urinary excretion of prostaglandin E (PGE), urinary excretion of PGE was measured before and after acute water loading (20 ml/kg orally) in patients with hypertension. Water loading promptly increased urinary excretion of PGE as well as urine flow rate and decreased urine osmolality (all p less than 0.001), but did not affect urinary excretions of sodium, potassium and creatinine, plasma renin activity and plasma aldosterone concentration. There was a significant positive correlation between urine flow rate and urinary PGE excretion rate (p less than 0.01). Urinary PGE concentration correlated negatively with urine flow rate when the flow was lower than 5 ml/min (p less than 0.01). Urinary PGE concentration correlated negatively with urine flow rate when the flow was lower than 5 ml/min (p less than 0.01), whereas it did not change when the urine flow rate was larger than 5 ml/min. These results may support the hypothesis that urinary excretion of PGE is determined mainly by urine flow rate in the situation of water diuresis.

Attenuation of pressor responses to norepinephrine and pitressin and potentiation of pressor response to angiotensin II by captopril in human subjects

The present study was conducted to investigate the influence of captopril on cardiochemodynamic responses in 38 normal volunteers (20- to 35-year-old men) to exogenously administered vasopressor substances. Norepinephrine (NE), 0.05, 0.1, and 0.2 micrograms/kg min-1; angiotensin II (AII), 5, 10, and 20 ng/kg min-1; and pitressin (2 mU/kg min-1) were infused for 10 minutes. Each infusion was reported twice, and the responses were reproducible. Captopril (50 mg by mouth) significantly attenuated the pressor responses to NE and pitressin, but the decrease in heart rate in response to NE and pitressin was almost the same before and after captopril treatment, suggesting that captopril potentiates reflex slowing of the heart. Captopril significantly potentiated the pressor response to AII. Attenuation of pressor response and potentiation of reflex slowing of the heart, in response to NE and pitressin, disappeared when a subdepressor dose of AII (1 ng/kg min-1) was infused in addition to captopril. Infusion of a subdepressor dose of bradykinin (BK), 0.1 microgram/kg min-1, had no influence on the pressor response to NE. In the subjects treated with indomethacin (225 mg/54 hrs), captopril still attenuated the pressor response to NE. These results suggest that captopril attenuates the pressor responses to NE and pitressin primarily by depletion of endogenous AII; decreased AII may desensitize the contraction of arterial smooth muscle and may potentiate the compensatory reflex mechanism.

[Clinical studies on amikacin for infectious diseases following intravenous drip infusion (author's transl)]

An antibiotic drug of aminoglycoside group, amikacin (AMK) for parenteral use was used to 8 hospitalized patients: 4 with acute or subacute cholecystitis and cholangitis, 4 with acute peritonitis (3 cases were due to acute appendicitis and a case was torsion of right ovarian cyst). AMK in a dose of 200 mg were administered by intravenous drip infusion for 1 to 2 hours, twice a day for 4 to 9 days. To the cases with biliary tract infection, AMK was treated to preoperatively and to the cases with acute peritonitis, AMK was treated to the postoperatively. Clinical response was excellent in 2 cases, good in 6 cases, fair and poor in none. No adverse effect was observed. The organisms were isolated in 4 cases, 4 were Escherichia coli, 1 was Klebsiella pneumoniae and 1 was Bacteroides fragilis. The MIC for AMK were 3.13-1.56 micrograms/ml in 10(8) and 10(6) cells/ml, except Bacteroides fragilis. Before the operation of above cases, AMK in a dose of 200 mg were administered by intravenous drip infusion in 2 cases (acute and subacute cholecystitis and cholangitis with cholelithiasis), 5 cases by intramuscularly and 1 case by intravenously (acute appendicitis with localized peritonitis). The materials of A-bile, B-bile, wall of gallbladder, the appendix, ascites and serum samples were taken during the operation. AMK concentration was measured by bioassay method with Bacillus subtilis ATCC 6633 as test organism. AMK concentration in B-bile were higher than those in the A-bile. AMK concentrations in wall of gallbladder were much higher than those in A and B-bile. The concentrations after intravenous drip infusion were higher than those after intramuscularly administration. AMK changes of inflammation. In a case of gastric ulcer, AMK 200 mg by intravenous drip infusion was administrated, the AMK concentrations of the tissues at 25 minutes after end of infusion, they were 15.00 micrograms/g in gastric ulcer, 7.20 micrograms/g in normal gastric wall, 9.14 micrograms/g in duodenal wall and 8.12 micrograms/g in the omentum, respectively. Serum concentration of AMK on this case at 58 minutes was 15.7 micrograms/ml. Therefore, it was supposed that AMK could be used safety and effective by intravenous drip infusion.

Effect of dietary sodium intake on the metabolism of prostaglandins in the kidney in hypertensive patients

To investigate the role of renal prostaglandins (PGs) in the renal handling of sodium, urinary excretion of PGE, PGF2 alpha and PGF2 alpha MUM (main urinary metabolite of PGF2 alpha) were measured after various manipulations of dietary sodium intake in 8 hypertensive patients. A low sodium intake increased urinary excretion of PGF2 alpha MUM (p less than 0.05), but failed to change urinary excretion of PGE and PGF2 alpha. In contrast, a high sodium intake increased urinary excretion of PGE (p less than 0.01) and decreased urinary excretion of PGF2 alpha MUM (p less than 0.02). A low sodium intake decreased the ratio of urinary PGE/PGF2 alpha MUM and high sodium increased it (both p less than 0.001). There was a significant positive correlation between urinary excretion of sodium and that of PGE (p less than 0.001). Additional oral administration of potassium chloride did not change urinary excretion of PGs. These results may suggest that dietary sodium intake may be one of the regulators of the metabolism of PGs in the kidney, supporting the hypothesis that renal PGE has a natriuretic action in humans.

The importance of arterial inflow in the distal side of a flap: an experimental investigation

Using abdominal skin flaps in experimental rats, we created flaps that exhibited relatively constant necrosis in the distal side. The existence of arterial inflow had a marked effect on the survival of the distal part of these flaps. We postulate that the so-called delay mechanism produces the arterial inflow as a consequence, although how this occurs is still unsolved. We suggest the possibility that a large flap may be transposed in one stage with vascular anastomosis in the distal part--preferably artery and vein, or artery only.

Exaggerated fractional sodium excretion in hypertension with advanced renal disease: the role of renal prostaglandin and kallikrein

1. The role of renal prostaglandin E (PGE) and kallikrein in the mechanism of the exaggerated fractional sodium excretion in hypertensive patients with advanced renal disease was investigated. 2. Urinary excretion of PGE and kallikrein was significantly decreased in patients with sustained hypertension. 3. Four times higher values for fractional sodium excretion and four or five times higher values for the urinary excretion of PGE corrected for creatinine clearance were found in patients with sustained hypertension. There was a significant positive correlation (r = 0.677) between the two, suggesting that PGE in the renal tubular compartment may be involved in the mechanism of the exaggerated fractional Na excretion in patients with advanced renal disease. 4. The urinary excretion rate of kallikrein corrected for creatinine clearance was three times greater in patients with borderline hypertension, but not significantly increased in those with sustained hypertension, compared with that in healthy volunteers.

Alphafetoprotein in congenital biliary atresia and neonatal hepatitis

Alphafetoprotein (AFP) production was investigated clinically and histologically in cases of congenital biliary atresia and neonatal hepatitis. While serum AFP levels were all higher than 16,000 ng/ml in seven patients with neonatal hepatitis, they were less than 10,000 ng/ml in 50 per cent of 12 patients with biliary atresia. Therefore, serum AFP levels below 10,000 ng/ml were suggestive of a diagnosis of biliary atresia. A number of AFP granules were identified in the liver cells and multinucleated giant cells in patients with neonatal hepatitis and biliary atresia, using an immunoperoxidase method. The serum AFP levels paralleled the number of cells with AFP granules. However, no characteristic differences in distribution of these granules occurred in the hepatic cells and giant cells. The AFP producing mechanism was qualitatively the same in neonatal hepatitis and biliary atresia. These phenomena suggest that congenital biliary atresia and neonatal hepatitis may have the same pathogenesis.