[Visuo-postural control of schizophrenics--variations of sway area during horizontal eye movement]

In the present study, we investigated the neurological mechanism of commonly known specific or unnatural postures in schizophrenic patients. Using a gravimeter, body sway studied in 26 chronic schizophrenic patients, 10 schizoaffective disorder patients and 21 normal subjects. During eye fixation at a target while keeping an upright posture, schizophrenic patients presented a larger gravimetric area than the normal subjects and the patients with schizoaffective disorder. There was a negative correlation (r = -0.509) between the standard deviation of the sway gravimetric area during fixation and the dose of neuroleptics in schizophrenic patients, but no correlation was found in patients with schizoaffective disorder (r = -0.01), although they took neuroleptics in a similar regimen to that for the schizophrenics. There was no correlation between the standard deviation of the sway gravimetric area during fixation and the duration of illness. There was also no correlation between the former and the amplitude ratio of saccades during smooth pursuit eye movements. When horizontal eye movements pursuing the target were loaded in this experiment, both the normal subjects and the patients with schizoaffective disorder showed a decrease in a loaded gravimetric area and a tendency towards postural stabilization. However, schizophrenic patients having higher SANS scores (Andreasen) presented an increase in gravimetric area. This suggests that schizophrenic patients with higher SANS score may have organic cerebellar changes related to impairment of the mechanism of visual and postural coordinations.

Diagnosis of paraaortic and pelvic lymph node metastasis of gynecologic malignant tumors by ultrasound-guided percutaneous fine-needle aspiration biopsy

Transabdominal ultrasonography was done in patients with gynecologic malignancies to detect paraaortic and pelvic lymphadenopathy. Of the 78 patients who underwent ultrasonic examination of pelvic lymph nodes, pelvic lymphadenopathy was detected in 24, of whom ultrasound-guided percutaneous fine-needle aspiration biopsies (FNAB) were done in 16. Of these 16 patients, the results of 13 biopsies were positive. Of the 41 patients who underwent ultrasonographic examination of the paraaortic lymph nodes, 27 had paraaortic lymphadenopathy. Ultrasound-guided percutaneous FNAB were done in 26 of these 27 patients, with positive findings in 21 of the 26. It was concluded that ultrasound-guided percutaneous FNAB is useful in detecting metastatic lymph nodes in gynecologic malignancies.

[A comparative clinical study of adjuvant chemotherapy of tumors in the head and neck areas by means of HCFU]

In order to evaluate the efficacy of HCFU as an adjuvant chemotherapy agent for squamous cell carcinoma of the head and neck areas, a randomized comparative study was performed with cooperative facilities. 191 patients who had undergone radical therapy were randomly assigned to the following two groups: Group A was the control group, which underwent radical therapy only, and Group B was a group which received long-term HCFU administration (300-600 mg/day x 12 weeks or more). In the comparison of non-recurrence rate in both groups, Group B had better results among patients who were at the advanced clinical stages such as N1 through N3, Stage II (p = 0.0583) and Stage III (p = 0.0970). The adverse reactions to HCFU included pollakiuria, feverishness, and digestive symptoms, but these were mild and the recovery was possible.

Significance of hemostatic molecular markers during disseminated intravascular coagulation in patients with liver cirrhosis treated by endoscopic embolization for esophageal varices

We studied the quantitative changes of hemostatic molecular markers with time during the course of disseminated intravascular coagulation (DIC) induced by endoscopic embolization using thrombin for esophageal varices in nine patients with liver cirrhosis. The plasma levels of D-dimer, a product of plasmin degradation of cross-linked fibrin, and thrombin-antithrombin-III complex (TAT) were significantly higher in patients before treatment when compared with 60 healthy individuals. The plasma levels of TAT, D-dimer, and plasmin alpha 2-plasmin inhibitor complex (PIC) increased significantly 5-15 min after thrombin injection into the varices, earlier than the changes of conventional coagulofibrinolytic factors, reached a maximum level after 180 min, and started to decline after 1 day. Although the plasma PIC level returned to normal after 7 days, both TAT and D-dimer were still above the pretreatment level. Although there was no change in urokinase-type plasminogen activator (u-PA), tissue-type plasminogen activator (t-PA) increased significantly after 5 min. The plasma level of plasminogen activator inhibitor type 1 (PAI-1) showed only a slight elevation after treatment. We propose that the hemostatic molecular markers TAT, D-dimer, and PIC are suitable for the early diagnosis of DIC after endoscopic embolization using thrombin in patients with liver cirrhosis and that the increase of PAI-1 is too small for the regulation of fibrinolysis due to t-PA in DIC occurring in liver cirrhosis.

[Tolerance to a sustained release form of isosorbide dinitrate: comparison between 20 mg four times and 40 mg twice-daily administrations]

Attenuation of antianginal effects of oral isosorbide dinitrate in a sustained release from (ISDN-SR) were studied using the treadmill exercise test in eleven patients with stable exertional angina and a positive exercise test. We compared the four-time-daily administration of 20 mg with a twice-daily regimen of 40 mg for 10 days using the double-blind, crossover method. On the 1st day of the administration, with both regimens, the treadmill walking time, the time to 1mm and 2mm ST depression, and several hemodynamic parameters increased significantly. These improvements were reduced gradually on day 5 and day 10 after the administration. In the comparison between the four-time-daily and two-time-daily regimens, the former application showed clearer antianginal and hemodynamic effects than the latter regimen, but these effects were attenuated more markedly in the four-time daily administration. With both dosage regimens, the plasma ISDN concentrations increased gradually. With the long-term four-time-daily regimen, the time-to-time changes of the ISDN concentration were smaller each day. These data suggest that tolerance to oral ISDN-SR exists even if it is applied only two time daily, but its degree is less than when a four-time-daily dose in administered.

Effects of proteolytic enzyme inhibitors on the nasal absorption of vasopressin and an analogue

Proteolytic enzyme inhibitors were examined as absorption enhancers for the nasal delivery of vasopressin (AVP) and desmopressin (1-d-8-DAVP) in rats. Aprotinin, soybean trypsin inhibitor, and camostat mesilate were used as enzyme inhibitors. The nasal absorption of AVP and 1-d-8-DAVP was evaluated by measuring its antidiuretic effect. Nasal administration of AVP (0.005 IU/kg) or 1-d-8-DAVP alone (2.5 ng/kg) produced a small antidiuretic effect. Coadministration with aprotinin (1000 and 10000 KIU/kg) or soybean trypsin inhibitor (1.25 and 6.25 mM) did not change the antidiuretic effect. However, coadministration with camostat mesilate (1 to 50 mM) significantly increased the antidiuretic effect and, thus, the nasal absorption of AVP and 1-d-8-DAVP. The activities of aminopeptidase, cathepsin-B, and trypsin in the nasal mucosal tissue of rats were 7 nmol/min/mg protein, 0.7 nmol/min/mg protein, and 4.6 pmol/min/mg protein, respectively. Aprotinin and soybean trypsin inhibitor inhibited only the trypsin activity, whereas camostat mesilate inhibited aminopeptidase and trypsin activities. Aprotinin (MW 6500) and soybean trypsin inhibitor (MW 8000), with relatively high molecular weights, may not permeate into the nasal mucosal tissue. In contrast, camostat mesilate is slowly absorbed (8%/hr) and could inhibit the proteolytic activity in the nasal mucosa, resulting in enhanced nasal absorption of AVP and 1-d-8-DAVP.

Serum pepsinogen I concentrations in peptic ulcer patients in relation to ulcer location and stage

To investigate the relation of the serum group I pepsinogen (PG I) concentration to the location of gastric ulcers and chronicity of peptic ulcers, ulcer patients (n = 322) were compared with endoscopically normal subjects (n = 174). The mean PG I concentration was significantly higher in male control subjects (n = 90) than in female control subjects (n = 84). In male patients with ulcers in the duodenum (n = 69), antrum (n = 34), or angulus portion (the lower third of the body; n = 83), the mean serum PG I concentration was significantly higher than in the control subjects but in patients with an ulcer in the upper body (n = 49) it was similar to control values. Men with active or healing ulcers (n = 149) showed a significantly higher serum PG I concentration than those with scarred lesions (n = 86) when the abnormality was located in either the upper body or in the angulus portion. For female patients (n = 87), the results were similar. These results suggest that serum PG I concentrations reflect the stages of activity of peptic ulcer.

Free radical production by the red tide alga, Chattonella antiqua

The red tide alga, Chattonella antiqua, was found to show a strong chemiluminescence, using luminol as the reagent, when exposed to ultraviolet irradiation. This luminescence was completely inhibited by ascorbate or catalase, suggesting that hydrogen peroxide was generated by the plankton. Red tide cells exposed to fish gill mucus from young yellowtail resulted in the release of a large number of mucocysts and a weak luminosity, and showed a strong reduction of cytochrome c in the medium. Therefore, the discharge of mucocysts from the red tide, induced by the presence of gill mucus, may be accompanied by the release of active oxygen species. The active oxygen may be involved in depolymerization of mucus glycoproteins from the gill lamellae.

Biphasic changes in hypothalamo-pituitary-adrenal function during the early recovery period after major abdominal surgery

Regulatory mechanisms of the hypothalamo-pituitary-adrenal (H-P-A) axis during and after major abdominal surgery were studied in a group of patients who underwent upper abdominal surgery. We first examined the general profile of the changes of the H-P-A axis from the day before surgery to the seventh day after surgery. On the day of surgery, plasma levels of CRH, ACTH, and cortisol were all significantly elevated after skin incision (phase I). During the next 2 days, plasma cortisol levels remained significantly elevated, and the both plasma CRH and ACTH levels were suppressed below the control levels obtained on the day before surgery (phase II). Several additional studies, carried out to analyze the mechanism that maintains the high plasma cortisol levels, revealed the following features of the H-P-A axis during phase II. Plasma free cortisol levels in this phase were higher than those during the preoperative period. The exogenously administered hydrocortisone clearance rate in phase II did not differ from that observed on the day before surgery. Dexamethasone administration resulted in a decrease in plasma cortisol levels similar to that observed preoperatively. Conversely, the ACTH-stimulated cortisol increase was significantly greater in phase II than that observed preoperatively. These results suggest that during and after major surgical stress, the H-P-A axis undergoes a biphasic change in the pattern of the stress response and during the second phase, not the continuous hypothalamo-pituitary drive but the increased adrenal responsiveness to ACTH is responsible at least in part for maintaining the elevated plasma cortisol level.

[Wrapping operation for Stanford type A acute dissecting aneurysms]

Four cases of Stanford type A acute aortic dissection were treated by wrapping operation. After careful dissection between the dilated ascending aorta and right pulmonary artery, 8 mm woven Dacron vascular prosthesis was passed around the aorta and tightened. Further enforcement wrapping was carried out using several prostheses from aortic root to the innominate artery. We call this technique "wrapping operation". Emergent operations were performed on all patients because of cardiac tamponade, 6.8-33 hours after the onset of dissection. Three patients are doing well 17-39 months after the operation, but only 1 patient died early postoperative period because of DIC and multiple organ failure. And 2 patients was showed closure of entry of the ascending aorta by the postoperative aortography. We think that the wrapping operation is a useful technique for the patients of ruptured Stanford type A acute dissecting aneurysms.

Immunocytochemical localization of synaptophysin (protein p38) and synapsin I in nerve terminals of rat neurohypophysis

Synaptophysin and synapsin I, the synaptic vesicle-associated proteins, were demonstrated immunocytochemically in nerve terminals of the neurohypophysis of rats. Although both are associated with microvesicles 50-60 nm in diameter, they are not localized on or around the large neurosecretory granules nor the clear vacuoles, 100-200 nm in diameter. These findings strongly suggest that the microvesicles in the nerve terminal of the neurohypophysis are, for the most part, not the structures involved in the retrieval of the limiting membranes of the released neurosecretory granules, but rather typical synaptic vesicles. The clear vacuoles, which are negative for synaptophysin and synapsin I, are considered to be related to the retrieval of the limiting membranes of the released neurosecretory granules.

[The step to improve the operative outcome in patients with severe valvular heart disease]

In an effort to improve the operative outcome in severe valvular heart disease, we investigated the effects of low-dose infusion of dopamine and dobutamine up to the day of operation. New York Heart Association Functional Class was improved significantly before operation, as compared with at the time of admission. It was possible to perform operation on individual patients when their physical condition seemed to be at their best. In patients with fear of postoperative renal failure, hemodialysis was combined during cardiac surgery to prevent failing to renal dysfunction after operation. As the result of these procedures, we were able to obtain satisfactory result. In patients with severe valvular heart disease, the preoperative combined infusion of dopamine and dobutamine, and hemodialysis during cardiac surgery to prevent postoperative renal dysfunction seemed to improve the operative outcome.

Secretory pathways and processing of human proopiomelanocortin (POMC) using transformed mouse cultured fibroblasts (L cells) and AtT20 cells by human POMC gene--preembedding immunoelectron microscopic studies

In order to elucidate the relationship between secretory pathway and processing for precursor molecule of peptide hormones, we performed immunoelectron microscopic studies to localize POMC-derived peptides in mouse cultured L cells (fibroblasts without secretory granules) and in mouse AtT20 cells (ACTH secreting pituitary tumor cells with secretory granules) which had been transformed with human POMC gene. From the electron microscopic localization patterns, L42 cells were considered to serve as a model of constitutive pathway without processing of POMC, and A53 cells were considered to serve as a model of transgranular (regulated) pathway with processing of POMC. Immunoblotting supported these interpretations.

[Influenza A virus-induced mucociliary dysfunction of tubotympanum]

There is amount of epidemiologic, clinical and laboratory evidence to document that viral infection is involved in otitis media with effusion (OME). However, few studies have demonstrated the direct influence of viruses on the tubotympanum. The purpose of this study is to establish the effect of influenza A virus invaded in the tubotympanum, in an attempt to elucidate the possible mechanism by which the virus contributes to the pathogenesis of OME. 80 guinea pigs with normal otoscopic findings were inoculated with 0.2ml suspension of influenza A (3.3 x 10(8)PFU/ml) into their tympanic cavities through their tympanic membranes. To serve as controls, the same number of guinea pigs were injected with 0.2ml of physiologic saline solution into their tympanic cavities. At 3, 7, 14, and 28 days postinoculation, they were used for examination of the mucociliary function. Middle ear effusions were observed only in the animals inoculated with the virus. Mucociliary dysfunction was observed only in the animals inoculated with the virus. The ciliary activity in the bulla was declined at any time examined. On the other hand, the ciliary activity in the eustachian tube and the tympanic orifice was slightly lowered between 7 and 14 days, but the level was not different from that of the control. However, the number of active ciliated cells (showing more than 500 beats/min) was significantly smaller than that of the control. The mucociliary clearance time of the tubotympanum was more prolonged than that of the control at 3, 7, and 14 days, and returned to the control level at 28 days. A variety of morphologic changes were observed in the tubotympanum treated with the virus. Major pathologies observed included a general inflammatory cell infiltration, vacuolation and other degeneration of ciliated cells, and vascular damage and increased vascular permeability. Regeneration of cilia or ciliated cells followed the degeneration, which included an increased number of basal cells and new formed centrioles. However, the viral infection had an influence on the epithelial cells with new centrioles. Our study has demonstrated that viral infection could evoke mucociliary dysfunction of the tubotympanum and create an increased susceptibility to bacteria. Therefore, viral infection could enhance bacterial infectious process in the tubotympanum. Through the failure viruses could contribute to the occurrence of OME.

Effects of viscous hyaluronate-sodium solutions on the nasal absorption of vasopressin and an analogue

The effects of viscous solutions of hyaluronate-sodium of various average molecular weights (MW) on the nasal absorption of vasopressin (AVP) and its analogue, 1-deamino-8-D-arginine vasopressin (1-d-8-DAVP), were examined in rats. Solutions of hyaluronate with MW greater than 3 x 10(5) daltons enhanced the nasal absorption of AVP; solutions of MW 5.5 x 10(4) daltons were not effective. The enhancing effects on the nasal absorption of AVP and 1-d-8-DAVP were dependent on the concentration in the range of 0-1.5% (w/v) hyaluronate (MW 1.4 x 10(6) daltons). The nasal absorption of AVP was increased with this solution at lower pH. Bioavailabilities after nasal administration of AVP and 1-d-8-DAVP in hyaluronate solutions (MW 1.4 x 10(6) and 2 x 10(6) daltons) increased more than 2-and 1.6-fold as compared to nasal administration of AVP and 1-d-8-DAVP in buffer solutions (pH 7.0), respectively. Hyaluronate solution (MW 1.4 x 10(6) daltons) did not affect the ciliary beat frequency of rabbit nasal mucosal membranes in vitro. Therefore, hyaluronate solution may be useful as a vehicle for nasal delivery of AVP and 1-d-8-DAVP.

Enkephalinergic synaptic axon terminals on serotoninergic neurons in the dorsal raphe nucleus of the rat: an electron microscopic study by the double immunostaining method

Met-enkephalinergic synaptic axon terminals on serotoninergic neurons in the dorsal raphe nucleus of the rat were observed with double immunostaining at the electron microscopic level. Met-enkephalin-like immunoreactive axon terminals were found to make asymmetrical or symmetrical synaptic contacts with serotonin-like immunoreactive nerve cell bodies and dendrites. The findings suggest that opioid-containing neurons modulate serotoninergic neurons through synapses in the dorsal raphe nucleus.

[A case of left atrial giant thrombus which appeared in a short period]

We reported a case with left atrial giant thrombus (LAGT) which appeared over a period of six months. The patient was a 65-year-old woman who came to our hospital complaining of syncopal attack. Her electrocardiogram showed atrial fibrillation with very slow ventricular response, and there was cardiac arrest for 1500 ms, mitral stenosis and regurgitation, aortic and tricuspid regurgitations were recognized in the echocardiogram. By coronary angiography, 90% stenosis in the left circumflex artery (LCX) was found, and using transseptal left atrium heart catheterization, pressure gradient from the left atrium to the left ventricle was also measured. We diagnosed that her valvular diseases were mild. To protect her from unconsciousness and heart failure, a permanent pacemaker was implanted and PTCA for LCX lesion was performed. After six months, we found LAGT by echocardiography. It is very rare that LAGT is formed in a short period. We suggested that the changes of hemodynamics caused by transseptal left atrial catheterization or the permanent pacemaker implantation effected the formation of the LAGT.