Clinical studies on dissolution of gallstones using ursodeoxycholic acid

Ursodeoxycholic acid (UDCA), 7beta hydroxy epimer of chenodeoxycholic acid (CDCA), has been used as a choleretica for 20 years in Japan. Recent report showing increased excretion of UDCA in bile after CDCA administration may suggest the possibility that UDCA has similar effects to CDCA on bile cholesterol unsaturation and on gallstone dissolution. The present paper describes the clinical usefulness of UDCA for gallstone patients during the past two years. Seventy-four gallstone patients with functioning gall-bladders, 19 men and 55 women with a mean age of 48 years, have been treated for 6 months or more. UDCA, supplied in tablets (Ursosan), was given 450 mg per day. The disappearance or the reduction of stone size or number, or both (dissolution effect) was recognized in 32 out of 74 patients (43%). In case of radiolucent stones, the overall effective rate was estimated for 24 of 46 patients (52%). There may be no significant difference in dissolution effect between CDCA and UDCA treatment, however, the merit of UDCA treatment seems to have its few side effects.

Dysgenesis of the deep venous system as a diagnostic criterion for holoprosencephaly

The angiographic features of three cases with holoprosencephaly are reported. In all of them, the galenic venous system seemed to be deficient and the basal ganglia were drained by peculiar veins which coursed laterally and drained directly into the lateral sinus. These peculiar veins are considered to be remnants of the embryonic diencephalic veins, suggesting that these patients retain their early embryonic pattern of venous drainage. The diagnosis of alobar holoprosencephaly is established by the demonstration of the azygos anterior cerebral artery coursing along the frontal bone with excessive undulations. But with lobar holoprosencephaly, this characteristic feature is not present, and dysgenesis of the deep venous system is important for the diagnosis of holoprosencephaly.

[Clinical study of ventriculo-lumbar perfusion in the patients of so-called normal pressure hydrocephalus (author's transl)]

The cerebrospinal fluid dynamics were studied in the ten patients between 33 and 67 years old with signs of so-called normal pressure hydrocephalus by the technique of ventriculo-lumbar perfusion. The perfusion fluid with Ringer's solution or Hartmann's solution containing tracer amounts (25 mg/dl) of insulin. The inflow fluid warmed up to the body temperature was introduced by the infusion pump to the trigone of the lateral ventricle through the ventricular tube. The outflow fluid was collected from the lumbar subarachnoid space through the spinal needle inserted into the L4-5 interspace. The perfusion pressure was adjusted by raising and lowering the height of the outflow manometric pressure relative to the spinous process. The distribution volume of the perfusion system was the range of 94 - 209 ml (average 136 ml) and exceeded the normal range. The formation rate of cerebrospinal fluid was the range of 0.21 - 0.69 ml/min (average 0.39 ml/min) at the opening pressure, and nearly equal to the bulk absorption rate. There was the relationship between the bulk absorption rate and the perfusion pressure, and the regression coefficients in nine cases were lower than reported in normals. The clinical condition of seven of the nine patients demonstrating this absorptive deficit improved after cerebrospinal fluid shunting. The perfusion test was useful to recognize the cerebrospinal fluid dynamics and also to determine the indication of cerebrospinal fluid shunt in the patients of so-called normal pressure hydrocephalus.

["Compensated hydrocephalus" (author's transl)]

Out of 60 consective cases with hydrocephalus of pediatric age group, 8 cases were found to be so-called "compensated" hydrocephalus and their clinical features were reported. "Compensation" of hydrocephalus in our cases was probably induced by increased ventricular absorption of cerebrospinal fluid since moderate to severe ventricular dilatation was present in all cases. Such "compensation" of hydrocephalus is apparently made at the expense of normal development of the brain function. Therefore, such "compensation" of hydrocephalus is not the condition to be aimed for, but to be avoided for preservation of normal brain function. In order to prevent such "compensation" of hydrocephalus, shunt function should be followed carefully especially in those whose initial shunts were placed at older age, and in whom symptoms of increased intracranial pressure were not so apparent before the initial shunt-placement. Further treatment for hydrocephalus was considered to be necessary in our cases since unrolling of the anterior cerebral artery was invariably present. Unrolling of the anterior cerebral artery was found even in such cases whose cerebrospinal fluid pressure was normal, head circumference did not show any increase, and IQ test was normal. In one case, "compensated" hydrocephalus became later "decompensated" with apparent signs of increased intracranial pressure. Other supplementary tests for cerebrospinal fluid dynamic such as saline infusion test or RISA cisternography were also discussed.

[Post-shunt subdural hematoma in infants and children--analysis of eleven cases (author's transl)]

Out of 122 hydrocephalic infants and children treated by cerebrospinal fluid shunt, post-shunt subdural hematoma was found in 11 patients in total, 8 cases with non-tumorous hydrocephalus and 3 cases with brain tumors obstructing the cerebrospinal fluid pathway. In most cases the diagnosis of subdural hematoma was delayed since signs of increased intracranial pressure were absent initially. The signs of increased intracranial pressure appeared later, when the shunted venricle collapsed and could not give any more space to the growing subdural hematoma. At this stage those cases were easily misdiagnosed as shunt dysfunction. Post-shunt subdural hematoma was apparently induced by the tear of the bridging vein or leakage of the cerebrospinal fluid into the subdural space through the torn arachnoid membrane due to over-drainage of the cerebrospinal fluid, especially when the patients took the erect position. Since such a complication is not rare and difficult to be diagnosed, intensive follow-up is necessary in the post-shunt period. The precautionary measures as well as the treatment for these subdural hematoma were also discussed.

[Subdural hematoma after cerebrospinal fluid shunt for hydrocephalus following subarachnoid hemorrhage-report of two cases (author's transl)]

Post-shunt subdural hematoma was found in two patients with hydrocephalus due to subarachnoid hemorrhage. The first case was a 46-year-old man with two episodes of subarachnoid hemorrhage from anterior communicating aneurysm. Two weeks after neck-clipping for the aneurysm, a ventriculo-peritoneal shunt with Pudenz's system was performed since hydrocephalus with moderately increased pressure had been found. He did well for one month, then soon after mild head injury, disorientation and right hemiparesis developed. Cerebral angiogram revealed avascular space in the left parietotemporal region. After the ligation of the shunt tube, subdural hematoma was removed. The symptoms improved in two weeks. The second case was a 62-year-old man with an aneurysm at the trifurcation of the right middle cerebral artery. One month after successful clipping of the aneurysm, he received a ventriculoperitoneal shunt with Pudenz's system for normal pressur hydrocephalus. One and a half years after the operations he hit his head against the ground during his convulsive seizure. Since then, disorientation, urinary incontinence and gait disturbance appeared. After cerebral angiogram, the subdural hematoma was removed and the shunt tube was ligated. He became free of these symptoms in two weeks. The cerebrospinal fluid shunt is recommended for hydrocephalus induced by subarachnoid hemorrhage, but careful follow-up is necessary since these patients might develop post-shunt subdural hematoma, especially after head trauma as shown in our cases.

The characteristics of human plasma lipoprotein metabolism: influence of low caloric diet on hyperlipidemia

We have classified hyperlipidemia into three groups according to different levels of VLDL-TG, and postulated the effect of low calorie-diets on plasma TCh are as follows: 1) Low calorie-diets are effective on VLDL-TG in every type of hyperlipidemia, except hyperlipidemia with VLDL-TG under 180 mg/100ml; 2) There was a reciprocal relation between the decreased amount of plasma TCh and the change VLDL-TG induced by the diet; 3) Catabolism of VLDL was accelerated by an increased esterification of VLDL-FC; 4) In the the group with VLDL-TG less than or equal to 180 mg/100ml, the LDC showed a high level of TCh: protein ration, and in the group with VLDL-TG greater than or equal to 260 mg/100ml, there was to be low level of TG: protein ratio in VLDL: 5) In hyperlipidemia with plasma TCh unchanged by the diet LDL-TCh increased significantly without any increase in LDL protein and LDL-TG.

Correlation of the response of the flushing device to compression with the clinical picture in the evaluation of the functional status of the shunting system

The functional status of cerebrospinal fluid shunting systems provided with flushing devices has commonly been assessed by the response of the flushing device to digital compression and a review of the clinical status of the patient. In order to study the reliability of the response of the flushing device as an indicator to shunt function, 47 hydrocephalic children with implanted shunts were studied. In 40% of these children, the flushing device was pumping well at the time of shunt obstruction, and in 50% it was not, although the patient's clinical status was perfectly normal. Accordingly, we conclude that the flushing device is a very poor indicator of shunt functioning.

Comparative study of various models of experimental hydrocephalus

The authors present morphological findings in the brains of rabbits, dogs, cats, rats, and mice that have been used as experimental hydrocephalic models. The methods used were as follows: (1) silicone oil injection into the cisterna magna and the neighboring basal cisterns in rabbits by the method of Wisniewski; (2) kaolin administration into the cisterna magna in rabbits and dogs (Dixon); (3) ballooning method with Foley's catheter into the 4th ventricle in rabbits (Milho-rat); (4) plug formation with small pieces of laminalia into the cisterna magna in rabbits by our method; (5) Hy-3 hereditary hydrocephalic mouse bred by Gruenberg; (6) ligation of the placental vessels of the pregnant rat at 13 days of gestation by our method, and (7) transplacental intraperitoneal administration of ethylnitrosourea in a pregnant rat at 9.5 days of gestation. The models with silicone oil, kaolin, laminalia, and ballooning methods produced obstructive hydrocephalus with various grades of ventricular dilatation. The models with the ethylnitrosourea-induced method, ligation of placental vessels, and Hy-3 mouse produced prenatal hydrocephalus. Dilatation of the ventricular system and histological abnormalities do not occur as a uniform process.

Changes in nitrogenous components of brain produced by stimulation of short duration

Brain cortex of cats was stimulated through the brachial plexus for 5–30 seconds and the sensory motor area was frozen in situ, the contralateral area frozen 3 seconds before stimulation, serving as control. Stimulation for 20 seconds at 60 cpm produced the following chemical changes per gm wet tissue: a) nonprotein nitrogen increased by 16 µEq; b) nucleic acid nitrogen decreased by 10 µEq; c) lipid nitrogen decreased by 12 µEq. Amino-nitrogen increased in the lipid and nucleic acid fractions and decreased in the acid-soluble fraction. These chemical changes were proportional to the number of effective stimuli and were reversible at rest. It is concluded that nucleic acids and lipids are metabolized in the brain cortex during activity.