Intermittent claudication in the foot and Buerger's disease

The objective of this investigation was to study the pathogenesis of intermittent claudication in the foot and to determine whether it could be used as a diagnostic manifestation of Buerger's disease. In 30 limbs with foot claudication and 20 limbs without foot claudication, systolic pressures at various levels of the leg were measured by a photoelectric technique, and the significance of collateral circulation in the foot on the development of claudication was studied. Although there was a significant difference between blood pressures at the foot and toe, considerable overlapping was seen between the two groups. This finding might indicate that muscle circulatory insufficiency in limbs with foot claudication results from occlusion of the nutrient arteries supplying the plantar muscles as well as poor collateral circulation in the foot. Hospital records of 48 patients with foot claudication were reviewed and the question of whether these patients could be diagnosed as having Buerger's disease was discussed. On the basis of clinical findings and arteriographic appearances, the diagnosis of Buerger's disease was made in all patients except one with hypercholesteraemia. From the results obtained here, foot claudication could be considered to be almost specific to Buerger's disease and a useful guide in the clinical diagnosis of this disease.

Involvement of the iliac artery in Buerger's disease (pathogenesis and arterial reconstruction)

Out of 216 patients with Buerger's disease, 14 showed the involvement of the iliac artery in addition to the occlusive lesion in the leg arteries. It occurred within 2 to 8 years after the onset of symptom. The obliterative lesion of the iliac artery might owe its cause to a direct proximal progression of thromboangitis obliterans of the femoral artery or to a skip progression of the disease. The skip lesion of the iliac artery might be due to an ascending progress of the thromboangiitic lesion in the branch arteries of the iliac artery. The indication for arterial reconstruction in the case with the involvement of the iliac artery depends on run-off in the deep femoral artery. Out of the 14 cases, 2 underwent thromboendarterectomy with autogenous vein patch grafting of the external iliac artery and 6 underwent bypass grafting, but their long-term follow-up result was poor.

Raynaud's phenomenon in arterial obstructive disease of the hand demonstrated by locally provoked cooling

Finger systolic blood pressure (FSP) was measured by cuff technique before and after local cooling in three groups of patients (Raynaud's disease (7), subclavian stenoses, (5), thrombo-angiitis obliterans (15)), and in 15 normals. The response to finger cooling registered as a decrease in FSP indicates an increase of digital arterial tone. In all three groups, digital arterial tone increased more than in normals during finger cooling. Patients with Raynaud's disease showed a pathological increase in arterial tone at 23.5 degrees C with closure of the digital arteries at a mean temperature of 18.5 degrees C. The temperature eliciting these phenomena in patients with thrombo-angiitis obliterans was about 7 degrees C lower (16.5 and 11.0 degrees C, respectively). Accordingly, cold sensitivity and Raynaud's phenomena in the two groups may have a different pathophysiological mechanism, namely a pathological arterial tone in Raynaud's disease vs. a normal arterial tone in obliterative diseases acting on a narrow vessel.

Dicentric yields induced by gamma-radiation and chromosome arm number in primates

To evaluate the effect of the chromosome arm number on the yield of dicentric chromosomes, frequencies of gamma-ray-induced chromosome aberrations were examined with peripheral lymphocytes from three different primate species, Saimiri sciureus (arm number, 77), Macaca fascicularis (arm number, 83) and Nycticebus coucang (arm number, 99). Irradiated blood samples were cultured by the same standard technique as that commonly used for human lymphocytes. The yields of dicentrics and dicentrics plus rings at doses of 100, 200 and 300 rad of gamma-irradiation were not significantly different among the three species, in spite of the difference in the chromosome arm number. Furthermore, dose-response relationships for these species were consistent with that for man. Statistical analysis indicated that the expected dicentric yields calculated from the arm number model were significantly different from the observed yields at 200 and 300 rad doses (P less than 0.01). From these results it can be pointed out that there is no correlation between the yield of dicentrics and the effective chromosome arm number, and that the chromosomal radiosensitivity of these primates is essentially the same as that of man, at least in the lymphocyte system.

Occlusion cuff for routine measurement of digital blood pressure and blood flow

A miniaturized blood pressure cuff made of plastic material and applicable to fingers and toes is described. The cuff was compared to rubber cuffs and to bladder-free cuffs. It was found to be more reliable than the former type and much easier to use than the latter type. It is recommended for use in conjunction with a mercury-in-Silastic strain gauge for routine measurement of digital blood pressure and blood flow in patients with arterial disease.

Glucose-phosphorylating enzymes of Candida yeasts and their regulation in vivo

Three glucose-phosphorylating enzymes having different specificities for glucose and fructose were separated from the cell-free extract of Candida tropicalis by means of ammonium sulfate fractionation and chromatography on DEAE-cellulose and Sephadex G-100. Two of them, which phosphorylated fructose 1.5 times faster than glucose, were designated as hexokinase I and II (ATP : D-hexose 6-phosphotransferase, EC 2.7.1.1.), and the other with very low or no fructose-phosphorylating activity, as glucokinase (ATP : D-glucose 6-phosphotransferase, EC 2.7.1.2). Km values for glucose with both hexokinase I and glucokinase were 0.3 mM, and that for fructose with hexokinase I was 2.2 mM. Time-course changes in the levels of these enzymes in C. tropicalis growing on glucose and on n-alkane revealed that hexokinase was induced specifically by the sugars, while glucokinase was a constitutive enzyme. Addition of cycloheximide to the culture medium prevented the increase in the hexose-phosphorylating activity and in the Fru/Glu ratio (the ratio of enzymatic phosphorylation of fructose to that of glucose) in the cells. Although Candida lipolytica also contained hexokinase and glucokinase, both enzymes seemed to be constitutive.

Studies on cyclic nucleotides in the adrenal gland. V. Adenylate cyclase in the adrenal medulla

Effects of various chemical agents eliciting the catecholamine-release on the adenylate cyclase-cyclic AMP generating system have been studied in the secretory process of the bovine adrenal medulla slices. Cyclic AMP levels were not affected at the interval of the maximal increase of the catecholamine-release by acetylcholine, but increased gradually some time after the end of the release/or at the beginning of the restoration of catecholamine in the medulla tissue. This delayed increase in the medullary cyclic AMP is not attributed to a direct involvement in 'stimulus-secretion coupling process' of the medullary secretion, but rather may be caused by release of intracellular catecholamine.

Vascular reconstruction in Buerger's disease

In 23 of 148 patients with Buerger's disease, it was possible to undertake 27 arterial reconstructive procedures: bypass in 22 and thrombo-endarterectomy in 5. In a follow-up of 10 months to 8 years, the overall patency rate was 26 per cent. The long term patency rate of bypass grafting was good in obstruction of main vessels, but unsatisfactory with multiple occlusions. Bypass grafting was preferred to thromboendarterectomy. To obtain long term patency of revascularaized segments, complete abstinence from tobacco is absolutely essential. The preparatory manoeuvres for antogenous venous graft should be as atraumatic as possible. A functional diagnosis is indispensable when considering operative indications and for follow-up study of patients with peripheral arterial occlusive disease.

Blood pressure measurement of all five fingers by strain gauge plethysmography

The aim of the present paper was to study the methodological problems involved in measuring systolic blood pressure in all five fingers by the strain gauge technique. In 24 normal subjects, blood pressure at the proximal phalanx of finger I and both at the proximal and the intermediate phalanx of the other fingers was measured using a 24-mm-wide cuff. Blood pressure at the proximal phalanx was higher than that at the intermediate phalanx in all fingers except finger V. The difference of blood pressure values corresponded well with circumference of the finger. In 15 normal subjects, blood pressure at the proximal phalanx was compared in fingers I, III, IV, and V, using 16, 20, 24 and 24 mm wide cuffs. Finger blood pressure was closest to arm systolic blood pressure when a 24-mm or 27-mm-wide cuff was used in fingers I, III, and IV, and with a 20-mm-wide cuff in finger V. As the standard deviation of the mean values was larter with the 27-mm-wide cuff than with the 24-mm-wide cuff, the 24-mm-wide cuff was considered to be most suitable for clinical use in fingers I, II, III, and IV. By using the 20-mm-wide cuff in finger V and the 24-mm-wide cuff in the other fingers, normal value of finger blood pressure was determined for both proximal and intermediate phalanxes.

Studies on cyclic nucleotides in cancer. I. Adenylate guanylate cyclase and protein kinases in the prostatic sarcoma tissue

Adenylate, guanylate cyclase and protein kinases in a fibrous sarcoma originating from rat prostate have been studied. A decrease in levels of adenosine 3', 5'-monophosphate (cyclic AMP) and adenylate cyclase activities and an increase in levels of guanosine 3',5'-monophosphate (cyclic GMP) and guanylate cyclase activities were observed in the tumor tissue when compared with the normal prostatic tissue of rats. Protein kinases from the tumor and the prostate were both responsive to exogenous cyclic AMP, with an apparent Ka of 0.08 muM in the tumor and of 0.11 muM in the prostate. It is of interest that the protein kinases from the tumor responded to cyclic AMP to the same extent as was observed in the enzyme preparation from the prostate. The protein kinase from the tumor was more sensitive to cyclic GMP than that from the prostate, showing an apparent Ka of 0.88 muM in the tumor and of 4.85 muM in the prostate. This tumor has been characterized with an increase in guanylate cyclase activities with a subsequent rise in cellular cyclic GMP and an increased sensitivity of the protein kinase to cyclic GMP.

Onset and clinicopathological course in Buerger's disease

From clinicopathological study, vasculitis of Buerger's disease seemed to start at small branch arteries and veins and progress to the trunk artery with thrombus. Progress of vascular lesions in trunk artery was gradual in general; the pathogenesis was briefly discussed.

Long-term follow-up results of the iliofemoral venous thrombosis

During the past 7 years 116 patients with acute and chronic iliofemoral venous thrombosis were treated surgically and medically. Exploration was undertaken mainly by clinical assessment and routine venography for follow-up was not considered as a requisite. Thrombectomy was performed 18 times in 17 patients with excellent or good results in 66.6%. Palma's operation was carried out 17 times in 17 patients with satisfactory results in 82.3%. These were contrasted with 34.2% satisfactory results among the medical patients. These lead to the following conclusion: 1. Venous thrombectomy within 14 days after the onset is effective. 2. The usefulness of delayed thrombectomy is uncertain. 3. Palma's operation offers satisfactory results for chronic iliofemoral venous thrombosis. 4. In Japan, in contrast with America and Europe, pulmonary thromboembolism is exceedingly rare and ligation or interruption of the inferior vena cava or the femoral vein is not performed routinely.

Intermittent claudication of the foot in view of foot muscle blood flow measured by 133Xe clearance technique and arteriographic findings

In 20 limbs of 10 healthy subjects and 55 limbs of 41 patients with occlusive areterial diseases of the legs, muscle blood flow was measured in the flexor hallucis brevis muscle by 133Xe clearance technique. The clearance curves after the ischemic exercise differenciated limbs with intermittent claudication of the foot from normals and limbs without claudication. An attempt was also made with arteriographic findings in 102 limbs of 84 patients with occlusions of the leg and/or foot arteries only. From results obtained, it is concluded that 133Xe clearance technique applied in the flexor hallucis brevis muscle can be used for diagnosis of foot pain during walking of uncertain origin and intermittent claudication of the foot is caused by severe circulatory insufficiencies of the plantar muscles during walking in the patients with involvements of the posterior tibial and/or plantar arteries.

Studies on monoterpene glucosides and related natural products. XXXI. Gas chromatography and gas chromatography-mass spectrometry of iridoid and secoiridoid glucosides

A total of 33 iridoid and secoiridoid glucosides were detected by gas chromatography on several columns such as OV-1 or OV-17. Representative glucosides were then subjected to gas chromatography-mass spectrometry, giving some characteristic peaks that permitted the discrimination of both types of glucosides from other compounds in most instances. The successful detection of both types of glucosides in several plant extracts showed the applicability of this combination of methods to small amounts of plant materials.

Recurrence of the nephrotic syndrome in the renal isograft: A preliminary report

The fifth case of kidney transplantation between monozygotic twins in Japan is presented. Immediately after the transplanation the original disease, nephrotic syndrome, recurred but it was treated with steroids successfully. There have been few cases reported in which recurrence of the original disease in the isograft was treated successfully.

Purification and properties of two ribonucleases in different intracellular compartments in pea root tissue

Two RNases in bound forms associated with the microsomal membrane and with the ribosomes or unknown particles in pea root tissue were solubilized by subjecting the membrane to sonic oscillation in the presence of EDTA and KC1 and by treating the particles with EDTA, respectively. The RNases were than purified by DEAE-cellulose and Sephadex G-75 column chromatographies. The elution profiles of RNases from the columns were very similar. No significant differences were observed in their electrophoretic mobilities in polyacrylamide gels, in molecular weight, in activation by inorganic ions, urea or phospholipid micelles or in the dependence of their activities upon pH. The purified RNASES were not different from the bound enzymes as regards activation by inorganic ions and urea and the dependence of the activity upon pH. Triton X-100 stimulated the activity only if RNase was in a bound form associated with the microsomal membrane. We propose that the two RNases may be the same molecular species and differ only in the form of association with intracellular structures.

Effects of lumbar sympathectomy on thromboangiitis obliterans

The clinical response to lumbar sympathectomy has been reported. The incidence of improvement was as follows: Coldness 52 percent, ulcer 58 percent, rest pain 64 percent, and claudication 31 percent, respectively. The blood flow in the anterior tibial muscles did not increase within 5 weeks postoperatively. There were correlations between the effects and the clinical stages, the interval from the onset to the operations, the abuse of tobacco, and the degree of reactive hyperemia, but not relation was observed between as to the site of obstruction. In the experiments, the influence of acetylcholine on blood flow increased after the operations and the duration of vasoconstriction following administration of noradrenalin became shorter. On the basis of the clinical and experimental facts, postoperative improvement seems to be due to increased blood flow to the peripheral skin and to relief of vasospasm.

Difference in pyruvate kinase regulation among three groups of yeasts

Yeast pyruvate kinase (ATP : pyruvate 2-O-phosphotransferase EC 2.7.1.40) was classified into three groups based on the interaction with fructose-1,6-bisphosphate. The pyruvate kinases of Saccharomyces cerevisiae and Saccharomyces carlsbergensis were activated by fructose 1,6-bisphosphate in the concentration range tested (up to 10 mM) of the substrate, phosphoenolpyruvate; the enzymes of "fermentative Candida" (Candida tropicalis and Candida utilis) were affected by fructose 1,6-biphosphate only when the substrate concentration was below 2 mM. Although the pyruvate kinase of Candida lipolytica (a yeast belonging to "oxidative Candida") was also affected by fructose 1,6-bisphosphate, the degree of the activation was extremely small as compared with the above four yeasts. The pyruvate kinase of C. tropicalis was inhibited by ATP more strongly in the absence of fructose 1,6-bisphosphate than its presence. In the case of the C. lipolytica enzyme, however, the enzyme was inhibited to a lesser extent by ATP, and fructose 1,6-bisphosphate did not reverse the inhibitory effect of ATP. Time course changes of the enzyme levels in the yeasts grown on glucose and on ethanol indicate that the pyruvate kinases of S. cerevisiae and C. tropicalis can be controlled both by an allosteric mechanism and by changes in the enzyme concentration, although a marked difference was observed in the susceptibility to the allosteric effect by fructose 1,6-biphosphate between these fermentative yeasts. On the other hand, that of C. lipolytica would be controlled only by the latter mechanism.

[Surgical treatment of varices of the lower extremities (author's transl)]

In the last 6 years we have treated 132 patients with varices of the lower extremities and operated on 65 of them. We came to the following conclusions: 1. Stripping of the saphenous vein with subfascial ligature of the incompetent venae communicantes is essential for the complete treatment of primary varicosity with or without ulcer. 2. Pelvic phlebography is necessary to exclude secondary varicosities in both bilateral and unilateral varices. 3. The removal of secondary varices has a definitely negative result if recanalisation is incomplete; i.e. they ought not to be extirpated if the outflow from the great saphenous vein is directed centrally on walking.