Clinical course and outcome of idiopathic membranous nephropathy in Japanese children

We retrospectively studied 12 Japanese children (8 boys, 4 girls) with idiopathic membranous nephropathy (IMN), aged 2.9-15.8 (mean 7.7) years at onset. All patients were identified through either screening or a routine urinalysis; proteinuria was present in all, haematuria, which was macroscopic in 4, in 11. Three had nephrotic syndrome (NS) at or soon after onset. Stages on electron microscopy, performed in 10 patients, were I in 3, II in 5 and III in 2. Steroids alone or with cyclophosphamide were administered to 5 patients, including the 3 patients showing NS. Complete remission of proteinuria occurred in 8 patients 0.3-1.6 (mean 0.6) years after onset, and proteinuria did not recur. After a follow-up of 1.6-11.6 (mean 5.9) years, these 8 patients were in complete remission and the remaining 4 had only mild proteinuria; none had hypertension or impaired renal function. Thus, we infer that IMN in Japanese children may have a better course and outcome than IMN in non-Japanese children. Based on a comparative study of Japanese (previously reported cases added to ours) and non-Japanese (mostly Caucasian) children with IMN, this was confirmed; it is possible that steroid therapy in Japanese patients is more effective in inducing remission of NS and preserving renal function.

Stimulatory effects of protein kinase C and calmodulin kinase II on N-methyl-D-aspartate receptor/channels in the postsynaptic density of rat brain

To clarify the regulatory mechanism of the N-methyl-D-aspartate (NMDA) receptor/channel by several protein kinases, we examined the effects of purified type II of protein kinase C (PKC-II), endogenous Ca2+/calmodulin-dependent protein kinase II (CaMK-II), and purified cyclic AMP-dependent protein kinase on NMDA receptor/channel activity in the postsynaptic density (PSD) of rat brain. Purified PKC-II and endogenous CaMK-II catalyzed the phosphorylation of 80-200-kDa proteins in the PSD and L-glutamate- (or NMDA)-induced increase of (+)-5-[3H]methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imi ne maleate ([3H]MK-801; open channel blocker for NMDA receptor/channel) binding activity was significantly enhanced. However, the pretreatment of PKC-II- and CaMK-II-catalyzed phosphorylation did not change the binding activity of L-[3H]glutamate, cis-4-[3H](phosphonomethyl)piperidine-2-carboxylate ([3H]CGS-19755; competitive NMDA receptor antagonist), [3H]glycine, alpha-[3H]-amino-3-hydroxy-5-methyl-isoxazole-4-propionate, or [3H]-kainate in the PSD. Pretreatment with PKC-II- and CaMK-II-catalyzed phosphorylation enhanced L-glutamate-induced increase of [3H]MK-801 binding additionally, although purified cyclic AMP-dependent protein kinase did not change L-glutamate-induced [3H]MK-801 binding. From these results, it is suggested that PKC-II and/or CaMK-II appears to induce the phosphorylation of the channel domain of the NMDA receptor/channel in the PSD and then cause an enhancement of Ca2+ influx through the channel.

Decrease in coupling of Gs in v-src-transformed NIH-3T3 fibroblasts: possible involvement of tyrosine phosphorylation of Gs by pp60v-src

In Rous sarcoma virus (RSV)-transformed NIH-3T3 fibroblasts expressing pp60v-src as tyrosine protein kinase, isoproterenol-stimulated cAMP accumulation was much lower than in normal cells. The reduction in v-src-transformed cells seemed to be mainly due to a decrease in the number of beta 2-adrenoceptors. When the membranes were phosphorylated with ATP, however, the binding affinity of isoproterenol to beta 2-adrenoceptors was reduced in transformed cell membranes by 34% compared to that in normal cell membranes. The reduction in transformed cell membranes was restored to the level of normal cell membranes by treatment of membranes with anti-pp60v-src antibody. GTP gamma S- and cholera toxin-stimulated adenylyl cyclase activities were reduced with no change in forskolin-stimulated adenylyl cyclase activity in transformed cell membranes. The reduced effect of GTP gamma S was also restored by treatment with anti-pp60v-src antibody or by adding staurosporine, which inhibits a variety of protein kinases, including tyrosine protein kinase. One of the 32P-phosphoproteins phosphorylated with [gamma-32P]ATP in v-src-transformed cell membranes was bound to GTP-agarose, and was a 46-kDa molecule on a sodium dodecyl sulfate-polyacrylamide gel. This 46-kDa 32P-labeled phosphoprotein was immunoprecipitated with anti-phosphotyrosine antibody or anti-stimulatory GTP-binding protein (anti-Gs) antibody. These results suggest that pp60v-src phosphorylates the alpha-subunit of Gs and consequently causes a decrease in the coupling of beta 2-receptors to Gs and in the coupling of Gs to adenylyl cyclase.

[Report of two cases presenting with myelodysplastic syndrome during treatment of recurrent breast cancer]

Two women with recurrent breast cancer presenting with myelodysplastic syndrome (refractory anemia) during chemotherapy were reported. At diagnosis of myelodysplastic syndrome, white blood cell count, hemoglobin and platelet count were 3,300/mm3, 4600/mm3, 5.5 g/dl, 6.3 g/dl, 1.1 x 10(4)/mm3 and 6.8 x 10(4)/mm3, respectively, in case 1 and 2. Bone marrow taps showed hypercellular marrows with dysplastic changes of erythrocytes, granulocytes and megakaryocytes in both cases. Before the occurrence of the myelodysplastic syndrome, both patients received various cytotoxic agents (mitomycin C: 77 mg, 108 mg; cyclophosphamide: 34,400 mg, 40,000 mg; doxorubicin: 340 mg, 460 mg; methotrexate: 410 mg, 700 mg; and vincristine: 9.5 mg, 14 mg, in case 1 and 2, respectively). One patient died 2 months after the onset of the myelodysplastic syndrome, and the other died 3 months after due to progression of metastatic breast cancer. Risk-benefits analysis of chemotherapy, especially adjuvant chemotherapy, should be performed in cases of breast cancer.

Hepatocellular carcinoma in adenomatous hyperplasia: detection with contrast-enhanced US with carbon dioxide microbubbles

Adenomatous hyperplasia (AH) of the liver is considered a precancerous lesion because hepatocellular carcinoma (HCC) has been found in nodules of AH at histologic examination. Contrast material-enhanced ultrasound (US) with intraarterial infusion of carbon dioxide microbubbles was performed in four patients with HCC in AH lesions. In all four patients, a "hyperechoic focus in an area of hypoechoic change" in relation to the adjacent liver was demonstrated, compatible with the minimal vascular change associated with neoplastic transformation and carcinoma development. Because early detection of the minute cancer foci that may develop in an AH nodule is clinically important, this contrast-enhanced US technique may be a useful tool for the detection of these associated lesions.

Treatment of vertigo using laser labyrinthectomy

Benign paroxysmal positional vertigo developed in a patient with perilymph fistula 3 years after closure of the fistula which was in the lower margin of the annular ligament. The patient's symptoms were long-lasting and intractable. The macula utriculi and utriculoampullary nerve were irradiated by argon laser beams through the stapedectomized oval window. Singular neurectomy was performed using Argon laser, although the nerve could not be identified. After surgery, the patient's symptoms disappeared. Pure tone average of the operated side was 50 dB which remained unchanged after surgery. The macula utriculi may have been completely destroyed. Ocular counter-rolling was indicative of hypofunction of the irradiated utricle. The singular nerve may or may not have been sectioned. The ampullary nerves to the lateral canal and probably the anterior canal were intact, judging from the normal caloric reaction.

Characterization of [3H]staurosporine binding in protein kinase C-II purified from rat brain

The type II protein kinase C (PKC-II) densely present in mammalian brain plays functional roles in CNS. We examined the characteristics of [3H]staurosporine binding to PKC-II purified from rat brain, compared to [3H]phorbol 12, 13-dibutyrate (PDBu) binding. In brief, [3H]staurosporine binding increased by phosphatidylserine (PtdSer) in a concentration-dependent manner and the binding was enhanced by Ca2+ and phorbol 12-myristate 13-acetate (PMA). In the presence of Ca2+, PMA and PtdSer, Bmax of these bindings markedly increased, but KD did not change. These characteristics of binding were similar to [3H]PDBu binding to PKC-II. Although [3H]PDBu binding was not affected by protein kinase inhibitors such as staurosporine, H-7, K-252a and K-252b, [3H]staurosporine binding was inhibited by these inhibitors. [3H]staurosporine binding was inhibited by several ATP analogues, but was not by guanine nucleotides. PtdSer-induced increase in [3H]PDBu binding was inhibited by Zn2+, but Zn2+ induced increase in [3H]staurosporine binding as well as PtdSer and/or Ca2+. Staurosporine would thus appear to bind to a domain different from phorbol ester-binding one in PKC, interactions between both domains may regulate kinase activity, and 1 mol staurosporine and 4 mol phorbol ester may bind to 1 mol PKC-II.

Hepatocellular carcinoma in adenomatous hyperplasia: detection with contrast-enhanced US with carbon dioxide microbubbles

Adenomatous hyperplasia (AH) of the liver is considered a precancerous lesion because hepatocellular carcinoma (HCC) has been found in nodules of AH at histologic examination. Contrast material-enhanced ultrasound (US) with intraarterial infusion of carbon dioxide microbubbles was performed in four patients with HCC in AH lesions. In all four patients, a "hyperechoic focus in an area of hypoechoic change" in relation to the adjacent liver was demonstrated, compatible with the minimal vascular change associated with neoplastic transformation and carcinoma development. Because early detection of the minute cancer foci that may develop in an AH nodule is clinically important, this contrast-enhanced US technique may be a useful tool for the detection of these associated lesions.

[Clinical studies on renovascular hypertension with bilateral renal artery stenosis]

Clinical studies were performed on 7 renovascular hypertensive patients (3 male and 4 female, mean age 50.6 +/- 18.6) with bilateral renal artery stenosis. Duration of hypertension ranged from 2 months to 24 years (mean 6.1 +/- 8.2 years) before evaluation. All had stenosis or occlusion of both main renal arteries or these branches shown by arteriography. In 4 of the 7 patients atheromatous stenosis or occlusion was present; the remaining two had aortitis syndrome and one had fibromuscular hyperplasia. Of the 7 patients operated, two who had both negative renal renin study and ureteric catheterization study; one was failure after bilateral percutaneous transluminal angioplasty (PTA), and another one was improved after axillo-femoral bypass operation. In one patient with positive results of both studies an area of focal cortical atrophy was present in upper part of the left kidney. The patient, therefore, underwent partial nephrectomy the left kidney but failed to have decrease of blood pressure and was subsequently treated with antihypertensive medications. In the remaining four patients operated, two who had both positive renin and catheterization studies preoperatively were cured or improved after PTA in negative side and nephrectomy of positive side kidney. Other two patients with contradictory results of renin and catheterization studies underwent, PTA of the renal artery of the kidney with the highest renin levels. But their hypertension was maintained despite sufficient dilatation of the renal artery and PRA from the contralateral kidney was noted to be markedly increased after PTA. Therefore, nephrectomy of the contralateral nonfunctioning contracted kidney was performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Presence of m3 subtype muscarinic acetylcholine receptors and receptor-mediated increases in the cytoplasmic concentration of Ca2+ in Jurkat, a human leukemic helper T lymphocyte line

Recent studies have demonstrated the presence and the regulatory function of several neurotransmitters in the immune system. In the present study, we examined the presence of acetylcholine receptors, using pharmacological and molecular biological assays, and their transmembrane control and functions, using a biochemical assay, in a cloned human leukemic helper T lymphoma cell line, Jurkat. Several muscarinic agonists, such as acetylcholine, carbachol, muscarine, and oxotremorine-M (Oxo-M), at 100 microM caused a transient elevation of the free cytosolic Ca2+ concentration ([Ca2+]i), in contrast to the tonic elevation of [Ca2+]i induced by 10 micrograms/ml phytohemagglutinin (PHA). It appeared that the elevation induced by Oxo-M, the most potent [Ca2+]i elevator, was more effectively inhibited by p-fluorohexahydrosiladifenidol hydrochloride (p-F-HHSiD) and 4-diphenylacetoxy-N-methylpiperidine methiodine than by pirenzepine and 11-2[[2-[(diethylamino)methyl]-1-piperidinyl]acetyl]-5,11-dihydro- 6H-pyrido[2,3-b] [1,4]benzodiazepine-6-one (AF-DX 116), suggesting that a pharmacological M3 subtype of muscarinic receptors is involved in the elevation of [Ca2+]i. Northern blot analysis showed that the m3 type of receptors are expressed in Jurkat cells. Scatchard analysis of [3H]quinuclidinyl benzilate binding to intact cells indicated a Kd of 14.1 nM and a Bmax of 45,370 binding sites/cell. [3H]Quinuclidinyl benzilate binding to cell membranes was also inhibited by p-F-HHSiD rather than by pirenzepine and AF-DX 116. Oxo-M induced formation of inositol trisphosphate, and 5'-O-(2-thio)diphosphate inhibited the formation. Cholera toxin treatment inhibited the PHA-induced [Ca2+]i rise but did not affect the Oxo-M-induced rise. Neither pertussis nor butulinus (type C) toxin affected the rise induced by Oxo-M or PHA. Thus, bacterial toxin-insensitive GTP-binding proteins seem to be involved in the Oxo-M-induced increase in [Ca2+]i. Treatment with 12-O-tetradecanoylphorbol 13-acetate abolished the Oxo-M-induced [Ca2+]i rise but did not affect that induced by PHA. m3 Muscarinic receptors thus appear to cause Ca2+ mobilization from intracellular stores via bacteria toxin-insensitive GTP-binding proteins, phospholipase C activation, and inositol trisphosphate formation in Jurkat cells. Protein kinase C seems to negatively modulate the m3 receptor system.

Development and evaluation of a novel sterilizer with rotary vibrators

A novel steam-air sterilizer with rotary vibrators was developed with the aim of promoting heat transfer and the effective sterilization of foods. To evaluate the effects of the sterilizer, experiments to examine heat transfer and sterilization tests were carried out. In the experiments to examine heat transfer, heat penetration factors of sterilizer with vibration, j and fh values, were 1.70 and 1.50, respectively, while those of sterilizer without vibration were 1.83 and 2.32, respectively. In the sterilization with vibration, no surviving cells were detected after 3 min, whereas 7 min were required for sterilization without vibration. The rate of the amino carbonyl reaction was repressed by heat treatment with vibration.

[MR tractography--visualization of structure of nerve fiber system from diffusion weighted images with maximum intensity projection method]

We developed a new noninvasive technique to visualize the anatomical structure of the nerve fiber system in vivo, and named this technique magnetic resonance (MR) tractography and the acquired image an MR tractogram. MR tractography has two steps. One is to obtain diffusion-weighted images sensitized along axes appropriate for depicting the intended nerve fibers with anisotropic water diffusion MR imaging. The other is to extract the anatomical structure of the nerve fiber system from a series of diffusion-weighted images by the maximum intensity projection method. To examine the clinical usefulness of the proposed technique, many contiguous, thin (3 mm) coronal two-dimensional sections of the brain were acquired sequentially in normal volunteers and selected patients with paralyses, on a 1.5 Tesla MR system (Signa, GE) with an ECG-gated Stejskal-Tanner pulse sequence. The structure of the nerve fiber system of normal volunteers was almost the same as the anatomy. The tractograms of patients with paralyses clearly showed the degeneration of nerve fibers and were correlated with clinical symptoms. MR tractography showed great promise for the study of neuroanatomy and neuroradiology.

[Clinical evaluation of NK 622 (toremifene citrate) in advanced or recurrent breast cancer--a comparative study by a double blind method with tamoxifen]

Efficacy and safety of NK 622 (toremifene citrate) were compared with tamoxifen (TAM) by a double blind test in patients with advanced or recurrent breast cancer. NK 622 and TAM were given orally for 12 weeks or more at daily doses of 40 and 20 mg/body, respectively. Eligible cases in NK622 and TAM groups were both 57 patients. No significant difference was observed in patient characteristics between either group. Response rates were 26.3% (8 CR and 7 PR, 15/57) in the NK 622 group and 28.1% (3 CR and 13 PR, 16/57) in the TAM group. Median values of duration to onset of CR were 91 days in the NK 622 group and 169 days in the TAM group. The duration was significantly shorter with the NK 622 group. Median duration of efficacy in CR and PR cases was 155 days in the NK 622 group and 154.5 days in the TAM group. Adverse effects were encountered in 7 patients (12.3%) of each of the 2 groups. The side effects were fatigue, hot flush, WBC decrease, abnormal values in liver function tests, etc. in the NK 622 group and anorexia, nausea, eruption, feeling of warmth, sweating, dry mouth, dizziness, abnormal values in liver function tests, etc. in the TAM group. Administration was discontinued in one patient with eruption and another patient with abnormal values of liver function tests in the TAM group, while there was no such case in the NK 622 group. Including the discontinued cases, the side effects were moderate and reversible in both groups. The patients in whom a drug was determined as useful or more numbered 24/57 (42.1%) in the NK 622 group and 23/57 (40.4%) in the TAM group. There was not significant difference between the 2 groups in the above results except the duration to onset of CR. From these results, NK 622 is expected to show comparable efficacy, safety, and usefulness in patients undergoing TAM treatment for advanced or recurrent breast cancer.

Effects of thiols on prostaglandin synthesis in bovine bladder epithelium

The regulation of prostaglandin (PG) synthesis was characterized in microsomes of bovine bladder epithelium. Coenzyme A (CoA) and its metabolite cysteamine drastically decreased total PG synthesis. Furthermore, CoA inhibited solubilized cyclooxygenase which was precipitated by anti-cyclooxygenase antibody. Reduced glutathione (GSH) slightly increased total PG production and changed the pattern of PG synthesis. Other thiols, cysteine and ergothioneine, did not change total PG production. None of the thiols stimulated the incorporation of arachidonic acid into the phospholipid fraction. These findings suggest that CoA may directly regulate cyclooxygenase activity and GSH may subsequently change the pattern of PG production in bovine bladder epithelium.

Acinic cell carcinoma of the parapharyngeal space: case report

We describe a case of acinic cell carcinoma (ACC) of the parapharyngeal space in a 58-year-old woman. A tumor originating from the deep lobe of the parotid gland was totally excised by an external cervical approach. The occurrence of ACC in the parapharyngeal space is extremely rare. We discuss the management, especially surgical procedure, of ACC in this area.

[Phase II study of NK 622 (toremifene citrate) in advanced breast cancer, a multicentral cooperative dose finding study]

In order to determine the usual dose in the first line therapy and a high dose in the second or third line therapy, a dose finding study of a novel antiestrogen NK 622 (toremifene citrate) was performed in patients (pts) with advanced or recurrent breast cancer. NK 622 was orally administered daily once for more than 8 weeks. In pts without previous drug therapy or in pts with cancer relapse after adjuvant therapy, the response rates [(CR + PR)/total] were 24.1% (7/29), 13.8% (4/29), 20.0% (1/5) and 40.0% (2/5) at doses of 40, 60, 120 and 240 mg/day, respectively. A 40 mg/day dose showed an objective response only in postmenopausal pts with estrogen receptor (ER) positive or unknown cancer. At a dose of 60 mg/day, some of the responding cases were premenopausal pts or pts with ER(-) cancer. In pts with cancer relapse during adjuvant therapy or in those with previous therapy and/or radiation, response rates were 25.0% (2/8), 0% (0/4), 13.5% (5/37) and 10.3% (4/39) at doses of 40, 60, 120 and 240 mg/day, respectively. Response was more frequent in pts with ER (+) cancer than with ER (-) cancer. The response rates in pts with previous therapy including tamoxifen (TAM) except medroxyprogesterone (MPA) were 14.3% (4/28) at a 120 mg/day dose and 6.1% (2/33) at a 240 mg/day dose. In pts with previous therapy including TAM, MPA and other antitumor agents, the rate was 18.2% (2/11) at a 120 mg/day dose. Side effects such as elevation of GOT, GPT and serum Ca level, decrease of hemoglobin, anorexia, nausea/vomiting, fatigue, dizziness and hot flush were observed. These side effects were moderate in grade and reversible. Dose dependency of side effects was not clearly observed in grade and incidence. From these results, NK 622 is expected to be a safe drug with efficacy in first line therapy at a dose of 40 mg/day and in second or third line therapy at a dose of 120 mg/day.

Drugs acting on the intracellular signalling system

Cellular response to extracellular messages is a basic process to maintain and to support cell life. Several signalling molecules important as sites of therapeutic drug action are involved in the response. Recent studies on life sciences have elucidated molecular properties of intracellular signalling factors and mechanisms of cascading. Novel drugs acting on signalling molecules and possessing new sites and mechanisms of action have been found. This article summarizes the properties (subtypes, structures, functions) of signalling factors (receptors, ion channels, GTP binding proteins, second messenger-generating enzymes, second messenger-metabolizing enzymes, second messengers protein kinases, protein phosphatases) and lists in Tables A-H drugs that act on signalling molecules and which should find clinical use.

[Efficacy and safety of high dose NK 622 (toremifene citrate) in tamoxifen failed patients with breast cancer]

Efficacy and safety of high dose administration of NK 622 (toremifene citrate) were studied in tamoxifen (TAM)--failed patients with breast cancer. The patients included in the study were the following failure cases in TAM therapy: unresponded cases in TAM therapy (TAM unresponded cases), temporary responded (CR, PR) but progressed cases in TAM therapy (TAM temporary responded cases), and those relapsing during TAM adjuvant therapy or within 6 months after the adjuvant therapy (TAM adjuvant failed cases). NK 622 of a 120 mg/day dose were orally given daily once at least for 8 weeks. The response rates in evaluable cases were 6.3% (1/16) in TAM unresponded cases, 11.1% (1/9) in TAM temporary responded cases, 15.4% (4/26) in TAM adjuvant failed cases, and 11.8% (6/51) in total cases including 1 CR and 5 PR cases. Long NC in which duration of NC maintained for more than 6 months was observed in 18.8% (3/16) of TAM unresponded cases, 22.2% (2/9) of TAM temporary responded cases, 11.5% (3/26) of TAM adjuvant failed cases, and 15.7% (8/51) of total cases. Rates of response and long NC were 14.3 and 19.0% in postmenopausal patients with estrogen receptor positive cancer, respectively. A median value of duration to the onset of response was 34 days (15-137). Median duration of response and long NC were 127 days (39-381) and 238.5 days (178-281), respectively. Adverse effects were experienced in 3 (5.1%) of 59 patients: nausea in 1, vertigo in 1 and increase of GOT, GPT, LDH and gamma-GTP in another 1. The side effects were moderate and reversible. From these results, NK 622 seems to become a safe and effective drug for TAM-failed patients with breast cancer by using a 120 mg/day dose.

Changes of rat urinary bladder during acute phase of spinal cord injury

Spinal cord injury (SCI) at Th13 was induced in female Wistar rats, and changes in the urinary bladder were examined during the acute phase of SCI. Wet weights of the spinal bladders increased twofold over controls by 7 days after SCI. Intravesical volumes increased sixfold over control values by day 3, and then decreased 7 days after the injury. Maximal pressure within the bladder decreased in all spinal rats compared with controls. Smooth muscle cells were isolated from the urinary bladder, and their total protein and DNA content were measured by multiparametric cytofluorometry. DNA content of isolated smooth muscle cells decreased by day 3 and remained 7 days after the spinal injury. Total protein content of isolated smooth muscle cells was decreased 1 day after and increased 7 days after the spinal injury, just when spinal reflex of the bladder recovered. These findings suggest that hypertrophy of smooth muscle cells in urinary bladder is related to the activity of peripheral autonomic nerve and that smooth muscle cells already begin to hypertrophy during the spinal shock period to adjust themselves to the new state, that is, the spinal bladder.

[Clinical study of total parathyroidectomy and autotransplantation for secondary hyperparathyroidism]

From April 1983 to September 1991 total parathyroidectomy (PTX) and parathyroid autotransplantation were carried out in 27 patients for secondary hyperparathyroidism. Of these patients, 13 were males and 14 were females. Their average age was 43 years old and their mean duration of dialysis was 126.4 months. As preoperative clinical symptoms, bone pain was observed in 19 cases, joint pain in 18, decrease of height in 7, pruritus in 3, muscle pain in 2, red eyes in 2 and others in 2. As roentgenographic findings, subperiosteal bone resorption and skull-salt and pepper were demonstrated in 26 cases, rugger jersey spine in 15, soft tissue calcification in 11, and pathological fractures in 4. Four parathyroid glands were removed in 23 cases, three glands in 4. Serum calcium level decreased remarkably within 24 hours after parathyroidectomy in all cases. The average total weight of parathyroid glands was 4.48 g. The preoperative diagnostic accuracy of echogram was 94% and that of CT scan was 90%. The clinical improvement after PTX was excellent in 12 cases and good in 11. The roentgenographic improvement of skull and/or finger bone more than one year after PTX was excellent in 11 cases and good in 11. Judging from histopathological findings of the bone, the clinical and roentgenographic improvement was observed better in the osteitis fibrosa group than in mild group. A significant correlation was found between the level of preoperative c-PTH and the weight of resected parathyroid glands. The level of preoperative ALP correlated with intact-PTH and was higher in the osteitis fibrosa group than in the mild group.(ABSTRACT TRUNCATED AT 250 WORDS)