[A study of Article 32 of the Mental Health Act analysis of those who made applications under Article 32]

Article 32 of the Mental Health Act was enacted in 1965 and entitles psychiatric outpatients to financial aid towards payment of psychiatric care costs. Psychiatric outpatients can make applications under Article 32 voluntarily at local public health centers. These centers are operated by the prefectural governments. Therefore, records of the applications are kept by the local public health centers. In order to study the effects of Article 32 on psychiatric care, we analyzed the records of those who applied for such benefits in I. County of Shiga Prefecture, at the K. local Public Health Center, and performed a comparative analysis of applicants vs. non-applicants. We also tried to find out which psychiatric illnesses were more significantly represented among those who applied than among those who did not. Our study showed that about 43.5 percent of all psychiatric outpatients in I. County had made applications for Article 32 benefits. This was significantly higher than any former percentages that had been anticipated. We also discovered that a significantly higher number of people with schizophrenia, atypical psychosis and epilepsy could be identified among those who had applied for benefits than those who had not applied. On the other hand, the number of people with neurosis and emotional disorders seemed higher among those who did not apply for the benefits. In addition, the study indicated that a large proportion of those who applied belonged to the 40 s and 50 s age group and to the group with chronic psychiatric problems. All of the above make it clear that Article 32 has been effective in making psychiatric care accessible to those people who suffer from chronic mental diseases over quite a long period time.

[Cisplatin/5-fluorouracil intraperitoneal administration superior to intravenous administration for liver metastases of colonic carcinoma]

A 28-year-old female underwent sigmoidectomy for sigmoid colon cancer with peritoneal seeding. One month later, a solitary metastasis was found in S3 of the liver. After CDDP/5-FU intravenous chemotherapy, another metastasis appeared in S7. Intravenous administration showed PD. But the metastatic tumors shrank and became inobservable by CT after the 1st round of CDDP/5-FU intraperitoneal chemotherapy, and S7 tumor could not be identified after the 2nd round. Many previous reports demonstrated the concentration of cytotoxic drug in intraperitoneal administration was much higher than in intravenous administration. Theoretically, intraperitoneal chemotherapy is superior to intravenous chemotherapy for the prevention and treatment of liver metastases. This case demonstrated this hypothesis was right. We think adjuvant intraperitoneal chemotherapy should be re-considered for the prevention of the liver metastases of gastrointestinal cancers.

Small-angle X-ray scattering study on CEL-III, a hemolytic lectin from Holothuroidea Cucumaria echinata, and its oligomer induced by the binding of specific carbohydrate

Hemolytic lectin CEL-III from a marine invertebrate Cucumaria echinata forms an oligomer upon binding of specific carbohydrate such as lactose at high pH values and in the presence of high concentrations of salt. In this study, using small-angle X-ray scattering, we characterized CEL-III and its oligomer induced by the binding of lactose. The molecular mass of the oligomer was determined as 1019 kDa from its forward scattering value, compared with 47,490 Da for the monomer. This oligomer size is much larger than that estimated using SDS-polyacrylamide gel electrophoresis (SDS-PAGE, 270 kDa). The monomer has a 24.6 A radius of gyration and can be approximated by a rod which has a 20 A radius and a height of 75 A, while the oligomer has a 101.4 A radius of gyration. Together with the comparison of the radii of gyration and the forward scattering of the cross-section of the monomer and oligomer, it is suggested that in aqueous solution the oligomer comprises three or four molecules of a smaller unit which was observed by SDS-PAGE (270 kDa), held by a relatively weak interaction. The scattering profile also suggests that the oligomer has a hole in its central axis which might be associated with the formation of ion-permeable pores in the erythrocyte membrane by CEL-III during the hemolytic process.

Cloning and characterization of NE-dlg: a novel human homolog of the Drosophila discs large (dlg) tumor suppressor protein interacts with the APC protein

We have cloned a cDNA for a novel human homolog of the Drosophila discs large (dig) tumor suppressor protein, termed NE-dlg (neuronal and endocrine dig). Northern blot analysis revealed that the gene is highly expressed in neuronal and endocrine tissues. Fluorescence in situ hybridization (FISH) and radiation hybrid mapping studies localized the NE-dlg gene to chromosome Xq13. We also found that the NE-dlg gene encoded a 100 kDa protein. Immunolocalization studies using an NE-dlg antibody showed that the protein tended to be expressed in non-proliferating cells, such as neurons, cells in Langerhans islets of the pancreas, myocytes of the heart muscles, and the prickle and functional layer cells of the esophageal epithelium. Proliferative cells, including various cultured cancer cell lines and basal cells in the esophageal epithelium, showed little expression of the NE-dlg protein. In addition, yeast two-hybrid screening and in vitro binding assays revealed that the NE-dlg interacted with the carboxyl-terminal region of the APC tumor suppressor protein. These data suggest that NE-dlg negatively regulates cell proliferation through its interaction with the APC protein.

[Analysis of contact dermatitis by cytokines. II]

We examined the mechanism of the onset of contact hypersensitivity reaction (CHR) induced by several kinds of chemical substances in mice, focusing on cytokines. Before doing this experiment, we investigated the involvement of T cells in the formation of CHR using each primer of CD4 and CD8 (surface markers of lymphocytes) positive cells. It was suggested that both cells participate in the formation of CHR. On the basis of these results we analyzed cytokines produced in the reaction site on the mRNA level in with or without the presensitization of two kinds of strong contactants. Consequently, there was a tendency that the expression of mRNA of Th1 types of cytokines was commonly observed around 24 h after the reaction irrespective of the presence or the absence of presensitization. These date suggested that CHR can be presumed on the genetic level by the only one priming of strong contactants.

[Analysis of contact dermatitis by cytokines. I]

The study of the participation of T cells and the kinetic studies of cytokines by the RT-PCR method in the challenge phase of contact hypersensitivity reaction (CHR) were performed using skin tissues collected at regular intervals from mice sensitized with 2,4-dinitro-1-fluorobenzene (DNFB). The results obtained from these studies and the further analyses using anti-CD4 and CD8 antibodies showed that the revelation of phenotype of lymph node cells at the reaction site and T lymphocytes at the CHR site were found to play important roles. Furthermore, we examined cytokines formed at the CHR site on the mRNA level. Consequently, it was found that 24 h after the challenge IFN-gamma, IL-6 and IL-1 beta were expressed and 48 h after the challenge IL-2, IL-4 and TNF-alpha were expressed in addition to these cytokines. The results of the expression of IL-12 and those of the examination using IFN-gamma knock out mice suggested that the expression of IFN-gamma among several Th1 types of cytokine is especially important for the formation of CHR.

Interplane Tunneling Magnetoresistance in a Layered Manganite Crystal

The current-perpendicular-to-plane magnetoresistance (CPP-MR) has been investigated for the layered manganite, La2-2xSr1+2xMn2O7 (x = 0.3), which is composed of the ferromagnetic-metallic MnO2 bilayers separated by nonmagnetic insulating block layers. The CPP-MR is extremely large (10(4) percent at 50 kilo-oersted) at temperatures near above the three-dimensional ordering temperature (Tc approximately 90 kelvin) because of the field-induced coherent motion between planes of the spin-polarized electrons. Below Tc, the interplane magnetic domain boundary on the insulating block layer serves as the charge-transport barrier, but it can be removed by a low saturation field, which gives rise to the low-field tunneling MR as large as 240 percent.

Efficacy of combination antiplatelet therapy and nicardipine for chronic cerebral infarction

To prevent recurrence of cerebral infarction (CI), the efficacy of antiplatelet therapy, when used in combination with a calcium antagonist, was examined. The study subjects were 57 chronic CI patients (40 men, 17 women; mean age, 68.5 years) who experienced either CI or its recurrence more than 3 months before the start of the study. They were randomly allocated into one of the following four groups for the 8-week study; group A--ticlopidine hydrochloride 200 mg once daily and nicardipine hydrochloride 20 mg three times daily (TID); group B--ticlopidine hydrochloride 200 mg once daily; group C--aspirin 81 mg once daily and nicardipine hydrochloride 20 mg TID; or group D--aspirin 81 mg once daily. Platelet aggregation was measured before treatment and 4 and 8 weeks after the initiation of each therapy by using adenosine diphosphate (ADP) (2 microM and 0.5 microM) and collagen (2 micrograms/mL), and evaluated in terms of percent maximum platelet aggregation. Results showed significant suppression of 2.0 microM ADP platelet aggregation in groups A, B, and C. At 0.5-microM ADP, only groups A and B showed significant platelet aggregation suppression. All groups showed significant suppression of collagen platelet aggregation. In comparing single therapy with combination therapy, groups A and B were not significantly different from one another after 4 or 8 weeks in 2-microM ADP or collagen platelet aggregation suppression. In contrast, group C had significantly greater suppression of both 2-microM ADP and collagen aggregations compared with group D. In conclusion, nicardipine hydrochloride administration with aspirin may be a useful alternative therapy for the prevention of CI recurrence.

Effects of lipo-prostaglandin E1 on random pattern flaps in rabbits

The effects of lipo-prostaglandin (PG) E1, which are lipid microspheres containing PGE1, were examined using 2 x 12 cm random pattern skin flaps on the backs of five rabbits. Five rabbits acted as controls. Both surviving length (8.5 (3.1) compared with 4.9 (1.8) cm) and surviving area (22.1 (9.3) compared with 11.5 (6.1) cm2) of the skin flap were significantly increased (p < 0.03 in each case). In three additional rabbits the blood flow on the distal side of the skin flap, where it was poor, was measured using a laser image blood flowmeter. Blood flow was improved five to 15 minutes after injection of lipo-PGE1 and was maintained for at least 60 minutes. In conclusion, lipo-PGE1 increased the blood flow of the random skin flaps, resulting in significant enlargement of the surviving area of skin flaps.

Facial contouring surgery with the scapular osteo-adipo-fascial flap

Recently, deepithelialized scapular or parascapular flaps have been used for reconstruction of facial contour. The authors used a scapular osteo-adipo-fascial flap, based on the subscapular vascular system, accompanied with scapular bone on the angular branch, for surgical correction of facial contour in two cases. At follow-up, both patients showed aesthetic improvements, and were pleased with the results. The scapular osteo-adipo-fascial flap provides a technique to reconstruct facial contour, including the bony structure as well as the soft tissue.

An automatic sleep-stage analysis system with off-line high-speed processing using a super mini-computer

An automatic sleep analysis system using a super mini-computer was developed. The system improved and expanded the data processed by the mini-computer. It had the following features: 1) wave-forms were collected and analyzed at a high speed (reproduced at 10 or 20 times the speed of a data recorder) by an off-line procedure to utilize the computer resources more efficiently; 2) all information and the original wave-forms were output to a laser printer because of the lower cost and more efficient arrangement of the data; 3) various wave-form parameters were measured by wave-form analysis; 4) the application program was based on general-purpose language; and 5) wave-form reanalysis and reconstruction of the logic was easily implemented for automatic evaluation of the sleep stages. Automatic analysis of the sleep stages was impossible for 15 of 1484 periods (20 sec per period) with one of the cases analyzed, and 142 of 1484 periods had to be corrected because of erroneous identification.

Automatic analysis of sleep spindles--assessment in one case treated with a benzodiazepine anxiolytic drug

Wave-form analysis and detection of sleep spindles should be automatically performed to achieve objective and highly precise determination of the pattern of appearance of sleep spindles. The conditions for constructing the automatic analysis and detection are as follows: 1) it is recommended that EEGs be sampled at 500 Hz or higher intervals; 2) the digital filter with the threshold that is most appropriate for removal of artifacts should be used; 3) various conditions for the analysis and detection of wave-forms are widely used; and 4) a procedure for inspecting and reading record paper should also be included in the set-up. Taking these points into consideration, the authors developed an automatic analysis system for sleep spindles, which employs a computer. The system was applied to a case preliminarily treated with a benzodiazepine anxiolytic drug, ethyl loflazepate (CM6912). The assessment using this system revealed that the CM6912 administration induced an increase in sleep spindles, delayed frequency, and caused amplitude increases and a prolonged duration.

Analysis of sleep EEGs by the interval histogram method--validity of the baseline night as a control and the effect of ethyl loflazepate (CM6912)

The effects of an anxiolytic drug, ethyl loflazepate (CM6912) on sleep EEGs were investigated by the interval histogram method originally developed. EEGs were classified into each of the delta 2-beta 2 and sigma 1 wave-form parameters, and the individual frequencies were determined on the third baseline, second drug and the first recovery nights in each sleep stage. In comparison with the second baseline night, the sigma 1 waves in stage 2 sleep and the delta 1 waves in REM sleep were decreased and the alpha and sigma 1 waves in stage 3 sleep were increased on the third baseline night. In consideration of the 5% significance level and the remarkable influence of drug administration, described below, no major problems were encountered in the use of the night as a control in this experimental schedule. The main characteristics of administration of CM6912 manifested as decreases in the slow wave, increases in the fast wave, and an increase in the sigma 1 wave in sleep stages other than stage 1. These tendencies were remarkable on the second drug night and were still evident even on the recovery night. Increases in sigma 1 wave were related to increases in sleep spindles. The increases in the beta 2 wave were particularly remarkable in REM sleep.

Production of chronic compression of the cauda equina in rats for use in studies of lumbar spinal canal stenosis

STUDY DESIGN

The pathophysiology of lumbar spinal canal stenosis was analyzed with a new model in rats.

OBJECTIVES

To produce chronic compression of the cauda equina in rats for analysis of the pathophysiology of lumbar spinal canal stenosis.

SUMMARY OF BACKGROUND DATA

Models of compression to date have involved acute or subacute compression. A model of chronic compression has not been available.

METHODS

A stainless steel wire fastened around the spine at L5 in 3-week-old rats, with a plate inserted against the ventral aspect of the vertebra to protect it from the wire. as the rats grew, the wire cut into the spinal canal. One year after the operation, canal stenosis was present without paralysis of the back limbs.

RESULTS

Stenosis seen in sagittal sections, as a percentage of the original width, was 51.6 +/- 6.2% (mean +/- standard deviation). In histologic analysis of the region near the wire, findings included axonal degeneration, demyelination, vacuolar degeneration of the nerve fibers, and narrowing the intradural blood vessels with a decrease in their number. Cephalad and caudad to the wire, congested intradural blood vessels, degenerative foci near these congested vessels, fibrosis around these foci, congested epidural vessels, and fibrosis around these vessels were observed. During electrophysiologic analysis (six rats with stenosis), the conduction velocity of the cauda equina was found to be delayed.

CONCLUSIONS

The histologic and electrophysiologic findings in this animal model were similar to findings in human subjects, so rats prepared in this way should be useful for study of chronic compression of the cauda equina.

[Minimizing of the blood preparation for elective surgery by maximum surgical blood order schedule as well as type and screen--two year's experience in Nagahama City Hospital]

To make the most of the blood products, we have introduced maximum surgical blood order schedule (MSBOS) as well as Type and Screen (T&S) into Nagahama City Hospital. As the hospital dose not have blood transfusion service unit, we, anesthesiologists set up MSBOS and the procedure of blood preparations for elective surgery. The results of two year's experience demonstrate that there was no trouble by reducing the blood preparation. The cross-match to transfusion ratio (C/T ratio) in surgical procedures and that of red cell products in our hospital have decreased, the effective use of red cell products has been promoted, and the outdating of the blood product has been reduced.

The effects of lipo-prostaglandin E1 on axial pattern flaps in rabbits

The effects of lipo-prostaglandin E1 (lipo-PGE1), lipid microspheres containing PGE1, on axial pattern flaps were examined using 12 x 20 cm axial pattern flaps based on the right superficial inferior epigastric vessels on the abdomens of rabbits. The surviving area of the skin flap in the lipo-PGE1 group (0.197 +/- 14.1 cm2; n = 10) was significantly increased (p < 0.02) compared with the saline control group (110.4 +/- 5.5 cm2; n = 10). Changes in pedicle blood flow after lipo-PGE1 administration were determined using an ultrasonic pulsed Doppler flowmeter (n = 5). Blood flow in the artery was increased immediately after administration, and it was maintained for 40 minutes. The surface blood flow at the caudal end of the flap on the nonpedicle side, where it was poor, was measured using laserflowgraphy. Blood flow in the skin flap surface was improved 5 to 15 minutes after lipo-PGE1 administration, and it was maintained for as long as 60 minutes. Venous occlusion of the skin flap was also improved (n = 3). In conclusion, lipo-PGE1 increased the blood flow in the axial pattern flaps, resulting in significant enlargement of the surviving skin flap area.

TGF-beta enhances macrophage ability to produce IL-10 in normal and tumor-bearing mice

In the present study, we demonstrate that TGF-beta is capable of enhancing macrophage ability to produce IL-10 in normal and EL4 tumor-bearing mice. We found the increase in IL-10 in ascitic fluid and IL-10 mRNA expression in macrophages in parallel with the TGF-beta level and tumor progression. The macrophage production of IL-10 in the tumor-bearing mice was significantly enhanced without LPS stimulation in vitro, compared with normal controls. To clarify the mechanism wherein increased IL-10 production was induced, anti-TGF-beta or anti-IL-10 Abs were administered to EL4-bearing mice. Administration of anti-TGF-beta Ab led to a reduction in the IL-10 contents in ascitic fluid of tumor-bearing mice; however, anti-IL-10 Ab administration did not prevent the increase in TGF-beta contents. Enhanced IL-10 production and mRNA expression of macrophages from the tumor-bearing mice were also reduced by anti-TGF-beta Ab administration. Both anti-TGF-beta and anti-IL-10 Ab administration restored the TNF-alpha production by macrophages in EL4-bearing mice. In normal macrophages, in vitro pretreatment with TGF-beta 1 potentiated IL-10 production, and when natural TGF-beta 1 was administered to normal mice, the recovered peritoneal macrophages showed enhanced IL-10 production. Based on the above findings it can be concluded that TGF-beta enhances macrophage ability to produce IL-10, which sheds a new light on the role of TGF-beta in the immune system.

TGF-beta enhances macrophage ability to produce IL-10 in normal and tumor-bearing mice

In the present study, we demonstrate that TGF-beta is capable of enhancing macrophage ability to produce IL-10 in normal and EL4 tumor-bearing mice. We found the increase in IL-10 in ascitic fluid and IL-10 mRNA expression in macrophages in parallel with the TGF-beta level and tumor progression. The macrophage production of IL-10 in the tumor-bearing mice was significantly enhanced without LPS stimulation in vitro, compared with normal controls. To clarify the mechanism wherein increased IL-10 production was induced, anti-TGF-beta or anti-IL-10 Abs were administered to EL4-bearing mice. Administration of anti-TGF-beta Ab led to a reduction in the IL-10 contents in ascitic fluid of tumor-bearing mice; however, anti-IL-10 Ab administration did not prevent the increase in TGF-beta contents. Enhanced IL-10 production and mRNA expression of macrophages from the tumor-bearing mice were also reduced by anti-TGF-beta Ab administration. Both anti-TGF-beta and anti-IL-10 Ab administration restored the TNF-alpha production by macrophages in EL4-bearing mice. In normal macrophages, in vitro pretreatment with TGF-beta 1 potentiated IL-10 production, and when natural TGF-beta 1 was administered to normal mice, the recovered peritoneal macrophages showed enhanced IL-10 production. Based on the above findings it can be concluded that TGF-beta enhances macrophage ability to produce IL-10, which sheds a new light on the role of TGF-beta in the immune system.

An anatomic study for the rectus abdominis myocutaneous flap combined with a vascularized rib

The anatomy of the vascular connections between the eighth intercostal vessels and the deep epigastric vessels was studied in a series of 20 dissections in 10 preserved cadavers to develop the rectus abdominis myocutaneous flap combined with a vascularized rib. The distance between the point where the eighth intercostal vessels attached to the costal margin and the xiphoid process and the arcuate line, which become a good guide for design of the flap, was measured. The average length of the vascular pedicle of a vascularized rib was over 10 cm. Possible clinical uses of this compound flap for reconstruction of a composite maxillary or mandibular defect are described.

[Perioperative management of dialysed patients for orthopedic surgery]

Recently, renal osteodystrophy is a remarkable problem in patients on long-term hemodialysis (HD). In this retrospective study, we evaluated the perioperative management of 21 patients receiving orthopedic surgery between January 1990 and December 1992. These patients had been maintained on HD for an average of 8.6 years (range, 18 months-20 years). The primary causes of orthopedic surgery were amyloidosis, diabetic gangrene, rheumatoid arthritis and fractures. Laminectomy, replacement of arthropathy, osteosynthesis and amputation of the lower extremity were undertaken. General anesthesia was performed on six patients. Vecuronium was given to all of these patients. Isoflurane was used in 5 patients and sevoflurane in 1 patient. Regional anesthesia was used in 15 patients. During anesthesia, the average infusion rate of intravenous fluids was 2.7 ml.kg-1.h-1, and the intraoperative complications included hypertension in 16, hypotension in 12, arrhythmia in 4 and prolonged sedation in 2 patients. Postoperative complications included hyperkalemia in 2, pneumonia in 2, psychological disorder in 3, clotting fistula in 1 and delayed wound healing in 7 patients. One early death in a diabetic patient following amputation occurred on the 13th postoperative day. Preoperative HD was performed within 24 hours and postoperative HD within 72 hours of the operation. Nafamostat mesilate was used as an anticoagulant. Excessive removal of potassium must be avoided during preoperative HD to prevent arrhythmia. The well-managed elective patients gave a good result. However, extreme care in nutrition and infection control should be taken, especially in diabetic patients.