Vibration technique for indirect measurement of diastolic arterial pressure in human fingers

Diastolic pressure Pd was indirectly measured by vibrating a finger artery with a 10 Hz sinusoidal pressure variation during a gradual increase (or decrease) in occlusive cuff pressure Pc. Pulsatile arterial volume changes on which sinusoidal variations are superimposed were detected by a transmitted infra-red photoelectric plethysmograph (TIPP). It is known that volume change in an artery shows a maximum amplitude at the transmural pressure Pt level equal to 0 mm Hg due to the nonlinear viscoelastic properties of the arterial wall. For the same reason, the amplitude of the sinusoidal volume variation reached its maximum at the end-diastolic phase, when Pc was controlled to be exactly equal to Pd. The indirect Pd values determined from Pc were compared with those simultaneously measured by a direct method in rabbit forelegs and by the volume-compensation method in human fingers. Using the principle of the volume oscillometric method systolic and mean pressures were also determined by this system.

Acute cytogenetic effects of potassium bromate on rat bone marrow cells in vivo

The acute cytogenetic effects of potassium bromate (KBrO3) on rat bone marrow cells in vivo were studied. The incidence of chromosome aberrations in bone marrow cells increased rapidly, reaching a maximum level 12 h after intraperitoneal injection and decreased within 24 h. Dose-response relationships were obtained for both intraperitoneal and oral administrations.

[Clinicopathological studies of the recurrence of esophageal squamous cell cancer--with special reference to the mode of recurrence and operative procedure]

In 93 out of 201 patients (46%) with squamous cell carcinoma of the esophagus who underwent radical resection (excluding death within 30 days after operation), the site of recurrence could be identified by means of X-ray, CT, ultrasonography, and biopsy. Recurrence was found in 55% of 93 cases within 12 months after surgery and in 86% of 93 cases within 24 months. Of 93 patients with recurrences, lymph node recurrences were present in 44 cases, visceral recurrences in 32 cases, both lymph node and visceral recurrences in 11 cases and others in 6 cases. Neck and/or upper mediastinal lymph node recurrences were found in 10 out of 15 patients who had recurrences within 3 months after surgery. Careful examination should be made in the left recurrent nerve chain and extended lymph node resection of upper mediastinal region should be performed under the adequate indication. Esophageal squamous cell cancer has a tendency to recur in the lymph nodes initially, and visceral metastases may occur thereafter. The incidence of visceral recurrence increased remarkably, when neck and/or upper mediastinal lymph nodes were involved at the time of operation. Accordingly, both irradiation and chemotherapy should also be applied for improving the prognosis of esophageal carcinoma.

[The significance and the indication to dissect para-aortic lymph nodes in esophageal and cardiac cancers]

Recently, now that the para-aortic lymph nodes have become a focus of attention, there has been a tendency to dissect the para-aortic lymph nodes of the abdomen for cases of esophago-cardiac cancers. One of the reasons why R4 procedures are being performed is due to the development of a clear analysis of the lymphatic pathways. In view of the importance of para-aortic lymph nodes, particularly focusing on the lymph nodes adjacent to left renal vein, we also are performing extended systemic lymph node dissections in certain cases. In determining the indication, a preoperative diagnosis by echogram of the neck region is important, and also a diagnosis of the para-aortic region as well. The significant benefit of para-aortic dissection is to be able to carry out a complete R3 procedure.

Computerized morphometry of liver cells in diffuse hepatic diseases

Computerized morphometrical measurements were made of liver cells and their nuclei taken from livers of healthy persons and from patients with acute hepatitis (AH), chronic hepatitis (CH), and liver cirrhosis (LC). Liver biopsies were performed on 127 people (24 convalescing from acute hepatitis, 20 with chronic inactive hepatitis (CIH), 24 with chronic active hepatitis (CAH), 38 with liver cirrhosis (LC) and 21 who were healthy controls (HC]. The specimens were stained with hematoxylin-eosin, then light microscopic pictures were obtained. The original cells were magnified 1000 times. The sizes of the cells and of their nuclei were calculated using a computer. Correlative variation was noted in cell and nuclear sizes resulting in an consistently constant nucleus-cytoplasm ratio. Average sizes of both cells and nuclei were maximal in livers with LC, followed in decreasing order by those in livers with CAH, CIH, HC and convalescent AH. The smallest cells and nuclei were found in convalescent AH cases. It might be possible to some degree to obtain gross impressions of the histopathological type of the liver lesion by measuring the sizes of cells and nuclei of the liver.

[Antitumor effect of intermittent oral administration of UFT against human rectal cancer xenografted in nude mice]

Effect and toxicities of oral administration of UFT were examined with tumor xenografts (COK-7LiM) in nude mice. Special attention was paid to the differences between daily (Q1D X 9) and intermittent (Q4D X 3) treatments with this agent. The optimal doses of UFT were determined on the basis of the maximal tolerated dose of the agent in nude mice. It was remarkable that the chemotherapeutic effect by intermittent administration of UFT showed a significantly better result than that by daily administration. No difference was seen in the toxicities between the two methods of administration of UFT. Moreover, the concentration of 5-FU in the tumor tissue treated with UFT intermittently was significantly higher than that by daily administration method.

Antrum preserving double tract method for reconstruction following proximal gastrectomy

The antrum preserving double tract method was originally designed in order to gain the smooth transfer of larger foods through the duodenal route. Surgical improvement was then made at a few points when carrying out the anastomosis between the residual stomach and the jejunum. In the clinical field, this method is characterized by a better transfer of large foods into the duodenum than the conventional double tract method. The clinical investigation revealed that gastrin release remained after the operation due to both the good passage and the presence of food in the residual stomach. The antrum preserving double tract method is a reasonable and simple method which can maintain physiological pancreaticocibal synchronism.

Excitatory input to burst neurons from the labyrinth and its mediating pathway in the cat: location and functional characteristics of burster-driving neurons

1. Spikes of single neurons were recorded extracellularly in the cat prepositus hypoglossi nucleus and the underlying reticular formation and were identified as type II neurons by horizontal rotation. Among these neurons, those activated by contralateral vestibular nerve stimulation with short latencies (1.5-3.0 ms) were selected for further study. 2. A class of these identified neurons was antidromically activated from the contralateral excitatory burst neuron (EBN) area immediately rostral to the abducens nucleus. Systematic tracking for antidromic stimulation revealed a wide distribution of effective spots in and near the EBN area, with varied latencies and thresholds, suggesting terminal branching in that area. The same neurons were also antidromically activated from the contralateral inhibitory burst neuron (IBN) area, the region near the midline, and the nucleus reticularis tegmenti pontis. 3. These neurons exhibited a characteristic firing pattern related to nystagmus: with contralateral rotation the firing rate gradually increased during the slow phase (type II response) and further steeply increased in a burst fashion before and during the contraversive quick phase. Since the time of occurrence of burst activity in these neurons was similar to that of contralateral ENBs and IBNs that received their axonal projection, it is suggested that they send excitatory input to burst neurons, and can thus be called burster-driving neurons (BDNs). 4. Intracellular study revealed that stimulation of the BDN area produced monosynaptic EPSPs in contralateral EBNs. The monosynaptic connection of BDNs with EBNs was confirmed by detecting unitary extracellular synaptic currents of EBNs with the spike-triggered averaging technique. 5. In contrast to BDNs, another class of nystagmus-related type II neurons in the prepositus hypoglossi and medullary reticular formation showed a discharge pattern similar to that of abducens motoneurons on the same side. None of them was antidromically activated from the contralateral pontine reticular formation including the EBN area. Some neurons responded antidromically to stimulation of the ipsilateral dorsomedial pontine reticular formation. 6. In conclusion, the input from the horizontal canal during rotation reaches the contralateral prepositus hypoglossi nucleus and the underlying reticular formation through the vestibular nuclei, and a class of neurons in these structures (BDNs) responds to the canal input in a burst fashion following a tonic type II activity. The axons of BDNs cross the midline and monosynaptically excite EBNs on the side of the canal stimulated.(ABSTRACT TRUNCATED AT 250 WORDS)

Effective chemotherapy for small cell carcinoma of the esophagus

This article documents the use of chemotherapy in a case of small cell carcinoma of the esophagus with multiple liver and lymph node metastases. A multi-drug regimen was used and included cis-dichlorodiamine platinum (CDDP), VP-16, vincristine (VCR), adriamycin (ADM), and cyclophosphamide (CPA). After chemotherapy, the esophageal tumor disappeared, and liver masses reduced in number and degenerated. Nine months later, however, the patient died of brain metastases. It was concluded that radiotherapy should be given to the brain for the prophylaxis of tumor relapse.

Effective chemotherapy for small cell carcinoma of the esophagus

This article documents the use of chemotherapy in a case of small cell carcinoma of the esophagus with multiple liver and lymph node metastases. A multi-drug regimen was used and included cis-dichlorodiamine platinum (CDDP), VP-16, vincristine (VCR), adriamycin (ADM), and cyclophosphamide (CPA). After chemotherapy, the esophageal tumor disappeared, and liver masses reduced in number and degenerated. Nine months later, however, the patient died of brain metastases. It was concluded that radiotherapy should be given to the brain for the prophylaxis of tumor relapse.

Lymph drainage originating from the lower esophagus and gastric cardia as measured by radioisotope uptake in the regional lymph nodes following lymphoscintigraphy

Lymph drainage originating from the lower esophagus and gastric cardia was determined using uptake of radioisotope (RI) in the regional lymph nodes in 19 patients with primary cancer at these sites. On the day prior to operation, 99m Tc colloid solution was injected submucosally in the distal esophagus or gastric cardia during endoscopy. The regional lymph nodes were removed at operation and RI uptake of individual nodes was measured in a well-type scintillation counter. Uptake was expressed as the amount per nodal weight. After radioactive colloid was injected into the lower esophagus, high RI uptake was common in both the mid-mediastinal and abdominal nodes, suggesting that lymph originating from the lower esophagus drains in both a superior and inferior direction. On the other hand, after radioactive colloid was injected into the gastric cardia, high RI uptake was never demonstrated in mediastinal lymph nodes suggesting that direct mediastinal lymph flow from the gastric cardia is rare. These results support clinical observations on the distribution of lymph nodal metastases in patients with lower esophageal and gastric cardia malignancies. As a diagnostic tool for lymph nodal metastases, however, lymphoscintigraphy is unreliable.

[Comparative study on the macroscopic and histopathological diagnosis of lymph node metastases in cancer patients]

Macroscopic diagnosis for lymph node metastases was compared with histopathological diagnosis in 444 patients with carcinoma of the esophagus, stomach, colon, thyroid and breast. The former indicated lymph node metastases in 181 patients. In all of them, none or less than five node metastases were proven by routine histopathological diagnosis. Detailed histological study revealed lymph node metastases in 25 out of 263 patients with macroscopically negative nodes, the rate of false negative being 9.5 per cent. The study also demonstrated no lymph node metastases in 51 of 181 patients with macroscopically positive nodes. Three additional specimens were obtained from originally examined 693 lymph nodes and reexamined microscopically in these 51 patients. Involvement by cancer cells was detected in 9 nodes (1.3 per cent) in 8 patients. Metastases were found from additional specimens in 7 of 9 nodes, indicating that metastatic carcinoma had been overlooked in the remaining two nodes. Additional specimens or embedding-techniques were recommended in such cases as macroscopic metastases were strongly suspected or lymph vessel invasions were remarkable. In 24 patients with esophageal cancer, one to one correspondence was available in the analysis of macroscopic diagnosis. Seventy-eight out of 108 involved nodes were macroscopically judged as involved (sensitivity; 72.2 per cent), and 1166 out of 1260 nodes without macroscopical metastases were judged as cancer-free (specificity; 92.5 per cent). Overestimation of macroscopic diagnosis was due to thickened capsule, fibrosis, inflammation and enlargement in size more than 10 mm in diameter of the nodes. Underestimation was observed in case of nodes with metastatic area less than one-third and with smaller size less than 5mm in diameter.

[Pre-operative staging in advanced gastric cancer by ultrasound; with special reference to para-aortic lymph node metastases]

Extraluminal cancer spreadings such as peritoneal dissemination, liver metastases, lymph node metastases and infiltration to surrounding organs were examined in 236 patients with gastric cancer by ultrasound (US). Peritoneal dissemination was found in 36 of 236 cases. Ascites, nodules in the cul-de-sac and thickened wall of the transverse colon could be detected by US in 24 of 36 cases (sensitivity of 67%). Liver metastases were detected in 18 out of 23 cases (78%). Infiltration to the surrounding organs, mainly to the pancreas, was impossible to demonstrate by US. Sensitivity was 44% (17/39). Lymph node metastases in the region around the celiac axis were indicated in 30 of 40 cases (75%) by US. Para-aortic nodal metastases were also detected in 27 of 34 cases (79%). Ultrasonic images of para-aortic lymph node metastases were classified into four figures: plate type, sandwich type, unilateral multiple type, unilateral solitary type. These types were not necessarily the same in indication of laparotomy, selection of combined or adjuvant therapy, significance of nodal dissection and also prognosis. Solitary involved para-aortic node near the left renal vein should be removed in a case free from peritoneal dissemination or liver metastases. Ultrasound could be very useful in screening patients with gastric cancer for peritoneal dissemination, liver metastases and lymph node metastases.

Step response analyses of the cardiovascular system and their application to the measurement of systemic and pulmonary vein compliances

A theoretical analysis of the step response in the closed cardiovascular system induced by a sudden shift of the right cardiac output curve predicted that if the relations of the right heart output (COr) and the total systemic capillary flow (CFs) to the systemic venous pressure (Psv) are linear, then the time course of Psv change will become monoexponential with a time constant T given by T = Csv/(Gr + Gs), where Csv is the systemic vein compliance and Gr and Gs are the conductances of the transient COr-Psv and CFs-Psv relationships. A similar prediction was obtained for the time constant T of the pulmonary vein pressure (Ppv) response to the step change in the left cardiac output (COl) curve, pulmonary vein compliance (Cpv) and the conductances of the COl curve, and the pulmonary capillary flow (CFp) curve against Ppv. The actual Psv or Ppv changes following sudden alteration of the COr or COl curve by inflation and deflation of the balloon in the right or left atrium revealed monoexponential time courses. Semilogarithmic plots of the transient vein pressure changes yielded correlation coefficients of -0.995 +/- 0.006 (means +/- SD) in 11 curves for Psv and 0.977 +/- 0.017 in 16 curves for Ppv (P less than 0.01). The assumed linearity of dynamic COr and COl curves was confirmed by beat by beat COr-Psv and COl-Ppv relationships during the step responses, except for the first few beats immediately after the balloon maneuver. The linearity of the dynamic CFs curve was examined by measuring CFs with a double-step balloon maneuver so as to cause rapid equilibrium between COr and CFs at varied moments of the transient process. The correlation coefficient between CFs and Psv thus obtained was 0.98 +/- 0.04 (P less than 0.01). A similar linearity of the dynamic CFp-Ppv relationship was suggested from their steady-state curves. The values of Csv calculated from the experimental data were 1.70 +/- 0.12 ml/mmHg/kg body wt in 11 curves and those of Cpv were 0.13 +/- 0.03 ml/mmHg/kg in 15 curves. These results are mostly consistent with those previously reported.

[Thyroid nodules; evaluation of malignancy by ultrasonography]

Preoperative ultrasonic examination was correlated to final pathological diagnosis in 102 cases which underwent thyroidectomy in our clinic from 1979 to May 1985. Preoperative ultrasonic diagnosis was as follows: Sensitivity was 78% (45/58 cases), and specificity was 86% (38/44 cases). Four factors in ultrasonic image were considered: Shape, boundary, internal echo and margin were featured, and correlated to malignancy in 75 cases with mainly solid nodules. Among 34 nodules with irregular shape, 33 (97%) were pathologically malignant and 40 of 42 (95%) with rugged boundary were also malignant. Whether internal echo was even or not could not be used as a diagnostic criteria. Similarly, whether a nodule had well defined margin or not was found not to be a significant criteria in order to differentiate malignant from benign lesions. In 15 of 34 cases with lymph node metastases, metastatic lymph nodes were detected by ultrasonography. Lymph node metastases must be also evaluated by ultrasonography preoperatively in thyroid diseases. Each of these factors must be considered individually in the diagnosis of thyroid nodules. By evaluation of the ultrasonography findings the pathological characteristics may be inferred, and consequently being possible to reach a correct diagnosis.

Vitamin D status after total gastrectomy

Serum levels of 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, 1,25-dihydroxyvitamin D, immunoreactive parathyroid hormone, and urinary excretion of nephrogenous cyclic AMP were measured in 25 patients after total gastrectomy. Two types of reconstruction after total gastrectomy were also compared. Serum 25-hydroxyvitamin D levels were significantly decreased and serum 24,25-dihydroxyvitamin D levels were markedly reduced, whereas serum 1,25-dihydroxyvitamin D levels were significantly increased in the patients. Although serum levels of immunoreactive parathyroid hormone did not show a significant difference, serum alkaline phosphatase levels and urinary excretion of nephrogenous cyclic AMP were significantly increased in the patients. The results suggest that defective vitamin D storage and enhanced vitamin D action coexist in patients after total gastrectomy and that the enhanced vitamin D action, possibly derived from slightly increased parathyroid function, would be a compensatory mechanism to sustained calcium deficiency. No substantial difference of vitamin D status was observed between the two types of reconstruction which differed in passage through the duodenum.

Venous occlusive RN plethysmography: comparison with electrical admittance plethysmography

A venous occlusion plethysmography using radionuclide (RN) was introduced for the measurement of the limb blood flow. This technique, called RN plethysmography, can be carried out in a subject who has been previously administered RN intravenously for the routine angiographic examination. The blood flow is calculated from the initial slope of the RN count rate change (RN accumulation curve) due to venous occlusion. In this study, this method was compared with electrical admittance plethysmography. The blood flow values determined by these two methods correlated well with each other.

Two stages of excitability change of pontine pause neurons in the cat

Spikes of single pontine pause neurons (PNs) in the cat were recorded extracellularly and identified by observing cessation of tonic discharges before and during the fast phase of vestibular nystagmus. PNs were antidromically activated from the excitatory burst neuron area. Antidromic spikes were abolished or their peak latencies were prolonged during particular periods within a nystagmic cycle. The excitability change in PNs indicated by alteration of the antidromic responses occurred with two stages; i.e. a moderate decrease in excitability before the onset of the fast phase and an abrupt, intense decrease starting form the beginning of the fast phase.

Superficial carcinoma of the esophagus

Nine cases of superficial carcinoma of the esophagus were described. Although 3 patients complained of abdominal sensations on swallowing or dysphasia, 6 patients did not present with any symptoms related to the esophageal lesion. The radiologic diagnosis is particularly difficult in cases with superficial type esophageal cancer, and no definitive findings were obtained in three such cases. However, esophagoscopy using Lugol spray was far more effective for the recognition of these superficial lesions. Although surgical resection of the esophagus is technically easier in these cases, the indications of surgery should be carefully evaluated. One operative death occurred in our series. In cases that are good indications, however, wide lymph node dissection should be carried out, since metastases occur even to distant lymph nodes, particularly in cases with cancer invasion of the submucosal layer. The histopathologic diagnosis was squamous cell carcinoma in 8 cases, but in one case it was adenocarcinoma of mucus-secreting gland origin in the mid-thoracic esophagus.