[Variation of serum free amino acids in fulminant hepatitis treated with hepatic assists (author's transl)]

A 10 year old boy, in grade IV hepatic coma, was treated by combination of XAD-4 resin hemoperfusion (HP), activated charcoal HP (Adsorba 300C, Gambro), exchange transfusion by up to 12.0 liters of fresh whole blood, and regular dialysis. Serum free amino acids' values were consecutively assessed during 4 days of treatment. The liver was 490 gr in weight at autopsy and histologic examination revealed cellular necrosis compatible with fulminant hepatitis. Pre-treatment values of alanine, lysine, proline, phenylalanine, arginine, threonine, tyrosine and methionine were increased by 2 to 38 times of normal control, while those of cystine, glutamic acid, serine and glycine were minimally increased up to 1.7 times. Histidine, isoleucine, leucine and valine, on the other hand, were decreased by 20 to 30% and aspartic acid was the lowest at 14% of normal control. The effect of XAD-4 resin HP and exchange transfusion was rather non-specific by decreasing the total amount of amino acids. The molar ratios of branched chain amino acids vs. aromatic amino acids or essential amino were elevated by activated charcoal HP, but, did not reach to normal range.

[Experimental study of the biliary excretion of antibiotic (cefotiam) in the presence of biliary tract obstruction (author's transl)]

Excretion of a new semisynthetic analogue of cephalosporin, cefotiam (CTM), and cefazolin (CEZ) in bile was investigated in dogs with experimental obstruction of biliary tract. In the control group, peak concentrations of antibiotics in bile after 50 mg/kg intravenous administration were as follows: In CTM administrated groups, 5,302 micrograms/ml at one hour after administration; and in CEZ administrated group, 1,249 micrograms/ml after one hour. The total biliary excretory rates summed to 6 hours after administration of antibiotics were 7.8% in the CTM group, and 2.1% in the CEZ group. On the other hand, in the biliary tract obstruction group, the peak concentration in bile in CTM group was 65.7 micrograms/ml after 1 hours, and in CEZ group, 62.4 micrograms/ml after 2 hours. The total biliary excretory rate in the CTM group was 0.202%, while in the CEZ group 0.12%. The peak concentration and the excretory rate of CTM in bile was four times higher than that of CEZ in the control group. No significant difference was revealed in the peak concentration and the excretory rate in bile between CTM and CEZ in the biliary tract obstruction group.

Iatrogenic and transient hyperglycinemia in patients with phenylketonuria

Two patients with phenylketonuria detected by newborn screening for inborn errors of metabolism were treated with low phenylanine formulae. Serum phenylalanine levels were well controlled, but serum glycine levels were elevated until 4 or 5 months of age. This was probable due to the high content of glycine in the formulae. Glycine level returned to be normal in these patients, even though they were kept on the same formula, suggesting, immature metabolism of glycine during this period. No clinical problems were encountered in either patient.

Use of digitised left ventricular echocardiograms in assessment of mitral stenosis

In order to establish a new echocardiographic index of the severity of mitral stenosis, left ventricular echocardiograms were digitised using manual tracing and a computer. The instantaneous left ventricular dimension was measured in 15 patients with mitral stenosis. The peak rate of change of left ventricular dimension (peak dD/dt) and the normalised peak rate (peak dD/dt/D) during early diastole were significantly lower in mitral stenosis than in normal subjects. Also, the time between the second heart sound and peak dD/dt was significantly shorter in patients with mitral stenosis than in normal subjects. Correlation between the mitral valve area calculated from the Gorlin formula and peak dD/dt/D was good, while valve area was poorly correlated with the EF slope of the anterior mitral leaflet echo. It is suggested that by continuous measurement of left ventricular dimension and of its first derivative, the reduced atrioventricular blood flow in mitral stenosis can be shown, and that peak dD/dt/D during early diastole is a possible index of its severity.

Use of curves for prediction of maternal blood levels of placenta-specific substances for diagnosis of placental function

Maternal blood levels of cystine aminopeptidase (CAP), human placental lactogen (HPL) and beta 1 glycoprotein (SP-1) were predicted and evaluated using the expressions and their charts developed by us to help diagnosis of placental function in women of the third trimester of pregnancy. This study was conducted on the assumption that these placenta-originating substances as markers would behave similarly to the previously reported heat-stable alkaline phosphatase (HSAP). The results realized the following features: (1) CAP, HPL and SP-1, like HSAP, had their normal ranges of values too wide to be based on for diagnosing placental function in general, but it was confirmed that on the individual basis these marker substances could develop adequate "prediction curves" for their values to come well answering to the test in the same way as with HSAP. (2) The expressions for predicted values revealed that these marker substances in their shift in the maternal blood had different critical points start of deviation from exponential rising. Particularly in abnormal pregnancy, their shifting patterns were often dissimilar to one another, with implications that impaired placental function could possibly be confirmed qualitatively by reference to the predicted curve for the values of either of the marker substances.

Malignant breast tumors among atomic bomb survivors, Hiroshima and Nagasaki, 1950-74

For 1950-74, 360 cases of malignant breast tumors were identified among the 63,000 females of the Radiation Effects Research Foundation's (Hiroshima and Nagasaki) Extended Life-Span Study sample of survivors of the 1945 atomic bombings of Hiroshima and Nagasaki; 288 of these females were residing in one of these two cities at the time of bombing (ATB). Two-thirds of all cases were classified as breast cancers on the basis of microscopic review of slides, and 108 cases received an estimated breast tissue dose of at least 10 rads. The number of cases of radiogenic breast cancer could be well estimated by a linear function of radiation dose for tissue doses below 200 rads. Excess risk estimates, based on this function, for women 10-19, 20-29, 30-39, and 50 years old or older ATB were 7.3, 4.2, 2.6, and 4.7 cases per million women per year per rad, respectively. Women irradiated in their forties showed no dose effect. Among all women who received at least 10 rads, those irradiated before age 20 years will have experienced the highest rates of breast cancer throughout their lifetimes. Separate excess risk estimates for Hiroshima and Nagasaki did not differ significantly, which indicates that for radiogenic breast cancer the effects of neutrons (emitted only in the Hiroshima explosion) and gamma radiation were about equal. Radiation did not reduce the latency period for the development of breast cancer, which was at least 10 years. The distribution of histologic types of cancers did not vary significantly with radiation dose. The data suggested that irradiation prior to menarche conferred a greater risk than irradiation after menarche.

Selective expression of paternal human major histocompatibility antigens on the surface of hydatidiform mole cells

The typing of human major histocompatibility antigens (HLA) of two cases of invasive hydatidiform mole showed that the fibroblast-like cells as well as trophoblasts from the mole selectively expressed paternal HLA haplotype specificity but not maternal HLA on the surface. This result was completely in agreement with the notion of androgenetic origin of hydatidiform mole from the aspects of HLA specificity. Immunological implication of this finding and development of chorionic tumor were discussed in the light of fetomaternal relationship and host immune surveillance against the tumor.

Histological and fine structural studies on pigmented neuroectodermal tumor of infancy

Pigmented neuroectodermal tumor of infancy originating from the anterior maxilla in a two-month-old male has been studied by light and electron microscopy. The tumor is characterized histologically by two types of neoplastic cells embedded in considerable amounts of fibrous stromal tissue. The first type of cell is cuboidal to columnar in shape with an epithelial appearance having abundant cytoplasm; either scanty or a heavy accumulation of melanin pigment is observed in the cytoplasm. These cells are aligned along the cleft-like space or arranged in small ductal structures. Electron microscopy shows the characteristic features of melanocytic cells having a varying degree of asynchronous maturation of melanosomes. The second type of cells is small and round in shape and has a hyperchromatic nucleus and scanty cytoplasm, resembling neuroblastic cells or lymphocytes. Electron microscopy reveals cytoplasmic processes resembling immature neuritis which protrude into the intracellular space; a small number of secretory granules having a central core surrounded by a single limiting membrane are observed in the cytoplasm and cytoplasmic processes.

Characterization of pyruvate kinase from the liver of a patient with aberrant erythrocyte pyruvate kinase, PK Nagasaki

The characterization of the L-type PK were made of PK extracted from the liver of a patient with congenital hemolytic anemia associated with an erythrocyte PK variant, PK Nagasaki. The L-type PK of PK Nagasaki showed the following parameters: slow migration on electrophoresis, high Km for PEP without F-1,6-P2, less activation by F-1,6-P2, normal Km for ADP, high utilization of UDP, acidic pH optimum, and instability to urea and heat. These tests served to differentiate this L-type PK variant from the other variants previously reported. At the same time, both the Km for PEP with F-1,6-P2 saturation and the electrophoretic mobility of L-type PK were found to be different from those of the erythrocyte PK and PK Nagasaki. Though the liver cell, with regard to L-type PK, has only the less functional and less stable mutant L-type PK there is no evidence of liver dysfunction or damage, although there is chronic hemolytic anemia.