[Serial change of 123I-metaiodobenzylguanidine (MIBG) myocardial concentration in patients with dilated cardiomyopathy]

123I-Metaiodobenzylguanidine (MIBG) is expected to be useful agent for functional evaluation of the myocardial sympathetic innervation. The aim of this paper is to investigate serial change of 123I-MIBG myocardial concentration in patients (pts) with dilated cardiomyopathy (DCM) as compared with 201Tl uptake. Eight pts with DCM and six non-cardiac subjects (controls) were examined. After injection of 111 MBq (3mCi) 201Tl and 111 MBq (3 mCi) 123I-MIBG, simultaneous myocardial imaging in anterior view was performed for both tracers in every 30-60 minutes during 5 hours (6 images). Myocardial uptake ratio per pixel to the injected dose was calculated for each tracer with background and cross-talk correction on each image. In pts with DCM, myocardial uptake ratio of 123I-MIBG did not differ significantly from that of controls. The washout of 123I-MIBG from the myocardium, however, was significantly increased in pts with DCM as compared with controls. The % decrease of the radioactivity in 3 hours was 46.9 +/- 13.8% in DCM, whereas 18.0 +/- 7.7% in controls (p less than 0.05). Especially, the decrease in the early phase (less than 1 hour) was significantly larger in DCM than controls (21.2 +/- 7.5% vs 5.3 +/- 4.0%, p less than 0.01). For 201Tl, on the other hand, neither uptake ratio nor washout rate, differed significantly between the two. In conclusion, the rapid washout of 123I-MIBG in the early phase may reflect some sympathetic dysfunction in pts with DCM.

Iron in cicatrix and abnormal CT findings in a patient with posttraumatic epilepsy

A 33-year-old male patient showed increasing frequency of seizures 12 years after a blunt head injury. From findings of x-ray computed tomography, the lesion was thought to be a benign glioma. Removal of the lesion was performed with the guidance of electrocorticography. Histological diagnosis was gliotic scar with calcification. Diffuse iron particles were detected in layers II-V of the cortex by hematoxylin and Berlin-Blue stain. These findings suggest progressing traumatic epilepsy which may be explained by the mechanism of Willmore's model.

A large inferior mesenteric-caval shunt via the internal iliac vein

A large portosystemic shunt between the inferior mesenteric vein and the right internal iliac vein in a 28-yr-old non-cirrhotic man is presented. This collateral was discovered by ultrasound done as a screening examination for gastrointestinal bleeding. The direct communication of the inferior mesenteric vein with the internal iliac vein was demonstrated by computed tomography and percutaneous transhepatic portography. Surgical ligation of the collateral, performed to prevent future portosystemic encephalopathy, resulted in reduction of serum ammonia level and cessation of long-standing hemorrhoidal bleeding.

Effect of protein intake on mineral (calcium, magnesium, and phosphorus) balance in Japanese males

A 26-day balance study was conducted to examine the effect of a high protein diet on calcium, magnesium, and phosphorus utilization in six healthy males (age 20-22 years, body weight 54.0-64.4 kg, body height 165-173 cm). In addition, the effect of physical exercise on calcium, magnesium, and phosphorus balance was also examined. After a 2-day stabilization period, two levels of protein--control (1.0 g/kg of body weight) and high (2.0 g/kg of body weight) protein--diets were given for three 4-day periods at each protein level. During the last 4-day period of each protein level, subjects exercised on a bicycle ergometer for two 1-h periods daily at a load of 1.5 kp., 50 cyc./min. The high protein diet increased urinary calcium and caused a significant negative calcium balance. Magnesium balance tended to be negative in the control diet. There were no significant changes in urinary calcium, magnesium, and phosphorus and also in the calcium, magnesium, and phosphorus balance during physical exercise.

[Clinical effects of terodiline hydrochloride for urinary frequency and sense of residual urine]

The clinical effects of terodiline hydrochloride were evaluated in forty-four patients with urinary frequency and/or sense of residual urine. After a four-week treatment with 24 mg terodiline hydrochloride once daily, subjective symptoms were improved and micturition frequency was decreased significantly. Slight dysuria was reported as a side effect only in one patient. Terodiline hydrochloride is considered to be superiorly effective and safe for the treatment of urinary frequency and sense of residual urine.

Role of hypovolemia in dialysis-induced hypotension

Blood volume was measured continuously during hemodialysis using the authors' hematocrit continuous measurement system in an attempt to determine any relationship between dialysis-induced hypotension with acute onset and blood volume. Hypotension resulted approximately 3 h into dialysis in the present study. This point in time was that at which blood volume was more than 5% above the minimum level during the dialysis treatment, and in some patients it was more than 10% over the minimum level of blood volume. At the time dialysis-induced hypotension occurred or before, there was no sharp decrease in blood volume nor any change in the plasma refilling rate. This suggested that this hypotension is caused by a sudden breakdown of the blood pressure support mechanism compensating for decreased blood volume.

Effect of carbon dioxide on heat production of frog skeletal muscles

1. Maintenance heat produced in tetani of frogs' sartorius muscles (Rana japonica) was measured under various values of intracellular pH (pHi) brought about by increasing the CO2 concentration in Ringer solution. The pHi values were measured using 31P nuclear magnetic resonance from the chemical shifts of the inorganic phosphate resonance. The pHi was 7.10 +/- 0.009 (mean +/- S.E. of the mean, n = 10) in the gas mixture of 5% CO2/95% O2 at 4 degrees C and it was reduced to 6.44 +/- 0.001 (n = 23) in 45% CO2. 2. As CO2 was increased, the maximum force was decreased and relaxation was prolonged. This is in accordance with the results of Edman & Mattiazzi (1981) and Curtin (1986). 3. An increase in CO2 induced a reduction of the maintenance heat production, which can be divided into stable and labile heats (Aubert, 1956). The stable heat, which is produced with a steady rate during contraction, was decreased as CO2 was increased. The labile heat, which is produced with an exponentially declining rate, was not significantly altered by increasing CO2 within the range studied. 4. The effect of previous contractile activity on the labile heat production, i.e. the time course of repriming of the labile heat, could be described by an equation with two exponential terms in 5% CO2 in accordance with the result of Peckham & Woledge (1986). The time course of repriming of the labile heat was not affected by increasing CO2 to 20%.

Complete evaluation of the cardiovascular lesions in 24 patients with Takayasu's aortitis using four-image, intravenous digital subtraction angiography

We studied the entire distribution of cardiovascular lesions with the use of intravenous digital subtraction angiography (DSA) in 24 patients having Takayasu's aortitis. The aorta, its branches, pulmonary vessels, and left ventricle were assessed by neck (anteroposterior), abdominal (anteroposterior), and chest (right and left anterior oblique) images. DSA showed multiple arterial lesions (n = 24) including proximal renal artery stenoses (n = 4), pulmonary arterial stenoses (n = 4), inferior-superior mesenteric arterial anastomoses (n = 3), brachiocephalic arterial aneurysms (n = 2), aortic root aneurysm (n = 1), diffuse left ventricular hypokinesis (n = 1), subclavian steal phenomenon (n = 1), and right aortic arch (n = 1). The incidence of total occlusion was highest in the right subclavian artery (n = 12). Average percent luminal stenosis (mean +/- S.D.) over the aorta and its branches tended to be smaller in patients with prior corticosteroid therapy (17.3 +/- 14.6%) than in those without (22.0 +/- 9.8%), but the difference was not significant. DSA (four-series) was useful in assessing the whole disease spectrum and often revealed subclinical lesions in this disease.

Intrahepatic portal-systemic shunt: its etiology and diagnosis

Four cases of enormous shunt between portal and hepatic veins (portal-hepatic venous shunt) are reported with special reference to sonographic and portographic findings. Ultrasonography, an examination for screening, delineated a snail-like anechoic area in the liver, its connection with the portal and hepatic veins, and marked dilatation of the veins connecting with the shunt. Transarterial or percutaneous transhepatic portography, a method for definitive diagnosis, demonstrated large pooling of the contrast medium flowing from the dilated portal branch and subsequent visualization of the hepatic vein. The etiology and prognosis are unknown at present. The most likely pathogenesis for this shunt seemed to be a congenital anomaly, namely, persistence of the omphalomesenteric venous system. With recent advances in and the more frequent use of real-time ultrasonography, detection of this kind of vascular abnormality will doubtless increase.

Monoclonal antibodies against rat brain protein kinase C and their application to immunocytochemistry in nervous tissues

Three monoclonal antibodies were prepared against rat brain soluble protein kinase C. Two of the antibodies, CKI-97 (IgG2b subclass) and CKII-90 (IgG1 subclass), showed weak binding to native protein kinase C. The third antibody, CKI-33 (IgG2b subclass), showed no binding. However, the mixture of CKI-97, CKII-90, and CKI-33 exhibited much stronger binding activity to this protein kinase than any of the antibodies alone. Although none of these antibodies showed protein kinase C-neutralizing activity, Western blot analysis indicated that these antibodies reacted specifically with protein kinase C, presumably its subspecies, that is present predominantly in nervous tissues. Immunocytochemical studies shows that these antibodies can be used for identification of this enzyme in nervous tissues. In rat Purkinje cells, the immunoreactive material was present throughout the cytoplasm, including dendrites and axons, but was poorly represented in the cell nucleus. In cerebellum, the localization of protein kinase C appears to be very similar to that of cGMP-dependent protein kinase.

[Studies on the usefulness of a long-term, high-dose treatment of methylcobalamin in patients with oligozoospermia]

Methylcobalamin (CH3-B12) was administrated in a dose of 6 mg per day (group A, 16 cases) or 12 mg per day (group B, 23 cases) for 16 weeks to patients with oligozoospermia. There was no difference between group A and group B regarding vitamin B12 concentrations in the serum or seminal fluid. CH3-B12 appeared to be transported to seminal fluid very efficiently. However, results from group A and group B did not differ with respect to this parameter. The efficacy rate for group A was 37.5% and that for group B was 39.1%. From these results, it was concluded that a long-term, high dose treatment of CH3-B12 was useful for the treatment of patients with oligozoospermia. Since the efficacy rates were not different between the two groups, 6 mg per day would be the recommended dose. Clinical adverse reactions were observed in one patient in each group. Drug-related laboratory adverse reactions were observed in only one patient in group B.

Newly developed circulating blood volume-monitoring system and its clinical application for measuring changes in blood volume during hemofiltration

Blood and ultrafiltrate electrical resistivities were continuously monitored during hemofiltration. By substituting these values into a previously developed equation that was modified by the authors, the hematocrit value was determined; and blood volume change was obtained from the change in this value. The following facts were discovered as the result of monitoring the blood volume change during treatment: When the body position was changed from the reclining to the sitting position, the blood volume decreased by 4.2 +/- 0.3%. With the body water removal rate kept constant, the body position recumbent, and the subject fasted, the blood volume gradually decreased. However, when the position was changed from reclining to sitting for food intake and once more returned to the supine position after the meal, the blood volume was greatly affected by the change in position and the food intake.

Calcification in glioblastoma multiforme of the cervical spinal cord

A patient having glioblastoma accompanied with calcification in the cervical spinal cord is presented. A calcifying lesion, detected on preoperative x-ray computed tomograms, was histologically confirmed as calcified areas in the tumor tissue. We discuss the difficulty in differentiating glioblastomas containing calcified masses from benign tumors with areas of calcification and present our hypothesis regarding the cause of calcification in the tumor tissue.

[Efficacy of a latex Foley catheter with sustained release of chlorhexidine: 1st report: Clinical trials for the prevention of urinary tract infection]

Seventy five patients requiring urethral catheterization for over 24 hours were treated with a latex Foley catheter with sustained release of chlorhexidine in a closed drainage system. While the catheter was indwelling, urinary concentrations of chlorhexidine were maintained at the level of 1 to 2 micrograms/ml in average in almost all patients. The catheter was highly effective in preventing the acquisition of catheter-associated bacteriuria in patients with initially sterile urine without systemic antimicrobial therapy. The acquisition rate of bacteriuria was 8, 16, 23, 35 and 74% on day 3, 4, 5, 6 and 7 with the catheter indwelling, respectively. The catheter was not effective in eradicating preexisting bacteriuria. Complications of the catheter were minimal.

Efficacy of an antibiotic coated indwelling catheter: a preliminary report

This study was conducted to examine if an aminoglycoside (dibekacin sulfate, DKB) incorporated into a coating layer on outer and inner surface of indwelling catheters would be released into urine both in vitro and in clinical cases on a sustained basis and if the released DKB would have any efficacy on delaying lower urinary tract infections. Released amounts of DKB from the catheter silicone rubber (SR) catheter were periodically measured both in vitro and in clinical applications. During the clinical applications, the catheters were indwelled in 14 patients. Organism counts in the patients' urine were determined and organisms were isolated from bacteriuria (defined as greater than or equal to 10(4) CFU/mL) and MICs to DKB were measured. Observations on several combined symptoms frequently associated with indwelling catheterization were performed. Results showed that sustained release of DKB continued for more than 25 days and 13 days in vitro and in clinical cases, respectively. Clinical studies suggested that 8 days of sterile urine after catheterization might be expected in patients without systemic administration of antibiotics and more than 2 weeks if combined with it. No particular problems in its use and associated symptoms were recognized.

[Regional cerebral blood flow in cerebrovascular disease studied using N-isopropyl-p-(123I) iodoamphetamine]

Twenty-one patients with cerebrovascular disease (5 with hemorrhage, 10 with infarction, 2 with TIA, 4 with motor disturbance of unknown cause) were studied using N-isopropyl-p-(123I)iodoamphetamine (123I-IMP) and single photon emission CT. In 3 of 5 cases with cerebral hemorrhage, perfusion defects were shown in and around the region of hematomas, furthermore, one of the cases with internal capsular hematoma, the perfusion defect extended to the cortical area corresponding to the neurological pathway. In one case with MCA infarction, the perfusion defect was greater and clearer than the low density area on X-ray computed tomography (CT). These results revealed the 123I-IMP study provides physiological information in contrast with X-ray CT which provides anatomical information. In 3 of 9 cases with multiple small deep hemispheric infarctions on X-ray CT, the perfusion to the basal ganglia was suspected to be decreased on 123I-IMP images. However, this visual findings was not definitive and, in fact, the diseased side was not always consistent with the clinical findings. For quantitative analysis, symmetrical regions of interest (ROIs) were constructed both basal ganglia and the ratio of average counts over the ROI to those over the whole slice was calculated. In the small infarction group, the mean +/- S.D. of the values was 0.89 +/- 0.09 in right and 0.89 +/- 0.08 in left. Although the values were not significantly different from those of normal subjects (0.99 +/- 0.02 in right, 0.97 +/- 0.03 in left), they distributed in the range less than normal in 5 of 9 cases. This method was thought to be useful and practical to evaluate the cerebral blood flow in basal ganglia of patients with deep hemispheric infarction.

ICP patterns and isotope cisternography in patients with communicating hydrocephalus following rupture of intracranial aneurysm

Intracranial pressure (ICP) was continuously recorded, isotope cisternography was performed, and the ventricular system size was evaluated on serial computerized tomography scans in 39 patients. All of these patients had communicating hydrocephalus after subarachnoid hemorrhage (SAH) from rupture of an intracranial aneurysm. The studies were carried out in both the acute stage (within 7 days after SAH) and the communicating hydrocephalus stage. In patients in the acute stage who had no ventricular dilatation, but who later developed communicating hydrocephalus, the resting ICP was high, and an ICP pattern of B-wave activity was seen; there was no delay in cerebrospinal fluid (CSF) absorption on isotope cisternography. Patients with communicating hydrocephalus in whom ICP recordings were started within 63 days after SAH had a pattern of plateau waves in conjunction with B-waves, and there was a marked delay in CSF circulation. In general, patients with higher resting ICP's had more frequent ICP irregularities. Patients with communicating hydrocephalus in whom recordings were begun more than 6 months after SAH had a low and flat ICP pattern, and there was no delay in CSF absorption in spite of bilateral convexity blocks on isotope cisternography. The results suggest that the ICP pattern of plateau waves in conjunction with B-waves can be regarded as a sign of delayed CSF absorption; hence, shunting procedures may be indicated in patients with plateau waves in conjunction with B-waves visualized on continuous ICP recordings.

A case of prostatic carcinoma with skin metastases

The 30th case of metastatic skin carcinoma of prostatic origin was presented. The cytosolic R1881 receptor was detected moderately in the metastatic nodule of the skin, however, the measurement of this receptor had a limited value for the purpose of treating the patient with antiandrogenic agents.

[Clinical experience with oxendolone for treatment of benign prostatic hyperplasia. Clinical efficacy and effects on serum lipid and lipoprotein fraction levels]

Forty-three patients with benign prostatic hyperplasia were treated with weekly i.m. injections of 400 mg oxendolone for 12 weeks. The subjective symptoms were improved in 83% of these patients. Residual urine was decreased significantly and Qmax was increased by this treatment. Serum VLDL level was suppressed significantly, whereas the levels of LDL, total cholesterol, HDL-cholesterol and triglycerides were changed little. Atherosclerotic index and the ratio of (total cholesterol--HDL-cholesterol) to (HDL-cholesterol), was not influenced by the treatment. No severe side-effect was found. These findings suggest that oxendolone is the drug of choice for non-surgical treatment of benign prostatic hyperplasia.

[Digital radiation monitoring system with a personal computer]

This paper describes a data processing system of monitors with a personal computer for a radioisotope laboratory. A monitoring system includes 6 area, 6 dust, and 3 gas monitors. Monitor signals through a multiplexer were fed to the personal computer which has analogue ports. Processed data were displayed on a color CRT, stored on a 5 inch mini floppy disk, and printed out as a report. We developed a data processing program with BASIC language. This system largely reduced manpower required to estimate radiation levels in the laboratory. The personal computer has sufficiently enough ability to construct a digital monitoring system for a small radioisotope laboratory.

Radioimmunoassay of diethylstilbestrol in plasma of patients with prostatic carcinoma

A method for the radioimmunoassay of diethylstilbestrol (DES) was established and it was used to measure the plasma concentration of DES in patients with prostatic carcinoma receiving intravenous drip infusion of 500 mg of diethylstilbestrol diphosphate (DES-DP). The sensitivity of this assay system was 40 pg per tube, with a recovery of 98%. The cross reactivity of the anti-DES antibody with estradiol, testosterone, and ethynylestradiol was less than 0.01% of DES, and that with DES-DP was 0.7%. In patients with prostatic carcinoma, plasma DES concentration at 6 and 24 hr after was declined to 10.2% and 4.4% of the level at the termination of intravenous administration of DES-DP, respectively; however, the concentration in patients with renal dysfunction was higher than that in ones with normal renal function.

Androgen receptor in electroresected and cold punch-resected specimens. Usefulness of Kaplan cold punch resectoscope

The measurement of androgen receptor and 5 alpha-dihydrotestosterone (DHT) levels in prostatic carcinoma may be of value in predicting responsiveness to anti-androgenic therapy. A sufficient amount of prostatic carcinoma tissue must be removed for measuring androgen receptor and DHT levels. We have studied the usefulness of Kaplan cold punch-resection compared with electroresection for obtaining tissue in 29 cases of enucleated benign prostatic hyperplasia. DHT level in electroresected specimens was similar to controls. However, following low, moderate, and high-power electroresection an average of total R1881 binding sites (Bmax) of electroresected specimens was reduced to 82.2, 71.9, and 52.1 per cent of corresponding controls, respectively. In contrast, the per cent decrease of Bmax of Kaplan cold punch-resected specimens was only 10 per cent of the control. From our data, Kaplan cold punch-resection of the prostate appears to be a useful tool for obtaining tissue suitable for measuring androgen receptor levels.

The changes in the binding capacity of testosterone-oestradiol binding globulin (TeBG) following castration and DES-D administration in patients with prostatic carcinoma

The levels of plasma testosterone, testosterone-oestradiol binding globulin (TeBG) and total serum acid phosphatase (TSAP) following antiandrogenic hormone therapy were investigated in 17 patients with prostatic carcinoma. The low levels of plasma total and free testosterone induced by castration decreased further after diethylstilboestrol diphosphate (DES-D) administration. Plasma TeBG binding capacity after castration was 118.9% of the pre-treatment level and increased to 193.9%, 204.0% and 212.7% at 1, 2 and 3 weeks after DES-D dosing. The in vitro binding of 3H-testosterone to TeBG was not influenced in the presence of DES-D or stilboestrol. Clinical response following the DES-D therapy was associated with a decrease in the levels of TSAP. A significantly inversed correlation was found between the decrease in TSAP and increase in TeBG at completion of DES-D therapy. These results suggest that the high binding capacity of TeBG lowers the biologically active fraction of testosterone and thus may produce clinical effects.