Lighted mirror for microneurosurgery

We describe a newly developed, lighted mirror that provides enough luminous intensity to obtain a clear image in deep operative fields under high magnification. Through the initial neurosurgical procedures in which it was tested, the mirror proved particularly useful for inspecting the ventral aspect of the fifth nerve in a microvascular decompression for trigeminal neuralgia, and for observing the fundus of the internal auditory meatus after removal of an acoustic neuroma to ensure no residual tumor.

The effects of pituitary adenylate cyclase-activating polypeptide on cerebral arteries and vertebral artery blood flow in anesthetized dogs

We investigated and compared the effects of pituitary adenylate cyclase-activating polypeptide (PACAP) and vasoactive intestinal peptide (VIP) on cerebral circulation in anesthetized dogs. The intracisternal administration of PACAP-27, PACAP-38, and VIP dilated canine cerebral arteries in a dose-dependent manner. A 10 nmol dose of PACAP-27, PACAP-38, and VIP dilated the basilar artery by 23 +/- 3, 27 +/- 3 and 30 +/- 3%, respectively. Rostrally located arteries tended to be more responsive to PACAP-27. Pretreatment with NG-monomethyl-L-arginine did not affect PACAP-27-induced vasodilation. Vertebral artery blood flow was also affected by intra-arterial injection of these peptides in a dose-dependent manner. A 100 pmol dose of PACAP-27, PACAP-38, and VIP increased the vertebral artery blood flow by 42 +/- 10, 29 +/- 4, and 62 +/- 11%, respectively. The VIP receptor antagonist, [Lys1,Pro2,5,Arg3,4,Tyr6]VIP, inhibited both the VIP- and PACAP-38-induced increase in vertebral artery blood flow. These findings suggest that PACAP plays a role in the regulation of cerebral circulation.

[Persistent discrepancy between FDP and D-dimer in a patient with acute leukemia]

In a patient with acute myeloblastic leukemia, serum fibrinogen/fibrin degradation products (FDP) were markedly elevated to 54.91 micrograms/ml, but plasma D-dimer was only slightly elevated (1.44 micrograms/ml). FDP in plasma measured by a method using monoclonal antibody specific to FDP was less than 5 micrograms/ml. Gradual reduction of blastic cells was obtained with the therapy of low-dose cytarabine, G-CSF and etoposide. The serum FDP increased up to 71.74 micrograms/ml accompanied with a transient elevation of D-dimer, and subsequently declined without any anticoagulant therapy. However, a discrepancy between serum FDP and plasma D-dimer lasted for a long time. In this case persistent acceleration of coagulation and fibrinolysis which may result in the elevation of serum FDP was not observed, suggesting that the greater part of increased FDP didn't reflect the true FDP formed by plasmin. There were possibilities that elevated serum FDP values were also caused by the presence of soluble fibrin, unclottable fibrinogen and the degradation products by nonplasmic proteinases. Simultaneous measurements of FDP and D-dimer are useful for a more accurate evaluation of hyperfibrinolytic states and to avoid possible misinterpretations due to falsely positive FDP.

Plasma urokinase-type plasminogen activator in patients with leukemias

Plasma levels of urokinase-type plasminogen activator (u-PA) were measured with an enzyme-linked immunosorbent assay in patients with leukemias. As compared with healthy subjects (0.73 +/- SD 0.17 ng/ml), plasma u-PA antigen level was markedly elevated in patients with acute promyelocytic leukemia (APL) (1.76 +/- 0.89 ng/ml) at disease onset. Mean u-PA concentrations in patients with other acute nonlymphoblastic leukemia (0.57 +/- 0.51 ng/ml), acute lymphoblastic leukemia (0.77 +/- 0.82 ng/ml) and chronic myelocytic leukemia in blastic crisis (1.30 +/- 1.35 ng/ml) were not significantly elevated, but some of them showed an elevation of plasma u-PA. Plasma u-PA values were correlated with some of the fibrinolytic parameters such as FDP and D-dimer. Plasma u-PA antigen was decreased after the administration of antileukemic drugs in patients with APL. These results suggest that the coagulopathy in patients with various leukemias may in part be associated with u-PA release from the leukemic cells, especially in patients with APL.

Dural arteriovenous malformations in the anterior cranial fossa

Two cases of dural arteriovenous malformation (DAVM) fed by the anterior ethmoidal artery in the anterior cranial fossa are reported, one of them examined by magnet resonance imaging (MRI). Only one other case with MRI findings so far has been published. Fourty-eight previously reported cases are reviewed. One of our patients presented with subdural haematoma (SDH) without subarachnoid or intracerebral haemorrhage. The other patient had a nasal bleed without any neurological manifestations. In comparison with previously reported cases, the clinical manifestation of our cases is infrequent (1 patient with nasal bleed, and 2 patients with pure SDH that is 2 and 4%, respectively, in the literature). Feeder was the anterior ethmoidal artery either unilateral or bilateral. Drainage of DAVMs was through a markedly dilated vascular sac into the superior sagittal sinus (SSS). The high incidence of haemorrhage from DAVM in the anterior fossa is related to this vascular sac. Magnetic resonance imaging (MRI) showed a flow void area in the left frontal region on T 1-weighted images in one case. These cases were treated by surgical excision of the malformation with good results. Aetiology, clinical presentation, and treatment of these rare DAVMs in the anterior cranial fossa is discussed.

[Clinical study of cyclic intra-arterial chemotherapy using mitoxantrone for advanced hepatocellular carcinoma]

Cyclic intra-arterial infusion chemotherapy using Mitoxantrone via reservoir system was prescribed for 8 patients with advanced hepatocellular carcinoma. According to the clinical staging system, two patients were in Stage III and the other six patients in Stage IV-A. Vp-3 portal invasion was observed in six out of the eight patients. Mitoxantrone (5-8 mg/body) was administered intra-arterially via port-a-cath device every 4 weeks. For tumor response, there were two PR cases, four NC cases, and two PD cases. Thus, the response rate was 25%. The mean survival period was 6.5 months, and 1-year survival rate was 13%. In one of two PR cases, the survival time has been more than two years so far. Gastrointestinal toxicities such as nausea and vomiting were not severe. Critical myelosuppression requiring medication was not observed. Although a temporary increase of serum bilirubin was found in two cases, no severe damage to hepatic function was observed. From our preliminary data, this arterial infusion chemotherapy using Mitoxantrone via reservoir system can be safely performed on non-hospitalized patients with advanced hepatocellular carcinoma, and may be a useful treatment modality.

Tissue factor in plasma of patients with disseminated intravascular coagulation

Recently it has been shown that tissue factor (TF), an important trigger for initiating blood coagulation, is present in the circulating plasma. In order to assess the clinical implications of TF in plasma, plasma concentration of TF was quantitated in 65 patients with disseminated intravascular coagulation (DIC). The mean concentration of plasma TF was elevated in patients with DIC at presentation as compared with healthy subjects (446 +/- SD 536 pg/ml vs. 138 +/- 51 pg/ml, P < 0.001). Abnormally high levels were found only in 46.2% of the patients, predominantly in patients with non-hematological solid tumors and acute leukemia. Plasma TF did not correlate with hemostatic markers of DIC such as thrombin-antithrombin III complex, prothrombin fragment 1 + 2, plasma-alpha 2-plasmin inhibitor complex, FDP, D-dimer, or fibrinogen. Serial determinations of plasma TF demonstrated that plasma TF changes roughly in parallel with the course of DIC in most patients with elevated TF at presentation of DIC. These findings suggest that plasma TF is potentially valuable for monitoring the progress of DIC in a limited population of patients.

Immaturity of the myenteric plexus is the aetiology of meconium ileus without mucoviscidosis: a histopathologic study

The most common aetiology of meconium ileus is a deficiency in trypsin activity caused by cystic fibrosis. The pathogenesis of meconium ileus without mucoviscidosis is less well understood, although a number of causative factors have been suggested. The symptoms and clinical course of nine patients with meconium ileus without mucoviscidosis were reviewed, and the myenteric plexus of a surgical specimen of intestine was examined histologically and cytometrically. The nuclei of the intramural ganglion cells were much smaller than were seen in normal newborn infants. The nuclear areas resembled those seen in fetuses of 5-6 months gestational age, but the number of ganglion cells approached normal. This immaturity of the ganglia was observed both in the contracted distal ileum and dilated proximal ileum. Patients with an ileostomy passed solid faeces for about 1 to 2 months postoperatively, after which time the faeces became watery. The intramural ganglia were mature at the time of ileostomy closure. We conclude that immaturity of the myenteric plexus in the ileum and colon seems to be the main aetiologic factor in meconium ileus without mucoviscidosis.

Extensive dissection at the porta hepatis for biliary atresia

Dissection at the porta hepatis is the crucial step in surgery for biliary atresia. The authors describe their procedure for extensively dissecting the porta hepatis. The technique is based on an anatomic cast corrosion of the human liver, and the portal vein serves as the landmark for dissection. Lateral dissection at the hepatic hilus is critical to the procedure. On the right side, the anterior portal branches are dissected to the bifurcation of the S5 and S7 segmental portal branches, over the bifurcation of the anterior and posterior portal branches. On the left side, the liver parenchyma, which bridges the umbilical point, is sectioned, and the left portal branch is dissected to the umbilical point over the pars transversalis and taped. The fibrous mass that lies within the confines of the portal branches, including the dorsal aspect, is transected completely. This procedure was performed in 16 infants; the jaundice cleared in 93.7%.

Fatal thromboembolism in acute promyelocytic leukemia during all-trans retinoic acid therapy combined with antifibrinolytic therapy for prophylaxis of hemorrhage

In contrast to patients with disseminated intravascular coagulation (DIC) due to other causes, patients with acute promyelocytic leukemia (APL) receiving standard cytotoxic chemotherapy can be treated safely with antifibrinolytic drugs for prophylaxis of hemorrhage, without the occurrence of thromboembolic complications. However, such drugs should be used cautiously in APL patients who are receiving all-trans retinoic acid (ATRA) differentiation therapy. We report here a patient with APL who had fatal thromboembolism after receiving ATRA and tranexamic acid therapy.

Bilateral periorbital eccrine hidrocystoma

We saw four patients showing identical features as cystic lesions on the bilateral external canthi. Histological examination showed cystic cavities in the dermis. Histological and enzyme histochemical findings suggest that these cystic tumors are of eccrine origin. Thus we diagnosed these cystic tumors as eccrine hidrocystoma with characteristic clinical feature. The recognition of this feature would help to correctly diagnose these eccrine hidrocystoma.

Cough variant asthma: a case study with antigen, histamine and methacholine inhalation challenge tests

This paper presents a 7 year old girl with cough variant asthma, in which house dust challenge test provoked fine crackles on auscultation without any changes of lung function test. Pretreatment with DL-chlorpheniramine maleate for 7 days inhibited the appearance of fine crackles. On histamine inhalation test, fine crackles and rhonchi appeared on auscultation without bronchoconstriction (% fall of one-second forced expiratory volume < 10%). These data suggest that the cause of cough variant asthma is mainly an immunoglobulin E-mediated allergic reaction in the mucus secreting system.

[Medical examination of workers exposed to lead in the Philippines]

The medical examination of workers exposed to lead was conducted as part of the activity of the Occupational Safety and Health Center (OSHC) Project in the Philippines (JICA Project). The subjects of the medical examination were 21 male and 193 female workers of a semi-conductor plant (abbreviated A company), 59 male and 6 female workers of a refrigerator manufacture (B company); 199 male workers of a storage battery manufacturer (C company); and 107 male and 6 female workers of a lead smelter (D company). Among the examination items were questions regarding occupational history, subjective complaints and objective signs, determination of blood lead levels, urine delta aminolevulinic acid levels, and examination for anemia. The survey was conducted from June to September in 1990. The following results were obtained: 1) The mean age of the workers ranged from 21.8 to 33.8 years. Those of companies A and B were younger than those of companies C and D. The mean employment duration of males at C company was 10.7 yr, and the longest among the four companies. That in both sexes for A company was 1.8 yr and the shortest among the above mentioned companies. 2) The blood lead geometric mean levels of companies C and D showed the highest concentration. The level in males of C company was 64.5 micrograms/dl and that of D company was 80.8 micrograms/dl. The level in females of A company was 9.9 micrograms/dl and the lowest in concentration. The urine delta aminolevulinic acid geometric mean levels were less than 6.0 mg/l in the four companies. There was no company having hemoglobin mean values less than 14.0 g/dl in males or less than 12.0 g/dl in females. 3) The proportion of blood lead levels of 60 micrograms/dl or more was 67.3% in males of C company, and 89.7% in males and 16.7% in females of D company. The proportion of urine delta aminolevulinic acid levels of 6 mg/l or more was 1.0% in females of A company, 20.1% in males of C company, and 43.0% in males of D company. The proportion of hemoglobin values less than 14.0 g/dl in males or less than 12.0 g/dl in females was 4.7% in females of A company, 1.7% in males of B company, 3.5% in males of C company, and 12.1% in males of D company.(ABSTRACT TRUNCATED AT 400 WORDS)

Purification of two types of TNF inhibitors in the urine of the patient with chronic glomerulonephritis

In order to clarify whether TNF inhibitory activity in the urine of glomerulonephritis (GN) patients depends on the existence of TNF inhibitors/soluble TNF receptors, we purified two types of TNF inhibitors from the urine of chronic renal failure (CRF) with GN patient. Using four steps of chromatography (anion exchange chromatography, preparative reverse phase chromatography, TNF affinity chromatography, analytical reverse phase chromatography), two types of 99% pure TNF inhibitors were purified. Amino terminal amino acid sequence revealed that one inhibitor was identical to soluble TNF receptor, p55, however, the other was homologous but not identical to soluble TNF receptor, p75. Our experiments demonstrated that TNF inhibitory activity in the urine of CRF patients depended partly on the existence of soluble TNF receptors in the urine.

Reversed-phase high-performance liquid chromatography for analysis of urinary proteins: diagnostic significance of alpha 1-acid glycoprotein

In order to analyze urinary proteins from patients with various renal diseases, a reversed-phase high-performance liquid chromatography with IPG PACK ODS column packed with polyporous glass was employed. The peak areas of alpha 1-acid glycoprotein (alpha 1-AGP), beta 2-microglobulin (beta 2-MG) and albumin were measured by a chromato-integrator. The alpha 1-AGP/albumin ratio was regarded as the marker of glomerular damage, while the beta 2-MG/albumin ratio indicated tubular dysfunction. As a result, the alpha 1-AGP/albumin ratio in the urine from patients with either various glomerulonephritis (GN) or idiopathic nephrotic syndrome was significantly higher than that from either patients with postural proteinuria or healthy children. However, the beta 2-MG/albumin ratio in the urine from patients with GN was the same level as controls. The beta 2-MG/albumin ratio was elevated only in urine from patients with tubular dysfunctions. These data suggest that the urinary alpha 1-AGP/albumin ratio could be a beneficial indicator in locating patients with GN from among children with asymptomatic proteinuria.

[Anatomical study on the right bronchial artery for operation of esophageal cancer through right thoracotomy with special reference to the intercostobronchial arteries]

In view of the operative field of esophageal cancer, anatomical findings of the right bronchial arteries were studied in specimens of 71 cadavers. Intercostobronchial arteries were absent only in 3 cadavers (4.2%; group A). As 22.6% of the cadavers had only one intercostobronchial artery supplied as the right bronchial artery (group B), it was considered to be important to preserve this artery. Cadavers both with the intercostobronchial artery and with the other right bronchial-arteries were observed in 70.4% (group C). Right bronchial arteries deriving from the aorta to course similarly to intercostobronchial arteries were present in small number (group D). Further, right bronchial arteries were classified into three types according to the deriving arteries as follows: (I) intercostobronchial arteries, (II) bronchial arteries deriving from the aorta, (III) other right bronchial arteries deriving from right subclavian artery, right inferior thyroid artery or right interthoracic artery. Considering difficulty of the approach from the operative field with right thoracotomy and the anatomical relationship with neighboring organs, it was thought that preserving the type (I) arteries is easy, the type (III) has a possibility to be preserved, and (II) is hard to be preserved. We concluded that preserving intercostobronchial arteries is important in esophageal cancer surgery approached through right thoracotomy because of small number of cadavers without these arteries and ease of preservation.

Successful Kasai operation for biliary atresia in a 9 month old

A rare case of a successful Kasai operation for biliary atresia in a 9 month old is described. For infants over 6 months of age, there had been no reports of long-term survival after this procedure.

Aneurysm arising from the petrous portion of the internal carotid artery: case report

A 21-year-old man with hearing loss and recurrent otorrhagia was shown angiographically to have an aneurysm arising from the intrapetrous internal carotid artery (ICA). Endovascular balloon occlusion of the aneurysm with preservation of the parent ICA was attempted twice, but each time the balloon deflated and the aneurysm reappeared two weeks and three months, respectively, following the endovascular procedures. The patient was then successfully treated with a surgical trapping procedure combined with superficial temporal artery-middle cerebral artery bypass.

[Determination of synephrine in Oriental pharmaceutical decoctions containing aurantii nobilis pericarpium by ion-pair high-performance liquid chromatography. II]

A simple method using ion-pair high-performance liquid chromatography was established for the rapid and precise determination of synephrine in thirty three species of oriental pharmaceutical decoctions containing Aurantii Nobilis Pericarpium. An ODS column and a mixed solvent system of water, acetonitrile, sodium dodecyl sulfate and phosphoric acid as a mobile phase were used for the separation. Synephrine was eluted without interference of other coexisting components within 15 min.

Possible role of metallothionein on the gastrointestinal absorption and distribution of cadmium

Although the role of metallothionein (MT) has been suggested by many researchers, the exact biological or physiological roles of MT are still unclear. Up to the present, the role of this ubiquitous low molecular weight protein has variously been reported as 1) the regulation of the normal absorption and homeostasis of essential metals such as zinc (Zn), copper (Cu), 2) the chelation and detoxification of toxic metals such as cadmium (Cd) or mercury (Hg). The mechanisms of Cd uptake from gastrointestinal lumen and its consecutive transport from the intestinal mucosa into blood circulation and tissue are not well known. The chemical form of Cd is an important factor on its gastrointestinal absorption. It has been reported that Cd in foods such as meat, seafoods, and vegetable is existing mainly as Cd-MT or MT-like Cd binding proteins. Also it is well known that MT is induced in the intestinal tissue by oral Cd administration. Until today, the mechanism of gastrointestinal absorption has been mainly discussed about Cd ion. However, it needs the consideration including the chemical form of Cd such as Cd-MT in foods or Cd bound by MT induced in the intestinal tissue. Namely, it is important to assess the possible role of MT on gastrointestinal absorption and its consecutive tissue distribution of Cd.

Fatal pulmonary haemorrhage and crescentic glomerulonephritis without autoantibodies: a paediatric case report

The case of an 8-year-old girl who had a fatal pulmonary haemorrhage and crescentic glomerulonephritis without autoantibodies is presented. Circulating anti-glomerular basement membrane antibodies, circulating immune complexes and anti-neutrophil cytoplasmic autoantibodies were not detected. To our knowledge this is the youngest reported case of the disease.

Circulating thrombomodulin as a novel endothelial cell marker: comparison of its behavior with von Willebrand factor and tissue-type plasminogen activator

Circulating thrombomodulin is a novel endothelial cell marker, which may reflect the endothelial injury. Plasma levels of thrombomodulin were quantitated by an enzyme-linked immunosorbent assay (ELISA) in patients with hematological malignancies, liver disease, diabetes mellitus, collagen disease, thrombotic disease, and disseminated intravascular coagulation (DIC), and the thrombomodulin values were compared with those of von Willebrand factor antigen (vWf:Ag) and tissue-type plasminogen activator (t-PA) which are released from stimulated or damaged endothelial cells. The mean plasma concentrations of thrombomodulin in these disease states were elevated as compared with healthy subjects. A relatively high mean thrombomodulin level was observed in DIC, liver disease, and collagen disease. Abnormally high thrombomodulin values (greater than normal mean value + 3 SD) were found in 32.3% of patients with hematological malignancies, 57.7% of patients with liver disease, 39.3% of patients with diabetes mellitus, 30.0% of patients with collagen disease, 23.1% of patients with thrombotic disease, and 69.0% of patients with DIC. Plasma concentrations of both vWf:Ag and t-PA were also elevated in these patients. On the whole, the plasma thrombomodulin concentration was positively correlated with vWf:Ag (r = 0.441, P less than 0.001) and t-PA (r = 0.398, P less than 0.001). These findings indicate that the elevation of plasma thrombomodulin is frequently seen in a variety of diseases and circulating thrombomodulin is possibly useful for evaluating the endothelial damage in selected disease states.

Accumulation of vanadium during embryogenesis in the vanadium-rich ascidian, Ascidia gemmata

It is a remarkable and previously unrecognized fact that ascidians, which are known to contain high levels of vanadium in their blood cells, begin to accumulate vanadium during embryogenesis. This study revealed that the accumulation starts quite dramatically 2 wk after fertilization, and 2 mo later, the amount of vanadium in larvae is 600,000 times higher than that in the unfertilized egg. These results were obtained by neutron activation analysis, a highly sensitive method for determining levels of vanadium, in the Ascidia gemmata, the ascidian that contains the highest known levels of vanadium and accumulates vanadium at 150 mM in its blood cells, a concentration that corresponds to 4,000,000 times the concentration in seawater.

An occupational hygiene survey in a Chinese viscose rayon factory

The retinopathy (microaneurysm/small dot hemorrhage) is an early and specific biological indicator to quantitatively evaluate the CS2 exposure. The appearance of retinal lesions was observed among Yugoslavian, German and American workers exposed to CS2. However, among Finnish CS2 workers a positive result was not obtained. We suggested a different response to CS2 exposure between two ethnic populations. We had an opportunity to do a cross-sectional medical and occupational hygiene survey in a Chinese rayon staple plant. Cross-sectional medical examinations failed to show any chronic CS2 effects on the Chinese workers.

[On the fenestration of the vertebral and basilar arteries]

The fenestration of the vertebral and basilar arteries was investigated macroscopically in 370 human cases. Altogether 43 fenestrations were found in 32 (8.6%) out of 370 cases. The fenestrations could be divided in three groups according to the position where the fenestration appeared. Group I was the fenestration observed along the vertebral artery (Fig. 1), and 7 such fenestrations were found in 6 (1.6%) out of 370 cases; 3 fenestrations among them were located on the right side, 2 were located on the left side and 1 was found on the bilateral vertebral arteries. In 4 out of 7 fenestrations in this group, the hypoglossal nerve was found passing through the fenestration. Group II was the fenestration observed along the basilar artery (Fig. 2), and 26 fenestrations of this type were found in 20 (5.4%) out of 370 cases: 23 fenestrations (88.5%) were located at the caudal half, 3 (11.5%) were located on the rostral half of the basilar artery (Fig. 5). A close relation was indicated between the side on which the fenestration appeared in the basilar artery and the largeness in caliber of the vertebral artery of either side. Group III was the fenestration observed at the lateral area of the vertebral and basilar arteries (Fig. 3), and 10 fenestrations of this type were found in 9 (2.4%) out of 370 cases; all the fenestrations were located on the right side. In this group, the hypoglossal nerve was observed passing through the fenestratin in 4 out of the 10 fenestrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Behaviour of tissue plasminogen activator, plasminogen activator inhibitor 1 and their complex in various disease states

Plasma levels of tissue plasminogen activator (t-PA) antigen, plasminogen activator inhibitor 1 (PAI-1) antigen and t-PA/PAI-1 complex were measured in plasmas from 18 healthy subjects and 75 patients with various diseases (28 patients with haematological malignancies, 20 with thrombotic diseases, five with infectious diseases, four with liver diseases, ten with bleeding disorders and eight miscellaneous conditions). In addition, we studied ten patients with bleeding disorders after DDAVP infusion and 18 healthy subjects after venous occlusion. Plasma levels of t-PA antigen, PAI-1 antigen and t-PA/PAI-1 complex were increased in the patients compared with the healthy subjects. t-PA/PAI-1 complex levels correlated well with t-PA antigen levels and molar concentrations of t-PA antigen were similar to those of the t-PA/PAI-1 complex. Venous occlusion induced an increase in both t-PA antigen and PAI-1 antigen and the molar concentration of the t-PA/PAI-1 complex was equivalent to that of t-PA antigen. Following DDAVP infusion, the levels of t-PA antigen and t-PA/PAI-1 complex increased but PAI-1 antigen levels decreased, and the increase of t-PA antigen was greater than that of t-PA/PAI-1 complex. These findings indicate that PAI-1 antigen exceeds t-PA antigen in healthy subjects and in patients with various diseases. We conclude that part of the t-PA/PAI-1 complex is rapidly cleared from the circulation and that free t-PA increases after DDAVP infusion.

Intracranial seeding following surgery for spinal cord astrocytoma--case report

We report a case of intracranial dissemination developing approximately 6 months after partial removal of a spinal cord astrocytoma in a 40-year-old male. The clinical course and postmortem findings indicate that the tumor originated in the cervical cord and extended into the subarachnoid space, first the spinal canal and later intracranially. Spinal cord glioma dissemination through the cerebrospinal fluid is more common than previously considered and indicates a dismal prognosis. An aggressive approach, including radical surgery, entire neuraxis irradiation, and adjuvant chemotherapy, is suggested as the initial treatment for malignant spinal cord glioma to prevent subsequent dissemination.

[Discrepancy between 123I-IMP SPECT and X-ray CT in chronic cerebrovascular disease]

The discrepancy between the low accumulation area (LAA) seen on 123I-IMP SPECT and the low density area (LDA) on X-ray CT was evaluated in 76 cases with chronic cerebrovascular disease. In 19 patients, LAA was larger than LDA beyond the vascular territory. Brain angiogram showed either obstruction or stenosis of the major arteries in as many as 59 percentages of this discrepancy group. In many patients of this group, cortical neurological symptoms were observed. In 37 patients in which the size of LAA was equal to that of LDA, abnormality of the major arteries was observed in only 7 percentages. These results indicated that the discrepancy mainly reflected the infarction due to irreversible ischemic change of perforate artery with the cortical low perfusion caused by the major artery disease. In some patients, the discrepancy was believed to show the remote effect caused by neurological pathway disturbance.

Inhibition of vascular permeability factor production by ciclosporin in minimal change nephrotic syndrome

In order to ascertain whether ciclosporin (Cs) has an inhibitory effect on the vascular permeability factor (VPF) production, various quantities of Cs were added to T lymphocyte cultures from 8 children with minimal change nephrotic syndrome (MCNS) and the VPF activity of culture supernatants was assayed. As a result of the addition of Cs, a dose-dependent inhibition of VPF production was seen. VPF production was inhibited by a level of between 100 and 250 ng/ml of Cs in vitro. The reduction of proteinuria by Cs in MCNS might be due to the inhibition of VPF production.

Primary intracranial amelanotic melanoma--report of an autopsy case

Primary intracranial amelanotic melanoma was verified at autopsy in a 38-year-old male. Correct diagnosis of amelanotic melanoma needs electron microscopy or immunohistochemistry, since Masson staining is negative due to the absence of melanin pigment. We adopted the following criteria for clinical use: macroscopically not dark and microscopically negative for Masson staining, but ultrastructurally various melanoma types present. Although the clinical profile of this case is consistent with melanotic melanoma, the more detailed features of primary intracranial amelanotic melanoma require future study.

Primary endodermal sinus (yolk sac) tumor of the anterior mediastinum: a report of a successfully treated eleven-year-old boy

An asymptomatic 11-year-old Japanese boy with an endodermal sinus (yolk sac) tumor of the anterior mediastinum was successfully treated with cisplatinum-based combination chemotherapy and subsequent surgical excision. The patient is alive and in good health 60 months from diagnosis.

Taxonomic properties of five Kitasatosporia strains isolated by a new method

Kitasatosporia strains were found to be resistant to an antibiotic, novobiocin. By a new method using novobiocin-containing agar medium, five Kitasatosporia strains, SK-3255, OM-5023, SK-3406, SK-3412 and SK-3421 were efficiently isolated from soils. These five strains were characterized in common by Rectiflexibiles, spores cylindrical with smooth surfaces, and no melanin formation. Two strains, SK-3255 and OM-5023 were taxonomically different from known species of the genus Kitasatosporia, while the two strains, SK-3406 and SK-3412 and the remaining strains SK-3421 were identified with K. phosalacinea and K. papulosa, respectively.

[Combination cancer chemotherapy using a DNA topoisomerase inhibitor CPT-11, as a core agent--the in vitro evaluation]

CPT-11, a derivative of camptothecin, has drawn attention to cancer chemotherapy because of the specific mode of action, and the clinical study is now under progress. Liu et al. proved that camptothecin was a DNA topoisomerase I inhibitor, and some kinds of antitumor agents have been recognized as DNA topoisomerase II inhibitors. Based on these findings, DNA topoisomerases have emerged as target enzymes of antitumor agents in cancer chemotherapy. This paper dealt with investigation on the cytotoxic effects induced by combined use of DNA topoisomerase targeting antitumor agents, especially using CPT-11 as a core antitumor agent. Synchronous administration of CPT-11 with other antitumor agents induced cytotoxic effects less than metachronous administration of CPT-11 with other antitumor agents, especially preceding use of CPT-11. Dose of antitumor agents was not necessarily correlated to the cytotoxic effects. In some instances, small doses of the agents showed better therapeutic effects than large doses. The cytotoxic effects of vincristine, vindesine, and hydroxyurea were reduced by combination with CPT-11. On the other hand, non-cytotoxic agents such as aphidicolin, novobiocin, propentofylline, pentoxifylline, norfloxacin, and tosufloxacin enhanced the cytotoxic effects of CPT-11. Hypothetical consideration of cell killing and acquisition of drug resistance was proposed.

Lipid peroxidation and concentration of glutathione in erythrocytes from workers exposed to lead

Lipoperoxide concentration in erythrocytes from workers occupationally exposed to lead (mean blood lead concentration 57.1 (SD 17.6) micrograms/dl) was significantly higher than that in controls. It was not different in plasma from the two groups. The activity of superoxide dismutase (SOD) and catalase in erythrocytes from workers exposed to lead was significantly lower than that of control subjects. The effect of lead was also seen in the glutathione concentration of erythrocytes from lead exposed workers, which was reduced to 69% of that found in erythrocytes from control workers. The increase in methaemoglobin content of erythrocytes from workers exposed to lead was less than expected and not significantly different from that of controls. A positive correlation between lipoperoxide concentration in erythrocytes and lead concentration in blood and a negative correlation between glutathione concentration in erythrocytes and blood lead concentration were found. Incubation of erythrocytes for 24 hours at 37 degrees C in the presence of lead (100 micrograms/dl) produced no changes in glutathione and lipoperoxide concentrations, although there was inhibition of activity of SOD (14.3%), catalase (10.1%), and glutathione peroxidase (35.1%). A similar experiment with heparinised whole blood showed increased haemolysis with no changes in membrane lipid peroxidation of erythrocytes. It is postulated that the lowered concentration of glutathione and decreased activity of SOD, catalase, and glutathione peroxidase in erythrocytes from workers exposed to lead may play a part in the increased membrane lipid peroxidation. Furthermore, the results suggest the possibility that leucocytes, or platelets, or both, may induce haemolysis in the presence of lead.

Recovery functions of fast frequency potentials in the initial negative wave of median SEP

Following far-field potential of P14 after median nerve stimulation, we identified several small wavelets, designated here as fast frequency potentials or FFP, over the ascending and descending phases of the major negative wave of 'N20.' In 10 normal subjects who had well defined FFP, namely N16, N17, N18 and N19, we studied recovery functions of FFP by applying paired (condition and test) stimuli of various interstimulus intervals (ISIs) ranging from 3 to 150 msec. Recovery of FFP was determined by the difference wave forms, i.e., subtracting the response of conditioning stimuli from the response to paired stimuli. Measuring latencies and amplitude of FFP and also of the far-field potential of P14, we found recoveries of P14 and each FFP to be different; P14 recovered with the shortest ISI while progressively longer ISIs were required for full recovery of the later FFP. This finding suggests the existence of progressively increased number of interspersed synapses from the early to late FFP. It is unlikely that FFP represents passage of the afferent volley from one anatomical site to the next, but rather that they are cortically generated via a closely situated polysynaptic network. The polysynaptic nature of FFP is consistent with the observation that they disappear in sleep and also during anesthesia. The study indicates that FFPs represent different physioanatomical systems from the primary negative wave of 'N20' that results from specific sensory input to the primary sensory cortex.

[Catheter-in-catheter replacement technique for bronchial arterial continuous infusion therapy for pulmonary malignancies]

The purpose of this study was to improve tumor effects and to reduce side effects caused by one shot bronchial arterial infusion therapy for pulmonary malignancies. The catheter-in catheter replacement technique in proper bronchial artery was introduced for infusion therapy for several hours for this purpose. Three kinds of combination of catheters were selected and the duration of replacement in bronchial artery was either eight or 24 hours. In eight patients of 12 patients with pulmonary malignancies superselective bronchial arterial infusion was carried out through the inner small catheter. No significant complications developed either at the time of replacement or during continuous infusion.

Evaluation of methyl bromide exposure on the plant quarantine fumigators by environmental and biological monitoring

The study was undertaken to assess the potential risk of exposure to methyl bromide (MB) gas of plant quarantine fumigators who wore full facepiece gas masks with respirator canisters. The mean ambient concentrations of MB determined by a personal sampling device exceeded the TLV-ACGIH level of 5 ppm in the degassing processes at three fumigation sites except at the silos. The mean urinary bromine concentration of 379 non-MB workers was 6.3 +/- 2.5 mg/l with 95% confidence limits of 10 mg/l. There were 44.6% of 251 MB workers whose urinary bromine levels exceeded the 10 mg/l. There was a significantly positive correlation between the urinary bromine concentrations of the MB workers and the ambient MB concentrations in the degassing process. The MB levels in the workers' exhalation were positive in the degassing process, while those were below the detection limit in the dispersion process. Three possible routes through which the workers are exposed to MB gas are considered to exist: leakage through the interstice between the facepiece of a gas mask and the wearer's face, breakthrough of MB gas in the respirator canister, and percutaneous absorption of MB gas. Biological monitoring of urinary bromine and exhalatory MB as well as environmental monitoring of the ambient MB provided useful information for evaluating exposure of workers to MB.

Uptake of lead by human red blood cells and intracellular distribution

Lead added to plasma was rapidly incorporated into suspended human red blood cells at 37 degrees C. The rate of lead uptake into the cells reached a maximum of 35 micrograms (0.17 mumole)/10(10) cells/h. The rate of lead uptake with resealed ghosts was comparable to that of intact cells. These findings indicate that the transport of lead across the erythrocyte membrane is, energy-independent, carrier-mediated passive transport, which confirms the conclusion of Simons. On the other hand, little release of incorporated lead from the cells in lead-free plasma was observed. Some 98% of intracellular lead was in cytoplasm, mostly in protein-bound form, and only 2% was in the membrane fraction. When red blood cells were incubated in plasma containing lead at about 10 mg/dl concentration for 24 hours at 37 degrees C, no progressive accumulation of lead and protein in the membrane fraction was observed. Thus, lead-protein complexes in cytosol are unlikely to associate with membranes. Human haemoglobin had forty-five binding sites for lead with the dissociation constant of 0.5 x 10(-6) M. The binding of lead to oxyhaemoglobin did not show any effect on the iron atom in the heme.

[Two cases of brain infarction associated with hypertriglyceridemia]

We reported two cases of brain infarction. They were cousins. Case 1 was a 12-year-old girl, who complained of aphasia, dyscalculia, right-left disorientation and right homonymous hemianopsia. CT showed low density areas in left superior and middle temporal gyri. Case 2 was a 15-year-old boy, who had left hemiplegia and hypesthesia to pain, temperature and touch on the left side of the body. CT showed low density areas from the genu of the internal capsule to the corona radiata, and from the posterior portion of putamen to the posterior limb of the internal capsule on the right side. Both cases had hypertriglyceridemia which might be associated with the etiology of infarction.