Direct enzymatic assay of urinary sulfated bile acids to replace serum bilirubin testing for selective screening of neonatal cholestasis

Direct enzymatic assay of urinary sulfated bile acids is a sensitive, rapid, minimally invasive, and convenient method of detecting cholestasis in young infants. It may replace measurement of serum direct bilirubin for selective screening for biliary atresia and neonatal hepatitis syndrome at 1 month of age.

Geographic population structure and sequence divergence in the mitochondrial DNA control region of the Japanese wild boar (Sus scrofa leucomystax), with reference to those of domestic pigs

Mitochondrial DNA (mtDNA) control regions from 40 Japanese wild boars were examined by direct sequencing after amplification by PCR. From the DNA sequences obtained, we found eight haplotypes, whose differences arose via transitions. The geographical distribution of these different haplotypes indicated that wild boar populations inhabited limited areas and that there was some restricted gene flow between local populations. Eight mtDNA haplotypes from Eastern and Western domestic pigs and the Ryukyu wild boar were also analyzed as references to those from Japanese wild boars. The cluster analyses of the control-region sequences showed that those from Japanese wild boars belong to the Asian type as do those from Eastern domestic pigs and the Ryukyu wild boar, which differed from the European type (Western domestic pigs).

Painless thyroiditis occurring during long-term treatment with interferon alfa in a patient with chronic active hepatitis C

We describe here painless thyroiditis during interferon (IFN) therapy in a 65-year-old man with chronic active hepatitis C. The patient had hypothyroidism in the late stage of a 24-week course of treatment with IFN-alpha. After cessation of the treatment a small, firm goiter was noticed, and chronic focal thyroiditis was diagnosed histologically. Analyses of the stock serum samples drawn before, during, and after IFN-alpha therapy revealed transient hyperthyroidism followed by transient hypothyroid states with aggravation of antithyroid hormone antibody titers. These findings suggest that long-term IFN-alpha therapy caused painless thyroiditis with aggravation of autoimmunity in our patient with preexisting chronic thyroiditis.

Hyperreninemia, hypertension, and congestive heart failure in focal interstitial nephritis

Hyperreninemia probably due to focal interstitial nephritis of the right kidney caused an acute onset of hypertension and cardiac dysfunction including valvular insufficiency in a 5-year-old boy. This congestive heart failure in association with valvular insufficiency and hypertension was dramatically improved following right nephrectomy. Abruptly activated renin-angiotensin II may lead to congestive heart failure and valvular dysfunction without myocardial hypertrophy in a young heart.

Calculation models for average stress and plastic deformation zone size of bonding area in dentine bonding systems

Average stress during shear bond testing, and deformation behaviour during nano-indentation testing were calculated for the bonding area as a bonding site for copolymerization with resin composite in dentine bonding systems. First average stress was calculated in the bonding area between bovine dentine and composite resin. Secondly, the plastic deformation zone size was calculated using an elastic/plastic deformation zone model after a nano-indentation test. The result clearly showed that average stress depended upon the elasticity of the bonding area, the elasticity value ratio of the composite resin-to-bonding area, and interfacial stress between the dentine and the adhesive resin. In this bonding area, the elasticity/hardness ratio changed depending on the thickness of the bonding area as well as the plastic deformation zone size (b), expressed as a (b/2a)-value (indented triangular length (2a) at nano-indentation test) expanded with increasing the elasticity value.

Neuroendocrine tumors of the liver and pancreas associated with elevated serum prostatic acid phosphatase

A 58-year-old man was revealed to have multiple liver tumors with elevated prostatic acid phosphatase (PAP) during a medical examination. The tumors were of neuroendocrine nature, but no abnormal findings were obtained in other organs in which neuroendocrine tumors develop frequently. Repeated transarterial embolization was partially effective. However, the tumors became resistant to the therapy three years later, continued growing and ruptured. Autopsy disclosed neuroendocrine tumors in the pancreas, which were immunohistologically positive for PAP. Neuroendocrine tumors of the pancreas and liver producing PAP are rare; this case is reported with a review of literature.

Simultaneous determination of citalopram and its metabolites by high-performance liquid chromatography with column switching and fluorescence detection by direct plasma injection

High-performance liquid chromatography with a successive column-switching technique was developed for simultaneous determination of citalopram and its four metabolites in plasma. Plasma samples were injected directly, and the target compounds were purified and concentrated with an inexpensive commercial octadecyl guard column. Then, the six-port valve was switched, and the compounds retained in the column were eluted by the back-flush method using 20 mM phosphate buffer (pH 4.6)-acetonitrile (70:30, v/v) containing 0.1% diethylamine and separated with an ODS column. The compounds were assayed with a fluorescence detector at an excitation wavelength of 249 nm and an emission wavelength of 302 nm. At least 30 plasma samples could be treated with an octadecyl guard column. The limits of quantitation of this method were 2.0 ng/ml for citalopram, desmethylcitalopram, didesmethylcitalopram, citalopram propionic acid and citalopram N-oxide. This method was applied to a pharmacokinetic study in dogs and a toxicokinetic study in rats.

Use of prostaglandin I2 analog in treatment of massive hepatic necrosis associated with endothelial cell injury and diffuse sinusoidal fibrin deposition

Endothelial cell damage causes massive hepatic necrosis as a result of fibrin deposition in the hepatic sinusoids. When a stable analog of prostaglandin I2, beraprost sodium, was administered to rats given either dimethylnitrosamine, carbon tetrachloride, or endotoxin following Corynebacterium parvum administration, the hepatic necrosis produced in each was attenuated, but to a greater extent in the dimethylnitrosamine and endotoxin/Corynebacterium parvum models, where fibrin deposition in the hepatic sinusoids occurs, as compared to the carbon tetrachloride model, where such fibrin deposition does not occur. Beraprost sodium reduced the expected increase of portal venous pressure in the endotoxin/Corynebacterium parvum model without affecting plasma thrombin-antithrombin III complex levels. Beraprost sodium also significantly reduced cell killing of both isolated rat hepatocytes and hepatic sinusoidal endothelial cells exposed to tert-butyl hydroperoxide when compared to controls. Beraprost sodium could prove to be a therapeutic candidate for the treatment of hepatic necrosis, particularly in cases associated with fibrin deposition in the hepatic sinusoids because of its fibrin clot-clearing action.

Reversible hyperkalemia during antihypertensive therapy in a hypertensive diabetic patient with latent hypoaldosteronism and mild renal failure

A 66-year-old hypertensive diabetic patient with latent hypoaldosteronism and mild renal failure was treated by adding enalapril, an angiotensin converting enzyme inhibitor, to the furosemide and nifedipine regimen because of an insufficient antihypertensive response for 1 month. Seven days after enalapril addition, the blood pressure was significantly reduced, but frank hyperkalemia occurred with a marked rise in BUN and a slight increase in serum creatinine. Plasma renin activity (PRA) and plasma aldosterone (PA) values remained low before and during enalapril therapy. Transient treatment with sodium polystyrene sulfate after enalapril withdrawal improved the hyperkalemia and renal function, but PRA and PA levels were low. PA and its precursor steroids also responded poorly to graded angiotensin II infusion and rapid ACTH injection. Latent hypoaldosteronism probably predisposed this patient to frank hyperkalemia with progressive dehydration and slightly reduced renal function during antihypertensive therapy.

Factor IX Bm Kiryu: a Val-313-to-Asp substitution in the catalytic domain results in loss of function due to a conformational change of the surface loop: evidence obtained by chimaeric modelling

Factor IX Kiryu is a naturally occurring mutant of factor IX that has 2.5% coagulant activity, even though normal plasma levels of factor IX antigen are detected. Factor IX Kiryu was purified from a patient's plasma by immunoaffinity chromatography with a calcium-dependent anti-factor IX monoclonal antibody column. It was cleaved normally by factor XIa in the presence of Ca2+, yielding a two-chain factor IXa. However, the resulting factor IXa showed only 1.5% of the normal factor IXa in terms of factor X activation in the presence of factor VIII, phospholipids, and Ca2+, and had 20% of the normal esterase activity for Z-Arg-p-nitrobenzyl ester. Therefore factor IXa Kiryu showed the defect of the catalytic triad or primary substrate binding site as well as defective interaction with factors VIII/X. Single-strand conformational polymorphism analysis and DNA sequencing of the amplified DNA revealed a missense point mutation, a T-to-A substitution at nucleotide number 31,059 of the factor IX Kiryu gene. This mutation resulted in the amino acid substitution of Val-313 by Asp in the catalytic domain. Restriction enzyme analysis of the amplified DNA showed that the mutation was inherited from the patient's mother. The chimaeric method was employed to construct a model of the serine protease domain of factor IXa, and the resultant model suggested that the Val-313 to Asp substitution altered the conformation of the substrate-binding site. These data combined with our previous findings on a Gly-311-to-Glu mutant of factor IX suggest that the loop conformation from Gly-311 to ARg-318 is important for the expression of coagulant activity.

Hepatic calcification in an anicteric patient with biliary atresia after hepatic portoenterostomy

Hepatic calcification was found in an anicteric infant with biliary atresia after hepatic portoenterostomy. When she was 2 years of age, ultrasonography detected an echogenic structure with acoustic shadowing. Computerized tomography located it at the proximal portion of Segment 6 in the right lobe. Although both techniques failed to exhibit dilatation of the peripheral bile ducts, we believe intrahepatic cholelithiasis provides the most likely diagnosis. Although seven cases with biliary atresia were reported to have this complication, all of them were icteric when the diagnosis was confirmed. The patient should be carefully followed up since the succeeding stones may cause jaundice by obstructing the main duct.

Effects of perindopril on glucose and lipid metabolism in patients with mild-to-moderate essential hypertension and glucose intolerance

The effect of perindopril, an angiotensin-converting enzyme inhibitor, on glucose and lipid metabolism was evaluated in 12 patients with mild-to-moderate essential hypertension and glucose intolerance. Perindopril was administered at a dosage of 2 to 8 mg once daily for 12 weeks. Both the systolic and diastolic blood pressures were significantly reduced throughout the treatment period. There were no significant changes in the insulinogenic index (delta plasma immunoreactive insulin/delta plasma glucose) calculated from the results of 75-g oral glucose tolerance tests performed before and after perindopril treatment. Serum levels of glycosylated hemoglobin, fructosamine, lipids, lipoproteins, and apolipoproteins were also not affected. These results suggest that perindopril can be used effectively to treat hypertension in patients with glucose intolerance without affecting glucose and lipid metabolism.

Transmission of hepatitis C virus from mothers to infants. The Vertical Transmission of Hepatitis C Virus Collaborative Study Group

BACKGROUND

Although there are case reports of vertical transmission of hepatitis C virus (HCV), it remains uncertain to what extent infected mothers transmit this virus to their infants.

METHODS

We investigated the transmission of HCV from infected mothers to their babies by analyzing HCV RNA in the blood. Three independent studies were performed. First, 7698 parturient women were tested for anti-HCV antibodies; 53 were positive. Their 54 infants (including one set of twins) were followed prospectively for at least six months and tested for HCV disease were prospectively studied. Third, the families of three HCV-infected infants were examined retrospectively.

RESULTS

Of the 53 antibody-positive mothers, 31 were also positive for serum HCV RNA: Three of the 54 babies born to these mothers (5.6 percent) became positive for HCV RNA during the follow-up period. None of the babies of the 22 women who were antibody-positive but HCV RNA-negative became positive for HCV RNA: In the second study, HCV RNA was detected in one of the six infants of infected mothers. In the third study, HCV RNA was detected in the mothers of the three HCV-infected infants. In each of the seven infected infants we studied, the genomic sequence of HCV was almost identical to that from the mother. These seven mothers had significantly higher titers of HCV RNA than did the mothers of infants with no evidence of infection (mean [+/- SD], 10(6.4 +/- 0.5) vs. 10(4.4 +/- 1.5) per milliliter; P < 0.001).

CONCLUSIONS

HCV is vertically transmitted from mother to infant, and the risk of transmission is correlated with the titer of HCV RNA in the mother.

Protective action of putrescine against rat liver injury

The hepatoprotective action of orally dosed putrescine was investigated using rat models of liver injury. When rats received putrescine orally soon after a dose of carbon tetrachloride or D-galactosamine, deranged serum alanine aminotransferase values and prothrombin times were significantly attenuated compared with control levels, with improved histologic extent of liver injury. Putrescine addition to the medium of rat hepatocytes in primary culture reduced cell killing induced by D-galactosamine or the membrane detergents chenodeoxycholic acid and Triton X-100. Similar reduction was seen in cells exposed to tert-butyl hydroperoxide (TBHP), an agent producing cell death through lipid peroxidation, with attenuation of cellular malondialdehyde content. Putrescine also significantly attenuated the extent of increased plasma membrane microviscosity as assessed with 1-[4-(trimethylammonio)phenyl]-6-phenyl-1,3,5-hexatriene in TBHP-treated cells. These results suggest that orally given putrescine protects against liver injury. Plasma membrane stabilization and reduction of lipid peroxidation may contribute to this hepatoprotection.

Radioimmunoassay of conjugated 1 beta-hydroxycholic acid in dried blood spots for diagnosis of congenital biliary atresia

Radioimmunological measurement of conjugated 1 beta-hydroxycholic acid in dried blood spots obtained from newborns at 4-5 d after birth has been carried out to investigate a diagnostic utility for congenital biliary atresia. The method allowed the determination of this bile acid, with a detection limit of 50 pg in one disc (3 mm i.d.), and showed good reproducibility with inter- and intra-assay coefficients with variations of 3.5-7.7% and 6.3-8.8%. With the analysis, a relatively high concentration of this substance was observed in the patients, as compared to normal subjects, averaging 1.63 ng/disc in the former and 0.97 ng/disc in the latter.

Electrolyte disturbances caused by intravenous contrast media

The changes in serum electrolytes (sodium, potassium, ionized calcium, and total calcium) produced by high-dose (3 ml/kg) intravenous contrast media were investigated in Japanese white rabbits. The test solutions included sodium/meglumine diatrizoate (370 mgI/ml), sodium/meglumine ioxaglate (320 mgI/ml), iohexol (350 mgI/ml), iopamidol (370 mgI/ml), 20% mannitol, and isotonic saline. The alterations in serum ionized calcium were relatively small and transient, and correlated with changes in the hematocrit. Diatrizoate caused a significant decrease in ionized calcium in comparison with other contrast media and mannitol. The ratio of ionized calcium to total calcium showed no significant decrease in any group. The changes in potassium did not correlate with those in hematocrit. Diatrizoate caused a smaller decrease in potassium than low-osmolality contrast media, which may suggest that diatrizoate caused a shift in potassium from extravascular space to intravascular space. In conclusion, intravenous infusion of high doses of low-osmolality contrast media did not cause clinically significant alterations in serum electrolytes.

Mutations within the S gene of hepatitis B virus transmitted from mothers to babies immunized with hepatitis B immune globulin and vaccine

A variant of hepatitis B virus (HBV) having a specific mutation within the S gene has been found to infect vaccinees. To know whether similar variants were involved in Japan, we analyzed two cases of maternal transmission of HBV in infants immunized with hepatitis B immune globulin and hepatitis B vaccine. DNA clones of HBV S genes were propagated from patients and family members and sequenced. In one family, the DNA clones from the baby patient had a Gly-to-Arg mutation at the 145th codon of the S gene, whereas those from her mother had no such mutations. In the other family, all the DNA clones obtained from the two infected children had the 145th codon intact, but they had a missense mutation at the 126th codon of the S gene, causing an amino acid substitution of Asn for Thr or Ile. This same mutation was observed in 12 of 17 clones of DNA obtained from their mother. In comparison with the wild type HBV-derived hepatitis B surface antigen, the two types of S gene mutations, either at the 145th or the 126th codon, were associated with a significant decrease in the antigenicity of some determinants on the hepatitis B surface antigen, measured by MAb. Amino acid substitution at these sites, therefore, would have induced the escape from conventional vaccines that were S gene products of wild type HBV and also from hepatitis B immune globulin, whose main components were probably also antibodies against the S gene products expressed by wild type HBV.

Bronchial artery embolization for hemoptysis: immediate and long-term results

The purpose of this study was to evaluate the immediate and long-term results in 63 patients who underwent transarterial embolization for control of hemoptysis. Overall immediate success rate was 86.1%. At long-term follow-up 50% of patients showed complete remission, 22% partial remission, and 28% recurrent hemoptysis. Hemoptysis remained controlled for a mean of 22 months and a median of 14 months. The long-term results among four disease groups differed substantially. Patients with bronchiectasis showed the best results, followed by those with idiopathic disease and with inflammation; patients with neoplasm showed the worst results.

In situ detection of oxidative stress in rat hepatocytes

In rat hepatocytes in primary culture incubated with nitro blue tetrazolium, formazan content was increased by addition of t-butyl hydroperoxide, a potent oxidant, in a dose-related manner, but not by addition of valinomycin, which kills hepatocytes through mitochondrial damage. This increment after t-butyl hydroperoxide addition was not seen in hepatocytes preincubated with deferoxamine mesylate, a ferric iron chelator which inhibits radical formation. Liver perfusion with nitro blue tetrazolium and t-butyl hydroperoxide in rats produced formazan deposition faintly on the surface of hepatocytes throughout the liver and prominently in the cytoplasm of some hepatocytes, which was attenuated when performed following deferoxamine mesylate perfusion. When liver perfusion with nitro blue tetrazolium was performed in carbon tetrachloride-intoxicated rats, formazan deposition appeared diffusely in hepatocytes in the centrilobular areas. Similar deposition was also observed on the surface and in the cytoplasm of hepatocytes in the periportal and mid-zonal areas in rats undergoing post-ischaemic reperfusion. Liver perfusion with nitro blue tetrazolium can detect in situ oxidative stress in hepatocytes and may be a useful tool for studying the role of lipid peroxidation in rat liver injury.

Identification of rat cDNA encoding hck tyrosine kinase from megakaryocytes

A rat homologue of hck tyrosine kinase cDNA from a rat megakaryocyte library contains 1911 nucleotides with an open reading frame encoding 503 amino acids. The rat hck had distinct amino acid residues from the mouse homologue exhibiting 97.6% identity. The sequence contains the SH2 and SH3 regions that interact with cytoplasmic signaling proteins, the kinase domain including the nucleotide binding site and the autophosphorylation site, and the C-terminal Tyr-499 known as a negative regulator.

Thrombin induces a biphasic 1,2-diacylglycerol production in human platelets

The 1,2-diacylglycerol (DAG) mass content was measured in thrombin-stimulated human platelets. Thrombin stimulates a biphasic accumulation of DAG, with an early phase reaching a peak at 10 s and a later phase reaching a peak at 2-3 min. The time course of first-phase DAG production corresponded well to that of Ins(1,4,5)P3 formation, which was rapid and transient. The second phase of DAG accumulation occurred after the level of Ins(1,4,5)P3 returned to nearly basal. Thrombin stimulated the decrease in PtdIns and phosphatidylcholine contents. The source of second-phase DAG was examined in platelets prelabelled with three radioactive fatty acids, i.e. arachidonic, palmitic and myristic. Thrombin stimulated the increase in radioactivity of DAG with decline of PtdIns in platelets labelled with [3H]arachidonic acid or [3H]palmitic acid, in which PtdIns was considerably labelled. In contrast, significant accumulation of [3H]DAG was not observed in [3H]myristic acid-labelled platelets, in which PtdIns was poorly labelled. In platelets prelabelled with [3H]inositol, an increase in InsP in response to thrombin was seen for more than 5 min. In contrast, upon stimulation, significant increases in [3H]phosphocholine and [3H]choline were not observed in [methyl-3H]choline-labelled platelets. Thrombin induced a small production of phosphatidylethanol, when ethanol was present during stimulation. However, the formation of DAG and phosphatidic acid was not significantly affected by ethanol. These results suggest that thrombin stimulates a biphasic accumulation of DAG, initially from PtdInsP2 and later from PtdIns in human platelets.

Hepatic cell necrosis with congenital heart disease in the newborn

Hepatic cell necrosis is a recognized complication of circulatory failure. Histological examination of the adult liver in such cases reveals centrilobular necrosis and hepatic congestion. Two cases of hepatic cell necrosis in infancy are reported: a four-day-old girl with the hypoplastic left heart syndrome, and a nine-day-old girl with interruption of the aortic arch. In the former, midzonal hepatic necrosis (and not centrilobular necrosis) was demonstrated at autopsy. Both patients exhibited severe hepatic insufficiency, but hepatic function improved rapidly with treatment of the coexistent heart failure. It is suggested that there is milder form of hepatic cell necrosis than that previously reported in autopsies.

Ultrasonographic findings and management of intrahepatic biliary tract abnormalities after portoenterostomy

Ultrasonographic examinations was made in 24 children who had undergone a portenterostomy to correct extrahepatic biliary atresia. Abnormalities were observed in six patients. These were the result of ongoing inflammatory reactions because all had been suffering from cholangitis after surgery, and the size of the biliary tract structure changed in accordance with the occurrence and subsidence of the cholangitis. Ultrasonographic examination showed dilation of the intrahepatic bile duct in one patient and cystic lesions in five patients. Treatment included percutaneous transhepatic bile drainage for dilated bile ducts, alcohol injections for intrahepatic cysts, and reoperation for cysts in the porta hepatis. Treatment was not required for cysts in controllable cholangitis. The results of these approaches were excellent, indicating that they were of benefit in treatment intrahepatic abnormalities occurring after portoenterostomy.

Effects of the diamond grit sizes of the commercial dental diamond points on the weight-load cutting of bovine enamel and glass-ceramic Typodont teeth

To evaluate the effect of the diamond grit size of commercial dental diamond points on the dental cutting, we conducted weight-load cutting tests on bovine enamel and glass-ceramic typodont teeth using 3 different diamond grit sizes and air-bearing and ball-bearing air-turbine driven handpieces. With the transverse load applied on the diamond point varied between 20 and 80 g, we measured rotational cutting speed and cutting volume. Generally, increases in applied load caused decreases in rotational cutting speed and increases in cutting volume. The intensity of this trend, however, differed between grit sizes. Regular grit diamond points most strongly showed this tendency, while super-fine grit diamond points were least affected. Fine grit diamond points behaved in a manner similar to regular grit points.

Studies on fracture toughness of dental ceramics

One important mechanical property of dental ceramics is fracture toughness, KIC, which represents the serviceability in the oral cavity, such as the resistance to marginal fracture. KIC values of several dental ceramics, natural tooth enamel and industrial ceramics were examined by use of the indentation microfracture (IM) method. This technique was based on the series of radial cracks emanating from the corners of the Vickers indentation. It was observed that appropriate load levels should be selected on each specimen to induce radial/median cracks. For feldspatic dental porcelains, larger loads of 10, 20 and 30 kg were needed to determine their KIC values in the range 1.5-2.1 MN.m-3/2. For natural tooth enamel and a new apatite-based castable glass-ceramic, a smaller force of 1 kg was sufficient to decide the respective KIC values of about 0.9 and 1.8 MN.m-3/2. The KIC values of most dental ceramics examined were slightly higher than that of soda lime glass, but less than one-third that of zirconia. It was confirmed that the IM method is simple and cost-effective for evaluation of KIC of dental ceramics.

Inhibition of nociceptive responses of wide-dynamic-range neurons by peripheral nerve stimulation

Of 107 neurons from the sacral and coccygeal levels of the spinal cord in anesthetized intact rats examined, 62 wide-dynamic-range (WDR) neurons that responded to noxious heating of the tail were recorded. On the basis of their inhibitory responses through A-beta or A-delta afferent fibers to noxious stimulation, these neurons were classified into one of the following three types: Type I--neurons inhibited only by A-beta afferent nerve impulses; Type II--neurons inhibited only by A-delta afferent nerve impulses; Type III--neurons inhibited by both. The present results are compared with previously reported behavioral results.

Dental cutting behaviour of mica-based and apatite-based machinable glass-ceramics

Some recently developed industrial ceramics have excellent machinability properties. The objective of this study was to evaluate the dental cutting behaviour of two machinable glass-ceramics, mica-containing Macor-M and apatite- and diopside-containing Bioram-M, and to compare them with the cutting behaviour of a composite resin typodont tooth enamel and bovine enamel. Weight-load cutting tests were conducted, using a diamond point driven by an air-turbine handpiece, While the transverse load applied on the point was varied, the handpiece speed during cutting and the volume of removal upon cutting were measured. In general, an increase in the applied load caused a decrease in cutting speed and an increase in cutting volume. However, the intensity of this trend was found to differ between four workpieces. Cutting Macor-M resulted in the second-most reduced cutting speed and the maximum cutting volume. Cutting Bioram-M gave the least reduced cutting speed and the minimum cutting volume. It was suggested that two machinable glass-ceramics could be employed as typodont teeth. This study may also contribute to the development of new restorative dental ceramic materials, prepared by machining.

[Studies on the roentgenological differentiation between complex and simple bowel obstruction]

We studied 81 cases of organic bowel obstruction. In complex obstruction 7 cases out of 25 (28%) were diagnosed on the plain film before operation, although in simple obstruction 54 cases out of 56 (96%). But in retrospective evaluation of the plain films, we noticed that in some cases of complex obstruction, marked small bowel obstruction and ascites were seen from the onset, which were never seen in simple obstruction. We considered this finding as the key point for the roentgenological differentiation between complex and simple obstruction.

[Fever of unknown origin: re-evaluation of 67Ga scintigraphy in detecting causes of fever]

Radioactive gallium citrate has been known to accumulate not only in neoplasms but also in inflammatory foci, and thus widely used to find out pyrogenic lesions in cases of unexplainable prolonged fever. However, with developments and improvements of other imaging modalities, its diagnostic significance may have changed. To probe that issue, recent 65 scans for the patients with fever of unknown origin were reviewed retrospectively. Of these, 56 had sufficient clinical assessment and laboratory examinations to evaluate causative illnesses. Gallium images of 33 patients were interpreted as positive. Local inflammatory lesions were detected in 23 cases, with lung tuberculosis, urinary tract infection, and inflammatory joint diseases as prevalent final diagnoses. Pyogenic abscesses, though popular in the literatures on fever of unknown origin, were found in only 2 cases in our present series. This seemed to be due to earlier detection of affected sites by other imaging technics. Osteomyelitis, other major cause of fever in the past, was not found this time, probably owing to wide use of antibiotics. Besides localized diseases, seven cases of generalized disorders were found. There were 3 patients with hematological malignancies, 3 with systemic autoimmune diseases, and 1 with severe infectious mononucleosis. There were three false positive cases; intestinal gallium radioactivity in 2 cases and physiological pulmonary hilar accumulation in 1 were erroneously read as abnormal. Of 23 cases with negative gallium scan, no definite cause of fever were found in 19; twelve patients had spontaneous reduction of fever, 2 did so with antibiotics, and 5 with corticosteroids. False negative cases were; two with urinary tract infection on antibiotics, one with bacterial meningitis, and one with polyarteritis nodosa. Our results reconfirmed the excellent sensitivity and accuracy of gallium scan in the diagnosis of fever of unknown origin. In addition to the detection of focal inflammations, it may sometimes contribute to an early diagnosis of unexpected systemic diseases. From the results obtained, it is advisable that, in patients with fever of unknown origin, this test should be done early in diagnostic schedule and before administration of drugs that may mask potential sites of abnormal accumulation.

Nonsegmental inhibition of rat dorsal horn neurons by innocuous stimulation

In rats anesthetized with thiamylal sodium, responses of spinal cord dorsal horn neurons to noxious skin heating of the tail were recorded by extracellular microelectrodes. Inhibition of these responses by innocuous mechanical stimulation (light brushing) of the ipsilateral forelimb was assessed. Short-lasting application (3 min, or less) of light brushing did not inhibit neuronal responses to noxious heating. Long-lasting application (5 min, or more) inhibited responses of these neurons to noxious stimulation. The results indicate that, in the anesthetized rat, remotely applied innocuous cutaneous stimuli can inhibit nociceptive responses of dorsal horn neurons, if applied for a sufficiently long time.

Nipple discharge cytology in mass screening for breast cancer

Since 1977 mass screening for breast cancer has been conducted in Miyagi Prefecture, Japan; inspection, palpation and cytologic examination of any nipple discharge are part of the initial screening procedures. Among 149,681 subjects examined, 404 cancer cases and 63 papilloma cases were detected. The nipple discharges from 20,537 women were examined cytologically; of the 61 cancer cases, the smears were positive in 18 cases, suspicious in 7, negative with atypical findings in 12 and negative in 24. Ten of the cancer cases were detected exclusively by the cytologic examination of a nipple discharge. In eight of these ten cancer cases, there was no other initial evidence of the primary tumor. The cytologic diagnosis of discharges without blood from 28 cancer cases was positive or suspicious in 10 cases and negative in 18. Thirty-seven of the papilloma cases were initially detected only by the cytologic examination of a nipple discharge; neither physical examination nor mammography showed any abnormal findings.

[Assessment and treatment of respiratory dysfunction in severely handicapped children: respiratory disorders during sleep]

In severely handicapped patients, chronic respiratory insufficiencies and recurrent hypoxemia especially during sleep are one of the major problems to take care of them. To clarify the pathophysiology of respiratory disorders during sleep, we examined 5 severely handicapped patients with no respiratory distress during wakefulness, but with signs of latent respiratory insufficiency by means of polygraphical all-night study including the arterial oxygen saturation (SaO2) monitoring. In the severely handicapped patients, sleep hypoxemia occurred frequently. The value of SaO2 decreased in proportion to the intensity of apnea determined by polygraph. The relationship between the value of SaO2 and sleep stage was variable in each patient. Four patients had mainly obstructive respiratory disorders and one had a central type respiratory disorder. The density of REM stage decreased in the obstructive type. In the central type, the repeat of REM stage with normal REM density was not observed. In one patient with obstructive type and one with central type, hypoxemia was improved with an increased number of REM stage by O2 inhalation.

Lower leg reconstruction using a sural fasciocutaneous flap

The fasciocutaneous flap in the lower leg has been widely used since Pontén's 1981 report. The cutaneous artery running along the sural nerve--known as the superficial sural artery--has an important role in the blood supply of the fasciocutaneous flap in the lower leg as stated by Haertsch. The superficial sural artery has great variation with regard to its location and the origin of the vessel. The cutaneous artery is intimately connected to the sural nerve or the lateral sural nerve. It may run along the sural nerve or along the lateral sural nerve. We examined this vessel in 10 cadaver dissections and applied it in 17 clinical cases of pedicled, island, and free flaps. The island sural fasciocutaneous flap is particularly versatile for the reconstruction of the soft tissue defect around the knee joint. The operative procedure involving the island fasciocutaneous flap and the characteristics of this sural fasciocutaneous flap are described.