[A case of intraocular histiocytosis X]

A solitary massive tumor developed in the left eye of a 61-year-old female who had a history of insulin-independent diabetes mellitus for 20 years and whose left eye had become blind due to repeated anterior uveitis in the recent several years. The eyeball was enucleated and used for further examinations. Intraocular tissues were widely infiltrated by histiocytes, though no extraocular invasion or further metastasis was found. Histological examination including alpha 1-anti-chymotrypsin and S100 staining revealed the features characteristic of histiocytosis X. This is probably a case of intraocular histiocytosis X with no evidence of systemic symptoms.

Intracerebral arteriovenous malformation fed by the anterior ethmoidal artery--case report

A 66-year-old male presented with a left frontal intracerebral arteriovenous malformation (AVM) fed by the anterior ethmoidal artery. The nidus was located intracerebrally, although the feeder was a dural artery, and was drained by the ascending frontal vein which showed varicose dilatation. The AVM was associated with an unruptured right anterior choroidal artery aneurysm. The AVM was removed and the aneurysm was clipped in a two-stage operation. The etiology of AVMs fed by the ethmoidal artery is still uncertain, but is probably due to a disturbance in normal embryonic development. The association with aneurysm seemed to be incidental.

[Endoscopic sphincteroplasty (not sphincterotomy) using the clips--a preliminary report]

Reports exist that incomplete division of the papilla by endoscopic sphincterotomy may lead to restenosis, cholangitis, and stone recurrence. In view of evolution of surgical sphincterotomy to sphincteroplasty, we studied feasibility of endoscopic sphincteroplasty. In 36 dogs, at laparatomy, the papilla was divided using a diathermy sphincterotome to create retroperitoneal perforation. Twelve dogs underwent approximation of the bile duct and duodenal walls with silk sutures. Another 12 dogs had the walls approximated with clips using an endoscopic clip appliance. The other 12 dogs had no approximation. Blood chemistry was obtained before and serially after surgery. Duodenobiliary barium regurgitation was determined in 2-3 weeks. Four dogs each in each group were sacrificed at 1, 2, and 4 weeks to examine the papilla macro- and microscopically. In regard to hemostasis and prevention of leakage, the effect of the clips was similar to the sutures, resulting in a wide opening with free regurgitation. The no treatment group had persistent abnormal liver function tests and amylase levels. Three dogs died on leakage with abscess and the other nine had stenosis of the papilla. These data suggest that endoscopic sphincteroplasty may be feasible using the clips. A first clinical case where the clips were used to obtain a wide opening which passed a 15-mm balloon is briefly described.

[Histological study on idiopathic epimacular membrane in three cases of different age]

Histological features of idiopathic premacular membrane were studied in 3 cases of different ages. All cases were female and complained of blurred vision without any causative moment. The age was 7 year in Case 1, 29 year in Case 2 and 68 year in Case 3. The cases underwent vitreous surgery with easy removal of the membranes. On light and electron microscopical observation, the membranes composed of retinal glial cells, connective tissue and the inner limiting membrane in Case 1, fibroblastic cells and connective tissues in Case 2, and connective tissues and the inner limiting membrane lacking any cellular component in Case 3. These findings strongly suggest the possibility of existence of various pathogeneity and developmental stages and types in idiopathic epimacular membrane.

[A case report of metastatic colonic carcinoma in the liver effectively treated by long-term, ambulatory and continuous, intra-hepatic-arterial infusion of 5-fluorouracil using disposable multi-day-type infusor]

A 42-year-old female was diagnosed as having sigmoid colonic carcinoma with multiple metastases in the liver. Following sigmoid colectomy and descending colostomy, a catheter was inserted from the right gastroepiploic artery to the proper hepatic artery. From the day of surgery 5-Fluorouracil was administered in doses of 250 mg/day continuously through a catheter over the 2-month period of hospitalization. After the patient was discharged, 250 mg/day of 5-Fluorouracil was administered at home using Vaxter Infusor according to a regimen of 10-day continuous infusion and subsequent 4-day rest. Five months after the initial operation, the serum CEA level decreased dramatically, and CT scan of the liver revealed the complete disappearance of the metastases. The patient underwent a second operation in which the colostomy was closed, and she is doing well at this writing. This case suggests that long-term, ambulatory, continuous and intra-hepatic-arterial infusion of 5-Fluorouracil can be a very effective treatment not only in reducing the hepatic metastases but also in improving the quality of life of patients with colonic carcinoma.

[The existence of vasomotor nerve in the retina of the rabbit and monkey]

In the first stage of this study, peri- or intravascular unmyelinated nerve axon which was clearly different from that of the optic nerve was confirmed in the rabbit retina transmission electron microscopically. In the second stage, the correlation of these unmyelinated nerves and autonomic nerve was studied in rabbits and monkeys. For the purpose, wheat germ agglutinin horseradish peroxidase (WGA-HRP) was injected into the superior cervical ganglion. Electron microscopic observation of the retina 48 hrs after the injection of WGA-HRP showed deposit of its reaction product in the axon of the unmyelinated nerve located around the vascular wall and in the adventitia and smooth muscle cell in both rabbits and monkeys. This result clearly reveals the existence of an autonomic vasomotor in the retinal vessels at least in rabbits and monkeys.

Enlargement of cerebellar arteriovenous malformation associated with fenestration of the vertebral artery--case report

We report a 30-year-old male case of an enlarged cerebellar arteriovenous malformation (AVM) associated with fenestration of the vertebral artery. Hemodynamic stress resulting from fenestration of the feeding system of AVM was probably an important factor in the enlargement of the small cerebellar AVM.

The Saccharomyces cerevisiae GAM2/SIN3 protein plays a role in both activation and repression of transcription

We have cloned GAM2, which is required for transcription of STA1, a gene encoding an extracellular glucoamylase in Saccharomyces cerevisiae var. diastaticus. DNA sequence analysis revealed that GAM2 is the same gene as SIN3, known to be a general negative regulator of yeast genes. RNA blot analysis indicated that GAM2/SIN3 also acts as a positive regulator of GAM3/ADR6, which in turn is required for transcription of STA1 and ADH2. These results suggest that GAM2 regulates STA1 expression through transcriptional activation of GAM3 and indicate that GAM2/SIN3 protein is a transcriptional regulator that can play a role in both activation and repression of transcription.

The GAM1/SNF2 gene of Saccharomyces cerevisiae encodes a highly charged nuclear protein required for transcription of the STA1 gene

We have cloned and sequenced the GAM1 gene which is required for transcription of the STA1 gene encoding an extracellular glucoamylase in Saccharomyces cerevisiae var. diastaticus. Complementation tests indicated that GAM1 is the same gene as SNF2 which is required for derepression of the SUC2 gene encoding invertase. Accumulation of SNF2 RNA was not regulated by the GAM2 and GAM3 genes which are also required for STA1 expression. The SNF2 gene was predicted to encode a 194 kDa highly charged protein with a glutamine-rich tract. A bifunctional SNF2-lacZ fusion protein was shown by immunofluorescence microscopy to be localized to the nucleus, suggesting that the SNF2 protein is located in the nucleus.

Sphincter of Oddi motor activity in patients with anomalous pancreaticobiliary junction

Sphincter of Oddi motor activity was investigated in seven patients with an anomalous pancreaticobiliary junction and in six controls by endoscopic manometry under fluoroscopy. Characteristic phasic wave activity was observed in the sphincter segment in both groups. Amplitude of the phasic contractions was significantly higher in the disease group than in controls (100.8 +/- 14.1 mm Hg vs. 55.2 +/- 4.3 mm Hg, p less than 0.02). Although those with the anomalous pancreaticobiliary junction had a longer common channel (15-30 mm), the length of the sphincter segment with the phasic wave activity was not different. The phasic activity was not seen at the junction of the pancreatic and bile ducts in disease groups. Bile obtained from within the bile duct showed a very high concentration of amylase. Morphine given to cause spasm of the sphincter increased basal pressure and frequency of the phasic waves in all controls. The response to morphine was similar in two patients in whom the anomalous junction was studied, but the procedure was complicated by acute pancreatitis in one of them. These findings suggest that contractions of the sphincter of Oddi in patients with the anomalous junction may contribute to reflux between the pancreatic and bile ducts, leading to various pathologic conditions associated with this anomaly.

[The effect of bile duct pressure on cholangiovenous reflux. A clinical study]

The measurement of the filling pressure of the bile duct during the process of endoscopic retrograde catheter cholangiography, and the determination of blood culture and blood iodine before and after cholangiography were carried out to probe into the effect of bile duct pressure on cholangiovenous reflux. In 32 cases, 2 had positive blood culture after cholangiography, with a bile duct pressure being 2.98 kPa and 3.72 kPa respectively. Nineteen cases with a pressure below 2.94 kPa showed negative blood culture. In 10 cases with a bile duct filling pressure below 2.16 kPa, no increase in blood iodine was noted whereas, blood iodine level was increased in 5 out of 9 cases (55.6%) with a bile duct filling pressure between 2.16-2.94 kPa, and in 9 out of 13 cases 69.2% with the pressure greater than 2.94 kPa. We believed that during direct cholangiography, the bile duct pressure should be lower than 2.94 kPa in order to prevent the complication of bacteremia. For patients hypersensitive to iodine, the bile duct pressure should be lower than 2.16 kPa.

[Acute and subacute toxicity studies of Bis(2,3-dibromopropyl) phosphate magnesium in rat]

Acute and subacute oral toxicity tests of Bis(2,3-dibromopropyl) phosphate magnesium (Bis-BP.Mg) were carried out in Wistar rats. In the acute toxicity test, Bis-BP.Mg suspended in arabic gum was administered orally to a group consisting of 10 male and 10 female rats, and they were observed for 14 days. LD50 values of male and female rats were 283 (253 approximately 314) mg/kg and 261 (219 approximately 310) mg/kg, respectively. As toxic symptoms, eyelid closure, crouching, shivering and staggering gait were observed in the treated groups of both sexes. In gross findings, hypertrophy, discoloration and necrotic change of the liver, and hypertrophy and discoloration of the kidney were observed in the treated groups. In histopathological examination, necrosis, desquamation, large nuclei formation of the tubular epithelium, and tubular dilatation of the kidney and necrosis of the liver cells were observed in the treated groups. In the subacute toxicity test, groups of rats consisting of 5 males and 5 females were fed a commercial diet containing 0, 30, 100, 300 and 1000 ppm Bis-BP.Mg for 45 days. In body weight and food consumption, there were no significant difference between the control and treated groups. Significant increases were observed in the liver and kidney weights of male rats fed 1000 ppm Bis-BP.Mg. Histopathologically, desquamation, swelling, and large nuclei formation of the tubular epithelium and tubular dilatation of the kidney were observed, but they were much less frequent than those in the acute toxicity test. It was concluded that Bis-BP.Mg has apparent renal toxicity.

[Combined chronic toxicity/carcinogenicity test of tris(2-chloroethyl)phosphate (TCEP) applied to female mouse skin]

Tris(2-chloroethyl)phosphate (TCEP), a widely used flame retardant, was tested for its skin chronic toxicity/carcinogenicity using female Slc: ddY mice. TCEP (5 and 50%) dissolved in ethanol was applied to the shaved skin twice a week for 79 weeks. The control group received ethanol under similar condition. In addition, 5 animals in each group were killed at 6 and 12 months and used for the chronic toxicity study. In body weight, food consumption and survival rate, there was no significant difference between the control and treated groups. Spleen weight was decreased in the 50% group. No significant difference in the incidence of tumors and other non-neoplastic lesions of the skin and other organs was found between the control and treated groups. The results indicate that under the conditions of the present study, TCEP has no carcinogenicity and toxicity for the skin.

Characterization and physical mapping of plasmids of black-pigmented Bacteroides

Eight species of black-pigmented Bacteroides (BPB) were examined for plasmid content. Three classes of plasmids with molecular sizes of 16.0 kilobase (kb), 5.4 kb and 5.0 kb were found in 7 of 125 Bacteroides intermedius strains. One strain each of Porphyromonas (former Bacteroides) asaccharolyticus and of Bacteroides levii were also shown to have plasmids. However, no plasmids were detected in 90 strains of Porphyromonas (Bacteroides) gingivalis. The plasmids were purified and digested with restriction endonucleases for restriction mapping. The maps obtained in this study have given us information on the scheme of constructing recombinants which may be usable as shuttle vectors, by the recombination of BPB and Escherichia coli plasmids.

[Clinical utility of long-term administration of trapidil (MDR-1865) in the treatment of diabetic retinopathy]

In order to investigate the usefulness of prolonged administration of trapidil in the treatment of diabetic retinopathy, a follow-up study was carried out after the end of a placebo-controlled, double-blind study of the drug in case of the trapidil-treated group who continued to be treated with 300 mg/day of trapidil (Rocornal) (TT group) and those of the placebo group who were not given any treatment after the end of the study (PP group). The TT group was significantly superior or tended to be superior to the PP group in improvement of hard exudates, retinal hemorrhages and soft exudates, and also in improvement of capillary microaneurysms on fluorescein fundus angiography. In the course of diabetic retinopathy by the global evaluation of findings in individual cases, the TT group was significantly superior or tended to be superior to the PP group. Photocoagulation was performed on 20 (28%) of 72 eyes of the PP group and 13 (19%) of 68 eyes of the TT group, with the mean interval to photocoagulation being 7.2 months for the PP group and 14.0 months for the TT group. There was a significant difference between the 2 groups in terms of the interval to photocoagulation. Randomized fundus photographic evaluation of the findings by the central evaluation committee showed that the TT group was significantly superior or tended to be superior in improving retinal hemorrhages, soft exudates and leakage of fluorescein dye, and was also significantly superior or tended to be superior in relation to the course of the retinopathy, which was consistent with the evaluation by the attending ophthalmologists.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intraretinal neovascularization in rats with experimental renovascular hypertension]

Newly formed intraretinal vessels caused by experimental renovascular hypertension were studied histopathologically in rats. In these rats, dystrophy of the outer retinal layer and disappearance of retinal small capillaries were found in correlation with the duration of hypertensive state. In particular, retina obtained from rats with severe hypertension maintained for 6 months or more showed marked tissue damage and intraretinal proliferation of pigment epithelial cell with numerous microvessels. Most of these vessels were characterized by endothelial cell with large nuclei and slit-like narrowed lumina. Similar microvessels were also frequently observed in neighboring pigment epithelial cell layer. Endothelial fenestrations were observed in these vessels, although no findings were observed suggesting vessels penetrating through Bruch's membrane from the choroid. Similar vessels were also found in the inner plexiform layer and rarely in the nerve fiber layer. They were surrounded by processes resembling basal infolding of pigment epithelial cell. However, no fenestration of endothelial cells was found in these vessels.

Islet cell tumors of the pancreas. The diagnostic value of endoscopic retrograde pancreatography

Eleven cases of pancreatic islet cell tumors were reviewed to compare diagnostic ability of endoscopic retrograde pancreatography (ERP) with other imaging modalities. ERP localized three out of five tumors studied and showed a suspicious finding in an additional patient. All these tumors were located in the pancreatic head. Thus, the diagnostic ability of ERP was superior in the head portion, where recognition of a tumor is often difficult at the operation, and a more complicated procedure is required for removal. Nonfunctioning islet cell tumors were localized by hypervascularity on angiogram, but retroperitoneal leiomyosarcoma remained to be excluded in one patient. ERP with an indwelling balloon catheter revealed the pancreatic origin of the tumors and precisely determined the line of pancreatic resection by vividly visualizing pancreatic duct obstruction and intact distal branches. We conclude that ERP is helpful to localize functioning islet cell tumors of the pancreas especially in the head portion and plays an important role for planning resection of nonfunctioning islet cell tumors.

[Clinical study of hypertensive cerebellar hemorrhage: surgical indication and measurement of volume of hematoma]

There have been a few reports available for determining surgical indications in hypertensive cerebellar hemorrhage based on volume of hematoma on computerized tomography (CT). The authors then studied the clinical results of hypertensive cerebellar hemorrhage, and the surgical indication based on clinical findings and volume of hematoma on CT scan was considered. Forty-five patients with hypertensive cerebellar hemorrhage diagnosed by CT scan who were hospitalized to Matsue Red Cross Hospital from January 1980 up to December 1986 were studied. The 25 male and 20 female patients ranged in age from 52 to 85 years, and 16 of them were operated on. The results were as follows: 1) The Kanaya's neurological grading tended to be high in the patients with cerebellar vermis hemorrhage or a large volume of hematoma (greater than or equal to 30 ml). 2) In patients with grade I or II and a moderate volume of hematoma (15-30 ml), the patient complicated with hydrocephalus should be treated with ventricular drainage. The patients with grade III and IVa should be treated with surgical therapy (suboccipital craniectomy and evacuation of the hematoma). The patients with cerebellar vermis hemorrhage should be treated with surgical therapy. The patients with a large volume of hematoma (greater than or equal to 30 ml) should be treated with surgical therapy. The patients with grade IVb and V should not be treated actively because the prognosis is bad.(ABSTRACT TRUNCATED AT 250 WORDS)

Choledochoscopic electrohydraulic lithotripsy and lithotomy for stones in the common bile duct, intrahepatic ducts, and gallbladder

Choledochoscopic lithotomy with the aid of electrohydraulic lithotripsy was performed in 40 patients, including 16 patients with choledocholithiasis, 15 with hepatolithiasis, and 9 with cholecystolithiasis. As a route for the choledochoscopy, a T-tube tract, external cholecystostomy, or jejunal limb of hepaticojejunostomy was used in nine patients, while percutaneous transhepatic biliary drainage followed by dilatation of the track was established in 31 patients. The largest cholesterol stone measured 55 mm by 33 mm and the largest bilirubinate stone measured 52 mm by 37 mm. The stones were disintegrated in all but one patient in whom choledochoscopic access to a gallstone was difficult due to deformity of the gallbladder. Complete removal of the stones was achieved in 38 of 39 patients. In a patient with hepatolithiasis, small stones located deep in inaccessible branches of the intrahepatic duct remained unremovable. There were no serious complication. Minor complications occurred, including bleeding from the bile duct mucosa in four patients and postprocedure chills and fever in three. Choledochoscopic lithotomy with electrohydraulic lithotripsy is efficient and useful to remove biliary calculi in patients who are poor surgical risks.

[Anterior pituitary function in the vegetative state]

Anterior pituitary function tests were performed in 33 patients in the vegetative state, and the results were assessed for correlation with various clinical factors. Radioimmunoassays were employed to measure the secretion of growth hormone and cortisol during insulin tolerance testing (regular insulin, 0.15 to 0.20 U/kg), luteinizing hormone and follicle stimulating hormone under administration of luteinizing hormone-releasing hormone (100 micrograms), and thyroid stimulating hormone and prolactin under administration of thyroid-releasing hormone (500 micrograms). Impairment rate, defined as number of abnormal hormone secretions divided by number of hormones examined, was calculated for each patient. The data were statistically assessed by analysis of variance in terms of disease, sex, age, site of lesion, etiology of vegetative state, duration of illness, brain atrophy as demonstrated by computed tomography, and Hockaday's electroencephalographic (EEG) grade. The results were as follows. 1) The levels of growth hormone, luteinizing hormone, follicle stimulating hormone, cortisol, thyroid stimulating hormone, and prolactin were abnormal in 70%, 67%, 45%, 39%, 36%, and 15% of cases, respectively. 2) Anterior pituitary hormone secretion was impaired in all 33 patients, severely in 52%. 3) The impairement rate was significantly increased in patients with ruptured cerebral aneurysms, primary coma, severe brain atrophy, and abnormal EEGs. 4) The impairment rate tended to be higher in long-term vegetative patients. These results suggest that, in the vegetative state, impairment of anterior pituitary function frequently occurs at the onset of disease and worsens over time.

[Basilar bifurcation aneurysm associated with internal carotid artery occlusion. Report of two cases]

Two cases of subarachnoid hemorrhage caused by rupture of a basilar bifurcation aneurysm associated with occlusion of the internal carotid artery (ICA) at the neck are presented. Case 1, a 71-year-old female, was hospitalized in a coma. Angiography demonstrated occlusion of the bilateral ICA, collateral blood supply through the branches of the foramen rotundum or vidian artery from the maxillary arteries and right posterior communicating artery, and a saccular aneurysm at the basilar bifurcation. The patient died 1 month later following rerupture of the aneurysm. Case 2, a 64-year-old male, was hospitalized for drowsiness. Angiography showed occlusion of the right ICA, collateral blood supply through a tortuous artery (a vidian artery), and a large aneurysm at the basilar bifurcation. Posterior circulation supplied anteriorly through the right posterior communicating artery. The patient died 1 month later because of rerupture of the aneurysm. Laminar thrombosis of the right ICA and an anastomotic vessel, seemingly a branch of the foramen rotundum or a vidian artery, were demonstrated by autopsy. The combination of cerebral aneurysm and collateral circulation is extremely rare in cases of occlusion of the ICA. The two cases described here suggest that hemodynamic stress is an important factor in the formation of cerebral aneurysms.