Toxins in the skin secretion of the oriental catfish (Plotosus lineatus): immunological properties and immunocytochemical identification of producing cells

Antiserum against toxin I, one of the lethal factors in the skin secretion from the oriental catfish (Plotosus lineatus), was used to examine immunological properties of the toxic factors and identify toxin-producing cells by an immunocytochemical technique. In immunodiffusion tests, the antiserum formed a precipitin line with toxin I while it formed no precipitin line either with another lethal factor (toxin II) or with a hemolysin. Lethal and edema-forming activities of toxin I were neutralized by the antiserum but lethal activity of toxin II and lytic activity of the hemolysin were not. These results suggested that toxin I can be antigenically distinguished from both toxin II and hemolysin. In immunocytochemical tests using the antiserum, club cells in the epidermis were positively stained, indicating that toxin I is produced in the club cells. Interestingly, venom glandular cells surrounding the dorsal and pectoral spines were also stained. The venom glandular cells appear to produce toxin I or a toxin with the same antigen determinants as toxin I.

Cor pulmonale due to embolization of metastatic chondrosarcoma

A 25-year-old woman with acute dyspnea was found to have nodular shadows in a chest X-ray film. Multiple defects in a perfusion scan indicated pulmonary embolization. The cause of acute cor pulmonale was extensive metastatic embolization from chondrosarcoma of the calf. Embolization by metastasis as a rare occurrence resulting in acute cor pulmonale should be considered in patients with a malignant tumor.

[Pre- and post-operative right ventricular functions in valvular heart diseases: the significance of noninvasive assessment]

This investigation was undertaken to evaluate right ventricular function in valvular heart diseases by calculating right ventricular ejection fraction (RVEF) from first-pass radionuclide angiography (RNA). One hundred cases of valvular heart disease were examined by RNA, 93 of whom underwent cardiac catheterization and contrast left ventriculography, preoperatively. Fifty of the 100 cases were examined by RNA; 18 by cardiac catheterization post-operatively. The results were as follows: 1. In 49 cases of mitral valve disease, there was a correlation (r = -0.75) between pulmonary artery mean pressure (PAm) and RVEF. This suggested that afterload of left atrial pressure elevation induced a decrease in RVEF. 2. Although PAm did not increase so much in aortic valve disease, RVEF decreased in some cases, especially in those having massive aortic stenosis or regurgitation. In 22 cases of aortic regurgitation which had normal PAm and a left ventricular-aortic systolic pressure gradient less than 50 mmHg, there was a correlation (r = -0.69) between the RVEF and the left ventricular end-diastolic volume index (LVEDVI). 3. Although post-operative RVEF did not improve significantly in mitral valve disease, it increased significantly in the early post-operative period in aortic valve disease. Also, the increase in RVEF and the decrease in LVEDVI seemed to correlate closely in aortic valve disease. It was speculated that pre-operative decrease of RVEF is derived from a deformity of the RV caused by pressure from the enlarged or thickened LV, and that post-operative increase of RVEF is dependent upon a decrease of LV size and volume.

Magnetic resonance imaging of human cerebral infarction: enhancement with Gd-DTPA

Five patients (1 female and 4 males) with cerebral infarction of 4 h to 27 months duration were studied 9 times with magnetic resonance (MR) using Gd-DTPA. Spin-echo (SE) MR images (MRI) were obtained before and after the administration of Gd-DTPA, and correlative CT scans were performed on the same day. In 2 cases, 4 h and 27 months after the ictus, there was no enhancement with Gd-DTPA. There was faint enhancement in 2 cases with cerebral infarction of about 24 h duration and obvious enhancement in all cases in the subacute stage. Compared with enhanced CT, MR using Gd-DTPA demonstrated more obvious enhancement of infarcted areas. MR enhancement using Gd-DTPA showed a gradual increase and the accumulated Gd-DTPA in infarcted areas slowly diffused to the periphery. MR enhancement with Gd-DTPA is similar to that of enhanced CT, but may be more sensitive in the detection of blood brain barrier breakdown.

Follow-up study of coronary artery lesions due to Kawasaki disease by serial selective coronary arteriography in 200 patients

In a follow-up study of coronary artery lesions (CAL) due to Kawasaki disease, 200 patients were examined by serial coronary arteriography 1 year after first detection of the condition. On comparing the findings of the two coronary angiographic studies, a worsening of stenotic lesions was detected in 30 patients (15%; 40 of 139 stenotic lesions, 29%), while improvement of stenotic lesions was seen in 24 patients (12%; 40 lesions, 29%). Relating these changes in CAL to the interval from the onset of disease to the first coronary arteriography showed the rate of increased or new stenotic lesions (37%) to be higher in the late group, in which the first study was performed 5 months after the onset of the disease, than in the early group (21%), in which the study was done within 4 months from the disease onset. The frequency of decrease in aneurysm size was higher in the early group (70%) than in the late group (19%).

31P in-vivo spectroscopic study by high-field whole-body MR system--an application to a case with arteriosclerosis obliterans

31P in-vivo spectroscopy was performed by a 1.5-tesla whole-body MR system. The 31P spectrum for the calf muscle in a patient with arteriosclerosis obliterans having intermittent claudication was obtained every two minutes. When the spectrum after the workload was compared with that at rest, an increase in inorganic phosphate (Pi) and a decrease in phosphocreatine (PCr) were observed, resulting in a strong decrease in the PCr/Pi ratio. This method can measure the ischemic and recovery stages of energy metabolism in skeletal muscle noninvasively and continuously in addition to magnetic resonance imaging.

Characterization of picomolar affinity binding sites for [125I]-human calcitonin gene-related peptide in rat brain and heart

We have characterized picomolar affinity binding sites for human calcitonin gene-related peptide (CGRP) in rat brain and heart (atria and ventricle) membranes. By saturation analysis, apparent dissociation constant (KD) values of high affinity sites for [125I]-human CGRP are 9 approximately 15 pM (brain), 34 pM (ventricle) and 85 pM (atria). Low affinity sites with KD values of about 50 nM are found in rat brain and ventricle, but not in atria. Human and rat CGRP potently inhibited [125I]-human CGRP binding to these high affinity sites with apparent inhibition constant (Ki) values comparable to their KD values. Salmon calcitonin marginally inhibited these binding with Ki values between 0.1 microM and 1 microM. Extremely potent cardiovascular and gastrointestinal actions of CGRP might be mediated through CGRP binding sites with picomolar affinity which are similar to those we characterized in this study.

Coronary arterial lesions of Kawasaki disease: cardiac catheterization findings of 1100 cases

In our institute, 1100 patients with a history of Kawasaki disease have been catheterized for selective coronary arteriography. Their age at examination ranged from four months to 13 years. Coronary artery lesions (CAL) were found in 262 patients. As far as the type of the CAL was concerned, occlusion was noted in 20 (7.6%), segmental stenosis in 15 (5.7%), localized stenosis in 62 (23.7%), aneurysm in 93 (35.5%), and dilatation in 72 patients (27.5%). In terms of the total number of lesions, there were 23 occlusions, 19 segmental stenoses, 109 localized stenoses, 449 aneurysms and 307 dilatations. The 262 patients with CAL were analyzed according to the interval from the onset to the time of selective coronary arteriography. The incidence of both occlusion and segmental stenosis was lowest in the group who were catheterized shortly after the onset of disease, whereas the prevalence of aneurysm was highest in this group. But the prevalence of dilatation was highest in the group of patients who were catheterized late. A total of 12 patients had to undergo femoral arterial thrombectomy for arterial thrombosis following the catheterization, but no other major complication was experienced.

Semiquantitative grading of severity of mitral regurgitation by real-time two-dimensional Doppler flow imaging technique

An attempt was made to determine whether mitral regurgitation could be detected and its severity evaluated semiquantitatively by newly developed real-time two-dimensional Doppler flow imaging in 109 patients who underwent left ventriculography. In the Doppler flow imaging technique, Doppler signals due to blood flow in the cardiac chambers are processed using a high speed autocorrelation technique, so that the direction, velocity and turbulence of the intracardiac blood flow are displayed in the color-coded mode on the monochrome B-mode echocardiogram in real time. Mitral regurgitant flow was imaged as a jet spurting out from the mitral valve orifice into the left atrial cavity. It was noted that the regurgitant jet in the left atrial cavity had a variety of orientations and dynamic features when studied by the present technique. The sensitivity of the technique in the detection of mitral regurgitation was 86% as compared with that of left ventriculography. Mitral regurgitation in the false negative cases was mostly mild. On the basis of the farthest distance reached by the regurgitant flow signal from the mitral valve orifice, the severity of regurgitation was graded on a four point scale and these results were compared with those of angiography. A significant correlation (r = 0.87) was found between Doppler imaging and angiography in the evaluation of the severity of mitral regurgitation. A similar result was obtained for the evaluation based on the area covered by the regurgitant signals in the left atrial cavity. Thus, noninvasive semiquantitative evaluation by real-time two-dimensional Doppler flow imaging appears to be a promising clinical technique.

Hemolytic, lethal and edema-forming activities of the skin secretion from the oriental catfish (Plotosus lineatus)

The crude extract from the skin secretion of the oriental catfish, Plotosus lineatus, contained at least one hemolysin, two lethal factors and two edema-forming factors; the lethal and edema-forming factors seem to be identical. The molecular weights of the hemolysin and the lethal factors (edema-forming factors) were estimated to be 180,000 and 12,000, respectively. Peculiar secretory cells, which resembled the venom glandular cells of the dorsal and pectoral stings, were observed in the epidermis.

False lumens in type III aortic dissections: progress CT study

The fate of false lumens in 13 patients having Type III aortic dissections was studied using computed tomography (CT). Contrast media filled false lumens with or without thrombosis were observed in ten patients; the false lumens of three patients were entirely thrombosed at initial examination. Follow-up CT studies showed shrinkage or disappearance of the false lumens with thrombosis in four patients, progression of thrombosis in two patients, and enlargement of the false lumen in one patient who subsequently required surgical repair. No change was observed in the remaining six patients during our observation period. CT study provides useful information for evaluating the efficacy of medical treatment and the timing of surgical intervention during follow-up evaluation of medically treated Type III aortic dissections.

Effect of chronic middle cerebral artery stenosis on the local cerebral hemodynamics

In 36 patients with angiographically proven middle cerebral artery (MCA) stenosis, local cerebral hemodynamics were studied employing angiography, 133Xe inhalation regional cerebral blood flow (rCBF) measurements and CT scans. They had transient ischemic attacks in 8 and completed stroke in 28. The patients with less than 50% stenosis (n = 16) had no hemodynamic abnormality in angiographical and rCBF examinations. The infarction in this group was small and located in the basal ganglia area. The patients with 50 to 74% stenosis (n = 9) often revealed a delayed filling of MCA branches in the angiography, however, they showed no significant rCBF reduction. The infarction in this group was also small and located in the basal ganglia area. The patients with 75 to 99% stenosis (n = 11) exhibited a significant flow depression both in angiographical and rCBF examinations. Three of them had large cerebral infarction in the watershed zone or the cerebral cortex. The results of the present study suggest that the hemodynamic effect of MCA stenosis begins to manifest at 50% in grade and becomes apparent at 75%. The danger of hemodynamic crisis as well as the risk of large cerebral infarction may increase when MCA stenosis exceeds 75% in grade.

[Digital subtraction angiography of the cerebral vessels by intraarterial injection]

Three hundred and fifty-seven digital subtraction angiography (DSA) were performed in 184 neurosurgical patients by intraarterial injection. Examinations consisted of 192 carotid angiography, 110 vertebral angiography, 23 aortography, 11 spinal angiography and 21 other angiography. In all examinations, visualization of the vessels was excellent and the complications were never experienced. High contrast sensitivity of DSA resulted in better visualization of tumor stains, phlebogram, and arteries in cerebral arteriovenous malformations with large shunt blood flow than conventional angiography. Selective catheterization into each cerebral arteries was not necessarily demanded for good opacification of the vessels because of high sensitivity. High contrast sensitivity also permitted low concentration of contrast material, small dose of contrast material, and slow injection rate. Low concentration of contrast material reduced pain and heat during injection especially in the external carotid and vertebral angiography. Using slow injection, recoiling of catheter into the aorta was reduced, so that injection from the innominate and subclavian arteries for visualization of origin of the cerebral arteries were always successful. Full study of cerebral arteries by Seldinger's method, if necessary, was easily achieved using DSA even in patient with high age or with severe atherosclerosis. Bolus injection of small dose of contrast material as well as serial imaging was helpful in evaluating hemodynamics in the lesion. Real time display of DSA reduced the time required for angiography and was very convenient for artificial embolization. Besides these advantages, DSA became comparable to conventional angiography in special resolution by use of intraarterial injection and could be a preoperative genuine examination as well as a screening method.

[Evaluation of right ventricular wall contractility in ischemic heart disease by cardiac computed tomography]

One hundred and eight cases with ischemic heart disease except for acute myocardial infarction were examined by cardiac computed tomography with ECG-gated scanning. The right ventricular (RV) wall contractility was evaluated by the long-axial and short-axial CT images in terms of (a) contraction rate of the RV area, (b) shortening rate of the RV free wall and (c) changes in the thickness of the RV free wall in cardiac cycle. These parameters were compared to the findings of coronary angiography and left ventriculography. 1. There was no difference of the contraction rate of the RV area between the cases with severe (90-100%) right coronary (RCA) stenosis and those with mild (0-75%) stenosis, while the contraction rate of the RV area was markedly decreased in the former combined with the impaired contraction of the ventricular septum. Consequently, it was assumed that RV function is hardly damaged by RCA lesion alone, and that the contraction rate of the RV area is not a suitable parameter for the assessment of the severity of RCA stenosis. 2. The shortening rate of the RV free wall in the long-axial image in cases with severe RCA stenosis was significantly decreased (14.5 +/- 4.6%) compared with that of mild stenosis (27.8 +/- 5.0%). The changes in the thickness of the RV free wall were also impaired in severe RCA stenosis. Same tendency was observed in the short-axial image, while the correlation between RCA stenosis and impaired contraction of the RV free wall was much more evident in the long-axis image than in the short-axis image. As the result, reduced RV contraction due to RCA ischemia seems to exist not only in acute myocardial infarction but also in chronic stage of the ischemic heart. 3. CT method is suitable for the evaluation of RV ischemia due to RCA lesion because the contractility of the RV free wall can be assessed independently of ventricular septal contraction. In cases with reduction of the free wall shortening rate under 20% combined with poor change in the thickness of the RV free wall, severe stenosis of the RCA should be suspected.

Clinical efficacy, extrapyramidal symptoms and serum levels: influence of administration schedules and concomitant drugs on serum bromperidol concentrations

Bromperidol (4 or 12 mg per day) was administered to 18 newly admitted schizophrenics and 29 chronic schizophrenic inpatients once or four times a day and the two dose schedules were compared. The bromperidol levels in the four-times-a-day group were significantly higher than those in the once-a-day group and the daily variation in the serum level of the agent was markedly wider in the latter than in the former patients. The incidence and severity of extrapyramidal symptoms were not significantly different between the two. A clear relationship was not present between the serum levels and the development of extrapyramidal symptoms. The bromperidol serum values were not correlated with the therapeutic response but, at more than 5 ng per ml, there might be a positive correlation between the bromperidol levels and clinical efficacy in the newly admitted schizophrenics. As for concomitant medication, levomepromazine may raise the bromperidol serum level. An anti-parkinson drug failed to depress the bromperidol level.

[Diagnosis of dissecting aortic aneurysm by digital subtraction angiography]

The aim of the study was to determine whether digital subtraction angiography (DSA) can be used in the diagnosis of aortic dissection. The study group consisted of six patients with aortic dissection including one of type 2 and five of type 3 by the DeBakey classification. DSA findings were compared to cineangiographic findings. The results were as follows; In all the patients, the diagnosis of aortic dissection was possible using DSA. Especially as to the entry, which was not detected by other non-invasive methods, there was an excellent correlation between cineangiograms and DSA (sensitivity 100%). Of the 20 vessels in the abdomen, which included the celiac, superior mesenteric, and right and left renal arteries, three vessels (15%) were not identified by DSA. Causes of the failure were the low spatial resolution and the artifact due to the motion of the patients and intestinal gas movement. The accuracy rate of the abdominal branch involvement was 70%. While using a prototype equipment, the preliminary study showed that DSA is a safe and very useful method not only for diagnosing aortic dissection, but for evaluation of the entry, extension of the dissection, and involvement of major branches of the abdominal aorta and for a follow-up study.

A model of in situ immune complex glomerulonephritis in the rat employing cationized ferritin

In the model described here the ability of cationized (basic) ferritin to bind to the glomerular basement membrane and act as a planted antigen was exploited. This planted antigen was accessible to circulating antibody resulting in in situ immune complex formation. Perfusion of cationized ferritin (isoelectric point greater than 9.5) directly into the renal arteries, followed by intravenous injection of anti-ferritin antibody resulted in induction of glomerulonephritis with heavy proteinuria lasting for about 3 weeks. Fine granular deposition of antigen, antibody and rat C3 along the glomerular capillary walls was seen by immunofluorescence. Electron microscopy revealed the presence of subepithelial deposits containing ferritin; the foot processes were fused. This demonstrates the potential role of basic antigens in the pathogenesis of in situ immune complex glomerulonephritis.