Reconstruction of the cervical trachea with a free forearm flap

With the aim of voice restoration after repair of a total defect or obstruction of the cervical trachea, we developed a new method of total cervical tracheal reconstruction with a free forearm flap. The forearm flap is inverted to form a tube and then interposed between the subglottic trachea and an adjacent cutaneous fistula created at the upper portion of the tracheostoma. A permanent tracheostoma is preserved, and an L-shaped silicone tube is inserted in the reconstructed cervical trachea and the tracheostoma as a stent. In two patients, both became able to speak.

[A case of spontaneous bacterial peritonitis with ascites caused by hypoproteinemia after a massive bleeding from a gastric ulcer]

A case of spontaneous bacterial peritonitis (SBP) developed in an old man whose ascitic fluid was related neither to portal hypertension nor nephrotic syndrome, but with severe hypoalbuminemia emerged after a massive bleeding from a gastric ulcer in a malnutrition state. Ascitic fluid, increasing day by day, yielded Enterobacter cloacae and Bacteroides fragilis. Though autopsy was not carried out because of refusal of his family, neither liver necropsy, nor abdominal CT scan nor repeated abdominal ultrasonography showed findings suggesting existence of liver cirrhosis. In the presence of his ascites, the extent of a chemiluminescence (CL) response of polymorphonuclear cells from volunteers was significantly lower than that of his serum. This report shows that SBP can develop in a patient with ascites unrelated to portal hypertension when ascitic fluid induces little CL response.

Estimation of plasma glucose fluctuation with a combination test of hemoglobin A1c and 1,5-anhydroglucitol

We investigated the effect of plasma glucose fluctuation on hemoglobin A1c (HbA1c) and plasma 1,5-anhydroglucitol (AG) levels, especially in insulin-dependent diabetes mellitus (IDDM). Plasma AG is a new marker that provides sensitive and analytical information on glycemic control. The basic mechanisms underlying both the reduction and recovery of the plasma AG level, ie, the excretion into urine with glucosuria and the amount supplied to the body, were presumed to be similar in IDDM and non-insulin-dependent diabetes mellitus (NIDDM) patients. The correlation coefficient for mean plasma glucose and AG was -.591, and it was .578 for mean plasma glucose and HbA1c in IDDM patients. In NIDDM, the correlation between mean plasma glucose and AG was -.869, and between mean plasma glucose and HbA1c, .875. The plasma AG levels in the IDDM group showed a lower range than in the NIDDM group, even with similar HbA1c levels. All the cases showing lower plasma AG levels among those with similar HbA1c levels manifested greater fluctuation of plasma glucose and a larger amount of urinary glucose. The lower AG level in IDDM patients was reversible to the level in NIDDM patients when the greater fluctuation of plasma glucose was corrected. Thus, it was suggested that because urinary glucose excretion is intermittently high in IDDM patients, plasma AG is frequently low, even though the mean plasma glucose and HbA1c levels suggest good control.(ABSTRACT TRUNCATED AT 250 WORDS)

Origin and disposal of 1,5-anhydroglucitol, a major polyol in the human body

The origin and disposal of 1,5-anhydro-D-glucitol (AG), one of the main polyols found in the human body, was studied in normal subjects and diabetic patients. AG was detected in various kinds of foods. The mean AG supplement through foods was estimated to be approximately 4.38 mg/day, which was compatible with that calculated in a food analysis (average 0.22 mg AG/100 kcal in Japanese foods) on eight healthy subjects. The mean AG excretion in urine was approximately 4.76 mg/day in these subjects. Excretion into stools was negligible. From observations on the patients without oral supplement of AG, 0.4 mg of daily de novo synthesis of AG was strongly suggested. It was also implied that urinary AG excretion occurred soon after food ingestion and that its amount was closely correlated with daily supplement through foods. Thus the fundamental kinetics of AG were recognized as follows: 1) AG in the body originates mainly from foods and is well absorbed in the intestine, 2) AG is little degraded and metabolized in the body, and 3) an equilibrium exists between oral supplement plus a small but steady amount of de novo synthesis and excretion in urine.

Chronic necrotising pulmonary aspergillosis caused by Aspergillus niger in a mildly immunocompromised host

A middle aged man with diabetes mellitus and chronic alcoholic hepatitis developed chronic necrotising pulmonary aspergillosis or semi-invasive aspergillosis due to Aspergillus niger.

BCG-induced granulomatous prostatitis: a comparative ultrasound and pathologic study

We analyzed the ultrasound findings and the information obtained from serial whole-mount cross-section histologic examination of the prostates from 6 patients with bacillus Calmette-Guérin (BCG)-induced granulomatous prostatitis. Similarities to prostate cancer included a hypoechoic pattern on ultrasound, multifocality, and a propensity for a peripheral zone location. BCG-induced granulomatous prostatitis cannot be distinguished from cancer by ultrasonography. We suggest performing an ultrasound examination prior to starting BCG immunotherapy as a baseline for future reference to aid in the clinical diagnosis of BCG-induced granulomatous prostatitis.

The distribution of prostate specific antigen in men without clinical or pathological evidence of prostate cancer: relationship to gland volume and age

We estimated the in vivo prostate gland volume in 408 men (320 without clinical evidence of prostate cancer, and 88 with an abnormal digital rectal examination and/or transrectal prostate ultrasound and negative biopsies) using sequential step-section ultrasound analysis and correlated it to the serum prostate specific antigen (PSA) value. Of the men 331 (81.1%) had a PSA value of 4 ng./ml. or less. The PSA value was greater than 4 but less than or equal to 10 in 64 men (15.7%) and greater than 10 in 13 (3.2%). The men were subclassified by prostate gland volume at arbitrary break points. A total of 139 men (34.1%) had a gland of 25 cm.3 or less, 2.2% of whom had a PSA value of greater than 4. Further analysis revealed that the incidence of a PSA value greater than 4 increased as the prostate volume increased (18.4% for greater than 25 but less than or equal to 50, and 65.4% for greater than 50) and as age increased. We found a statistically significant association between prostate gland volume and patient age (p less than 0.00005) to the serum PSA concentration. The finding of a PSA value of greater than 10 was uncommon regardless of the prostate gland volume. Clinical implications of these results are discussed, and a statistical model to estimate the serum PSA by gland volume and patient age was constructed.

Case report: fulminant hepatitis C viral infection after allogeneic bone marrow transplantation

The authors describe two patients with acute leukemia who died of fulminant hepatitis caused by hepatitis C virus (HCV) after an allogeneic bone marrow transplant, the first such cases reported in Japan. Both had developed posttransfusion hepatitis during chemotherapy to induce remission and for consolidation. Six months after blood transfusion, the blood serum of each patient was positive for HCV antibody and HCV RNA. In each case, there was a transient improvement in liver function after the transplant. However, within 5 months of receiving the transplant and coincident with the withdrawal of cyclosporin A, each patient developed an acute exacerbation of hepatitis. The fulminant hepatitis in our patients may, therefore, have been caused by the reactivation of HCV induced by the immunosuppressive therapy followed by a reconstitution of the immune system.

Islet beta-cell regeneration and reg genes

In this paper, we show that the reg gene is expressed in experimentally induced regenerating or hyperplastic islets. We have previously reported that ectopic expression of the reg gene occurs in some human colonic and rectal tumors, suggesting that enhanced reg expression may be related to the proliferative state of tumor cells. Reg protein has also been shown to have significant sequence homology with plant and animal lectins, a class of compounds that has been shown to be a growth promoter. At present, any direct relationship between reg protein and beta-cell replication remains to be established. However, since the reg protein is a secretory protein and reg can be expressed at an early stage of pancreatic cell differentiation, the reg protein may act on the stem cells of beta-cells in an autocrine or paracrine manner. In normal mature exocrine cells, the reg gene is expressed and the gene product may be necessary to maintain adequate exocrine pancreatic function. The physiological reasons for the maintenance of two functional reg genes encoding proteins of slightly different sequence in mice are still unclear. The cloning of additional rat and human non-allelic reg genes could provide additional clues.

Low-dose cytosine arabinoside for treating hypocellular acute leukemia in the elderly

Ten previously untreated elderly patients with hypocellular acute leukemia received a low dose of cytosine arabinoside (Ara-C), 10 mg/m2 injected subcutaneously every 12 hours for 14-28 days. Six patients achieved a complete remission (CR) for periods ranging for 6-23 months (median 8.5 months) and the others had a partial remission (PR). Relapse has occurred in three patients to date. The median survival ranged from 10-24 months (median 14.5 months). Only two of the six patients, in whom bone marrow biopsy was performed at CR, had a normal cellularity. This change, however, did not appear to be a significant prognostic factor in those patients. In seven patients who achieved a CR or PR low-dose Ara-C was administrated as maintenance therapy at the same low dose for 10 days each month. Treatment was well tolerated in all patients despite for myelosuppression. There were no drug-related deaths. These observations suggest that low-dose Ara-C is effective in treating elderly patients with hypocellular acute leukemia.

Hb Kanagawa [alpha 40(C5)Lys----Met]: a new alpha chain variant with an increased oxygen affinity

An abnormal hemoglobin was suspected in a 70-year-old Japanese male with cerebral infarction and erythremia with high performance liquid chromatography assay of Hb A1c. The hemoglobin variant migrated to the anode more rapidly than Hb A. Structure determination studies, including amino acid analysis of the abnormal peptide and DNA sequencing of a partially cloned alpha-globin gene, demonstrated that it is a new hemoglobin variant which has been named Hb Kanagawa [alpha 40(C5)Lys----Met]. This variant showed an increased oxygen affinity, decreased heme-heme interaction, and a lowered 2,3-diphosphoglycerate effect relative to normal.

Antibiotic production by the marine photosynthetic bacterium Chromatium purpuratum NKPB 031704: localization of activity to the chromatophores

Over 200 strains of marine purple photosynthetic bacteria were isolated. Two strains showed antibiotic activity towards Saccharomyces cerevisiae and were tentatively identified as Chromatium purpuratum. Crude antibiotic, prepared by solvent extraction, showed a broad antimicrobial spectrum. The highest activity was found in the chromatophore fraction. Chromatographic separation of purified light harvesting complex from one strain, NKPB 031704, showed the presence of two separate pigmented compounds which were responsible for antimicrobial activity. Our findings reveal the unexpected ability of photosynthetic bacteria to produce broad spectrum antibiotics. In addition, this is the first example of intracellular localization of antibiotic activity in a marine bacterium.

Vascular smooth muscle cells from genetically hyperlipidemic rabbit (WHHL rabbit) exhibit decreased growth response

The Watanabe Heritable Hyperlipidemic (WHHL) rabbit is a widely studied animal model for the human genetic disorder familial hypercholesterolemia, and spontaneously develops atherosclerotic disease. We studied the growth characteristics of cultured vascular smooth muscle cells (VSMC) from WHHL rabbits compared with VSMC from Japanese white rabbits. We measured cell proliferation, DNA synthesis, and c-myc proto-oncogene expression, in response to growth stimuli such as fetal bovine serum (FBS) and platelet-derived growth factor (PDGF). VSMC from Japanese white rabbits exhibited a 4-fold increase in cell numbers during a 5-day incubation period compared with those from WHHL rabbits. FBS and PDGF stimulated DNA synthesis, as measured by thymidine incorporation into VSMC, in both Japanese white rabbits and WHHL rabbits, however the response was significantly higher in the former strain. The intracellular pH value of VSMC determined using the pH-sensitive fluorescence dye 2',7'-bis-carboxyethyl-carboxyfluorescein was significantly higher in WHHL rabbits than in Japanese white rabbits. Proto-oncogene c-myc was induced by exposure of VSMC to FBS, however there was no significant difference in c-myc mRNA levels between the two strains. These results suggest that VSMC from WHHL rabbits are not genetically growth accelerated, but show decreased growth response to growth stimuli.

Donor-HLA-incompatible marrow transplantation with an anti-donor cytotoxic antibody in the serum of the patient

A 42-year-old female with acute mixed lineage leukemia received a marrow transplantation from an HLA non-identical sibling. The serum of the patient showed a positive crossmatch for anti-donor lymphocytotoxic antibody and exhibited a complement-mediated cytotoxicity to donor hematopoietic progenitor cells. In an attempt to reduce the risk of graft rejection, a large volume plasma exchange was performed, which was followed by an infusion of irradiated donor lymphocytes to eliminate remaining antibodies from her serum. The level of anti-donor antibody fell below the sensitivity of the anti-human immunoglobulin lymphocytotoxicity test after the infusion of donor lymphocytes. The cytotoxic activity against donor progenitor cells also disappeared from the serum. Cyclosporin had been administered for 2 weeks before marrow infusion, and methylprednisolone and prednisolone for 1 week before the initiation of conditioning chemoradiotherapy. Conditioning comprised cytosine arabinoside 5.6 g/m2, cyclophosphamide 4500 mg/m2 and fractionated total body irradiation with 15 Gy followed by an infusion of 4.0 x 10(8) cells/kg of unmodified marrow cells. Engraftment of donor cells was documented by HLA typing of peripheral lymphocytes. A sustained engraftment may be obtained in a donor-incompatible HLA non-identical marrow transplantation with anti-donor antibody by elimination of the antibody and achieving an intensive immunosuppression in the recipient before marrow infusion.

Early detection program for prostate cancer: results and identification of high-risk patient population

Three hundred sixty-two men underwent transrectal ultrasound of the prostate (TRUS), digital rectal examination (DRE), and serum prostate-specific antigen (PSA) determination as part of an early detection program for prostate cancer. Thirty-seven (10%) cancers were detected. DRE had the highest sensitivity and specificity, 89 percent and 84 percent, respectively. TRUS and PSA had comparable sensitivities (84% and 81%) and specificities (82% and 82%). The positive predictive values of DRE, TRUS, and PSA determination were 39 percent, 35 percent, and 33 percent, respectively. We found a cancer detection rate of 16 percent among patients with symptoms of bladder outlet obstruction and 5 percent in patients without these symptoms. The detection rate was 36 percent for physician-referred patients and 3 percent for self-referred patients. This suggests to us that at the present time the best utilization of medical resources to increase prostate cancer detection is to educate men to have annual medical evaluations by primary-care physicians who are encouraged to incorporate risk assessment and screening DRE as part of their routine practice. Any man with either abnormal findings on examination or increased risk should be referred to a urologist for further evaluation.

[Clinical effects of low-dose Ara-C in acute nonlymphocytic leukemia and myelodysplastic syndromes]

Forty-eight patients with acute nonlymphocytic leukemia (ANLL) and myelodysplastic syndromes (MDS) were treated with low-dose Ara-C regimen (LDAC) (10 mg/m2 or 10 mg/body subcutaneously every 12 hours). Complete remission (CR) was obtained in sixteen patients (33%) and partial remission (PR) in six (16%). Seven of eight patients with hypoplastic leukemia entered CR. However, LDAC was not effective in MDS and ANLL developing from MDS. The rate of CR was 20% in relapsed or refractory ANLL. Relapse was occurred in thirteen patients until now. The median duration of remission was 7 months (range: 3-20 months). Seven of the sixteen patients who achieved CR were received LDAC at the same dose for 10 days every month as a maintenance therapy. The duration of CR of these patients was shown to be longer than that of the patients without any maintenance therapy. Myelosuppression was observed in nearly all of them and the other clinical findings including cytogenetic analysis indicated cytotoxicity rather than differentiation as the mechanism of LDAC. LDAC was effective especially in hypoplastic leukemia and the maintenance therapy was found to prolong the duration of CR.

[A study of non-aromatizing androgen C10-19lyase in adrenal tissue]

The conversion of androgen to estrogen is mediated by aromatase activity, and 19-hydroxylase and C10-19lyase are seen to be involved in C19-demethylation. The present study is to demonstrate C10-19lyase activity in adrenal tissue. Fetal bovine and pig adrenal tissue homogenates were incubated with 14C-androstenedione(A) and NADPH under air. The products 14C-19-OHA, 14C-19-norA, with added carrier standard 3H-19-OHA, 3H-19-norA were separated and purified by T.L.C.. The identification of 19-norA was established by recrystallization and that of 19-OHA by C.C.D.. The 3H/14C ratios of the products 19-norA were found to be constant in repeated crystallization. The amount of 19-OHA from A in fetal adrenal tissue was 30.0nmol/h/g protein, and that of 19-norA from A was 12.59pmol/h/g protein. C10-19lyase activity from 19-OHA, calculated by the amounts of 19-norA in fetal, bovine and pig adrenal tissue, was 49.7, 3.50, 10.3pmol/h/g protein, respectively. This is the first report to demonstrate androgen C10-19lyase in human fetal adrenal tissue, and it is assumed that fetal adrenal tissue forms 19-norA via 19-OHA.

Relationships among islet cell antibodies, residual beta-cell function, and metabolic control in patients with insulin-dependent diabetes mellitus of long duration: use of a sensitive C-peptide radioimmunoassay

Relationships among islet cell antibodies (ICA), residual beta-cell function, and metabolic control were studied in 60 insulin-dependent diabetics (IDDs) of long duration (6 to 31 years). Sensitive C-peptide immunoreactivity (CPR) and ICA assays with limits of 0.017 nmol/L and 5 Juvenile Diabetes Foundation (JDF) U, respectively, demonstrated that baseline (0.16 +/- 0.02 nmol/L, mean +/- SE, n = 26), as well as maximum CPR values (0.34 +/- 0.05 nmol/L), during 100-g oral glucose tolerance tests (OGTT) in ICA-positive IDDs were significantly higher than corresponding values in ICA-negative ones (baseline values, 0.10 +/- 0.01 nmol/L, P less than .05; maximum values, 0.20 +/- 0.04 nmol/L, P less than .01, n = 34). Negative correlation was observed between increment of serum CPR and metabolic control indices, including fasting blood glucose (FBG) and HbA1c levels (P less than .05). In addition, ICA-positive insulin-dependent diabetes mellitus (IDDM) patients had lower values of FBG (8.2 +/- 0.4 mmol/L, P less than .01 v ICA-negative IDDs) and HbA1c (9.2% +/- 0.2%, P less than .05 v ICA-negative IDDs) than ICA-negative ones (FBG, 9.9 +/- 0.4 mmol/L; HbA1c, 9.8% +/- 0.2%). These results indicate that minute CPR responses to OGTT detected by sensitive methods may represent residual pancreatic beta cells, which may contribute to ICA generation and good metabolic control in IDDs of long duration.

Chloramphenicol acetyltransferase expression in marine Rhodobacter sp. NKPB 0021 by use of shuttle vectors containing the minimal replicon of an endogenous plasmid

A vector, pUK318, was constructed to allow the expression of foreign genes in the marine photosynthetic bacterium Rhodobacter sp. NKPB 0021. This strain has been cured of its two endogenous plasmids. pUK318 consists of a 2.3-kb PstI-BamHI restriction fragment, containing a marine Rhodobacter plasmid replication region, cloned into pUC18. This fragment was derived from plasmid pRD31, a 3.1-kb endogenous plasmid purified from the marine strain Rhodobacter sp. NKPB 043402. A kanamycin resistance gene from Tn903 was cloned into the PstI restriction site to provide antibiotic selection. pUK318 was transferred to Rhodobacter sp. NKPB 0021 by transformation, and efficiencies of 7.2 x 10(-5) were obtained. Furthermore, pUK318 was stably maintained when transformants were grown either heterotrophically or photosynthetically in the absence of antibiotics. pUK318 was used to express the Escherichia coli chloramphenicol acetyl transferase (CAT) gene in Rb. NKPB 0021. Transformants expressed a maximum CAT activity of 1.12 mmol/min/g dry cells. In addition, the DNA region essential for pUK318 replication in Rb. NKPB 0021 was localized to a 1.36-kb HincII-PstI fragment. This is the first report of a plasmid vector containing a marine Rhodobacter-specific replicon that allows stable expression of foreign genes in the absence of antibiotic selection.

Influence of induced cholestasis on pharmacokinetics of digoxin and digitoxin in dogs

Dogs with ligated common bile ducts were used to determine effects of cholestasis on pharmacokinetics of digoxin and digitoxin. Forty-three dogs were assigned to: group 1--sham-operated controls (n = 13); group 2--dogs with ligated common bile duct (n = 17); group 3--dogs given phenobarbital for 2 weeks before common bile duct was ligated (n = 11); or group 4--dogs with an induced biliary fistula (n = 2). Digoxin (group A) or digitoxin (group B) was given as single IV injections, and digitalis concentration in plasma was measured by radioimmunoassay. In 18 dogs given digoxin, differences in plasma digoxin concentrations among groups 1A to 3A were not significant (P greater than 0.1). Plasma elimination rate of digoxin was delayed in group 2A. Group-3A dogs had a shortened beta phase half-life (t1/2 (beta] and a decreased distribution volume. In 25 dogs given digitoxin, group-2B dogs maintained a significantly higher plasma digitoxin concentration (P less than 0.01) and had a significantly longer t1/2 (beta] than did dogs in groups 1B and 3B (P less than 0.05). In group-3B dogs, plasma digitoxin concentration was decreased and t1/2 (beta] of digitoxin was shortened. In 10 group-B dogs given 3H-digitoxin (groups 1B, 2B, and 4B), the excretion of total radioactivity in urine and bile was 15 to 20 and 7% of the dose, respectively in the first 24 hours. Most radioactivity in urine and bile was a dichloromethane-unextractable fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Improvement of plaque score after oral hygiene instruction in patients with periodontitis]

The purpose of this study was to investigate the variations in oral hygiene conditions after oral hygiene instruction. We divided the patients with periodontitis into three groups according to the number of times oral hygiene instruction had to be given to achieve the O'Leary plaque control record (PCR) of 20%. The first group was those who achieved PCR 20% quickly (early achievement group). The second group was those who achieved PCR 20% gradually but slowly (slow achievement group). And the third group was those who showed no progress at all (non achievement group). Results showed that there were statistical differences among the average changes in PCR and residual plaque score (PS) of the teeth surfaces in each group. Especially the early achievement group were significantly superior to the other groups in improvement of PS of mandibular lingual surface with one oral hygiene instruction. We also have investigated differences in the probing depth, age and sex at initial treatment among these three groups. The average probing depth at initial treatment was significantly deeper in the non achievement group than in the early achievement groups, and there were more males than females in the early achievement and non achievement groups.

[A rapid diagnosis for periodontitis based on enzymatic activity of periodontopathic bacteria. Correlation between enzymatic activity, clinical periodontal parameters, and subgingival level of microorganisms]

There have been various laboratory methods for the microbiological diagnosis of periodontal disease. However, there have been some disadvantages in these methods. In this study of the application of a chair-side test for microbiological diagnosis, the activity of peptidases in periodontal pockets of patients was examined by using the assay system SK-013. SK-013 consists of synthetic substrates and is capable of rapidly (in 15 min) evaluating the activity of specific peptidase from Treponema denticola and Bacteroides species. Using SK-013, we evaluate the correlation between the enzymatic activity, clinical periodontal parameters and subgingival level of microorganisms, including phase contrast microscopy. We calculated the sensitivity and efficacy of SK-013 as a diagnostic indicator in the presence of Spirochetes and in periodontitis. A positive correlation were demonstrated between enzymatic activity, clinical periodontal parameters, the numbers of total cell count, Spirochetes, and M & S ratio. SK-013 was highly sensitive and efficacious (sensitivity: 92%, efficacy: 96%). We concluded that the assay system SK-013 is a useful chair-side method for diagnosing periodontal disease.

[A case of pneumococcal arthritis in a patient with gout]

A 62 year-old man had suffered from gout and mild renal insufficiency since he was 40 years old. He was admitted to our hospital complicated by a productive cough, high fever and a right swollen knee joint. The chest radiographs demonstrated a left upper lobe infiltration shadow. Streptococci pneumoniae were found in the sputum, arterial blood and synovial fluid of the right knee joint, suggesting a severe pneumonia followed by pneumococcal septicemia which led to purulent arthritis. He was treated with cefamandole (CMD) and penicillin G (PC-G) for one week, but the chest X-ray findings were not improved. After treatment with cefbuperazone (CBPZ) and latamoxef (LMOX), his fever and other symptoms gradually resolved. Streptococcus pneumoniae is an uncommon organism of septic arthritis. Pneumococcal arthritis in a patient without immunodeficiency such as this case is very rare, and has not been reported in Japan.

[Study of the penetration of extrinsic tracers into exposed cementum in vitro]

The purpose of the experiment was to study the possible penetration of extrinsic tracers with different molecular weights into exposed cementum in vitro and pathway of penetration. 75 human extracted teeth-55 periodontally diseased teeth and 20 embedded 3rd molars-were used. Each tooth was maintained in 0.005% fluorecein isothiocyanate (FITC) solution (M.W. 400), 0.05% FITC conjugated peroxidase solution (M.W. 40,000), or 0.01% FITC conjugated human IgG solution (M.W. 160,000) for 10 days. Morphological observations were made by means of fluorescence microscopy. Other extracted teeth were maintained in 0.05% microperoxidase solution (M.W. 1,900) for 5 days. Observations were then made using the TEM, and micrographs were taken and analyzed with an image analyzer. As a result, solutions of higher molecular weight showed lower penetration, and unexposed cementum showed a tendency toward greater penetration. Furthermore, the penetration of tracers on the surface of the cementum was along collagen fibers, but in the inner cementum, was into cementocyte lacunae and canaliculi.

Mononeuritis multiplex in incomplete Behçet's disease: a case report and the review of the literature

A case of Behçet's disease with peripheral nervous system involvement is described. A 58-year-old female with a 16-year history of Behçet's disease was admitted to our hospital because of numbness in multiple areas in both the upper and lower extremities. A biopsy of the sural nerve revealed degeneration of the axons and a capillary lesion. This finding was compatible with mononeuritis multiplex. This case of Behçet's disease with biopsy-proved mononeuritis multiplex is a very rare one.

Plasma 1,5-anhydro-D-glucitol as new clinical marker of glycemic control in NIDDM patients

To elucidate the value of using plasma 1,5-anhydro-D-glucitol (AG) as a marker of glycemic control in diabetic patients, the relationship between the plasma concentration of AG and glucosuria was examined in 152 patients with non-insulin-dependent diabetes mellitus (NIDDM). After recovery from the deterioration of glycemic control in NIDDM patients had started, AG began to increase day by day. The recovery of plasma AG showed a constant linear increase curve when excellent glycemic control was attained. The ordinary daily recovery rate of plasma AG was estimated to be 0.3 microgram/ml, which was independent of body weight, sex, age, the difference in treatment, the duration of diabetes, or the level of plasma AG among NIDDM patients. This rate decreased according to the increase in urinary glucose. When we calculated the decrease rate of plasma AG (delta AG), assuming 0.3 microgram/day to be the maximum increase rate in a day, we found a high correlation between delta AG and urinary glucose at almost all AG levels except the normal range and observed that plasma AG (A) times urinary glucose (G) was relatively constant. The formula A x G = 16 is a simple equation for rough estimation of urinary glucose from the plasma AG concentration in a stable glycemic-controlled NIDDM patient, and we call it the A.G index. The plasma AG also correlated significantly with fasting plasma glucose (r = -.810) and glycosylated hemoglobin (r = -.856) in the same stable glycemic-controlled NIDDM patients. Based on these observations, we propose that plasma AG can serve as a new marker that may provide sensitive and analytical information about glycemic control.

[Relationship between subjective symptom and presumed circle area ratio (PCAR) in benign prostatic hypertrophy]

Subjective symptoms on voiding were analysed in 419 subjects who were submitted to mass screening program for prostatic diseases by means of transrectal sonography, consisting of 296 normal subjects and 123 cases of benign prostatic hypertrophy (BPH). Subjective symptoms were encountered in about 70% of normal subjects and 80% of BPH cases. However, almost all normal subjects complained of single symptom, while many BPH cases of multiple symptoms. The frequency of subjective symptoms in BPH cases was significantly higher than that in normal subjects. Relationship between each subjective symptom and the presumed circle area ratio (PCAR) was evaluated in all cases of BPH. As the results, it was proved that the higher the PCAR was, the more the appearance of the urinary prolongation and nocturnal frequency were encountered. Moreover, it was presumed that these symptoms on voiding, especially the urinary prolongation, correlated closely with the degree of urinary obstruction in BPH patients.

[Sepsis in patients with hematological diseases]

Sepsis is one of the important complications on the treatment of severe hematological diseases. In this report, we analyzed sepsis in 309 patients with hematological diseases who were admitted to the First Department of Internal Medicine of Yokohama City University Hospital from 1979 to 1986. Positive blood culture were found in 17.8% (55/309 cases) and total positive cases were 73 including recurrent patients. Positive rate by underlying diseases was 30.3% in acute leukemia, 20.8% in chronic myelocytic leukemia, 17.2% in aplastic anemia, 8.0% in multiple myeloma, 6.0% in malignant lymphoma and 6.5% in others. The organisms causing sepsis were as follows; gram negative bacilli 56.4%, gram positive organisms 34.6%, fungus 6.4% and anaerobic bacteria 2.6%. Pseudomonas aeruginosa was found in 19.2%. The mortality rate of patients with sepsis was 34.2% (25/73 cases). The significant prognostic factors in patients with sepsis were the degree of neutropenia, duration of neutropenia (500 less than microliters), the species of organisms, simultaneous complication with shock and the site of other infections.

[Introduction of a method of promoting periodontal disease awareness]

In periodontal diseases, due to lack of subjective symptoms, disease awareness and professional consultations are often dismissed even by subjects with already established periodontal lesions. The purpose of this study was to gain data concerning the relationship between bleeding induced by interdental stimulating and some of the clinical indices used in routine periodontal examinations in order to consider if wooden interdental cleaners, which are available to patients themselves, could be used as a means of arousing disease awareness. Furthermore, the buccolingual insertion of interdental cleaners was confirmed together with reconsiderations on its role as a means of proximal plaque control. 180 interdental sites of 30 new out-patients suspected of gingivitis or periodontitis consisted the material. As comparative indices to interdental stimulating, Bleeding on Probing (BOP), Probing Depth (PD), Gingival Index (GI) and Gingival Crevicular Fluid (GCF) measurement were selected. The interdental cleaning efficiency was reconsidered by assessment of interproximal plaque removal. As a result, bleeding was induced both by interdental stimulating and probing in 106 of the 180 experimental sites and was the majority. In relation to PD, concerning pockets less than 1.5 mm, bleeding was not induced by interdental stimulating. 58.8% of 3 mm pockets and all of the pockets deeper than 5 mm bled on interdental stimulating. Concerning the relationship with the GI, no site evaluated GI. 0 bled on interdental stimulating. 12.9% of sites evaluates GI. 1, 73.3% of sites evaluated GI. 2, and all of the sites evaluated GI. 3 bled on interdental stimulating. 39.0% of sites with GCF measurement of 0-21, 51.9% of sites with GCF measurement of 21-40 and 96.8% of sites with GCF measurement of over 81 showed bleeding on interdental stimulating.(ABSTRACT TRUNCATED AT 250 WORDS)

[Percutaneous nephroureterolithotomy in two city hospitals: review of 102 cases]

The authors experienced 102 cases of percutaneous nephroureterolithotomy (PNL) in the urological clinic at two city hospitals between May, 1984, and July, 1986. Percutaneous access for renal pelvis was performed under interventional ultrasound and the disintegration of stones was mainly performed by an electric drill system. Stones were successfully removed in all the cases, although residual stones were recognized in 16 cases (15.7%). Complications were rather minor and were treated conservatively without open surgery. PNL is a very effective and promising method not only for university hospitals but also for the urological clinic in city hospitals.

[Histochemical studies of muscle fibers of the triceps surae in the rat under different types of tonus]

To investigate the relationship between muscle atrophy and its tonus, triceps surae in four groups of rats were studied changing the muscle tonus by cutting of Achilles tendon, by shortening or lengthening of the tibia and compared with those of control groups. During the eight weeks after the operation, rats were sacrificed every week except for the seventh. The muscles were evaluated by histochemical methods (NADH-TR and myosin ATPase reaction), in which the diameter of the muscle fiber was measured according to the Brooke method. The following results were obtained; (1) Targetoid fibers were observed more frequently among type 1 fibers as the muscle tonus was decreased. (2) Diameter of both fiber types was reduced as the muscle tonus changed. (3) These changes were reversible as the muscle tonus was restored to normal.

Renal handling of hypoxanthine and xanthine in normal subjects and in four cases of idiopathic renal hypouricemia

Pyrazinamide (PZA) was used to study the renal handling of hypoxanthine, xanthine and uric acid in 2 normal subjects and in 4 patients with idiopathic renal hypouricemia; one patient was classified as having a postsecretory reabsorption defect, whereas the others were classified as having a presecretory reabsorption defect. In normal subjects, PZA suppressed strongly the excretion of xanthine as well as uric acid; however, it showed a weak effect on that of hypoxanthine. PZA suppressed all excretion of these 3 compounds in the patient with postsecretory reabsorption defect. PZA showed almost no effect on the excretion of either hypoxanthine, xanthine or uric acid in the patients with presecretory reabsorption defect.

Molecular structure of the replication origin of a Bacillus amyloliquefaciens plasmid pFTB14

The structure of a 1.5-kb DNA sequence that is necessary and sufficient for the replication of an 8.2-kb cryptic plasmid, pFTB14, isolated from a strain of Bacillus amyloliquefaciens has been characterized. The 1.5-kb DNA sequence contains an open reading frame, rep, stretching for 1017 bp, a promoter region for rep expression, and a possible replication origin for the plasmid upstream of the promoter. The rep product is trans-active and essential for plasmid replication. The predicted rep protein is a basic protein, as are the RepC protein of pT181, RepB of pUB110 and protein A of pC194 (all these found in staphylococci) and the pi protein of the R6K plasmid of Escherichia coli. The predicted rep protein has highly homologous amino acid sequences with protein A of pC194 and RepB of pUB110 throughout the protein molecule, but not with RepC of pT181, pi of R6K or protein RepH encoded by and initiating the replication of pC194.

[Laboratory and clinical studies of flomoxef]

Laboratory and clinical studies were performed on a new oxacephem antibiotic, flomoxef (FMOX, 6315-S). In vitro antibacterial activity of FMOX was evaluated in comparison to latamoxef (LMOX), cefmetazole (CMZ), cefazolin (CEZ) using clinically isolated strains of Gram-negative and Gram-positive bacteria. Antibacterial activities of FMOX were stronger than LMOX, CMZ, CEZ against Escherichia coli, Klebsiella but only slightly effective against Staphylococcus aureus. This antibiotic drug was administered to 5 patients consisting of 2 cases with pneumonia, one each with pyelonephritis, chronic bronchitis and urinary tract infection. The drug was given in 1 g drip infusion twice a day for 8 to 13 days. Clinical efficacies of FMOX were excellent in 1 case, good in 2, fair in 1, and unevaluable in 1. As for bacteriological effect of FMOX, organisms were eradicated in 3 cases. No side effect was noted and there was no abnormal change in laboratory findings.

Non-invasive transgastric detection of ultrasonic Doppler signals from canine renal vessels

We successfully obtained ultrasonic Doppler signals from canine renal vessels non-invasively by the transgastric approach. An outline of the method and newly developed transgastric probe is presented in this preliminary report.

Coexistence of cardiac lesions and thrombophlebitis in a patient with rheumatoid arthritis

A 41-year-old Japanese female developed polyarthritis with fusiform deformity. Diagnosis of rheumatoid arthritis was made and anti-inflammatory drugs were prescribed. Later thrombophlebitis in legs and cardiac lesions developed. The clinical course and treatment of this patient are briefly discussed.

[Analgesic effect of calcitonin in patients with metastatic bone lesions from urogenital cancer]

The analgesic effect of eel-calcitonin (Elcitonin) was evaluated in 10 patients with metastatic bone lesions from urogenital cancer. Five patients had renal cell carcinoma, while the remaining 5 patients had prostatic cancer. Eel-calcitonin was injected intravenously to each patient at a dose of 80 units every day. The drug was markedly effective for 3 patients, effective for 4 patients and ineffective for 3 patients. The effect was better for prostatic cancer than renal cell carcinoma.