A changing pattern of causes of death among diabetic during a 25-year period in the Osaka District, Japan

A total of 23,577 death certificates mentioning diabetes, in 10,927 cases as the underlying cause and in 12,650 cases as a contributory condition, were selected from approximately 1,000,000 death certificates filed in Osaka Prefecture, Japan, during a 25-year period between 1960 and 1984. These certificates were analyzed by use of a multiple coding system. The proportion of deaths associated with diabetes, which was only 0.88% of the total deaths in the period 1960-1964, increased to 3.49% in the period 1980-1984. It was also notable that the proportion of certificates with diabetes as the underlying cause of death to the total number of certificates mentioning diabetes decreased strikingly, from 60.8% in 1965-1969 to 36.8% in 1980-1984. Among diabetic subjects, the proportion of patients aged 65 years or over at death increased markedly during the same period, from 47.2% to 68.8%, and a clear increase in the mean age at death was apparent during the 25-year period. Remarkable changes in the underlying causes of death among diabetics were observed during the study period; an increase in disease of the circulatory system, and especially in disease of heart was noted. In the period 1980-1984, disease of heart exceeded cerebrovascular disease which had been the most frequent cause of death in diabetic subjects until that period. An increase in renal disease, including diabetic nephropathy, which was not observed in the standard analysis of underlying causes, was confirmed in the analysis of contributory conditions which was based on the multiple coding system.

[Clinico-pathological findings of recurrent pleomorphic adenomas of the parotid gland]

We analyzed the clinical courses and pathological findings of six recurrent benign pleomorphic adenomas of the parotid gland, compared with fifty-nine primary pleomorphic tumors. Primary cases were treated with extirpation of a tumor nodule with a surrounding area of parotid tissue with preservation of the facial nerve. Of the 59 patients, 42 who had follow-up information have had no recurrent tumors during a average 6.6 years follow up period. On the other hand, all six recurrent cases had received surgical enucleation or excisions elsewhere. To avoid the recurrence of the primary pleomorphic adenoma it was considered to be very important to remove a tumor completely without damaging the tumor capsule. CT scan is very useful to know the relationship between the recurrent tumor and the surrounding important organs. In order to determine the surgical approach and procedures for those cases, it is important to obtain the information of the previous pathological diagnosis or surgical procedures. For the recurrent tumor, complete extirpation of the tumor and surrounding operative scar was necessary for the management of the tumor. When the tumor was tightly adhesive with the facial nerve, sacrifice of the nerve and immediate nerve transplantation might be required.

Successful treatment of disseminated cutaneous cytomegalic inclusion disease associated with Hodgkin's disease

A case of disseminated cutaneous cytomegalic inclusion disease associated with Hodgkin's disease is described. The patient had a diffuse eruption of pruritic, erosive erythematous nodules. Histologically, many inclusion bodies were observed in perivascular areas of the skin lesions. Immunohistologically, the inclusion bodies positively stained with both anticytomegalovirus antibody and anti-factor VIII-related antibody. On electron microscopy many virus particles and dense bodies were found in the area where inclusion bodies were observed. Treatment with high-dose intravenous acyclovir and a large amount of immunoglobulin resulted in prompt healing of the skin lesions. Subsequently, the patient's Hodgkin's disease was well controlled on chemotherapy. The patient steadily improved without relapse of skin lesions 1 year after antiviral therapy was administered.

[MR imaging of optic neuritis using short T1 IR (inversion recovery)]

We evaluated the ability of MRI using short T1 inversion recovery (STIR) to diagnose optic neuritis. Eleven patients with previous or recent attack of optic neuritis were studied with MRI at 0.5 tesla. STIR images revealed high signal regions in 7 of 12 symptomatic and 5 of 10 asymptomatic nerves. Three of five asymptomatic nerves with high intensity were pertinent to the cases with past attack and seemed to reflect the demyelinating change. The other two nerves were pertinent to the cases without past attack and seemed to show occult lesions. We consider that STIR is useful in detection of optic nerve lesions associated with optic neuritis.

Development of diabetic retinopathy and its associated risk factors in type 2 diabetic patients in Osaka district, Japan: a long-term prospective study

Incidence rates of diabetic retinopathy and its associated risk factors were studied in a long-term prospective study involving 976 type 2 (non-insulin dependent) diabetic patients that showed no retinopathy at entry to the study. 322 of the patients (one-third of the subjects studied) developed diabetic retinopathy during the observation period (average length 8.3 years). The incidence rate per 1000 person-years was 39.8. The rate was significantly related to age at onset of diabetes, to fasting plasma glucose (FPG) level at entry, and to type of treatment. The incidence rate was also related to the duration of the disease. Glycemic control clearly played a role in the occurrence of retinopathy. Patients with FPG greater than or equal to 200 mg/dl had the highest incidence rate, while patients with FPG less than 140 mg/dl showed the lowest incidence rate throughout the observation period. Furthermore, a longer period between onset of diabetes and development of retinopathy was observed in patients with FPG less than 140 mg/dl compared to patients with FPG greater than or equal to 200 mg/dl. The findings suggest that strict glycemic control may be of particular value to reduce the incidence of retinopathy and to delay its appearance in type 2 diabetic patients.

[The method of esthetic crown restoration with composite resin jacket crown in primary molars]

The term "esthetics" has recently been also used in the dental field, and a field called esthetic dentistry is increasingly being noted. The number of not only adult but also pediatric patients who visit for treatment aiming at esthetic recovery is being increased. Inpedodontics, composite resin of the coronal color is generally used in the restoration of deciduous incisors. However, the method using metal crowns for the deciduous teeth is used for the deciduous molars at present. We applied a composite resin jacket crown to the deciduous molar in a way similar to that of esthetic crown restoration for the anterior teeth. The surgical procedure before crown preparation varied slightly according to the presence or absence of pulpal treatment of vital teeth and with non-vital teeth, but the application was performed as follows: 1) Desensitization of pulp, pulpal treatment and core construction. 2) Preparation of crown. 3) Selection, trial set and occlusal equilibration of a metal crown for the deciduous tooth. 4) Precision impression with a silicone impression material. 5) Removal of the metal crown for the deciduous tooth from the impression material. 6) Making of an under-cut to the abutment tooth on the buccal lingual side. 7) Filling of the impression with chemical polymerization resin. 8) Application of pressure in the oral cavity. 9) Adjustment of edge and crown forms. Thus, the preparation method for the composite resin jacket crown was relatively simple. Since this surgery, the patient has been followed up for 1 year and 6 months, and no specifically troublesome points have been observed clinically. The patient and her parents are satisfied with the results.(ABSTRACT TRUNCATED AT 250 WORDS)

IgE-positive epidermal Langerhans cells in allergic contact dermatitis lesions provoked in patients with atopic dermatitis

To see whether or not IgE-bearing epidermal Langerhans cells are specific to skin lesions of atopic dermatitis (AD), we performed immunohistochemical and immunoelectron microscopic examinations of dinitro-chlorobenzene (DNCB) contact dermatitis lesions provoked in uninvolved skin of eight patients with AD. In all of the eight examined, IgE-positive epidermal Langerhans cells were observed in the DNCB dermatitis lesions. Typical staining of anti-IgE was absent in the epidermis of normal-appearing skin of five patients with AD. Thus, it is likely that IgE positive epidermal Langerhans cells non-specifically occur in different eczematous diseases provoked in patients with AD.

Blood eosinophilia in atopic dermatitis

Blood eosinophil levels were examined in 200 (100 mild and 100 severe) patients with atopic dermatitis. Eosinophil levels roughly correlated with disease severity. However, the pattern of eosinophilia was not homogeneous. Very high eosinophil counts were common in severe cases of atopic dermatitis who had a personal or family history of respiratory atopy, while normal or moderately elevated eosinophil values were obtained in severe cases of 'pure' atopic dermatitis who had neither personal nor family history of respiratory atopy. It is suggested that disease severity and personal or family history of respiratory atopy are important factors in determining high blood eosinophil levels in atopic dermatitis.

The development of the pecten oculi in the chick

The development of the pecten oculi, a structure peculiar to the avian eye, was studied by scanning electron microscopy (SEM) correlated with light microscopy (LM) in embryonic and adult chickens. The development of the chick pecten was divided into 4 phases: (1) formation of the primordial pecten (Hamburger-Hamilton's stages 27 to 29), (2) formation of the plate-like pecten (stages 30 to 34), (3) pleat formation and pigmentation (stages 35 to 37), and (4) bridge formation and high-vascularization (stage 38 to adult). The primordial pecten is formed entirely from the ectoderm by fusion of the inwardly-projecting edges of the optic fissure. The primordial pecten grows into a tall, thin plate rising from a broad base. The pecten begins to fold slightly at stage 35. The number of pleats increases rapidly, from 7 at stage 35, to 16 at stage 36, 18 at stage 37, and 19 to 20 at stage 40. The bridge begins to form at stage 38 by a swelling of the apical edge of the pecten and completes its development by the twentieth post-hatch day. Blood vessels appear first in the broad base of the plate-like pecten, then become more numerous and gradually extend into the pleats. The pecten becomes more vascular than cellular at stage 43, and it is highly vascularized in the adult. The pleat surface becomes conspicuously irregular with increased vascularization. The peripectinate cells, located on the pecten, are already present at stage 27.

[Clinical evaluation of serum biotin levels and biotinidase activities in patients with various liver diseases]

In order to evaluate the clinical significance of serum biotin and biotinidase in liver disease, serum biotin levels and biotinidase activities were determined in 83 patients with various liver diseases and 10 healthy controls. Serum biotin levels and biotinidase activities were determined by a simplified lactobacillus plantarum bioassay and liquid chromatography with fluorimetric detection respectively. Serum biotin levels in decompensated liver cirrhosis, hepatoma and fulminant hepatitis were found to be significant low compared with healthy controls, while it was significant high in autoimmune hepatitis. There was no significant difference between serum biotin levels in the other liver diseases and healthy controls. In various liver diseases except for both acute hepatitis and alcoholic liver disease biotinidase activities were significantly reduced than in healthy controls. Serum biotinidase activities were correlated with serum albumin, prothrombin time, ChE and total cholesterol respectively, suggesting that biotinidase activities may reflect the degree of liver damage. These results seem that biotin deficiency may occur in some cases of severe liver diseases.

[Evaluation of non-surgical treatments of hepatocellular carcinoma--investigation of the cases with long and short survivals after treatment]

One hundred and one cases of hepatocellular carcinoma (HCC) treated in Maebashi Red Cross Hospital from May 1984 to August 1987 were classified according to the therapy and progression of the disease and were investigated on their prognosis. Furthermore, "long survived group" in which, patients survived for more than one year were compared with "short survived group" in which patients died within one month after non-surgical treatment. In operated patients, the prognosis was the best, but the rate of operable cases was only 13.9%. In patients with stage IV, one year survival rate was significantly low. In patients with portal trunk invasion (Vp4), or with Child C that was the poorest functional reserve of the liver, one year survival rate was also significantly low in comparison with patients with other stages or other Child's classification. In HCC patients treated with transcatheter arterial embolization (TAE), the prognosis tended to be poor as stage and portal invasion progressed, but in regard to reserve function of the liver, the prognosis was not so poor in patients of Child C significantly as in cases of A or B. The comparisons between long and short survived group were as follows. a) In 17 cases belong to long survived group, mean survival period was 24 months and the longest one was 4 years and 10 months. On the other hand, in 10 cases belong to short survived group, mean survival period was 17 days, the shortest one was 3 days. b) The main reason of inoperability in long survived group was progression of the tumor. Complications such as diabetes mellitus, advanced age and rejection of treatment by the patient were the other reasons of in operability. In almost half of the patients in short survived group, the tumor progression and low functional reserve of liver were found in 4 patients. c) In short survived group, esophageal varices were more common and functional reserve of the liver was poorer than in long survived group. In short survived group, LDH and total bilirubin were significantly higher than those of long survived group, but there was no significant differences in transaminase value and ICG retention in 15 minutes. d) In short survived group, extent of the tumor in liver and portal invasion were advanced. Three cases of this group (30%) had distant metastasis. e) In long survived group, the main reason of death was hepatic failure. Renal failure, or pulmonary complications were also found in short survived group.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of plasmapheresis on familial type III hyperlipoproteinemia associated with glomerular lipidosis, nephrotic syndrome and diabetes mellitus

A 59-year-old woman, one of 5 cases with familial type III hyperlipoproteinemia reported at our clinic to date, had nephrotic syndrome and diabetes mellitus, but had neither coronary atherosclerosis nor xanthoma. A renal biopsy specimen revealed a massive cluster of foam cells containing apolipoprotein B and E in the mesangial region of the kidney. A restricted diet intake combined with lipid-lowering drugs such as cholestyramine, clinofibrate, and bezafibrate, in addition to methylprednisolone was not very effective in lowering serum triglyceride and cholesterol levels within physiological ranges. Therefore, plasmapheresis, using a dextran sulfate-cellulose column, was performed. Repeated plasmapheresis resulted in a marked decrease in both serum total cholesterol and triglyceride. A second renal biopsy specimen performed 2 years later revealed a marked reduction in foam cells with concurrent improvement in her nephrotic syndrome and glucose intolerance. These results suggest that familial type III hyperlipoproteinemia may be responsible for glomerular lipidosis resulting in nephrotic syndrome. They also indicate that plasmapheresis using a dextran sulfate-cellulose column is very effective in the removal of abnormal lipoproteins such as beta-very low density lipoprotein and intermediate density lipoprotein in a case of familial type III hyperlipoproteinemia.

Persistent albuminuria as an index of diabetic nephropathy in type 2 diabetic patients in Osaka, Japan-incidence, risk factors, prognosis and causes of death

A group of 1196 type 2 (non-insulin-dependent) diabetic patients was followed for a mean of 10 years to determine the incidence of persistent albuminuria, its associated risk factors and prognosis, as well as causes of death in patients. None of the patients studied had albuminuria on entry. The mean annual incidence rate of persistent albuminuria per 1000 person-years in the patients was higher in males than in females (18.42 and 12.57, respectively). Development of persistent albuminuria was associated with age at entry, duration of known diabetes, systolic blood pressure, fasting glucose level, presence of diabetic retinopathy and type of treatment. Among 193 patients who developed persistent albuminuria during the observation period, 66 (34.2%) died before the end of the observation period, with a mean survival period (+/- SD) of 3.0 +/- 3.1 years after the onset of persistent albuminuria, indicating an extremely poor prognosis. Renal disease was the predominant cause of death in patients who developed persistent albuminuria, followed by heart disease and cerebrovascular disease.

[NK activity in various liver diseases--especially the relation between NK activity and reserve function of the liver in liver cirrhosis and hepatocellular carcinoma]

NK activity in acute viral hepatitis, chronic hepatitis, liver cirrhosis (LC), metastatic liver cancer and hepatocellular carcinoma (HCC) was preserved and had no significant change compared with the normal control in each disease. In acute hepatitis, NK activity was higher in convalescent phase than in acute phase. Although in LC and HCC, some liver functions such as total bilirubin, the rate of ICG 15' excretion, AFP and IAP did not have significant correlation with NK activity, advanced cases according to Child's classification and E factor which was anatomical extent of HCC in liver showed significantly low NK activity. The low NK activity group advanced much more in Child's classification, performance status, stage and E factor of HCC than high NK activity group significantly. According to those facts, LC or HCC is not a single entity of disease in view point of NK activity. NK activity may change in accordance with the advancement of hepatic disease and reserve function of the liver in LC and HCC.

Familial background of respiratory atopy. A factor of type I allergy to house dust mite in patients with atopic dermatitis

Skin prick and radioallergosorbent tests with the house dust mite were performed in 120 patients with atopic dermatitis. The results showed that about 60% of the patients had type I allergy to the mite. Results of the prick and radioallergosorbent tests did not relate to the severity of skin involvement, nor to the seasonal fluctuation of the disease. Positive skin and radioallergosorbent tests occurred in many patients with atopic dermatitis who had a personal or family history of respiratory atopy. However, both of these tests were negative in the majority of patients with "pure" atopic dermatitis who had neither a personal nor a family history of respiratory atopy. It was suggested that a familial background of respiratory atopy is an important factor for the development of type I allergy to the house dust mite in patients with atopic dermatitis.

Development of the heartbeat during normal ontogeny and during long-term organ culture of hearts of the newt, Cynops pyrrhogaster

Development of cardiac contraction was investigated in the newt, Cynops pyrrhogaster, during normal development and in hearts maintained in long-term organ culture. In the embryos the heart began beating as early as stage 33. The heart rate increased up to stage 52 and then gradually decreased to the adult rate by stage 60. The heart rate showed a logarithmic temperature dependence. In organ-cultured hearts the pattern of heart rate depended on the stage at which the heart was explanted; cultured embryonic hearts showed a pattern of increase and decline similar to that seen in vivo, and hearts explanted near metamorphosis showed only a slow decline.

Developmental physiology of cardiac contraction in the Japanese newt in vivo and in vitro

Development and differentiation of whole hearts of larvae of an experimental amphibian species, the Japanese newt (Cynops pyrrhogaster), were studied in vitro and in vivo with particular reference to cardiac contraction, its temperature sensitivity and morphology. Hearts cultured in the solid or flat state in plastic flasks for 27 days developed from stage 35 to stage 55 and corresponded closely to in vivo developing hearts with respect to morphologic criteria and temperature sensitivity of cardiac contraction. The peak rate of contraction at room temperature occurred after 20 days, both for cultured hearts in vitro and for in vivo hearts, which had reached stage 50 to 52 of development. Excised fractions of heart continued to beat at reduced rates for extended periods. Hearts cultured at late stages (50 to 55) continued to beat for 282 days, though the rate decreased to 1 bpm. Although cardiac contraction rate gradually declined during long-term culture, the sensitivity of this tissue to temperature change remained constant for 250 days. Thus, culture of the heart of this species should prove useful to the investigation of factors related to induction and developmental regulation of contractility.

Mortality and causes of death in type 2 diabetic patients. A long-term follow-up study in Osaka District, Japan

A follow-up study of 1939 diabetic patients with a mean observation period of 9.4 years was carried out in Osaka, Japan. The mortality rates per 1000 person-years were 31.35 for males and 21.99 for females, and the ratios of observed to expected number of deaths were 1.69 for males and 1.74 for females, indicating an excess mortality for diabetic patients of both sexes and higher mortality in males than in females in Japan. Factors related to the prognosis of the patients were age, elevated fasting glucose level, lower obesity index, hypertension, diabetic retinopathy, and albuminuria at entry to the study. Insulin treatment was also associated with poor prognosis. Cerebro-cardiovascular and renal disease were the major causes of death in diabetic patients; heart disease killed 19.5%, cerebrovascular disease 16.7% and renal disease 13.1%. The relatively high frequency of renal disease as a cause of death in type 2 diabetes, especially in patients with a lower age of onset, was noteworthy, suggesting some difference in the clinical manifestations of diabetes between Japan and Western countries. Malignant neoplasms accounted for 25% of deaths, and cirrhosis of the liver for 6.4%.

A case report of transcatheter arterial embolization of cholestatic type of hepatoma

A 57-year-old man with hepatocellular carcinoma (HCC) invading the hepatic duct was treated with transcatheter arterial embolization (TAE). The dilated hepatic duct was decompressed his jaundice disappeared and he survived for 10 months after the first TAE, succumbing due to bleeding from gastric erosion. Although total bilirubin was 26.7 mg/dl and massive ascites was noted on occasion of the first TAE, hepatic dysfunction did not worsen and both icterus and ascites decreased, disappearing one month after the therapy. Autopsy revealed HCC with trabecular arrangement originating in the left lobe and growing into the left hepatic duct accompanied by liver cirrhosis and follicular carcinoma of the thyroid gland. Severe icterus caused by bile duct obstruction does not correlate with the grade of hepatic failure in HCC with liver cirrhosis, so TAE was effective and should be tried as a first choice therapy in such a poor risk case.

A longitudinal study of contact sensitivity in patients with atopic dermatitis

Sensitization trials with dinitrochlorobenzene (DNCB) were performed in 150 patients with atopic dermatitis (AD) (24 severe, 86 moderate, and 40 mild cases). Dinitrochlorobenzene challenge tests were positive in 33% (8/24) of severe cases, in 95% (82/86) of moderate cases, and in 100% (40/40) of mild cases, indicating that DNCB contact sensitivity is diminished only in patients with AD who have extensive skin lesions. Of the 20 patients who were nonreactive on the first DNCB challenge tests, 18 became reactive on the second challenge tests that were performed at the time when the dermatitis was well controlled. It is likely that the suppressed contact sensitivity seen in patients with AD is secondary to the disease.

[Radiation therapy of hepatocellular carcinoma]

After the transhepatic arterial therapy, irradiated 11 patients with hepatocellular carcinoma were investigated clinically and pathologically. As the effect to the main tumors except for 3 cases who dropped out because of the side effect of irradiation, partial response (PR) was found in 1 case, minor response (MR) was in 2. There was no change (NC) in 4 and 1 had progressive disease (PD), so the rate of effectiveness was 12.5%. Irradiation to the tumor thrombosis of the portal vein were done for seven cases, 2 of them (28.6%) showed the decrease of the thrombosis or improvement of the blood stream in the portal vein on angiography or histology. AFP decreased in four of seven measurable cases within one month after the irradiation. Side effects were jaundice, fever, appetite loss and so on, which were seen especially in cases of Child's B or C. Liver dysfunction and bone marrow suppression were also observed though not so severe. For the cases received lipiodol injection before radiation, lipiodol collection to the tumor was beneficial for the determination of the irradiated field.

Evolutionary changes of immunohistological characteristics of secondary lesions in pityriasis rosea

In 15 patients with pityriasis rosea, we studied the evolutionary changes of the immunohistological characteristics of the secondary lesions. Many CD1a+ cells were seen in the epidermis and dermis of early lesions. In the well-developed lesions, the number of CD1a+ cells greatly increased in the dermis. In the late lesions, CD1a+ cells in the dermis significantly decreased as compared with the well-developed lesions. Early lesions showed a moderate T-cell infiltrate. In the well-developed lesions, the dermal T-cell infiltrate was dense, and the CD4 CD8 ratio was 2.9. The late lesions had a moderate T-cell infiltrate, in which the CD4 CD8 ratio significantly decreased as compared with the well-developed lesions. Thus, the relative decrease in CD4+ helper inducer cells during lesion regression, concomitant with a decrease in number of CD1a+ Langerhans cells, is in accordance with a broader concept of increased suppressor mechanisms during healing.

Studies of neural tube development in the chicken embryo tail

The tail regions of chick embryos between stages 21 to 46 were studied by light microscopy using paraffin- and epoxyembedded serial sections. The embryonic tail attains its maximum length at about stage 22. The present study examined the morphogenesis of the caudal neural tube during the reduction and remodelling processes of the embryonic tail. Between stages 21 and 28, the embryonic tail became markedly shorter, and the neural tube, with a single central canal, merged caudally with the short medullary cord and tail bud. Between stages 29 and 31, the neural tube elongated and curved rostrally, while the caudal end of the notochord and the tail bud disappeared. Between stages 32 and 39, after showing various structural changes such as dilatation or rupture and abnormal elongation of its marginal zone the neural tube became shorter. By stage 40, development of the caudal neural tube was essentially complete and the neural tube was shorter than the notochord. The neural tube opened dorsally, as in the adult chicken. The caudal opening may be newly-formed as the open portion was found to contain numerous macrophages.

Immediate hypersensitivity skin reactions to human dander in atopic dermatitis. Partial purification and characterization of human dander allergens

Using high-speed gel filtration chromatography, an aqueous extract of human dander was divided into four fractions (fractions I to IV). Scratch tests with the crude human dander extract and each fraction were performed in 147 patients with atopic dermatitis and 100 control subjects. The crude extract provoked positive reactions in 61.9% (91/147) of patients with atopic dermatitis and 6% (6/100) of control subjects. The most potent allergenic component was present in fraction II, which induced positive reactions in 61.2% (90/147) of patients with atopic dermatitis. Sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis demonstrated that fraction II contained two proteins with molecular weights of 10,000 and 13,000, respectively.

Follicular occurrence of prurigo nodularis

Thirty-eight biopsies of prurigo lesions (22 large, mature nodules and 16 smaller, intermediately developed nodules) were obtained from 17 patients with idiopathic prurigo nodularis Hyde who had not been bitten by insects, nor had other underlying diseases. Each biopsy was serially sectioned to reveal its histological structure. In 88% (14/16) of the smaller nodules and in 55% (12/22) of the large ones, a hair follicle was observed in the center of the prurigo lesion. The follicular epidermis and the adjacent surface epidermis showed various degrees of acanthosis and spongiosis. The dermal infiltrates extended from the superficial dermis into the middle dermis in a triangular fashion around the involved hair follicle. It is suggested that idiopathic prurigo nodularis most frequently occurs in connection with a hair follicle.

[Effect of combination therapy with an adriamycin-lipiodol emulsion and a mitomycin C microcapsule in hepatocellular carcinoma complicated by portal thrombosis]

An intra-arterial injection of an Adriamycin-Lipiodol emulsion and a Mitomycin C microcapsule has been given to two patients of hepatocellular carcinoma (HCC) complicated with a tumor thrombosis of the portal trunk. One patient showed a partial response, while the other evidenced no change, alpha-Fetoprotein decreasing from 4510 to 419 ng/ml in the partial response case, and from 328 to 283 ng/ml in the no change case. In each instance the hepatic injury treated by this combination therapy was mild and reversible. Bone marrow suppression by this therapy was not demonstrated. Thus, this therapy is thought to be applicable to cases of hepatocellular carcinoma complicated with a tumor thrombosis of the portal trunk who should not be indicated for transcatheter arterial embolization.

Rings and double minutes in a case with blastic phase of chronic myelocytic leukemia

The patient studied was a 33-year-old female in the blastic phase of chronic myelocytic leukemia resistant to busulfan. The results of cytogenetic studies of bone marrow cells were as follows: The abnormal chromosomes were double Ph1, +19, +6, +B, ring D, double ring D, double minutes (DM) of various sizes, etc. The mean number of DM per cell was increased in 4-day culture compared with that in 1-day culture.

Morphological studies of the spinal cord in tetraodontiformes fishes

The spinal cord of two tetraodontiform fishes, the Japanese file fish (Navodon modestus) and the panther puffer (Takifugu pardalis), are unusual among vertebrates in having a markedly abbreviated spinal cord with a long and flattened filum terminale. Only the rostral short part of the cord of both species is cylindrical; the greater part of the cord is markedly flat. The majority of the spinal nerve roots leave the short cylindrical part. The flattened part of the cord contains the central canal, myelinated nerve fibers, and a few motoneurons surrounding the cauda equina, and it is histologically similar to the filum terminale of amphibians and mammals. The spinal cords of other teleosts, the sun-fish and angler, also are abbreviated and possess a filum terminale and cauda equina. These orders possess an enormous head and short trunk. However, the correlation between this body form and an abbreviated cord is not causal, since the tetraodontiform species described here show ordinary body proportions. The spinal cord may be abbreviated in tetraodontiform fishes in general.

[Circadian rhythms of lithogenic and inhibitory substances in the urine]

The diurnal variations of urine composition with respect to urinary pH, volume, creatinine, calcium, magnesium, phosphate, uric acid, citrate and oxalate were studied in five healthy men. Generally, there was considerable variations in the excretion of the different urine constituents with meal related peaks except phosphate, which was most pronounced after dinner. The analysis of a 24-hour urine collection cannot account fully for the crystallization properties of urine and a fractionated urinalysis might be of value for therapeutic decisions. However, such procedures probably will not be possible in clinical practice and more reliable methods for evaluation of the crystallization propensity in whole 24-hour urine have to be developed.