[Treatment of rejection with deoxyspergualin after renal transplantation]

Deoxyspergualin (DSG), which is a new immunosuppressive drug developed in Japan, is expected to be an immunosuppressant for the treatment of rejection, because it has immunosuppressive action different from that of other drugs. In the present study we used DSG to treat renal allograft rejection of in total 17 cases; 6 cases with acute rejection, 8 with chronic rejection and 3 with acute on chronic rejection. We infused DSG very slowly over 3 hours at a dose of 3-7 mg/kg/day for 5-7 days. Four cases (44.4%) with acute or acute on chronic rejection showed excellent response to DSG, three cases (33.3%) showed fair response and two cases (22.3%) did not respond at all. We also used DSG in patients with chronic rejection. In many of them, the increase in serum creatinine was suppressed. Ten of the total patients (58.8%) developed side effects including leukocytopenia, thrombocytopenia, numbness of the fact etc. No patients needed discontinuation of DSG. From the above results, we think that DSG is a safe and effective drug to treat acute rejection. Furthermore, we could get the results which suggest that DSG is effective for the treatment of chronic rejection.

[Clinical and hemodynamic sequelae of mitral prostheses evaluated by Doppler echocardiography]

To determine the relative superiority of a prosthesis in the mitral position, in vivo hemodynamics were examined by Doppler echocardiography, and the results were compared with other types of mechanical mitral valves including 63 Björk-Shiley convexo-concave (BS) values, 30 Duromedics (DM) valves, and 58 Medtronic Hall (MH) valves. For this comparison, the following indices were evaluated: peak velocity of mitral flow (PV), mitral valve orifice area (MVA), mitral valvular regurgitation, New York Heart Association (NYHA) classification, pulmonary capillary wedge pressure (PC), cardiac index (CI) and valve-related complications. On Doppler echocardiograms, PV ranged from 1.2 to 2.0 m/sec with a mean of 1.6 m/sec. There was no evident relationship between the PV and the valve size in each type of prosthesis, and no significant difference in the PVs among the valves. The mean MVA was 2.6 cm2 (25 mm DM, 25 mm MH), which was regarded satisfactory from a clinical standpoint. MVA increased with the increase in the valve size in all types of valves, and of all sizes, MVA was larger in the DM and MH groups than in the BS group. Similarly, the incidence of valvular regurgitation was relatively low in all groups, and the degree of regurgitation proved to be grade II or less in all cases. As for the clinical results, clinical symptoms (NYHA) and hemodynamic states (PC, CI) improved postoperatively, with the differences among the types of prosthetic valves being insignificant. The incidences of thromboembolism, valvular thrombosis, valve failure and prosthetic endocarditis were relatively low in all groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Responses of atrium and ventricle to sustained sympathetic nerve stimulation

To determine whether chronotropic and atrial inotropic responses to sympathetic nerve stimulation are maintained longer than ventricular inotropic response, the present study was performed with control and acute reserpinized dogs. We stimulated the right stellate ganglion of both groups supramaximally for 60 min and compared right atrial responses (chronotropism and inotropism) with left ventricular (LV) dP/dtmax. In the control group, heart rate (HR) immediately increased and was only slightly attenuated with 60 min of stimulation, and right atrial (RA) inotropic response was less attenuated than was LV response (7% in HR, 33% in RA dP/dtmax, 50% in LV dP/dtmax, P less than 0.01, from the peak value of each response). RA and LV norepinephrine (NE) content was decreased by the stimulation but remained higher than the LV control value. In the reserpinized group, NE content in the RA was low before the stimulation and was further decreased by the stimulation. In this group, HR response was attenuated (27% in HR, P less than 0.01) as was LV dP/dtmax, and the difference in contractile responsiveness between atrium and ventricle disappeared (58% in RA dP/dtmax vs. 61% in LV dP/dtmax, NS). The results indicate that the chronotropic response was only slightly attenuated and that the atrial contractile response was attenuated less than the ventricular response, with sustained sympathetic nerve stimulation in the normal heart. This can be ascribed to the much higher NE content in the RA than that in the LV.

[Experimental studies on the mode of action of cyclosporine and FK506 assessed by proliferation response of human cloned T lymphocytes]

We applied cloned human T lymphocytes established in our laboratory to evaluate the mode of action of Cyclosporine (CsA) and FK506. Phenotypic and functional analysis led us to conclude that HTL403 was a helper T cell clone and HTL805 a cytotoxic one. Susceptibility of HTL-403 to the immunosuppressants demonstrated that alloantigen-driven proliferative response can recover to the rIL2-driven level by the addition of rIL2 at higher concentration of the agents. Although full recovery was not observed in FK506, this finding indicated that FK506 as well as CsA inhibit IL2 secretion from HTL403. FK506 showed remarkable suppressive effect on the proliferative response of HTL-805 even at a considerably low concentration, while CsA suppressed such a response dose-dependently. We concluded that FK506 can be used to reverse ongoing acute rejection as well as to prevent acute rejection.

Identification of an unusual structure in the Drosophila melanogaster transposable element copia: evidence for copia transposition through an RNA intermediate

The Drosophila melanogaster transposable element copia is usually 5 kb long with long terminal repeats (LTRs), and its major transcripts are a full-length 5-kb RNA and a 2-kb RNA. We have previously shown that the 2-kb RNA is generated through splicing. Here, we have cloned a genomic intronless copia using an oligodeoxyribonucleotide probe which is specific for the junction of the two exons. The unusual copia is bounded by two LTRs and lacks precisely the intron of the 2-kb copia RNA. Identification of genomic intronless copia strongly suggests that copia transposes through an RNA intermediate. Moreover, we have found that copia virus-like particles (VLPs), in which reverse transcription of copia RNA seems likely to occur, packages the spliced copia RNA much less efficiently than the full-length copia RNA. This result leads to the suggestion that much lower copy number of genomic intronless copia, as compared with that of 'normal' copia, may be responsible for the inefficient packaging of the spliced copia RNA into the VLP.

Autoprocessing of Drosophila copia gag precursor to generate a unique laminate structure in Escherichia coli

Drosophila copia protease is likely to be encoded in the gag gene. We have expressed copia gag polyprotein precursor in E. coli. The gag precursor was correctly processed to generate a unique laminate structure in E. coli. The processing was almost completely blocked by a mutation at the putative active site of copia protease, and resulted in accumulation of the precursor. Furthermore, the laminate structure was not found in E. coli expressing the mutant precursor. These results indicate that the protease is involved in cleaving the gag precursor itself. Also, the assembly of copia gag protein should correlate to the autoprocessing of copia gag polyprotein precursor.

Strain specific sensitivity to diethylnitrosamine-induced carcinogenesis is maintained in hepatocytes of C3H/HeN in equilibrium with C57BL/6N chimeric mice

The C3H/HeN (C3H) and C57BL/6N (C57) mouse strains are known, respectively, for their high and low susceptibility to both spontaneous and chemically induced hepatocarcinogenesis. The present study was aimed at elucidating whether this difference is dependent on intrinsic features of the target hepatocytes or in the in vivo milieu and associated growth promoting factors to which the cells are exposed. C3H in equilibrium with C57 chimeric mice were produced and given injections of diethylnitrosamine (20 microgram/g body weight) at the age of 15 days. The animals were sacrificed 6 or 9 months thereafter, and the numbers and sizes of altered cell lesions were scored. The clonal growth of both cell types was immunohistochemically confirmed using anti C3H-specific antigen antibodies. Quantitative assessment revealed C3H lesions in the chimera livers to be far larger (5:1) than those of C57 derivation and associated with more frequent malignant progression as was evident histologically. Furthermore, foamy change and hyalin body formation, which have been described as characteristics of C3H and C57BL hepatic tumors, respectively, were also featured as differentiative characteristics in lesions of both cell types in chimera mice. Thus, the results clearly demonstrated that the principal mechanism(s) underlying strain difference in diethylnitrosamine-initiated hepatocarcinogenesis exists in the target cells and is not milieu-dependent.

Influence of reduced presynaptic myocardial norepinephrine stores on left ventricular contractility

Many investigators have reported that myocardial norepinephrine content is decreased in congestive heart failure. However there have been no studies of how decrease in myocardial norepinephrine might influence myocardial contraction. To clarify whether decreased myocardial norepinephrine per se affects myocardial contraction, we observed the change in left ventricular contractility during 30 min of left stellate ganglion stimulation in control and acutely reserpinized dogs. We obtained left ventricular max dp/dt and left ventricular end-systolic pressure-segment length relationships as indicators of left ventricular contractility. Both parameters decreased after left stellate ganglion stimulation in reserpinized dogs (left ventricular max dp/dt: 2064 +/- 200 to 1608 +/- 168 mmHg/s, left ventricular end-systolic pressure-segment length slope 117 +/- 22 to 79 +/- 14 mmHg/mm, n = 8, P less than 0.05), while they did not change in controls. In reserpinized dogs, left ventricular norepinephrine content decreased to one-third that of controls before the stimulation, and further decreased after stimulation. These data indicate that lowered myocardial norepinephrine itself may be responsible for the negative effect on left ventricular contractility in congestive heart failure.

[Studies on the multiple-drug induction immunosuppressive therapies with cyclosporine after renal transplantation]

Our induction immunosuppressive therapies were carried out on patients split into three groups. The first group of 25 recipients were treated with regimen I [cyclosporin (CsA); 12 mg/kg/day and prednisolone (Pred)]. The second group of 16 recipients were treated with regimen II [CsA; 6 mg/kg/day, Pred and mizoribine (MIZ) or azathioprine (AZA)]. The third group of 14 recipients were treated with regimen III [CsA; 10 mg/kg/day, Pred and MIZ or AZA]. There was no significant difference among the three groups in renal function three months after renal transplantation. The frequency and grade of rejection were significantly higher in Group II than in the other groups. One of group I had CsA nephrotoxicity and none of group III had liver dysfunction three months after renal transplantation. Group I had a higher incidence of posttransplant hypertension. Hypertension of group I was very severe. We concluded that the triple-drug therapy on group III was the best induction immunosuppressive therapy after renal transplantation of the above three.

A comparative study between a new, 50-degree right-semidecubital scanning and usual supine scanning of thallium-201 myocardial tomography for evaluation of coronary artery disease

Images of thallium-201 cardiac tomography in the 50-degree right-lateral-semidecubital vs. usual supine positions were compared after a single dose of the isotope in 225 patients with or suspected of coronary artery diseases. Compared with the supine position method, the semidecubital position method enabled 25% shortening of the orbital radius (20.0 +/- 0.9 cm to 15.3 +/- 0.6 cm, n = 174, p less than 0.05), higher posteroinferior wall counts in both exercise and 3-hour-delayed images by up to 18%, better image sharpness and contrast, less motion artifact, more marked redistribution in the ischemic walls, and significantly higher specificity (57% vs. 78%, p less than 0.05) and accuracy (63% vs. 79%, p less than 0.05) for inferior wall lesions. The results indicate that the thallium cardiac scan is significantly affected by patient position during scanning, i.e., artifactual inferior wall defects due to photon attenuation in the supine position method. The semidecubital position method is recommended to minimize this artifact. The method is simple, easy to perform, well tolerated, feasible in any 1-headed tomography system, inexpensive, and free of running costs.

Restricted diversity of the variable region nucleotide sequences of the heavy and light chains of a human rheumatoid factor

The complete nucleotide sequences of the variable region genes of the heavy and light polypeptide chains of a human monoclonal rheumatoid factor (RF) produced from a human-mouse heterohybridoma were determined. The antibody, designated YES8c, contained V kappa III, J kappa 2, VH1, JH4, and a D gene segment of 9 amino acids. The nucleotide sequences and the deduced amino acid sequences of the light chain variable region were remarkably homologous (97-98%) to previously described RF of the Wa idiotypic family (PAY, GLO, CUR, FLO, and GAR) and to that of a V kappa III germline gene (Humkv325). The YES8c heavy chain variable region gene was most closely related to the VH1 gene of the restricted human fetal repertoire, designated 51p1, and also to 3 rearranged VH1 genes that were recently isolated from patients with chronic lymphocytic leukemia. These results suggest that variable region genes of RFs are highly conserved and that YES8c VH, as well as V kappa, may be identical to heavy and light chains expressed during early B cell development.

Assessment of the long-term results of ileocecal conduit urinary diversion

We reviewed our 12.5-year experience with ileocecal conduit (ICC) and report the long-term results of 147 cases of ICC compared with those of our 102 cases of ileal conduit (IC). We usually performed ICC following total cystectomy for carcinoma of the bladder, while we chose IC in cases of high stage or recurrent malignancies. The average follow-up period was 41.7 months in the ICC group and 28.8 months in the IC group. The postoperative mortality (6.1%) and the incidence of early complications (21.1%) in the ICC group were comparable with the reported incidences for IC. In the later period, stomal problems were most frequently encountered. Urinary tract complications are important because they affect renal function in the course of a long period of time. Excretory urogram showed a satisfactory result and serum creatinine remained within the normal limits even in patients followed up for a long time in both groups. The incidences of pyelonephritis and urinary stones in the ICC group were 13.6 and 5.4%, respectively. We had expected a much lower incidence of these complications and ICC could not cover all the drawbacks of IC. However, at present, there is no ideal or perfect method of urinary diversion, ICC should be one of the acceptable options which has a satisfactory long-term result.

[Management of hypertension after renal transplantation]

We report the clinical result of our management for post-transplant hypertension in 47 renal allograft recipients who were followed up for more than one year after transplantation. Hypertension developed in 4 (26.7%) out of 15 cases who were treated with conventional immunosuppressive therapy (Group I) and 18 (56.3%) out of 32 cases treated with CsA (Group II). In group I, all the 6 patients who had been nephrectomized their original kidney at the time of transplantation did not develop hypertension. And the blood pressure before transplantation had a marked effect on post-transplant blood pressure. In group II, there were many recipients who had become hypertensive after transplantation though most of them became normotensive with dose reduction of immunosuppressants. Ten normotensive patients before transplantation who had not developed hypertension retained their normal blood pressure throughout the course without any antihypertensive medication. We could find no correlation between graft function and blood pressure, although recipients with poor graft function had a tendency to be hypertensive. A satisfactory fall in blood pressure in the patients treated with CsA was observed when the immunosuppressive regimen was changed to triple therapy to reduce the dose of CsA. The recorded blood pressure were 174.0 +/- 19.0/105.2 +/- 16.5 mmHg after transplantation and 145.2 +/- 15.7/78.4 +/- 17.1 mmHg at the latest follow-up. We performed original nephrectomy in 6 patients whose blood pressure could not have been controlled by the antihypertensive medication. All the venous sampling studies showed that increased renin secretion was confined to original kidneys.(ABSTRACT TRUNCATED AT 250 WORDS)

[Urinary FDP D-dimer and E fragments in renal transplantation]

Both D-dimer and E fragments in urinary FDP were determined in renal transplantation patients. Urinary D-dimer fragments increased in 14 out of 20 acute rejections (70.0%) and in 6 out of 18 chronic rejections (33.3%). Urinary E fragments increased in 8 out of 9 acute rejections (88.9%) and in 4 out of 5 chronic rejections (80.0%). It is suggested that urinary FDP-E fragment is a better indicator to detect or predict rejection than the whole Urinary FDP. The appearance of D-dimer in the urine indicates intravascular coagulation in glomeruli followed by a secondary fibrinolysis in the course of the rejection reaction. The urinary D-dimer/FDP ratio which was used as the indicator of fibrinolytic activity in glomeruli was obtained in various conditions of renal transplants. The ratios were relatively high in the urines from well functioning grafts. This ratio deteriorated at the onset of rejection crisis and tended to go upward during the course of the recovery when the rejection was reversible. In the cases of irreversible acute rejection and chronic rejection, these ratios remained at a low level. D-dimer/FDP ratio might be useful indicator to predict the reversibility of rejection and the prognosis of renal allograft. Furthermore, these findings suggest that fibrinolytic and thrombolytic therapy by the tissue-type plasminogen activator (t-PA) along with immunosuppressive drugs might be more effective for the treatment of these rejections.

[Clinical studies on hyperuricemia and gout after transplantation]

We performed renal transplantation on 67 patients (living 37, cadaver 30) between November 1975 and December 1987. Twenty-seven of the 67 patients had hyperuricemia (serum uric acid: male greater than or equal to 8.0 mg/dl, female greater than or equal to 7.0 mg/dl) and 2 of them had episodes of gout. However, there was no correlation between serum creatinine and uric acid in 27 hyperuricemic patients. Twelve of 27 hyperuricemic patients were treated with either allopurinol or benzbromarone. These therapies were effective for 9 of them and serum uric acid level controlled well. One of 2 gouty patients developed gout 4 years after cadaveric renal transplantation. She was treated with anodyne and benzbromarone for gout. These treatments were effective and she has been in good condition. We consider it necessary to treat hyperuricemia after renal transplantation and to control serum uric acid well.

[Interaction between phenobarbital and ciclosporin following renal transplantation: a case report]

We report a case of decreased ciclosporin (CsA) trough level due to the interaction with phenobarbital after living renal transplantation in a 15-year-old male. Two other cases prescribed valproate sodium as an anticonvulsant, showed no change in the plasma CsA levels. Therefore, it is necessary to recognize the drug interaction with CsA, and appropriate drug should be chosen in clinical renal transplantation.

Lymphocyte spontaneous blastogenesis as a monitor of renal allograft rejection

Spontaneous blastogenesis (SB) of peripheral blood lymphocytes was studied by determining protein synthesis using 3H-leucine to establish an immunological monitoring method after renal transplantation. In acute rejection, the SB level was twice as high as those in ATN and in the quiescent state. A rise in SB level comparable to that in rejection was observed in patients with infection. The SB level was continuously determined postoperatively in eight patients undergoing renal transplantation. Of the eight patients, three showed acute rejection four times in total. Elevation of SB level was simultaneously observed at each rejection episode. Rejection was not noted in any of the other five patients. False positive elevation of SB level was observed five times. The cause of the false positive changes was unknown in three cases and due to infection in two cases. Elevation of SB level is considered to be nonspecific and represents total lymphocyte activity. Due to its simple procedure and quick results, this method should provide a useful clinical parameter of rejection.

Mouse-human chimeric monoclonal antibody to carcinoembryonic antigen (CEA): in vitro and in vivo activities

Mouse-human chimeric antibody specific for human carcinoembryonic antigen (CEA) was produced by recombinant DNA techniques. The genes of the mouse variable regions of heavy and light chains were cloned from the mouse hybridoma, 2.7.1G.10., which secreted anti human CEA antibody (IgG1, kappa), and were joined with human gamma 1 and kappa constant genes. The affinity of the resultant chimeric antibody to its relevant antigen was the same as that of the parental mouse monoclonal antibody when analysed by Scatchard plot analysis. The chimeric antibody showed a potent antibody dependent cell-mediated cytotoxicity (ADCC) activity with human peripheral blood mononuclear cells against CEA-positive human adenocarcinoma cells. In vivo imaging analysis revealed that the present chimeric antibody was specifically localized on the tumor site. These results indicate that our mouse-human chimeric antibody is a promising reagent for the diagnosis and therapy of CEA-positive human cancers.

Clinicopathological study on end-stage reflux nephropathy in renal-transplanted children

Five children with end-stage reflux nephropathy underwent kidney transplantation at our clinic. Reflux nephropathy was studied clinically and histologically. All children had proteinuria before starting hemodialysis, and hypertension was present in 2 cases. Three children underwent antireflux operations prior to transplantation. The original kidneys exhibiting reflux were removed during renal transplantation. All original kidneys exhibited atrophy and scarring. Focal and segmental glomerulosclerosis was found in 4 cases. PAS deposition in the interstitium, suggestive of Tamm-Horsfall glycoprotein, was found in all cases. No recurrent signs of focal and segmental glomerulosclerosis have been found in the children who have been followed up from 1 to 6 years after transplantation.

[The influence of left ventricular function on surgical risk in mitral stenosis]

The influence of left ventricular (LV) function on surgical risk was assessed in 98 patients with mitral stenosis (MS) using echocardiographic studies including a dobutamine test in 42 cases. Intraoperative LV myocardial biopsy was also performed in 24 cases. Preoperatively, depressed LV function [% fractional shortening (%FS) less than or equal to 27%] was observed in 21 patients (21%). Seven patients had postoperative LV failure, five of whom had preoperative depression of LV function. Among these five patients, three had low cardiac output; and in the other two preoperative %FS was severely depressed. In cases of poor responses to preoperative dobutamine, postoperative improvement in %FS and the cardiac index were not as marked in the good-response group, and some of these patients had LV failure postoperatively. Percent fibrosis of the LV myocardium, which was demonstrated by intraoperative biopsy, correlated negatively with preoperative %FS, and %fibrosis was greater in the group responding poorly to dobutamine administration, especially in patients with postoperative LV failure. These results suggest that some patients with MS were developing LV failure postoperatively due to impaired myocardium. Myocardial fibrosis seemed to be an important causative factor in these patients. Preoperative evaluation utilizing dobutamine administration is useful in screening for high-risk patients.

[Studies of urinary proteins, FDP (fibrinogen degradation products), and NAG (N-acetyl-beta-D-glucosaminidase) in renal transplanted patients]

The urinary proteins, FDP (fibrinogen degradation products), and NAG (N-acetyl-beta-D-glucosaminidase) in renal transplanted patients were studied. SDS (sodium dodecyl sulphate) electrophoresis was used for the differentiation of urinary proteins according to their molecular size. In the azathioprine-treated patients with stable renal function, most of the urinary proteins were albumin. However, the low molecular weight (LMW) proteins, which were suggestive of tubular proteins, appeared in the urine of the ciclosporin-treated patients with stable renal function. During the rejection episodes of the ciclosporin-treated patients, the fraction of LMW proteins increased. The elevation of urinary FDP and NAG index (urinary NAG/urinary Cr) were detected in association with rejection episodes. Urinary NAG index increased in proportion to the elevation of serum Cr. However, the elevation of urinary NAG index was found in some ciclosporin-treated patients with normal serum Cr. The elevation of NAG index without the elevation of urinary FDP occurred in ciclosporin nephrotoxicity. The SDS electrophoresis of urinary proteins, urinary FDP, and urinary NAG index can be useful parameters for monitoring ciclosporin nephrotoxicity.

General pharmacology of beraprost sodium. 2nd communication: effect on the autonomic, cardiovascular and gastrointestinal systems, and other effects

Beraprost sodium (sodium (+/-)-(1R*,2R*,3as*,8bS*)-2,3,3a,8b-tetrahydro-2- hydroxy-1-[(E)-(3S*)-3-hydroxy-4-methyl-1-octen-6-ynyl]-1H- cyclopenta[b]benzofuran-5-butyrate, TRK-100) is an orally active epoprostenol (prostaglandin I2, PGI2) analogue. Its general pharmacological effects on peripheral organs were studied. 1. In isolated organs, beraprost sodium relaxed the trachea and increased atrial beating rate (2.4 x 10(-5) mol/l). It also dose-dependently contracted the stomach, aorta, ileum and uterus (2.4 x 10(-7)-2.4 x 10(-4) mol/l). These effects of beraprost sodium were similar, but inferior to those of PGI2 and PGE1. 2. Intravenous administration of beraprost sodium produced a dose-related decrease in blood pressure (BP), its potency being about 1/3 times that of PGI2 in anesthetized rats and dogs. Beraprost sodium and PGI2 had no effects on heart rate (HR), and enhanced respiration in conjugation with a decrease in BP. Oral administration of beraprost sodium in high doses (1-3 mg/kg in rats and 0.3 mg/kg in dogs) caused a decrease in BP. A compensatory tachycardia and an elevated plasma renin activity (PRA) occurred after low doses (0.1-0.3 mg/kg) in rats. In contrast, a change of HR and PRA in rabbits and dogs was mild. 3. Beraprost sodium produced suppression of digestive organs: markedly, gastric motility and secretion and intestinal transport; slightly, but significantly, biliary secretion. On the other hand, it enhanced ileal motility at a high dose (300 micrograms/kg i.v.). 4. Oral administration of beraprost sodium caused a decrease in urinary volume and electrolyte excretion in rats. 5. Oral administration of beraprost sodium prolonged bleeding time in mice, while it had no effect on the blood coagulation system in vitro. In addition, beraprost sodium had no hemolytic action. 6. The other effects of beraprost sodium were weak. Beraprost sodium had no local anesthetic activity and no effect on salivation, pupil size and neuromuscular transmission in the skeletal muscle. Beraprost sodium slightly contracted the uterus of non-pregnant rats in situ and dose-independently inhibited carrageenin-induced paw edema. In conclusion, beraprost sodium produced various effects on the autonomic, cardiovascular, and gastrointestinal systems. Probably, these effects may be based on its own action like PGI2.

[Clinical reevaluation of aztreonam (AZT) on urinary tract infections]

The clinical effectiveness and safety of Aztreonam (AZT) were studied in 55 patients with complicated urinary tract infections. AZT was administered at a dose of 4 g/day for 5 days. The results as evaluated by the UTI criteria were excellent in 8 cases, moderate in 26 and poor in 21. The overall effectiveness rate was 61.8%. Out of 64 strains of bacteria isolated before treatment, 50 strains (78.0%) were eradicated by the treatment. Bacteriological eradication rates for gram negative rods and gram positive cocci were 79.6% and 66.7%, respectively. There were no obvious side effects, except for a temporary elevation of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase alkalinephosphatase, and total bilirubin in some patients. The results indicate that AZT tablets are useful and safe for the treatment of complicated urinary tract infections.

Experimental observation of plastic deformation areas, using an acoustic microscope

Novel techniques are described for the observation of plastic deformation areas by using an acoustic microscope. On a test piece subjected to plastic deformation, an area was found that had an abnormal contrast in the crystal grain and a pointed end at the V notch. Calculation of the propagation velocity of the surface acoustic wave (SAW) showed a difference of several percent between this area and the rest of the test piece. It has been presumed that this difference reflects the local plastic deformation, and that the abnormal contrast area corresponds to the image of the two-dimensionally distributed plastic deformation area of metals.

Measurement of a damaged layer thickness with reflection acoustic microscope

An acoustic microscope was used for determining the frequency dependence of surface acoustic wave (SAW) velocity on a specimen whose silicon single-crystal surface was machined under various conditions. Consequently, thickness of the damaged layers could be estimated from the curvature points of frequency dispersion curves of the SAW velocity. It was revealed that thicknesses of the damaged layers can be estimated through rough approximation by about one-half the wavelength determined by the frequency at curvature points. From specimens possessing two damaged layers, frequency dispersion curves with two curvature lines can be obtained. From the curvature point at high frequencies the thickness of the top damaged layer can be determined. On the other hand, from the curvature point at low frequencies, the thickness of the inner damaged layer can also be determined. By choosing an acoustic lens as the condition for exciting SAWs, images can be observed while varying the frequency. From observation results obtained with this method, the distribution in the depth direction can be clarified.

[Chemotherapy of renal cell carcinoma: experimental study and clinical effect]

In vitro sensitivity tests of 6 antineoplastic agents (mitomycin C, bleomycin, adriamycin, Vinblastine , cis-dichlorodiamine platinum, ACNU) were carried out on cultured cell line (OUR-10) established from human renal cell carcinoma and the results were compared with clinical results of 16 cases of renal cell carcinoma treated in our clinic. The effect of these drugs was estimated from the cell growth curve and DNA histogram determined by flow cytometry. All these drugs showed a concentration dependent effect. However, the usefulness of these drugs was not recognized in 10 clinical cases of advanced tumors.

The effect of sustained stellate ganglion stimulation on left ventricular contractility in the dog

Although a progressive reduction in left ventricular contractility during sustained left stellate ganglion stimulation has been well documented, there have been no reports on the contractile state after nerve stimulation. Left ventricular contractility after cessation of 60 min of electrical (10 V. 10 Hz. 1 msec) left stellate ganglion stimulation has been assessed in open chest dogs. Before and 15 min after stimulation, left ventricular contractility was evaluated by the end-systolic pressure-segment length relationship using ultrasonic crystals during a stepwise aortic constriction to increase left ventricular afterload. Restimulation of the left stellate ganglion was also performed 15 min after cessation of the first stimulation. After sustained left stellate ganglion stimulation, the end-systolic points shifted to the right from the control and the slope of multiple pressure-segment length coordinates significantly decreased (102.5 +/- 16.1 to 76.5 +/- 10.2 mmHg/mm, mean +/- S.E., p less than 0.05, n = 5), indicating a depression of left ventricular contractility. Increased left ventricular dP/dt max and norepinephrine level in the coronary sinus gradually returned to near base line during 60 min of stimulation. These reduced responses lasted for at least 15 min after cessation of stimulation. The myocardial norepinephrine content was reduced to 0.59 +/- 0.08 (mean +/- S.E.) ng/mg wet tissue from 0.90 +/- 0.15 of the control level (p less than 0.05). These data suggested that left ventricular contractility decreased after sustained cardiac sympathetic nerve stimulation, probably due to norepinephrine reduction in the myocardium.

Renal transplant blood flow evaluation by ultrasonic duplex scanning

The transplant blood flow was measured renal transplantation by ultrasonic duplex scanner composed of pulsed Doppler flowmeter and real-time B-mode linear scanner in 32 patients. The blood flow information could be obtained from anywhere of interest within the renal transplant. Then blood flow in 3 regions including renal hilum, central echoes and renal parenchyma were measured. The parenchymal peripheral blood flow was not always similar to the hilar central blood flow. Parenchymal blood flow was the most correlated with graft function and decreased remarkably during acute rejection episode. This method enabled detection of occurrence of acute rejection in the course of post-cadaver transplant ATN. Prolongation of delta t (acceleration time) in Doppler spectrogram from parenchyma was also reliable evidence for the deterioration of graft function. Ultrasonic duplex scanning is a useful method in managing post-transplantation patients because intrarenal hemodynamics can be evaluated by this method.

[Studies involving 11 cases of early gastric cancer with a widespread lymph node metastasis]

Over the past 10 years, we have experienced 11 cases of early gastric cancer limited to the mucosa and submucosa, with a widespread lymph node metastasis over the perigastric node. These cases represented 3.8% of all the early gastric cancer cases treated at our hospital during this period. The average age of these patients was 49.1 years, and consisted of 7 males and 4 females. Of these 11 cases, 10 cases (90.9%) were, macroscopically, the depressed type. Histologically, 7 cases (63.6%) were poorly differentiated carcinoma. Curative resections were possible in 8 cases (72.7%). The cumulative 5-year survival rate was poorer than for other types of early gastric cancer, and amounted to 66.7% in cases that were curative, and 0% for non-curative cases.

[Treatment of primary gastric lymphoma and factors that influence the prognosis]

Twenty-two cases of primary gastric lymphoma have been clinicopathologically reviewed and factors influences the prognosis were examined. An increased tumor size of more than 10 cm, an increased tumoral penetration, a lymph node involvement, and stage IV classification decreased the survival rates. All patients given stage I classification have remained alive without having received chemotherapy. The survivors of stages III & IV amounted to only three patients who were treated by surgery and systemic chemotherapy. A radical operation is the choice of treatment for a gastric lymphoma but aggressive chemotherapy should be supplemented for advanced cases.

Defective interleukin-1 production in a familial monocyte disorder with a combined abnormality of mobility and phagocytosis-killing

Monocytes in a familial monocyte disorder, a recently recognized primary immunodeficiency syndrome, with impaired phagocytic functions were studied for their ability to produce interleukin 1 (IL-1) as well as the surface property. Monocytes from two children (siblings) with the disorder possessed CD11b, CD13, CD14, CD33, Ia and LFA-1/Mac-1/p150,95 beta subunit antigens as determined by flow cytometry. Electron microscopic cytochemistry showed that the monocytes had surface glycoproteins reactive with four representative lectins. The IL-1 production by monocytes was assayed in the two patients and compared with that in six children with primary immunodeficiency syndromes and some monocyte abnormalities; three had congenital neutropenia, two had hyper-IgE syndrome, and one had defective monocyte chemotaxis. Monocyte culture supernatants were prepared with stimulation by lipopolysaccharide or silica, and their IL-1 activity was measured by the mouse thymocyte-proliferation assay. The patients' monocytes were defective in IL-1 production: the values were less than 1.0% of the control monocyte values (n = 12) and were in contrast with those of congenital neutropenia monocytes of 186.2% to 204.3%. These results demonstrate a familial monocyte disorder which is characteristic among the immunodeficiency syndromes with regard to the defective IL-1 production and the impaired phagocytic functions.

[Measurement of nerve conduction velocity of the dorsal nerve of the penis]

Tests for evaluating the function of the nervous system in patients with erectile impotence have been performed indirectly with the measurement of nerve conduction velocity in the extremities and other neurological procedures, since it has been technically difficult to measure the nerve conduction velocity of the dorsal nerve of the penis. Calculation of the nerve conduction velocity of the dorsal nerve of penis from values of the bulbocavernosus reflex latency was not reliable and the development of a technique to measure accurately the nerve conduction velocity of the dorsal nerve of penis has been awaited. Ten impotent men were studied, and a precise description was made about the procedure of measuring the orthodromic nerve conduction velocity of the dorsal nerve of the penis. The dorsal nerve of the penis was stretched optimally with a weight of 300 g, and its conduction velocity reached the maximal value. This new methodology is of use in the evaluation of erectile impotence.

Right ventricular aneurysm due to congenital muscular defect in an adult

A large right ventricular aneurysm was detected by an echocardiographic examination in a 50-year-old woman presenting with weakness, collapse and hypotension. At surgery, another smaller aneurysm, arising from the anterior infundibulum of the right ventricle, was found in addition to the large one. Both were resected. Histological studies on the resected specimen revealed that much of the myocardium was replaced by adipose tissue. As far as we know this is the first reported case in Japan in which two congenital aneurysms arose from the right ventricle as a result of muscular defect.

[A case of early gastric cancer forming a large abdominal tumor from a lymph node metastasis]

A 37-year-old male was admitted to our hospital because of an abdominal tumor, about the size of a fist, located anterior to the pancreas head. This tumor oppressed the antrum of the stomach to the left, and an operation was performed, the tumor being diagnosed as a leiomyosarcoma of the stomach, determined from image findings. After histopathological examination, however the tumor proved to be an adenocarcinoma. An early gastric cancer was found at the anterior wall of the antrum during the operation, and the tumor was thought to be a metastatic lymph node. Lymph node metastasis also was observed at the root of the mesentery.

[Complication during the period of anuria after cadaveric transplantation--with special reference to wound bleeding]

Some period of anuria is usually expected after cadaveric renal transplantation, and hemodialysis is necessary during the period. Postoperative bleeding in the anuric period is not uncommon and usually can be easily controlled with adequate conservative treatment. However, it becomes uncontrollable in some cases and causes a series of serious complications. Out of 22 patients having undergone cadaveric renal transplantation in our hospital, six patients had postoperative bleeding. On investigation of these cases, we found that not only a hemorrhagic tendency due to uremia but also hemodialysis is a risk factor of bleeding in the wound.