[Effect of erythromycin on neutrophil function in chronic respiratory tract diseases with Pseudomonas infection]

The "low dose and long term" erythromycin (EM) therapy has been reported as effective (or useful) in chronic respiratory tract disease with pseudomonas (P.) infection including diffuse panbronchiolitis (DPB), however the mode of action is still obscure. Therefore in this study we have examined the effect of EM on the interaction between P. aeruginosa and human polymorphonuclear leukocyte (PMN) in vitro. The efficiency of intracellular killing and the ability of superoxide production were employed to evaluate the PMN functions. For the first step, the following results were obtained; 1) Pretreatment of PMN with 20 micrograms/ml EM did not affect the killing ability of PMNs against opsonized P. aeruginosa of standard and clinical isolate from DPB patient. 2) Superoxide production from PMNs was observed by phagocytosis of P. aeruginosa in the presence of serum. This was not affected by exposure of PMNs to 20 micrograms/ml EM even with increased ratios of bacteria to cells. 3) Pretreatment of P. aeruginosa with 20 micrograms/ml EM before opsonization enhanced the killing ability of PMNs in both standard and clinical isolate. 4) Pretreatment of P. aeruginosa with 20 micrograms/ml EM resulted in no effect on superoxide production from PMNs by phagocytosis of the bacteria. These results indicate that EM may modify a certain step of the interaction between bacteria and intracellular host defence mechanisms. Therefore for the second step, we have investigated the susceptibility of EM-exposed bacteria to killing by the cell free (glucose oxidase-glucose) system, which will detect the enzymatic generation of hydrogen peroxide (H2O2). The following results were observed; 1) EM-exposed bacteria was more susceptible to killing than control bacteria.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of endothelin on angiotensin converting enzyme activity in cultured pulmonary artery endothelial cells

We studied the effects of endothelin on angiotensin converting enzyme (ACE) in cultured pulmonary artery endothelial cells. ACE activity was increased 2.5-fold by the addition of 1 x 10(-8) mol/l endothelin-1. Endothelin-1 also stimulated calcium influx and phospholipase C activity in a dose-dependent manner. Calcium influx, phospholipase C and ACE activity were suppressed 60-70% in the presence of endothelin-1 (10(-10) to 10(-6) mol/l) by 50 microliters neomycin. These results suggest that ACE was stimulated by endothelin-1 and that its activity may be closely related to phosphatidylinositol turnover stimulated by endothelin-1.

Distribution of atrial natriuretic peptide in the conduction system and ventricular muscles of the human heart

Atrial natriuretic peptide (ANP), a cardiac hormone, is known to be located in the atrial specific granules, but its presence and localization in the ventricular muscle of the human heart has not been examined fully. Using a specific antibody to human ANP, we studied the conduction system and ventricular muscle with immunohistochemical and ultrastructural methods in 30 hearts obtained at autopsy. These included 12 normal and 18 diseased hearts. In the normal hearts, ANP-positive granules, which were regularly observed in the atrial myocytes, were found in small quantities in the cells of the penetrating and branching bundles in 4 of 12, and in the cells of the ventricular free walls in 2 of the 12 hearts. In the diseased hearts, the positivity increased significantly (P less than 0.05), being found in 13 of 18 (72.2%) conduction systems and 10 of 18 (55.6%) ventricular muscles. The granules were confirmed to be immunoreactive with ANP by ultrastructural examination. Furthermore, the presence of ANP mRNA in the conduction system as well as in the ventricular myocytes was demonstrated by Northern blot hybridization for which we used the complementary DNA of human ANP. Thus, a small quantity of ANP appears to be synthesized and stored in the conduction system and ventricles of some normal hearts. However, ANP was shown to be present in a larger percentage of the diseased hearts.

Effect of atrial natriuretic factor on angiotensin converting enzyme

We studied the effects of atrial natriuretic factor (ANF) on the conversion of angiotensin I to angiotensin II. Pulmonary artery endothelial cells converted 1.22 nmol/min per dish [125I]angiotensin I to angiotensin II, but ANF suppressed the conversion by 0.475 nmol/min per dish. The maximum rate of inhibition of angiotensin converting enzyme (ACE) activity by ANF was 60% at 10(-6) mol/l ANF compared with control conditions. The amino acid fragments of ANF were studied to determine whether its specific structure was necessary for inhibiting ACE in endothelial cells. We found that atriopeptin II (fragment 5-27) inhibited ACE activity as much as ANF. Fragment 7-25 had the same rate of inhibition, but fragment 13-27 had no effect on the conversion of angiotensin I to angiotensin II. These results suggest that the amino acid sequence of Cys (7)-Cys (23) in ANF is important for the inhibition of ACE in pulmonary endothelial cells.

Endothelin stimulates angiotensin I to angiotensin II conversion in cultured pulmonary artery endothelial cells

We studied the effects of endothelin on the conversion of angiotensin I to angiotensin II in pulmonary artery endothelial cells. Endothelin had a novel effect on angiotensin I conversion. When endothelin was added to pulmonary artery endothelial cells, the conversion of angiotensin I to angiotensin II was enhanced about two-fold. The maximum stimulation was achieved at 10(-8) M of endothelin. This stimulatory effect was suppressed by angiotensin converting enzyme inhibitors such an enalapril. When the calcium antagonist, nifedipine, was incubated with 10(-8) M of endothelin, the conversion of angiotensin I to angiotensin II stimulated with endothelin was slightly suppressed by nifedipine. Enalapril (10(-6) M) completely inhibited the conversion of angiotensin I to angiotensin II in the presence of endothelin. These results suggest that endothelin may play an important role in regulating vascular tone by modulating the conversion of angiotensin I to angiotensin II.

Mechanism of increased angiotensin-converting enzyme activity stimulated by platelet-activating factor

We studied the effects of platelet activating factor (PAF) on angiotensin-converting enzyme (ACE). PAF (1 x 10(-10) to 1 x 10(-6) M) had a novel effect on angiotensin I conversion. Pulmonary artery endothelial cells converted 1 nmol/dish of 125I-angiotensin I to angiotensin II in the absence of PAF. ACE activity was increased to 2.5 nmol/dish by the addition of 1 x 10(-6) M of PAF. To clarify the mechanism of this stimulatory effect of PAF on ACE, Ca2+ influx and inositol 1,4,5-trisphosphate (IP3) release in pulmonary artery endothelial cells were determined. PAF stimulated Ca2+ influx in a dose-dependent manner. PAF also stimulated phospholipase C (PLC) activity and released IP3. To study the relationship between PLC activity and ACE activity, neomycin was added. The Ca2+ influx and IP3 release stimulated by 10(-6) M of PAF were suppressed by about 60-70%. ACE activity was also inhibited up to 70% in the presence of PAF (10(-10) - 10(-6) M) by 50 M of neomycin. These results suggest that ACE was stimulated by PAF, and that its activity in endothelial cells may be mediated by the PI-turnover pathway via changes in PLC activity and IP3-mediated Ca2+ release from intracellular stores.

[Angiotensinogen: gene expression and protein localization in human tissues]

Angiotensinogen, the precursor of the biologically active peptide angiotensin II, is known to be synthesized in the liver and to be localized in plasma, constituting the circulating renin-angiotensin (R-A) system. Recent animal studies have provided evidence for the local generation of angiotensinogen within tissues, independently of the circulating R-A system. To determine the sites of angiotensinogen synthesis in human tissues, we tested for the presence of angiotensinogen and its mRNA in various organs. Messenger RNAs extracted from the liver, kidneys, heart, and brain were all hybridized with human-angiotensinogen complementary DNA. By using a monoclonal antibody generated by in vitro immunization of spleen cells with the synthetic peptide, we first confirmed that the antibody detected only angiotensinogen on immunoblots. In immunohistochemical studies, intense immunoreactivity was found in atrial muscle and in the muscle fibers of the conduction system. The ventricular working myocytes were not stained. Less intense staining was observed in the glomerular tufts of the kidneys, in a few hepatocytes and Kupffer cells, and in the bile duct epithelium of the liver. Thus we demonstrated that angiotensinogen is also synthesized in extrahepatic tissues, including the heart, and that it is localized mainly in the specific cells of the heart. This suggests that the tissue R-A system plays an important role in the human heart.

Platelet-activating factor stimulates angiotensin converting enzyme activity

We studied the effects of platelet-activating factor (PAF) on the conversion of angiotensin I to angiotensin II in pulmonary artery endothelial cells. PAF had a novel effect on angiotensin I conversion. The apparent Vmax and Km for angiotensin converting enzyme (ACE) were 2.5 nmol/min per dish and 50 mumol/l, respectively. This activity was enhanced by the addition of PAF to cells. When PAF was added to pulmonary artery endothelial cells, the conversion of angiotensin I to angiotensin II was enhanced about twofold at 10(-6) mol/l PAF. Maximal stimulation was achieved at 10(-5) mol/l PAF. This stimulatory effect was suppressed by ACE inhibitors such as enalapril and PAF antagonist CV3988. When cells were incubated with 10(-6) mol/l PAF, the conversion of angiotensin I to angiotensin II stimulated with PAF was suppressed by CV3988. Enalapril (10(-6) mol/l) completely inhibited the conversion of angiotensin I to angiotensin II in the presence of PAF. Bradykinin also suppressed ACE activity, but phosphatidylcholine and lysophosphatidylcholine did not affect its activity. These results suggest that PAF may have an important role in regulating vascular tone by modulating angiotensin conversion.

Contrary effect of lactic acid on expression of neuron-specific enolase and glial fibrillary acidic protein in human glioma cells

We examined the effect of lactic acid on cultured human glioma cell lines expressing glial fibrillary acidic protein (GFAP), vimentin and neuron-specific enolase (NSE). The growth of the cells was inhibited by the lactic acid in a dose-dependent manner. At 56 mM of lactic acid, the surviving cells of the KNS-42-c2 cell line developed slender processes and increasingly formed bizzar giant cells. In an immunofluorescence study of the lactic acid-resistant cells, the GFAP-positive cells prominently decreased in number, while the NSE-positive cells clearly increased. The vimentin was not affected throughout the experiment. After removing lactic acid from the medium, the GFAP-positive cells gradually increased in number. The method of dot immunoassay was useful for quantifying GFAP in cellular extracts. It indicated that the amount of GFAP decreased in the cells cultured with lactate-containing media and increased to the primary values after removing the lactic acid. These results may suggest that the morphological and immunochemical diversities of glioma cells are secondarily affected by cellular microenvironments such as lactic acid.

Ruffling membranes in cultured human and rat glial cells

We have previously described how mouse monoclonal antibody Mab S-11E10 specifically stained ruffling membranes and filopodia of cultured human glioma cells. We found that this antibody stains ruffling membranes, not only of human astrocytes and glioma cells, but also of rat astrocytes and rat C6 glioma cells. In addition, we newly prepared rabbit polyclonal antibody for the antigens, which were eluted by Mab S-11E10 affigel 10 (Bio Rad) affinity column chromatography from cultured rat C6 glioma cells. The polyclonal antibody detects 65KDa, 57KDa, 46KDa, 43KDa bands in Western blotting analysis and specifically stained ruffling membranes of human glioma cells on cell spreading. Using the polyclonal antibody, we studied the change of the distribution of the antigens during cell spreading and in fully spread cells. At the beginning of cell spreading, ruffling membranes were specifically stained, but 72 hours after plating the immunofluorescence was localized in membranes of supranuclear regions and small protuberances. Furthermore, we semi-quantitatively measured the contents of the antigens detected by the polyclonal antibody, using dot blotting immunoassay. The contents of the antigens rapidly increased at the beginning of cell spreading and thereafter gradually reduced. The change of the contents seemed to be time--and cell density--dependent and to relate to the extent of cell spreading. These results suggest that the antigens may play an important role in cell spreading of glial cells.

Effect of atrial natriuretic factor on angiotensin converting enzyme

We studied the effects of atrial natriuretic factor on the conversion of angiotensin I to angiotensin II. Atrial natriuretic factor had a novel effect on angiotensin I conversion. Pulmonary artery endothelial cells converted 1.22 nmol/min/dish of [125I]angiotensin I to II in the absence of atrial natriuretic factor, but this activity was suppressed by atrial natriuretic factor. When atrial natriuretic factor was added to pulmonary artery endothelial cells, the conversion of angiotensin I to angiotensin II was suppressed 0.475 nmol/min/dish at 10(-6) M of atrial natriuretic factor.

Positive transmission of Creutzfeldt-Jakob disease verified by murine kuru plaques

Kuru plaque is a pathognomonic feature in the brain of patients with Creutzfeldt-Jakob disease (CJD) and in the brain of CJD-infected mice. Kuru plaques from CJD-infected mice were immunolabeled with rabbit anti-murine prion protein (PrP) absorbed with human PrP, but not so with mouse anti-human PrP. Therefore, the murine kuru plaque is composed of the host (mouse) PrP and can be distinguished antigenically from human PrP. Immunostaining using the anti-murine PrP and formic acid enhancement on tissue sections revealed not only birefringent kuru plaques but also nonbirefringent diffuse and small PrP accumulations. This immunohistochemical detection of kuru plaques provides more positive evidence than heretofore employed histochemical approaches. There were kuru plaques in brains of the first passage mice inoculated with tissues from 30 (91%) of 33 patients with CJD, the 3 negative patients belonging to a type of Gerstmann-Sträussler syndrome. Tissues from 6 other demented patients did not produce kuru plaques. In the evaluation of spongiform changes, mice inoculated with tissues from 23 (70%) of 33 patients were considered cases of successful transmission. In some mice, kuru plaques were present in the absence of spongiform changes. Further inoculations from 9 mice with kuru plaques but no spongiform changes were successful in almost all mice. Therefore, mice with murine kuru plaques in the absence of spongiform changes are also infectious. Thus, the presence of murine-specific kuru plaques can serve as another hallmark of a successful transmission.

[Comprehensive 10-year strategy for cancer control]

Since 1981, cancer has been No. 1 cause of death in Japan. A "Comprehensive 10-Year Strategy for Cancer Control" is a national project that was strongly promoted by the former Prime Minister Mr. Yasuhiro Nakasone in 1983. The program comprises project research studies and functions supporting them. These include the education and utilization of young researchers (research resident), international cooperation and research resources (cell and gene) bank. The aim of studies is clarification of the mechanism of human carcinogenesis within 10 years and the results will be applied to prevention, diagnosis and therapy of cancers.

Requirement of ATP in the second step of the pre-mRNA splicing reaction

The requirement of ATP in the second step of mRNA precursor splicing was examined by dissecting the two steps of the in vitro splicing reaction using a heat-treated nuclear extract from HeLa cells. When a mRNA precursor containing two exons and a single intron from the delta-crystallin gene was initially incubated for 60 min with the heated extract, thereby allowing only the first step of the splicing reaction to occur, and subsequently with a normal extract for 10 min, the final spliced product was produced without any lag. The production of the spliced molecule during the second incubation with the normal extract represents conversion of the intermediates already formed with the heated extract into the spliced product. The conversion was stimulated by the addition of ATP during the second incubation and inhibited by a nonhydrolyzable ATP analogue. These results led us to conclude that ATP is required for the second step of the splicing reaction.

Immunohistochemistry of retinoblastomas

Immunohistochemical stains using neuronal and glial marker proteins were applied to retinoblastomas tissues from 14 children. Among the neurofilament triplet proteins, NF68Kd positive cells were observed in 12. Few NF160Kd positive cells were noted in 2, and NF210Kd positive cells were not detected. The positive ratio of NF68Kd and gamma-enolase seems to relate to the Flexner-Wintersteiner rosettes. Gamma-enolase positive cells were observed in 13. The distribution in tumor tissues was broader than that of NF68Kd positive cells. The immunoreactivities of NF68Kd were in parallel with those of gamma-enolase. Few GFAP positive cells were present around blood vessels, while S-100 protein and MBP positive cells were never observed. Our results indicate that retinoblastoma possesses predominantly neuronal properties, albeit in an immature form.

Surface proteins localized in ruffling membranes and filopodia of human glioma cells detected using Mab S-11E10

We prepared mouse monoclonal antibody (Mab S-11E10) for the surface antigen specifically distributed in ruffling membranes and filopodia of cultured human glioma cells. The antibody reacted to the specified structures of other glioma cells (U251MG, KNS 60) as well as those of KNS 42 cells, which were the immunizing source. The antigens, identified by Mab S-11E10, had molecular weights of 65 and 66 kDa. Immunohistochemically, the antibody reacted only to astrocytes in the human brain, but the cross-reactivity was noted in extraneural tissues such as lymphocytes and epithelium of the bowel ducts. In 5 out of 6 low grade astrocytomas, most of the tumor cells were strongly stained, while tumor cells of highly cellular areas of anaplastic astrocytomas and glioblastomas were either not stained or only weakly stained. The specific localization of 65-66 kDa doublet proteins may suggest relation to spreading and locomotion of cells, and may correlate to astrocytic differentiation and/or function.

Proliferative activity of meningiomas as evaluated by bromodeoxyuridine uptake examination

Proliferative activity of meningiomas was examined in 12 consecutive cases by administering bromodeoxyuridine (BrdU) before surgical removal and by immunohistochemical staining of the removed tumours using anti-BrdU monoclonal antibody (anti-BrdU MAb) to detect BrdU-labelled tumour cells. The 12 cases consisted of 6 with a primary tumour and 6 with a recurrent tumour. All of the tumours contained labelled cells and the labelling index (LI) was obtained in each tumour. The highest average LI was 13.6% and the second highest was 9.0% both in recurrent cases of histologically malignant meningothelial meningioma. The high LIs of both cases were thought to correspond well with the rapid recurrence of the tumour. The average LI of a case of recurrent haemangiopericytic tumour was 2.0%, and that of a case of meningioma associated with von Recklinghausen disease was 1.5%. The other 8 meningiomas showed the average LIs ranging from 0.1 to 0.9%, which were considered to be the LIs of usual benign meningiomas. The results of the BrdU uptake examination was considered to reflect well the clinical behaviour of meningiomas. The usefulness of the BrdU uptake examination in brain tumours, which can be employed in the clinical practice without any serious side-effects, is stressed.

Neuronal and glial proteins in medulloblastomas. II. Heterotransplantation of human medulloblastoma

Seven resected medulloblastomas were inoculated into hereditary athymic (nude) and asplenic athymic (Lasat) mice. From these, only one transplantable tumor line was obtained, in nude mice. We studied the transplanted medulloblastoma immunohistochemically and by electron microscope. In addition, using enzyme immunoassay, the gamma-enolase contents of the transplanted medulloblastomas were measured and the results were compared with those of transplanted glioblastomas. Neurofilament proteins (NF68Kd, NF160Kd) and gamma-enolase positive cells were maintained in the successful transplants of medulloblastomas, but the GFAP positive cells were lost. Under the electron microscope, a few cells with ten nanometer intermediate filaments and microtubules were observed in the transplanted tumor. The medulloblastoma possesses some of the neuronal characteristics which are maintained in the transplants in nude mice.

Neuronal and glial proteins in medulloblastomas. I. Immunohistochemical study

Neuronal and glial specific proteins were studied in 35 cases of medulloblastomas, using immunohistochemical methods and antibodies to neurofilament triplet proteins (NF68Kd, NF160Kd, NF210Kd), gamma-enolase, GFAP, S-100 protein, and myelin basic protein. NF160Kd positive cells were observed in 12 of the 35 cases. NF160Kd positive cells were noted in 2, but NF210Kd positive cells were not detected. Gamma-enolase positive cells were observed in 23 cases. GFAP and S-100 protein positive cells were seen in 25 and 28 cases respectively; many of these cells were reactive astrocytes. The myelin basic protein positive cells could not be identified. The expression of neuronal and glial proteins had no relation to the postoperative survival of patients with medulloblastoma, but gamma-enolase may be one factor for evaluating prognosis.

Neuron-specific gamma-enolase derived from human glioma

Neuron-specific gamma-enolase in human neurogenic tumors, including gliomas, transplanted gliomas, and permanent human glioma cell lines, was studied quantitatively, using newly established enzyme immunoassay methods, together with immunostaining of the tissue and cell preparations. A significantly high level of gamma-enolase was found in some glioblastomas, astrocytomas and oligodendrogliomas as well as medulloblastomas. Glioblastomas transplanted into mice and cultured cell lines derived from the same origins, as well as the permanent human glioma cell lines, also contained gamma-enolase, although the contents were low compared with findings in the original tumor tissues. Immunohistochemically, gamma-enolase stained intensely in the glioblastomatous cells. Serum gamma-enolase concentrations in some patients with gliomas and those of all the transplanted mice were enhanced. The serum gamma-enolase levels in the mice correlated well with size of the transplanted tumor tissues. These results indicate that neuron-specific gamma-enolase is produced in some neurogenic tumors of nonneuronal origin, therefore, serum gamma-enolase may be a useful biomarker for monitoring the extent of disease in patients with gliomas.

[Central pontine and extrapontine myelinolysis following rapid correction of hyponatremia--report of an autopsy case]

A case of central pontine myelinolysis (CPM) following rapid correction of hyponatremia was reported and literatures were reviewed. The case was 61-year-old nonalcoholic female who had taken an operation of craniopharyngioma 23 years ago. Fifteen years later, she received re-operation for the recurrent tumor, followed by replacement therapy of corticosteroid and clofibrate. She was otherwise well until two weeks before entry, when she noticed abrupt onset of high grade fever, nausea, vomiting and general malaise. She was admitted to an emergency hospital because of weakness, disorientation and a slight impairment of consciousness, but she was able to speak and to take some food per os. Laboratory studies disclosed urinary tract infection and showed a serum sodium level of 117 mEq/l, potassium 2.9 mEq/l, a serum osmolarity 232 mO sm/l and urine osmolarity 141 mEq/l. She was diagnosed to have an exacerbation of adrenal insufficiency with hyponatremia and hypotonic dehydration triggered by urinary tract infection. Intravenous administration of vitamin B complex, electrolytes including KCL, 5% glucose solution and physiological saline with a large amount of corticosteroid was performed aggressively. Serum sodium concentration was raised to 161 mEq/l in two days, and the increased level had been maintained more than five days, resulting in coma and flaccid quadriplegia. During this period, there was no episode of hypotension, hypoglycemia, hypoxia nor hepatic failure which could have caused brain damage.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of congenital subclavian steal]

A case of congenital subclavian steal is reported. A 7-year-old girl was admitted on July 1980 to Shimane Medical University for evaluation of murmur over the region of the chest. Heart murmur was pointed out at the age of three month, however, she had no complaints and was growing normally. On admission, the blood pressure was 108/48 mmHg in the left arm and unobtainable in the right arm. The length of the arm was 53 cm on the right side and 55.4 cm on the left side. On auscultation, a systolic murmur was present over the chest and the right neck. The arch aortography disclosed the left aortic arch, the isolation of the right subclavian artery and the right patent ductus arteriosus (PDA). The left transfemoral vertebral angiography showed the retro-grade filling from the right vertebral artery to the right subclavian and pulmonary artery via the right PDA. The right external carotid angiography showed the filling of the right vertebral artery through muscular branches of the right occipital artery. The right retrograde brachial angiography showed small right subclavian artery and the filling of the pulmonary artery through the right PDA. The recorrective operation was made. Postoperatively, normal blood flow was recognized in angiography. The blood pressure improved in the right side and the murmur was diminished.

[Ocular complications in chronic pansinusitis--report of two cases]

Case 1. A 38-year-old male was admitted with an 8-month history of progressive visual disturbance in his right eye. He had a past history of operations for paranasal sinusitis 24 years and 5 years prior to admission. Neurological examination revealed right anosmia, left hyposmia and vision in his right eye reducing to light perception. Case 2. A 61-year-old male was admitted with complaint of headache and a 2-month history of deteriorating vision in his right eye. On admission, vision in his right eye was found to be reduced to hand motions and associated with a concentric contraction of the visual field. Bilateral hyposmia and the right exophthalmos were also noticed. Plain x-ray films, tomography and especially CT scan were useful to demonstrate the definite inflammatory changes of the paranasal sinuses and the extension of the lesion beyond the confines of the sinuses. In both cases, external ethmoidectomy and sphenoidectomy with removal of the infected granulation tissue from the sinuses were performed, but neither mucocele nor pyocele was found. Vision improved postoperatively. Previous reports about ocular complications of infection in the paranasal sinuses without mucocele or pyocele are few. Early diagnosis of ocular complications of sinusitis is important. Once the diagnosis established, a timely surgical approach is essential to prevent visual loss.

[Moyamoya disease associated with a false aneurysm--case report and review of the literature]

A 67-year-old male was admitted to our clinic on May 1, 1981, because of mild confusion and a left hemiparesis. About 6 years ago, when he had a left-sided homonymous hemianopia, carotid angiography revealed moyamoya disease. CT scan on the admission showed an intracerebral hematoma in the right temporal lobe, which ruptured to the lateral ventricle. An angiogram demonstrated the net work of moyamoya vessels in the base of the brain and a "newly-appeared" aneurysm at the peripheral portion of the right anterior choroidal artery. This artery was shown on the previous angiogram also but did not bear the aneurysm. At the emergent operation the hematoma was evacuated and the aneurysm was excised, which was proved histologically to be a false aneurysm. Thirty-six cases of moyamoya diseases associated with aneurysm including the present case were reviewed. There were 44 aneurysms in this series. They were classified into groups--1) the major artery aneurysms arising from the major cerebral arterial segments; 2) the peripheral artery aneurysms arising from the distal segments of the peripheral cerebral arteries. The major artery aneurysms were found more frequently in the vertebro-basilar system, and the peripheral artery aneurysms in the basal ganglia, near or in the moyamoya vessels. Of 26 major artery aneurysms 12 were proved to be saccular aneurysms, 9 by surgeries and 3 by autopsy studies respectively. Of 18 cases of the peripheral group the aneurysms were excised operatively in two cases, and autopsy studies were performed in other two cases. The peripheral artery aneurysms were examined histologically in three cases; one was proved to be a false aneurysm, the other was thought to be a true aneurysm, and the third one was not verified. In 8 cases, the peripheral artery aneurysms disappeared on the follow-up angiograms and were supposed to be false aneurysms. From these reported cases, it may be suggested that major artery aneurysms are mainly true aneurysms and peripheral artery aneurysms are false aneurysms.

Thallium-201-chloride thyroid scintigraphy to evaluate benign and/or malignant nodules: usefulness of the delayed scan

The purpose of this study is to evaluate benign and/or malignant thyroid tumors with 201TI thyroid scan. We studied 76 cases of histologically verified thyroid tumors, all seen as cold nodules on the 123I thyroid scan. 201TI thyroid scan was performed 5-15 minutes (early scan) and 3-5 hours (delayed scan) after intravenous administration of 1.5-2.0 mCi of 201TI. In 35 (94.6%) of 36 malignant tumors (anaplastic carcinoma, six; papillary carcinoma 23; follicular carcinoma, five; epidermoid carcinoma, one; malignant lymphoma, 1) 201TI accumulated in the cold nodule of the 123I thyroid scan on both early and delayed scans. On the other hand, the delayed 201TI scan was negative in 35 out of 39 (89.7%) benign tumors. Employing early and delayed 201TI scans, we were able to differentiate most malignant thyroid tumors from those which were benign. False-negative and -positive cases are discussed.