[Usefulness of the prick test for anaphylactoid reaction in intravenous fluorescein administration]

We examined whether a prick test was a valuable method in comparison with an intradermal skin test for predicting an anaphylactoid reaction to intravenous injection of fluorescein solution. Fifteen hundred cases were tested. The number (rate) of positive reactions to the prick test with 10% and 1.0% fluorescein solution was 2 (0.1%) and 0 (0.0%), respectively. In contrast, positive reaction to the intradermal skin tests with 10% and 0.1% fluorescein solution was observed in 686 cases (45.7%) and 13 cases (0.9%), respectively. Fluorescein angiography (FAG) was performed in 1,499 of the 1,500 cases. Adverse reactions such as nausea, cough, cold sweat, urticaria, and shock were noted in 85 cases (5.7%). Typical anaphylactoid shock occurred in one case (0.07%), which was one of the two cases positive to the prick test with 10% fluorescein. In the other positive prick test case, FAG was cancelled because of the high probability of anaphylactoid shock. The results suggest that a prick test with 10% fluorescein solution can markedly cut down the false positive reactions and can be a useful test for the prospective diagnosis of anaphylactoid reactions to intravenous fluorescein administration.

[Adenosine deaminase isoenzymes in patients with Graves' disease]

CD26, the T cell activation antigen, is identical to the ADA binding protein and is considered to interact with ADA to activate the T cells on the surface. Therefore, we examined the activity of serum ADA isoenzymes in patients with Graves' disease in whom CD26 presented T cells were increased. The activities of total ADA and ADA2 were significantly higher in Graves' disease than normals. We also observed that the levels of soluble interleukin-2 receptor (sIL-2R) and neopterin, markers of T cell activation, were significantly higher in Graves' disease. The correlation coefficients among ADA2, neopterin, and sIL-2R were significantly high (p < 0.001). Among these parameters, only sIL-2R was correlated with the thyroid hormones. ADA2 activity was considered to reflect the activated state of T cells and to be, independent of the thyroid hormone levels.

Subungual exostosis of the finger

Subungual exostosis is a benign tumor or cartilaginous bone beneath or adjacent to the nail. It is usually a solitary lesion that develops most often in the substance of the great toe and less frequently in other toes. It rarely occurs in the fingers. We present a case of subungual exostosis of the finger. At 4-year follow-up, the result was excellent, with no sign of recurrence.

Ethanol injection sclerotherapy for Baker's cyst, thyroglossal duct cyst, and branchial cleft cyst

Six patients with Baker's cysts, 3 with branchial cleft cysts, and 2 with thyroglossal duct cysts were treated with percutaneous aspiration and absolute ethanol sclerotherapy using a 7-French pigtail catheter. Cystography was performed before ethanol injection to confirm that there was no extravasation and that it was a monocystic lesion. One recurrence of a Baker's cyst was revealed in follow-up examinations, which ranged from 11 months to 36 months (mean, 25 months). The major complication of hypoesthesia of the popliteal region was observed in 1 patient treated for Baker's cyst. The results of this series suggest that ethanol sclerotherapy is the treatment of choice for Baker's cyst, branchial cleft cyst, and thyroglossal duct cyst.

Improvement of hemocompatibility on a cellulose dialysis membrane with a novel biomedical polymer having a phospholipid polar group

To improve surface hemocompatibility on cellulose hollow fibers for hemodialysis, newly designed hemocompatible polymers with a phospholipid polar group, 2-methacryloyloxyethyl phosphorylcholine (MPC) polymers, were introduced on the surface through two different methods: direct grafting of MPC on the surface, or coating of a water-soluble cellulose grafted with MPC. The MPC was polymerized using cerium ion as an initiator in the cellulose hollow fibers, and the poly(MPC) chains were grafted directly on the surface. Another modification of the cellulose hollow fibers was attempted by coating them with a water-soluble graft copolymer composed of a poly(MPC) side chain and a cellulose backbone. The coating process from an aqueous solution of the graft copolymer was very convenient, and the graft copolymer on the surface was not detached even after water circulated into the hollow fibers. These cellulose hollow fibers modified with MPC polymers displayed excellent hemocompatibility such as prevention of blood cell adhesion and aggregation after contact with blood without an anticoagulant. The permeability of the hollow fibers did not decrease as a result of these modifications. From these results, it is clearly suggested that introduction of the MPC units was effective for improving the hemocompatibility of the hollow fibers for hemodialysis.

[Personnel requirements for health examination of infants under 5 months in municipalities in Japan]

Municipalities offer health education, health counseling, health examinations, and home visitation service for infants and their mothers. In order to determine what the personnel staffing requirements were for health examination of infants under 5 months for municipalities in Japan in 1989, a questionnaire survey was conducted in 1990. Questionnaires were sent to all municipalities and 3,198 responses were received for a response rate of 97.9%. Responses from 912 municipalities were considered invalid, leaving a total of 2,286 responses that were analysed. Results showed that 79.2% of the 2,286 municipalities were able to perform health examinations for infants under 5 months independently, while in 6.5% of the municipalities these examinations were performed by the clinical hospitals. Analysis by size of municipalities showed that 85.7% of the cities with populations of 500,000 or more were able to perform health examinations independently. In the large cities designated by the Government, the health personnel system adequately supported these health examinations. However in rural towns and villages with small populations, it was necessary for public health nurses to be assisted by other staff, most of whom were public health nurses from prefectural health centers. For example, in areas with populations of less than 3,000, about 60% of the total volume of the work required to be performed by public health nurses during the health examinations had to be covered by assistance from prefectural public health nurses.

[Mechanism and prevention of postoperative hemolysis in the corrective surgery of subarterial ventricular septal defects]

Intravascular hemolysis following the repair of subarterial ventricular septal defects (VSD) was studied in 34 patients. The VSD was closed through a main pulmonary arteriotomy with a Dacron double-velour patch (Meadox, Oakland, NJ) in 17 cases (Group B) and with a Dacron single-velour patch covered by autologous pericardium facing toward the right ventricular outflow tract (RVOT) in 17 cases (Group A). No significant intergroup difference in age, weight, Qp/Qs, Pp/Ps, and Rp/Rs was found. There were no significant differences in the preoperative values of serum LDH, total bilirubin, and flow velocity at the RVOT (Group A: 1.7 +/- 0.4 m/sec vs Group B 1.8 +/- 1.0 m/sec). The severity of hemolysis was evaluated by serum LDH levels, total bilirubin levels, and hemoglobinuria on the morning of the first operative day. Postoperative LDH levels were significantly lower in the Group A (812 +/- 205 IU/L) than in the Group B (1098 +/- 427 IU/L) (p < 0.05). Hemoglobinuria developed in 2 patients in Group B (12%) and none in Group A. These data suggest that the pericardium apparently protects against postoperative hemolysis. The intensity of the turbulence at the RVOT was graded as follows using color-doppler echocardiography (0: none; Grade 1: turbulence was detected near the patch only; Grade 2: turbulence was detected halfway to the RVOT; Grade 3: turbulence extended to the anterior wall of the RVOT). The relationship between the presence of hemolysis and the degree of turbulence was examined. Turbulence at the RVOT appeared in 73% of those in Group A and in 82% of those in Group B.(ABSTRACT TRUNCATED AT 250 WORDS)

[Peritoneal dialysis following open heart surgery in children]

From 1982 to 1991, 13 (3.9%) of 336 children who underwent open heart surgery required peritoneal dialysis postoperatively, including 5 with transposition of the great arteries, 4 with tetralogy of Fallot, 2 with ventricular septal defect, 1 each with atrioventricular canal defects and total anomalous pulmonary venous connection. Patients ages ranged from 12 days to 4 years (mean, 1 year and 4 months). The infusion catheter was directed toward diaphragm from the right lower quadrant, and the drainage catheter was placed in the pelvis from the left upper quadrant. Dialysis solution was instilled and drained simultaneously. Seven children (54%) recovered renal function, with six (46%) longterm survivors. Differences between patients who did and did not recovered renal function (Group A and Group B respectively) were examined. No significant intergroup difference existed in age or weight. PD was initiated significantly sooner in Group B (1.2 +/- 0.8 days) than in Group A (3.2 +/- 1.9 days) (p < 0.05). The negative fluid balance was 88.0 +/- 31 mL/kg/day in Group A and 78.4 +/- 25.0 mL/kd/day (NS). BUN and serum creatinine concentrations were slightly elevated in both group, but were not significant different. Patients in Group A were dialyzed from 3 days to 21 days (mean 9.9 +/- 6.4 days), and patients in Group B were dialyzed from 1 day to 14 days (mean 5.3 +/- 5.2 days) (NS). The central venous pressure (CVP) in Group A decreased while blood pressure (BP) and renal perfusion pressure (RPP) increased following initiation of PD. CVP increased in Group B, while BP and RPP decreased. All patients died of low cardiac output syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

[A survey of goals and the utilization of numerical goals in the health planning of 47 prefectures]

Health plans of 47 prefectural governments based on the Medical Law of 1985, were evaluated regarding four health planning factors: final goal, implementation plan, development of resources, and evaluation planning. Results of the evaluation showed that 8.5% of the 47 prefectures had defined future level of health based on numerical goals. On the other hand, all of the prefectures had developed numerical goals specifying the number of hospital beds in each medical district. A major component of health planning is improvement in the accomplishment of the implementation plan. There were 14 prefectures which had numerical goals for the upgrading of facilities and for manpower development to meet future health care activities. The following factors are required in the health planning to meet the needs for improving the health status of the population. 1) Including in the future health goals, in addition to the number of medical bed in regional areas, objective levels of health that should be attained. 2) Development of practical plans for evaluation of effectiveness of health planning.

[Health personnel staffing requirements for health examination for three year old children in municipalities in Japan]

Based on the Maternal and Child Health Law, municipalities offer health education, health counseling, health examination, and home visitation service for three year old children and for their mothers. In order to determine personnel staffing requirements for the health examination of three year old children for municipalities in Japan for 1989, data from a questionnaire survey in 1990 conducted by the Ministry of Health, was analyzed. Questionnaires were sent to all municipalities and there were 3,198 responses for a response rate of 97.9%. Results showed that in 1989, only 7% of the 3,198 municipalities were able to perform health examinations for three year old children independently. However 83% of the cities which had populations 500,000 or more were able to perform the health examinations independently. In both the large cities designated by the Government and those cities which have Health Centers, the health personnel system adequately supported these health examinations. Due to the lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, most often public health nurses from prefectural Health Centers. For example, in those areas with populations less than 3,000, 43% of the total volume of the work required to be performed by public health nurses during the health examinations had to be covered by assistance for prefectural public health nurses.

Factors influencing surgical results in proliferative diabetic retinopathy

Although the anatomical results of diabetic vitrectomy have been reported to be rather good when silicone oil is used as a tamponade substitute, the functional results remain unsatisfactory. To investigate the factors influencing the functional results in these cases of severe diabetic retinopathy, the correlation between the surgical results and the overall condition of these patients, including the tamponade substitute, was examined. The vitrectomy results obtained in cases of diabetic retinopathy treated using silicone-oil tamponade were studied retrospectively in comparison with those obtained using SF6 gas tamponade or without any tamponade substitute. The visual acuity of more than 80% of eyes belonging to the groups treated with SF6 gas or without any tamponade improved postoperatively, whereas the rate of improvement in the silicone-oil group was limited to low and the postoperative vision ranged widely, since the silicone was usually used in much more severe cases. Iris rubeosis that occurred after pars plana vitrectomy subsided following secondary silicone-oil injection into the vitreous cavity. Only one disadvantage in using silicone oil was that an additional operation was required to remove it, and the visual acuity of nearly 30% of the eyes deteriorated after its removal. As far as the general condition of these patients is concerned, the visual outcome of subjects who had hypoalbuminemia and anemia due to renal dysfunction was poor as compared with that of patients who did not have these disorders. Blood transfusion did not lead to better function.(ABSTRACT TRUNCATED AT 250 WORDS)

An anatomic study of the innervation of the wrist joint and Wilhelm's technique for denervation

Innervation of the wrist joint has been clarified in this study by loupe dissection and histologic examination. The posterior interosseous nerve, the lateral antebrachial cutaneous nerve, the superficial branch of the radial nerve, and the dorsal branch and the perforating branches of the ulnar nerve innervate the wrist joint from the dorsal side. The anterior interosseous nerve, the palmar cutaneous branch of the median nerve, and the deep branch and the main trunk of the ulnar nerve innervate it from the palmar side. The findings indicate that surgical denervation of most of the articular nerves of the wrist joint is possible with the use of Wilhelm's procedure, but denervation of the palmar side of the intercarpal and carpometacarpal joints, which are innervated by the deep branch of the ulnar nerve, is not included in Wilhelm's technique.

[Emergent operation of left atrial ball thrombus associated with mitral stenosis]

A 71-year-old woman with old cerebral infarction and arterial obstruction was admitted with the diagnosis of a free floating ball thrombus in the left atrium associated mitral stenosis. The emergent open heart operation was performed for removal of ball thrombus and mitral commissurotomy. The size of ball thrombus was 4.8 x 4.0 x 3.0 cm. Postoperative course was uneventful.

Cellulose acetate electrophoretic determination of bone alkaline phosphatase activity in healthy subjects and diabetic patients with and without osteopenia

We adapted the electrophoretic method of bone alkaline phosphatase (ALP) determination using neuraminidase from Vibrio cholerae to separate bone and liver ALP on cellulose acetate membrane. Treatment of separator plus serum (1:8, neuraminidase 111 U/l in final) for 10 min at room temperature (25 +/- 1 degree C) and subsequent electrophoresis made it possible to quantify bone ALP activity simply and rapidly. The precision of the data was at the level of CV of 1.6% (within-day) and 4.7% (day-to-day), with recovery rates of 97-103%. The normal range of bone ALP activity depended on age and sex. Seventy-eight diabetes mellitus (DM) patients, excluding those with renal failure, were divided into two groups of those with and without osteopenia with matching of age (+/- 3 years) and sex. Bone ALP (P < 0.001) and total ALP (P < 0.05) activities and urine calcium/creatinine ratio (P < 0.05) were significantly higher in DM with osteopenia than in DM without osteopenia. Therefore, bone formation and absorption may be accelerated in DM with osteopenia in comparison with DM without osteopenia.

Improvement of blood compatibility on cellulose dialysis membrane. 2. Blood compatibility of phospholipid polymer grafted cellulose membrane

The blood compatibility of a cellulose haemodialysis membrane whose surface was grafted with a methacrylate having a phospholipid polar group, 2-methacryloyloxyethyl phosphorylcholine, was evaluated with attention to platelet adhesion to the membrane surface and complement activation induced by the membrane. When the original cellulose membrane came in contact with platelet-rich plasma for 30 min, numerous platelets adhered to the surface and aggregated. On the other hand, the membrane grafted with 2-methacryloyloxyethyl phosphorylcholine effectively suppressed platelet adhesion and activation. This effect became more pronounced with increasing surface distribution. Especially, the 2-methacryloyloxyethyl phosphorylcholine grafted membranes, whose distribution exceeded 0.27, completely inhibited platelet adhesion, even when the contact time was 180 min. Moreover, the complement activation was also reduced with increased 2-methacryloyloxyethyl phosphorylcholine distribution on the surface of the membrane.

Improvement of blood compatibility on cellulose dialysis membrane. I. Grafting of 2-methacryloyloxyethyl phosphorylcholine on to a cellulose membrane surface

A methacrylate with a phospholipid polar group, 2-methacryloyloxyethyl phosphorylcholine (MPC), was grafted on cellulose membrane for haemodialysis in an aqueous medium using cerium ion (Ce4+) as an initiator. The effects of the concentrations of MPC and Ce4+, and degassing of feed solution on the grafting of MPC on the surface and the membrane properties such as permeability and mechanical strength were examined. The grafted MPC composition depended on the concentrations of both the monomer and initiator in the feed solution. When the grafted MPC distribution was controlled by the monomer concentration, the permeability of the membrane decreased with an increase in grafted MPC distribution. On the other hand, the permeability was not changed from the original membrane's value when the MPC distribution was regulated by Ce4+ concentration. The tensile strength of the membrane did not change during the grafting of MPC and this indicated that the grafting had taken place in the amorphous region of the cellulose. These results suggested that this method is a promising way to improve the blood compatibility of a cellulose membrane without having an adverse effect on the haemodialysis membrane.

Erythrocyte deformability in workers exposed to lead

Erythrocyte deformability and other hematological indicators were determined in 17 male workers exposed to lead at a secondary lead refinery and 13 controls. Blood lead, urine lead, urine coproporphyrin, delta-aminolevulinic acid and erythrocyte zinc protoporphyrin were determined to evaluate the degree of lead exposure in the lead workers above. For the measurement of erythrocyte deformability, the microfilter method was used. The results were summarized as follows: 1. The mean values of blood lead, urine lead, urine coproporphyrin, urine delta-aminolevulinic acid and erythrocyte zinc protoporphyrin levels in lead workers were 53.5 micrograms/100g, 141.4 micrograms/l, 115.9 micrograms/l, 12.0 mg/l and 68.9 micrograms/dl respectively, suggesting a moderate influence of lead exposure. 2. The mean values of erythrocyte count, hematocrit and hemoglobin were significantly lower in lead workers than those in controls. No significant differences were found in the mean values of mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and corpuscular natrium and potassium between lead workers and controls. 3. Erythrocyte deformability was significantly reduced in lead workers compared with controls.

[Congenital bronchomalacia of left main bronchus combined with lobar emphysema, pectus excavatum and right aortic arch--a case report]

One-year-old girl was admitted because of recurrent pneumonia and pectus excavatum. Chest X-ray showed hyperlucency at the upper lung field and infiltrated shadow at the lower field of the left lung. Bronchoscopy and bronchograms revealed marked collapse in a long segment of the left main bronchus during expiration. CT scan showed an emphysematous change and a giant bulla of left lung. Angiogram showed right aortic arch. Sternoturnover was performed at 5 years of age for pectus excavatum. After 10 months, left pneumonectomy was performed for bronchomalacia and lobar emphysema. Pathologic findings of the bronchus revealed that the rings were flattened, while the cartilage was microscopically normal.

A case of lead poisoning recovered by transposition of the work post

A case of lead poisoning in a secondary lead refinery was reported. A 58 year old man working at the post of lead refining complained of severe lassitude and diarrhea. By increased urine coproporphyrin excretion, he was suspected of a case of lead poisoning. Clinical data from the health examinations revealed that he had been affected by lead. The patient was transposed to another work post where lead was not handled and rapidly recovered from the poisoning.

Effect of hypothermic ischemia and reperfusion on calcium transport by myocardial sarcolemma and sarcoplasmic reticulum

The effects of hypothermic ischemia and reperfusion on sarcolemma and sarcoplasmic reticulum Ca2+ transport were studied in vesicles isolated from rabbit hearts. Hypothermic global ischemia was produced by immersing hearts in saline at 4 degrees C for 3 h. Following hypothermic ischemia, reperfusion was carried out for 40 min using a Langendorff perfusion system for the working heart. Na+,K(+)-ATPase activity of sarcolemmal vesicles (SL), was not depressed by hypothermic ischemia nor by ischemia and reperfusion. The initial rate of Na(+)-Ca2+ exchange in SL vesicles was not depressed, but the maximum amount of Ca2+ uptake was increased both after hypothermic ischemia and after reperfusion. Ca2+ uptake activity of sarcoplasmic reticulum vesicles (SR) isolated from hearts subjected to hypothermic ischemia was slightly lower than that of control, and was further reduced following reperfusion. Ca(2+)-ATPase activity of SR was unaffected by hypothermic ischemia, while it was markedly lowered after reperfusion. Although the phosphoenzyme level in SR vesicles was slightly decreased, the turnover rate was reduced after reperfusion. Reperfusion injury thus took place mainly in SR while SL appeared to be tolerant to ischemia and reperfusion.

Reverse vascular pedicle hypothenar island flap

The vascular supply of the skin of the hypothenar region was investigated using 12 cadavers and 24 hands. The ramifications of the proper palmar digital artery of the little finger were also investigated by angiogram in 20 hands. It was found that it is possible to raise the hypothenar skin as an island flap, using the reverse vascular pedicle of the proper palmar digital artery of the little finger. We applied this island flap in three cases. With the result of these anatomical and radiological studies, the details of three cases are described.

Effect of prolonged hypothermic ischaemia on myocardial sarcoplasmic reticular calcium transport

STUDY OBJECTIVE

The aim of the study was to assess the effects of hypothermia on sarcoplasmic reticulum in myocardium subjected to prolonged ischaemia.

DESIGN

Calcium regulatory activity of myocardial sarcoplasmic reticulum was measured in hearts subjected to various periods of hypothermic ischaemia in comparison with hearts subjected to normothermic ischaemia.

SUBJECTS

Hearts (n = 5-9 per experiment) were obtained from male New Zealand white rabbits, 2.0-2.8 kg weight.

MEASUREMENTS AND RESULTS

Calcium uptake and calcium dependent ATPase activity were measured in isolated sarcoplasmic reticulum vesicles after hypothermic ischaemia was produced by immersing hearts in saline at 4 degrees C for 3, 6, or 12 h. Normothermic hearts were immersed for 3 h at 37 degrees C. Calcium uptake and calcium dependent ATPase (Ca-ATPase) activity were markedly inhibited by normothermic ischaemia. In hypothermic ischaemia, calcium uptake was only slightly depressed after 3 h, though longer periods of ischaemia resulted in significant depression of uptake. Ca-ATPase activity was unaffected after 6 h of hypothermic ischaemia. The ratio of calcium uptake to Ca-ATPase activity decreased after 3 h of hypothermic ischaemia. The phosphoenzyme concentration in sarcoplasmic reticulum was unaffected up to 6 h. The ratio of Ca-ATPase activity to phosphoenzyme concentration was not significantly altered until 12 h. Protein composition, examined by SDS-polyacrylamide gel electrophoresis, showed a decrease in 100,000 dalton polypeptide in normothermic ischaemia and after 12 h of hypothermic ischaemia.

CONCLUSIONS

These results suggest that the depression of calcium uptake activity after 6 h of hypothermic ischaemia is likely to be due to uncoupling of calcium transport from ATP hydrolysis. Depressed Ca-ATPase activity at 12 h can be attributed to a reduction in the number of active calcium pump units. Hypothermia preserves function of myocardial sarcoplasmic reticulum during ischaemia for up to 3 h.

[Activity of guanase in serum and liver function tests in HBe antigen-positive chronic hepatitis]

Forty-one patients with chronic hepatitis were divided into an HBe antigen-positive group (n = 13) and an HBe antigen-negative group (n = 28) to clarify the relationship between the presence of HBe antigen and liver function. In the HBe antigen-positive group, the activities of serum alanine aminotransferase (p less than 0.01), aspartate aminotransferase (p less than 0.05) and guanase (p less than 0.01) were significantly higher than those in the HBe antigen-negative group. The correlation coefficient between the HBe antigen titer and guanase activity was 0.528, which was higher than the corresponding values for alanine aminotransferase and aspartate aminotransferase. The determination of guanase activity in serum may be useful for evaluating the clinical severity of HBe antigen-positive chronic hepatitis.

[Omentum in the management of thoracic surgery: especially its application to tracheobronchial surgery]

Omentum is now not only policeman of the abdomen but also of the thorax. We applied omental pedicle flap in the management of 14 patients with thoracic surgery including chest wall reconstruction, empyema, thoracic skeletal infection and tracheobronchial problems. Especially, tracheobronchial reconstruction using omental pedicle flap for the patient combined with lung cancer (T4N2M0 STAGE IIIB) and asthma under steroid therapy was reported. The case was 71-year-old man with complaint of hemosputum. He had 5-6 year history of bronchial asthma with disturbed pulmonary function of % VC 44%, FVC1.0% 37%. Bronchoscopic study revealed the tumor invading the right side of trachea originating from right upper bronchus with histological diagnosis of moderately differentiated squamous cell carcinoma. Preoperatively, he experienced a heavy asthma attack which was controlled by steroid administration. Following extended right sleeve upper lobectomy, we applied omental pedicle flap around the reconstructed portion for the protection of infection, impaired wound healing due to postoperative steroid therapy and strong tension at anastomoses. Postoperative course was satisfactory. We suggest omental pedicle flap is an effective surgical armamentarium in the management of tracheobronchial surgery for the patient with strong anastomotic tension, immunocompromised condition, preoperative irradiation at bronchial stump and use of drug causing delayed wound healing (steroid, anticancerous drug etc).