[Clinical study of intravesical instillation therapy of superficial bladder tumor--combination therapy of mitomycin C, adriamycin, peplomycin and cytosine arabinoside]

The effect of intravesical combination chemotherapy on superficial bladder tumors was analyzed. Seventy-two patients were treated with intravesical instillation of the following anticancer drugs. MMC group: Mitomycin C (MMC) 10 mg and cytosine arabinoside (CA) 300 mg. ADM group: Adriamycin (ADM) 30 mg and CA 300 mg. PEP group: Peplomycin (PEP) 30 mg and CA 300 mg. MAC group: MMC 10 mg, ADM 30 mg and CA 300 mg. Antitumor effects in the MMC, ADM, PEP and MAC groups were evaluated in 16, 18, 17 and 21 patients and objective response (CR + PR) of tumor was observed in 87.5%, 50.0%, 35.3% and 28.6% of these patients. The papillary tumors, small tumors and low grade tumors responded better to these intravesical chemotherapies than the non-papillary tumors, the middle grade tumors and the high grade tumors. The recurrence rate in 72 patients was 6.9, 14.6 and 26.8% within 1, 2 and 3 years. No significant difference in the recurrence rate was observed between the MMC, ADM, PEP and MAC group, but the MMC group tended to have a lower recurrence rate than the other groups. The recurrence rate for the low grade tumors and the middle grade tumors was significantly lower than that for the high grade tumors and the small tumors. The major side effect of instillation therapy with these drugs was bladder irritation which appeared in 16.7% of all the patients (78 cases). In conclusion, intravesical chemotherapy is a useful approach for controlling superficial urinary bladder tumors, especially the combination of MMC and CA.

Fusiform superior cerebellar artery aneurysm presenting with contralateral abducens nerve paresis--case report

A 25-year-old female suddenly developed headache and diplopia. On admission, neurological examination revealed neck stiffness and left abducens nerve paresis. A computed tomographic scan suggested subarachnoid hemorrhage. Left vertebral angiogram showed an aneurysm on the anterior pontine segment of the right superior cerebellar artery (SCA) and marked flexion and meandering of the basilar artery to the left. At surgery, an atherosclerotic, fusiform aneurysm was found through the right subtemporal transtentorial approach, and the right SCA was clipped just proximal to the aneurysm. Thirteen cases of SCA aneurysm have been described in the literature, but none was a fusiform aneurysm.

Snap helix with knob and hole: essential repeats in S. pombe nuclear protein nuc2+

The S. pombe nuc2+ gene is required for mitotic chromosome disjunction. Its mutation arrests mitosis at the metaphase. The gene product is present in the nuclear scaffold-like fraction. The nuc2+ protein contains a domain, separated from ten 34 amino acid repeat segments, that is capable of binding AT-rich DNA in vitro. The ts mutation resides in one of the 34 amino acid repeats. Circular dichroism, limited proteolysis of the repeats, and model fitting indicate the presence of helical segments connected by protease-sensitive hinges. We propose that these repeats form a novel secondary structure (snap helix) having "knob and hole" helix-associating motifs. The packing of the snap helices would be stabilized by the bonding between the hydrophobic amino acids surrounding the knobs and holes. The nuc2+ protein may in one way bind to DNA and in another way mutually associate to form a part of the chromosome scaffold.

[Assessment of reproducibility of transcranial Doppler velocimetry]

In recent years, transcranial Doppler velocimetry has been widely used as a noninvasive method for measurement of blood flow velocity in basal cerebral arteries. As for the reproducibility of this method, however, there have been only few reports so far. In the present study, we attempted to evaluate the reproducibility of this method by changing the examiners and the timing of the examination. Fifteen healthy volunteers were investigated by using a pulsed wave Doppler ultrasound device with a 2 MHz transducer. Both peak and mean spatial frequencies calculated from the frequency spectrum of the Doppler signals from the middle cerebral artery (MCA) and the basilar artery (BA) were used as blood flow parameters for assessing the reproducibility. The arterial blood pressure and the end-tidal carbon dioxide partial pressure (PECO2) were also monitored during the ultrasonic examinations. The intra- and inter-observer reproducibilities were evaluated by obtaining the coefficient of variation (CV) of the differences and/or analyzing the correlation between the values from the two measurements by the same examiner and by two separate examiners, respectively. The intraobserver reproducibility in separate days was also evaluated. Both in the mean arterial blood pressure and in PECO2, no significant changes were observed between the two measurements in each subjects. In the present examination, the CV and r values ranged from 6.7 to 19.5% and from 0.69 to 0.95, respectively, showing good reproducibility of the transcranial Doppler method for measurement of blood flow velocity, though some differences were observed as follows. The intraobserver reproducibility was better than the interobserver reproducibility.(ABSTRACT TRUNCATED AT 250 WORDS)

The fission yeast dis2+ gene required for chromosome disjoining encodes one of two putative type 1 protein phosphatases

S. pombe dis mutants block mitotic chromosome disjunction in a manner reminiscent of aneuploidy formation, and belong to three distinct genes, dis1-dis3. We cloned two independent genomic DNAs that complemented both the cold-sensitive and caffeine-hypersensitive phenotype of dis2-11. These genes, dis2+ and a suppressor sds21+, encode proteins (calculated MW 37,000) with similar predicted amino acid sequences. dis2+ and sds21+ have overlapping functions, and disruptants are lethal only when both genes are disrupted. The gene products identified by anti-dis2 serum are enriched in nuclei. By hybridization, we obtained two cDNA clones from mouse and one genomic clone from S. cerevisiae; the latter complements S. pombe dis2-11. These dis2+ and similar polypeptides of yeasts and mouse are found to be highly homologous (75%-90% identical) to rabbit protein phosphatase 1. The implications of these findings are discussed with regard to mitotic control.

Composite motifs and repeat symmetry in S. pombe centromeres: direct analysis by integration of NotI restriction sites

S. pombe centromeres are large and complex. We introduced a method that enables us to characterize directly centromere DNAs. Genomic DNA fragments containing cen1, cen2, or cen3, respectively, are made by cleaving NotI sites integrated on target sites and are partially restricted for long-range mapping in PFG electrophoresis. The 40 kb long cen1 consists of two inverted approximately 10 kb motifs, each containing centromeric elements dg and dh, flanked by a central region. In cen2, three motifs are arranged in inverted and direct orientations with flanking domains, making up the approximately 70 kb long repetitious region. In cen3, approximately 15 copies of dg-dh constitute a region longer than 100 kb. A set of inverted motifs with an approximately 15 kb central region might be a prototype for the S. pombe centromeres. The motifs appear to play a role in chromosome stability and segregation. Their action may be additive, and the mutual directions of dg and dh inside a motif may not be essential for function.

Diastolic atrioventricular valve closure and regurgitation following atrial contraction: their relation to timing of atrial contraction

Some authors have proposed that atrial contraction per se is able to close the atrioventricular (AV) valves. To determine whether tight closure of the AV valves can be accomplished solely by atrial contraction, the existence of diastolic regurgitation following atrial contraction and its relation to the PQ interval were examined in 13 patients with AV block (2 of the first degree, 4 of the second degree, and 7 of the third degree), using pulsed Doppler echocardiography, which allowed noninvasive estimation of valvular regurgitation in the physiological state. Diastolic mitral and tricuspid regurgitations were detected in the left and right atria near the respective AV valves in all 13 patients despite different degrees of AV block, while these valves were observed to be in apparently closed position during regurgitation on the two-dimensional and M-mode echocardiograms. The duration of regurgitant signals was prolonged with an increase in the PQ interval in the electrocardiogram, but it became short again as the P wave approached the preceding rapid filling wave. These results suggest that atrial contraction may initiate the closure of the AV valves but is not capable of closing the valves tightly, and atrial contraction with long PQ interval may contribute little to augmentation of cardiac output in patients with AV block.

Alpha-fetoprotein antibody-lectin enzyme immunoassay to characterize sugar chains for the study of liver diseases

An antibody-lectin enzyme immunoassay (EIA) technique was developed for the analysis of sugar chains of serum alpha-fetoprotein in various liver diseases. The anti-'alpha-fetoprotein'-IgG was coated on a microtiter plate and then treated with periodic acid. A serum sample was added to the plate and then a 'peroxidase'-conjugated lectin was added. The amount of lectin bound to the sugar chain of the 'alpha-fetoprotein' was estimated from the 'peroxidase' activity. The 'peroxidase' activities of 4 different lectins, LCA, Con A, LCA and EPHA, were compared. The LCA/'wheat germ agglutinin' activity ratio and LCA/EPHA activity ratio were increased in liver diseases and LCA/'wheat germ agglutinin' ratio showed a statistically significant difference between the chronic hepatitis and the liver cirrhosis groups (p less than 0.05). Furthermore, when serum samples were pretreated with sialidase, a statistically significant difference was observed in the LCA/EPHA and LCA/Con A ratios between the chronic hepatitis and the hepatoma groups (p less than 0.05). These results indicated that low sialylation at the non-reduced end of the sugar chains of 'alpha-fetoprotein' occurs in liver cirrhosis and that high fucosylation at the reduced end of N-acetylglucosamine residue of 'alpha-fetoprotein' occurs in hepatomas.

Evidence for early mitogenic stimulation of metabolic flux through phosphoribosyl pyrophosphate into nucleotides in Swiss 3T3 cells

Various mitogens activate purine and pyrimidine de novo biosynthesis and purine base phosphoribosylation as an early response in quiescent fibroblasts. Increased synthesis of 5-phosphoribosyl 1-pyrophosphate (PRPP) may precede or underlie these activations, but little direct evidence has been presented for this notion, due to lack of suitable analytical methods. To preferentially label intracellular ribose phosphate and quantitatively follow metabolic flux through PRPP into nucleotides, we prepared [ribosyl-14C]inosine and used it as a tracer. Evidence showed the validity of this method. Prior exposure of quiescent Swiss 3T3 cells in culture to epidermal growth factor plus insulin for 45-60 min enhanced approximately 2-fold the radioactivity incorporation from [ribosyl-14C]inosine into nucleotides, without increasing the specific radioactivity of intracellular free ribose 5-phosphate. [14C]Uracil incorporation into nucleotides, a measure of PRPP-independent ribose phosphate utilization for nucleotide synthesis, was not increased. These and other results indicate that epidermal growth factor plus insulin stimulates the metabolic flux through PRPP. Similar extents of stimulation were induced by bombesin and melittin in combination with insulin and by fibroblast growth factor alone, suggesting the presence of an unknown signaling pathway common to these mitogens. This system is highly useful for studies of the mechanisms that stimulate in situ activity of PRPP synthetase.

Cold-sensitive and caffeine-supersensitive mutants of the Schizosaccharomyces pombe dis genes implicated in sister chromatid separation during mitosis

We isolated novel classes of Schizosaccharomyces pombe cold-sensitive dis mutants that block mitotic chromosome separation (nine mapped in the dis1 gene and one each in the dis2 and dis3 genes). Defective phenotype at restrictive temperature is similar among the mutants; the chromosomes condense and anomalously move to the cell ends in the absence of their disjoining so that they are unequally distributed at the two cell ends. Synchronous culture analyses indicate that the cells can enter into mitosis at normal timing but become lethal during mitosis. In comparison with the wild-type mitosis, defects are found in the early spindle structure, the mitotic chromosome structure, the poleward chromosome movement by the spindle elongation and the telophase spindle degradation. The dis mutants lose at permissive temperature an artificial minichromosome at higher rates than occur in the wild type. We found that all the dis mutants isolated are supersensitive to caffeine at permissive temperature. Furthermore, the mutant cells in the presence of caffeine produce a phenotype similar to that obtained at restrictive temperature. We suggest that the dis genes are required for the sister chromatid separation at the time of mitosis and that caffeine might affect the dis gene expression. We cloned, in addition to the dis2+ and dis3+ genes, multicopy extragenic suppressor sequences which complement dis1 and dis2 mutations. A complex regulatory system may exist for the execution of the dis+ gene functions.

Clinical implications of pulmonary regurgitation in healthy individuals: detection by cross sectional pulsed Doppler echocardiography

Pulsed Doppler echocardiography in healthy individuals often shows a disturbance of diastolic flow in the right ventricular outflow tract just below the pulmonary valve that suggests regurgitation. This disturbance of diastolic flow was studied in 50 healthy individuals and 40 patients with cardiopulmonary disease, some of whom had a pulmonary regurgitant murmur. Diastolic flow was disturbed in 39 of the 50 healthy individuals. In 32, cross sectional echocardiography gave a satisfactory image of the pulmonary valve. The characteristic Doppler signals usually lasted throughout diastole, were directed toward the right ventricular cavity, and gradually waned towards end diastole; they formed a spindle shaped area of abnormal signals that extended to within 10 mm of the coaptation of the pulmonary valve towards the right ventricular cavity and the pressure difference estimated from the signals by the modified Bernoulli equation seemed to be proportional to the normal retrograde transpulmonary pressure difference. In all 40 patients with cardiopulmonary disease, signals indicating pulmonary regurgitation were found whether or not a regurgitant murmur was present. When it was present, however, the spindle was longer than 20 mm and in patients with pulmonary hypertension the velocity of abnormal diastolic flow was higher than in healthy individuals. The Doppler signals registering disturbed flow in the healthy individuals resembled the signals caused by pulmonary regurgitation in the patients in terms of location, orientation, and configuration. These results show that healthy individuals usually have trivial pulmonary regurgitation. In practice the distance that the flow disturbance extends from the valve and estimated pressure difference across the valve are probably the most important variables for assessing the clinical significance of pulmonary valve regurgitation.

[High resolution ultrasound examination in the diagnosis of the undescended testis in the inguinal region]

Twenty-six undescended testes in 22 patients between 1 and 31 years old were evaluated with ultrasonographic examination between October, 1981 and December, 1985. All 22 patients were operated on, and the accuracy of the ultrasonic diagnosis was evaluated in comparison to that of palpation diagnosis. Fourteen of 26 testes could be palpated preoperatively and these were all identified ultrasonographically and surgically. Twelve testes could not be palpated. On these 12 testes, surgical exploration revealed 9 testes in the inguinal region and absence of 3 testes. Ultrasound examination predicted its presence in 5 of 9 testes and its absence in all 3 testes. Both sonography and palpation failed to identify their presence in 4 tests. Thus, sensitivity of ultrasound examination was 82.6%, specificity 100% and accuracy 84.6% retrospectively. We conclude that ultrasound examination is useful in diagnosis of impalpable undescended testes in inguinal region.

Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography

The aim of the present study was to elucidate the mechanisms of mitral regurgitation accompanying myocardial infarction. Severity and site of mitral regurgitation was evaluated by the real-time two-dimensional Doppler flow imaging technique in 81 patients with old myocardial infarction. The incidence of mitral regurgitation did not depend on the region of infarction. There was, however, a close relationship between the site of regurgitation and the region of infarction. In patients with mitral regurgitation spurting from the posteromedial area of the valve, the inferior wall was involved in infarction without exception and in some of these patients, the posteromedial papillary muscle was also found to be affected by myocardial infarction; in those with regurgitation spurting from the anterolateral area, the anterior wall showed asynergy. On the other hand in patients with mitral regurgitation spurting from the central area, the region of infarction varied. In these patients, however, the larger the diameter of the mitral anulus, the more severe the grade of regurgitation. The extent of asynergy was another factor related to the severity of mitral regurgitation. Both longitudinally and transversely, broad infarction leads to the enlargement of the mitral anulus. However, even if the mitral anulus is not so dilated, severe involvement of either commissural area results in severe mitral regurgitation from the same commissural side. Thus, there are two major causative factors of mitral regurgitation: (1) asynergy of the papillary muscle or the ventricle that results in mitral regurgitation located in the commissural area of the same side as asynergy, and (2) enlargement of mitral anulus, which results in regurgitation from the central area of the orifice.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diurnal variation in plasma oxalate concentration and oxalate clearance in calcium oxalate stone formers with special reference to the effect of oxalate loading]

The diurnal variations in the plasma oxalate concentration and oxalate clearance were examined at the state of oxalate restriction and loading on 6 normal subjects and 11 calcium oxalate stone formers. The oxalate-restricted diet contained 44.5 mg of total oxalate, 32.2 mg of soluble oxalate, and for oxalate loading, spinach (100 g: total oxalate 429 mg, soluble oxalate 156 mg) was added to the oxalate-restricted diet at breakfast. Normal subjects showed a diurnal variation in plasma oxalate at oxalate restriction and loading. The plasma oxalate concentration showed the highest level under the fasting condition, gradually dropped and was then fixed at the lower level during the day. The oxalate clearance during the day was significantly higher (p less than 0.05) than that during the night in normal subjects taking the oxalate restricted diet, and after they were oxalate loaded, it increased significantly (p less than 0.05) for 6 hours, but returned to the level at oxalate restriction during the night. Meanwhile, there was no significant difference in oxalate clearance between day and night in calcium oxalate stone formers. As compared with the control group, there were no significant differences in the diurnal variation in the plasma oxalate concentration, oxalate clearance at oxalate restriction, or in the diurnal variation of the plasma oxalate concentration at oxalate loading. However, the oxalate clearance during the night after oxalate loading increased significantly (p less than 0.05) compared with the control group. Based on the pattern of urinary oxalate excretion during the night compared with the control group, the stone formers were divided into two groups. The first group showed significantly (p less than 0.01) higher oxalate clearance during the night both during oxalate restriction and loading. The oxalate clearance increased significantly up to 8 hours after oxalate loading (p less than 0.01) and during the night (p less than 0.05) compared with the level during oxalate restriction. The plasma oxalate concentration did not increase after loading. The second group showed a significantly (p less than 0.05) lower oxalate clearance during the day after oxalate loading. The oxalate clearance (p less than 0.05) was significantly increased for 4 hours after the loading compared to the during oxalate restriction. The plasma oxalate concentration increased at 6 hours after oxalate loading. There was no significant difference in oxalate clearance during the night. The diurnal variation in plasma oxalate level, a decrease during the day and an increase during the night, was shown in both normal subjects and stone formers.(ABSTRACT TRUNCATED AT 400 WORDS)

A novel sequence common to the centromere regions of Schizosaccharomyces pombe chromosomes

An approximately 4 kb long sequence (designated dh) is located in the centromere regions of all three chromosomes of S. pombe. There is one copy each of dh per centromere in chromosomes I and II and multiples in the centromere of chromosome III. Nucleotide sequence determination shows that dhI and dhII are highly homologous. A part of the sequence (ca. 300-400 bp) contains short direct repeats, otherwise dh is in general internally non-repetitious. Although there are three segmental deletions (total 821 bp) and two insertions (27 bp) in dhII (an 80% overall homology to dhI), there are only nine substitutions between dhI and dhII in the remaining 3980 bp, giving a 99.77% homology. The substitutions are restricted to the non-repetitious domains and are only of the pyrimidine-pyrimidine or purine-purine types. A possible conformational role of dh is discussed.

[Noninvasive measurement of cardiac output using two-dimensional Doppler echocardiography and analysis of sources of error]

The purpose of this study was (1) to analyze the factors responsible for errors in the two-dimensional Doppler echographic measurements of cardiac output (C.O.) and (2) to establish a noninvasive method for measuring C.O. The subjects were 50 cardiac patients who had neither aortic valve disease nor intracardiac shunts. The C.O. was calculated using the following formula: C.O. (l/min) = mean flow velocity (cm/sec) x pi(aortic ring diameter/2)2 (cm2) x 60/10(3) Left ventricular ejection flow velocity was recorded in the center of the aortic ring from the apical approach. Mean velocity was calculated by integration of instantaneous mean velocity in the ejection phase divided by the cardiac cycle length, and was corrected by the Doppler incident angle. The inner diameter of the aortic ring was measured in the parasternal long-axis view at the time of the maximum ejection flow velocity. The following results were obtained: 1. Sources of error in the measurement of cardiac output. 1) Accuracy of instantaneous mean velocity calculating circuit: This calculating circuit was accurate in model experiments using pulsatile flow. 2) Effect of high-pass filter: In model circuits, application of high-pass filter overestimated flow velocity. The higher the cut-off frequency of the high-pass filter, the larger the overestimation. This was probably due to the parabolic flow velocity profile in the circuit. 3) Flow velocity profile in the aortic ring: The flow velocity profile seemed to be flat in the aortic ring except near the anterior aortic wall. Therefore, the effect of the high-pass filter was considered to be negligible in case of clinical application. 4) The effects of shift and size of sample volume: The location of sample volume relative to the aortic valve ring shifted about 7 mm during systole. However, the shift and size of sample volume seemed to have little effect on the measured C.O., because the flow velocity profile was nearly flat in the aortic ring. 5) Ultrasound beam incident angle: From a practical viewpoint, it was necessary to set an incident angle of less than 50 degrees for minimizing the error. We were able to set the angle within 50 degrees in all but one of patients. 6) Diameter of the aortic ring: Two-dimensional echographic measurement of the aortic ring diameter was not so accurate; it seemed to become a major source of error in the calculation of C.O.(ABSTRACT TRUNCATED AT 400 WORDS)

[The physiological role of the pericardium: studies based on right heart inflow dynamics in cases of left-sided pericardial defect]

Using pulsed Doppler echocardiography, the effects of postural change on the blood flow pattern in the superior vena cava and in the right ventricular inflow tract were investigated to evaluate the physiological role of the pericardium. Eight cases of left-sided pericardial defect and eight healthy subjects were examined. 1. Suppressed inflow into the right atrium during systole in left-sided pericardial defect was manifested as a reduction of the systolic wave (S) in the superior caval vein and impairment of the systolic shift of the tricuspid annulus. This suppression suggested unsatisfactory volume expansion in the right atrium due to the absence of negative intrapericardial pressure. 2. In left-sided pericardial defect, the right ventricular inflow pattern differed from the normal, most distinctly in the right lateral recumbent position, though the cardiac motion was nearly identical with that of the normal in this position. In this position, the ratio of the peak velocity of presystolic filling to that of rapid filling was increased, and the deceleration half time of rapid filling was prolonged. These findings indicated that the right ventricular rapid filling was retarded, and was compensated by the filling due to atrial contraction. It is assumed that right ventricular filling is influenced by hydrostatic pressure due to changes in posture in the absence of restriction by the pericardium. 3. It is concluded that the pericardium maintains negative intrapericardial pressure, so that each cardiac chamber is uniformly expanded for its filling, and that this function minimizes the influence of posture on cardiac hemodynamics.

[Epidemiological study on urolithiasis in Mie Prefecture. 1. Present status in 1985]

To determine the present status of urolithiasis in Mie Prefecture, we analyzed the 1,314 patients of urolithiasis at 17 Departments of Urology and 2 Departments of Medicine in 1985. The ratio of male patients to female patients was 2.6 to 1. The most frequent incidence of urolithiasis was observed in Iinan county. The incidence of urolithiasis in the urban area was the same as that in the country. Most of the stones (96.9%) were in the upper urinary tract. The incidence of lower urinary tract calculi tended to be high in southern Mie Prefecture. The ratio of upper urinary tract calculi to lower urinary tract calculi in the urban area was the same as that in the country. The peak incidence in males was in the forties, while that in females was in the fifties. The average age was 44.5 years old. Ureterolithotomy was the most frequent (37.5%) surgical therapy, percutaneous nephrolithotomy and shock wave lithotomy done in 8.0% and 6.3%, respectively. The most frequent component of the urinary tract calculi was calcium oxalate and/or calcium phosphate (84.0%). The incidence increased in summer (April through September).

[Clinical observation of urolithiasis in Mie University Hospital]

The urinary tract calculus patients seen at our Department between January, 1974 and December, 1983 were reviewed to determine the trend of urolithiasis. The urinary tract calculus patients accounted for 10.1% of all the outpatients. Recurrent calculus diseases were seen in 16.9% of male patients and in 12.1% of female patients. The frequency of recurrence was very high in the patients in their forties. Upper urinary tract calculi were seen most frequently in the patients in their forties. We could expect spontaneous passage of stone for at least 6 months in the case of a middle-sized stone (less than 6 X 10 mm). The percentage of calcium oxalate-containing stone was 73.2% in male patients and the percentage of phosphate-containing stones was 81.6% in female patients. Hypercalciuric patients were seen in 34.0% of the calculus inpatients. Urinary bacterial culture revealed positive in 33.0% of the calculus inpatients.

Right atrial flow topography in healthy subjects studied with real-time two-dimensional Doppler flow imaging technique

The pattern of normal blood flow in the right atrial cavity was studied using the newly developed real-time two-dimensional Doppler flow imaging technique as a standard reference for the Doppler diagnosis of heart diseases with intracardiac shunts at the atrial level. The study was performed primarily with use of the apical four chamber and the parasternal right ventricular inflow tract views in 21 healthy subjects. The following patterns were observed: blood from the inferior vena cava flowed up along the posterior wall of the right atrium and joined with blood from the superior vena cava in the posterocranial part of the right atrial cavity; the flow then coursed along the roof of the right atrium toward the tricuspid valve in the atrial relaxation phase. This flow was always noted along the interatrial septum in the four chamber view. During and after mid-systole of the right ventricle, additional blood flow away from the tricuspid valve appeared, moving from the valve to the central part of the right atrial cavity, that is, at the lower right of the preceding inflow; this flow was interpreted as arising from eddy currents caused by the preceding inflow. In early diastole of the right ventricle, the flow signal area along the interatrial septum and the roof of the right atrium extended into the right ventricular cavity through the tricuspid valve. In the atrial contraction phase only the blood near the tricuspid valve in the right atrial cavity appeared to flow into the right ventricular cavity. Inflow from the coronary sinus was almost undetectable.(ABSTRACT TRUNCATED AT 250 WORDS)

Semiquantitative grading of severity of mitral regurgitation by real-time two-dimensional Doppler flow imaging technique

An attempt was made to determine whether mitral regurgitation could be detected and its severity evaluated semiquantitatively by newly developed real-time two-dimensional Doppler flow imaging in 109 patients who underwent left ventriculography. In the Doppler flow imaging technique, Doppler signals due to blood flow in the cardiac chambers are processed using a high speed autocorrelation technique, so that the direction, velocity and turbulence of the intracardiac blood flow are displayed in the color-coded mode on the monochrome B-mode echocardiogram in real time. Mitral regurgitant flow was imaged as a jet spurting out from the mitral valve orifice into the left atrial cavity. It was noted that the regurgitant jet in the left atrial cavity had a variety of orientations and dynamic features when studied by the present technique. The sensitivity of the technique in the detection of mitral regurgitation was 86% as compared with that of left ventriculography. Mitral regurgitation in the false negative cases was mostly mild. On the basis of the farthest distance reached by the regurgitant flow signal from the mitral valve orifice, the severity of regurgitation was graded on a four point scale and these results were compared with those of angiography. A significant correlation (r = 0.87) was found between Doppler imaging and angiography in the evaluation of the severity of mitral regurgitation. A similar result was obtained for the evaluation based on the area covered by the regurgitant signals in the left atrial cavity. Thus, noninvasive semiquantitative evaluation by real-time two-dimensional Doppler flow imaging appears to be a promising clinical technique.

Ultrastructural study of the effect of calcium ionophore, A23187, on rat muscle

The present study was undertaken to investigate changes in the muscle fiber when treated with calcium ionophore. Muscles treated with ionophore showed disruption of the plasma membrane of the muscle fiber, delta lesions, marked contraction of the myofibrills, and dissolution of Z lines and I bands. Black granules of calcium pyroantimonate were observed inside the plasma membrane in ionophore-treated muscle fibers without alteration of the other muscle organelles. The density of the intramembranous particles was less in muscle treated with calcium ionophore than in the control muscle. These results support the previous hypothesis that the increased concentration of intracellular calcium activates calcium-activated neutral protease and induces necrosis of the myofiber. The mechanism for the decrease in the density of intramembranous particles is unsolved. However, the disruption of the plasma membrane may not be a direct effect of calcium ionophore on it, but a secondary phenomenon which occurs after the calcium-induced necrosis of the muscle fibers.

Intrasinusal pyelocalicotomy with lower pole nephrotomy for removal of renal stones

A small renal sinus often limits exposure of the intrarenal pelvis and restrains the sinus approach for removal of renal stones. For 14 such cases, we used a lower pole nephrotomy combined with extended pyelolithotomy. Incision of the renal parenchyma through the intersegmental avascular plane greatly facilitated exposure of the intrarenal collecting system and enabled stone removal through the longitudinal incision of the collecting system. The indication for operative technique and results of the procedure are described.

[Two cases of triple primary neoplasm and two cases of quadruple primary neoplasm including bladder cancer]

Two cases of triple primary neoplasm and two cases of quadruple primary neoplasm including transitional cell carcinoma (TCC) of bladder are reported. The first case was a 70-year-old male who had bladder cancer, occult cancer of prostate (adenocarcinoma) and highly differentiated adenocarcinoma of pancreas. He died of cachexy. The second case was a 69-year-old male. This case was also triple primary neoplasm including bladder cancer, squamous cell carcinoma (SCC) of penis and SCC of larynx. The third case was a 78-year-old male who had bladder cancer, adenocarcinoma of prostate similar to that of the first case, adenocarcinoma of stomach, and SCC of lung. He died of obstructive jaundice and renal failure owing to massive metastases of gastric cancer. The fourth case was a 78-year-old male who had four primary neoplasms such as bladder cancer, branchiogenic epithelial carcinoma, SCC of buccal mucosa and adenocarcinoma of rectum.

[Mitral regurgitation: detection and quantitative evaluation by two-dimensional Doppler echocardiography]

Mitral regurgitation was detected and quantitatively evaluated using two-dimensional Doppler-echocardiography. The subjects consisted of 74 cases having a variety of heart diseases, who underwent left ventriculography within one week before or after the Doppler study. Among 50 patients with mitral regurgitation confirmed by left ventriculography, the Doppler study detected mitral regurgitant flow signals in 46, for a sensitivity of 92%. Minimal mitral regurgitation in four cases could not be detected by Doppler studies. Twenty-four patients had no mitral regurgitation according to left ventriculography; all but one also had no mitral regurgitation by Doppler study, for a specificity of 96%. In one false positive case, typical mitral regurgitant flow signals were detected in an area localized within the left atrial cavity near the mitral valve orifice. The possibility remains that left ventriculography missed this minimal regurgitation. For quantitative assessment of mitral regurgitation, the following two methods were used. Three long-axis views through the lateral, middle and medial parts of the mitral valve, and a short-axis view at the level of the mitral orifice were imaged via the parasternal approach. The area where mitral regurgitant flow signals were detected was mapped on each cross-sectional echocardiogram, then the distance attained by the regurgitant flow from the mitral valve and the area covered by the regurgitant flow were determined. The maximal distance among the three long-axis views and the sum of the distances in these views was parallel to the severity of mitral regurgitation as assessed by left ventriculography.(ABSTRACT TRUNCATED AT 250 WORDS)

[Six cases of spontaneous peripelvic extravasation from the renal pelvis]

The diagnosis and management of 6 patients with spontaneous non-traumatic urinary extravasation are reported. It is important to distinguish extravasation of the fornical backflow type from that owing to frank rupture of the diseased renal pelvis. In Japan, 26 cases of spontaneous peripelvic extravasation and 29 cases of spontaneous pelvic rupture have been reported. Most of them were caused by calculous ureteral obstruction. Many of the cases of spontaneous peripelvic extravasation could be managed conservatively, and many of the cases of spontaneous pelvic rupture often required surgical treatment due to the patient's clinical condition, the persistence of obstruction or extravasation, or the presence of complication of extravasation such as urinoma or abscess. All of our 6 cases were managed conservatively and had no complications.

[Retention cyst of the prostate gland: report of a case]

A 55-year-old man was admitted to our hospital because of pollakisuria and dysuria. Rectal examination revealed a normal prostate and did not show fluctuation or tenderness. Cystography and cystoscopic examination revealed a lesion projecting into the bladder cavity. An echogram showed an irregular internal echo at the left lobe of the prostate, but prostatic biopsy revealed benign prostatic hypertrophy. Transvesical removal of the prostatic cyst was performed. The cyst was about 3 cm in diameter and filled with yellow fluid (5.8 ml). The fluid contained no sperm and its acid phosphatase and zinc levels were high. The cystic wall was lined by cubo-collumnar cells and partly by flattened epithelium.

[A case of preputial calculi]

A case of a 73-year-old patient with preputial calculi is presented. The patient visited our hospital complaining of consciousness loss. It was impossible to place a catheter because of complete phimosis. Palpatory examination suggested the presence of stones in preputial cavity. Dorsal incision was made. After pus discharge nine small stones were extirpated. Ammonium hydrogen urate (96%) and calcium phosphate (4%) were found in these stones with infrared spectroscopic analysis. Bacteriodes ureolytcus and Peptostreptcoccus asaccharolyticus were isolated from urine specimen.

Doppler echocardiographic features of ventricular septal rupture in myocardial infarction

Doppler echocardiography was used to evaluate the features of interventricular septal rupture in six patients with acute myocardial infarction and to substantiate the hemodynamic data and morphologic findings at surgery or autopsy. Although echocardiographic visualization of the septal rupture was obtained in only two of the six patients, unusual Doppler flow signals were detected in the apical portion of the right ventricle in all six patients. Five patients had unusual flow signals during both systole and diastole; one had such signals only during systole. The location of these unusual flow signals coincided with the site of septal rupture confirmed at surgery or autopsy. The pattern of the flow signals in one cardiac cycle was very similar to that of the pressure difference between the left and right ventricular cavities. These findings indicate that the unusual flow signals represent the left to right shunt flows resulting from septal rupture. In conclusion, Doppler echocardiography may be a very useful tool for diagnosing interventricular septal rupture easily and noninvasively in patients with acute myocardial infarction.

Proton motive force is not obligatory for growth of Escherichia coli

When 50 microM carbonyl cyanide-m-chlorophenyl hydrazone (CCCP), a protonophore, was added to growth medium containing glucose at pH 7.5, Escherichia coli TK1001 (trkD1 kdpABC5) started exponential growth after 30 min; the generation time was 70 min at 37 degrees C. Strain AS1 (acrA), another strain derived from E. coli K-12, also grew in the presence of 50 microM CCCP under the same conditions, except that the lag period was ca. 3 h. When this strain was grown in the presence of 50 microM CCCP and then transferred to fresh medium containing 50 microM CCCP, cells grew without any lag. Neither a membrane potential nor a pH gradient was detected in strain AS1 cells growing in the presence of CCCP. When either succinate or lactate was substituted for glucose, these strains did not grow in the presence of 50 microM CCCP. Thus, it is suggested that E. coli can grow in the absence of a proton motive force when glucose is used as an energy source at pH 7.5.

[Analysis of left ventricular blood flow in cases of myocardial infarction: a preliminary report]

Analysis of left ventricular blood flow in cases of myocardial infarction was attempted by two-dimensional Doppler echocardiography. Subjects consisted of 25 cases of myocardial infarction with and without ventricular aneurysm, and 15 healthy persons as controls. The Doppler recordings were made in nine areas within the left ventricular cavity from the apical approach. For healthy subjects, ejection flows were recorded in the main cavity and directed towards the aortic orifice in systole, and diastolic flows in the left ventricular inflow were recorded from the mitral orifice to the apex. However, diastolic flows toward the aortic orifice were also recorded along the interventricular septum, and interpreted as eddy currents from the apical cavity. There were no high velocity flows in the phases of isometric contraction and relaxation. In seven of 25 cases of myocardial infarction, abnormally high velocity flows of more than 30 cm/sec were recorded in the isometric relaxation phase, which were directed away from the asynergic part. In eight of the 25 patients examined, high velocity flows toward the cardiac apex were recorded at the posteroapical area in systole. Such flows have never been observed in healthy subjects. Inertia of the diastolic mitral inflow is considered to continue during systole due to impairment of contractions of the apicoinferior wall.

[Aortic flow patterns in heart diseases with left-to-right shunts from the aorta, and their clinical significance: a Doppler echocardiographic study]

Aortic flow patterns were analyzed using two-dimensional Doppler echocardiography for 15 patients with patent ductus arteriosus, seven with ruptured aneurysms of the sinus of Valsalva, two with coronary artery fistulae and for 22 healthy persons, with special reference to diastolic flow patterns. The conclusions were as follows: In healthy subjects, there was a tiny and transient reversed flow signal in early diastole followed by a slow and sustained diastolic forward flow signal. The velocity of the diastolic forward flow was slower and the duration was shorter in the lower abdominal aorta than in the upper portion. In patients with shunts from the aorta to the right-sided chambers, the early diastolic reverse flow was enhanced, and another reversed flow developed in mid- and late diastole, which was the most evident in the lower portion of the abdominal aorta. The extent of the reversed flow correlated significantly with Qp/Qs by catheterization (r = 0.73). Thus, the abdominal flow patterns in cases with left to right shunts from the aorta to the right-sided chambers of the heart provided information for estimating the size of the shunt volume. In patients with bi-directional shunts, the dominant direction of the shunt during diastole can apparently be determined by analyzing the aortic flow patterns.

Clinical applications of a new type of real-time two-dimensional Doppler flow imaging system

The clinical significance of a newly developed real-time 2-dimensional (2-D) Doppler flow imaging technique was assessed. In the instrumentation of the echocardiograph, the pulsed Doppler mechanism was incorporated in a wide-angle, phased-array system. The Doppler flow signals obtained from the cardiac chamber were processed on the basis of the autocorrelation principle. The direction, velocity and variance of the intracardiac blood flow were calculated in real time and displayed in the color-coded mode on the television screen, and were superimposed on the 2-D echocardiographic image of the heart. The technique was used in 20 healthy subjects and 100 cardiac patients. The new technique clearly visualized the whole aspect of intracardiac blood flow by the cine mode in real time; thus, the technique may be called Doppler cineangiocardiography. The mitral inflow and the aortic ejection flow were clearly demonstrated. A regurgitant jet from the valve orifices was dynamically visualized as seen in the cineangiogram. The spatial orientation and extent of the regurgitant jet were easily assessed. The jet stream through the stenotic mitral orifice was well imaged in the left ventricular cavity, showing a variety of stream directions. Intracardiac shunts in ventricular septal defect and atrial septal defect were clearly visualized. The defect could be localized on the interventricular septum on the basis of the site where the shunt flow spurted, although the echocardiographic interruption was not demonstrated in the 2-D echocardiographic image of the cardiac structure. Although some technical problems remain, our new technique greatly improves the diagnostic efficacy of ultrasound.

[Study of bulbocavernosus reflex using electrostimulation electromyography]

Evoked response of bulbocavernosus reflex was taken in 8 normal control individuals and in 15 abnormal voiding patients (8 benign prostatic hyperplasia, 4 diabetic neuropathy, 3 supranuclear neurogenic bladder). the latency in control group showed 31.5 +/- 5.0 msec duration after penile stimulation and 65.4 +/- 11.0 msec duration after posterior urethral stimulation. The latency in diabetic neuropathy group was obviously prolonged but not that in the supranuclear neurogenic bladder group. This modern neurophysiological electrostimulation method provides simple and accurate information of bulbocavernosus reflex.

[Amikacin concentration in the severely obstructed urinary tract]

Urinary amikacin concentration was determined in 9 patients with severely unilateral ureteral obstruction. Serum levels were within the normal range. The average concentration of amikacin in the urine from obstructed urinary tract was 118.9 mcg/ml 6 hours after 100 mg amikacin iv infusion. Urine concentration from the normal kidney was 155.9 mcg/ml at the first 2 hours after intravenous infusion, 98.8 at the second 2 hours 83.3 at the third 2 hours. Urinary amikacin excretion from severely obstructed urinary tract was about one third of the total excretion from a normal system. In summary, the urinary level in severely obstructed urinary tract after iv infusion of 100 mg amikacin may be enough prophylactically. But at the onset of infection in severely obstructed urinary tract, the administration of at least 200 mg amikacin intravenously is required.

[A case of the coexistence of renal cysts and renal cell carcinoma associated with direct invasion of the liver (stage IV)]

A 63-year-old male was admitted with a complaint of right abdominal mass. A right renal tumor associated with direct invasion to liver and with lobulated cystic lesion and renal solitary cyst were diagnosed preoperatively by aortography and computed tomography. Transperitoneal radical nephrectomy and partial resection of liver metastasis were performed. Histological diagnosis was clear cell carcinoma with dilated tubuli. Tumor invasion to the inferolateral portion of the liver and to the renal solitary cyst wall were demonstrated by both gross and microscopic examinations. The coexistence of tumor and cyst in the same kidney is rare. Our case probably had both the type I and II or III tumors according to Gibson classification. Twenty months after radical nephrectomy, pulmonary metastases were detected by chest x-ray, tomography and bronchial arteriography. All metastatic lesions were replaced by fibrous change 7 months after the four bronchial arterial infusions (BAI) of ADM 30 mg and irradiation with a dose of 5,000 rads to each lesion. After 9 tumor-free months, recurrence of pulmonary metastases were pointed out by chest x-ray and tomography. They (four coin lesions) were treated with anticancer therapy, mainly irradiation and twice insufficient BAI. Three of them were occupied entirely by fibrous change and another solid one remained in the right pulmonary apex without enlargement for the past 4 months. Radical nephrectomy and partial resection of the liver for the primary renal cell carcinoma with direct invasion to liver, BAI and irradiation for the two pulmonary metastases have kept the patient alive for 4 years.