[Mitral valvuloplasty for mitral regurgitation due to torn chordae of the posterior leaflet]

Four patients with mitral regurgitation due to torn chordae of the mitral posterior leaflet underwent mitral valvuloplasty. Standard operation was McGoon's procedure which was sometimes combined with Kay's annulorrhaphy. There were no sign of mitral insufficiency and/or stenosis in all patients revealed by the post-operative cardiac catheterization and all of them are on good health. Then, our plans of mitral posterior valvuloplasty for mitral regurgitation are as follows: A resected area is not beyond 33% of the posterior leaflet and the target mitral valve area after valvuloplasty is 2.8 cm2.

Abnormality in the cavernous sinus in three patients with Tolosa-Hunt syndrome: MRI and CT findings

Three patients with Tolosa-Hunt syndrome (THS) were examined using computed tomography (CT), orbital venography and magnetic resonance imaging (MRI). CT of the brain showed no definite abnormality in two patients, right optic nerve enlargement and an abnormal area around the orbital apex in one patient. Orbital venography showed an occlusion of the superior ophthalmic vein in one of three patients. MRI showed an abnormal soft tissue area in the cavernous sinus, with intermediate to high signal intensity on T1- or intermediate weighted images. There was clinical improvement following corticosteroid therapy and the abnormal soft tissue on MRI decreased in volume and in signal intensity, although this was equivocal in one patient. Thus MRI proved to be useful in demonstrating lesions in the cavernous sinus in patients with THS.

[A case report of implantation of the Greenfield vena cava filter for recurrent pulmonary embolism]

A 68-year-old woman with recurrent pulmonary embolism due to deep vein thrombosis underwent implantation of a Greenfield vena cava filter. She has no signs of recurrence and complications for 15 months postoperatively. We recommend this filter for the properly selected patients.

Lysosomal glycogen accumulation in rat liver and its in vivo kinetics after a single intraperitoneal injection of acarbose, an alpha-glucosidase inhibitor

A single intraperitoneal injection of acarbose (400 mg/kg) into rats caused lysosomal accumulation of glycogen in the liver, mimicking the cytological characteristics of human glycogen storage disease type II (Pompe's disease). The animal model is therefore useful for studying the pathogenesis of the disease. In the present study, we applied this model to examine the lysosomal hydrolytic pathway of glycogen in vivo. To quantify the lysosomal glycogen, the lysosome-rich fraction was rapidly prepared from liver homogenate by agglutination in the presence of Ca2+. Then the fraction was treated with alpha-amylase in isotonic medium to remove cytosolic glycogen, followed by transfer to hypotonic conditions in the presence of Triton X-100 to destroy total glycogen. The amount of lysosomal glycogen was calculated from the difference between the glycogen levels measured before and after the treatment under hypotonic conditions, and then it was corrected based on measurements of the intactness (%) of lysosomes and the recovery (%) of the lysosomal marker enzyme (beta NAGase). We observed no measurable lysosomal glycogen in normal liver by this method, and this was confirmed by electron microscopy. After administration of acarbose, the lysosomal glycogen level increased to 2.5 mg/g liver within 2 days, and then decreased gradually at a rate of 0.4 mg/day/g. The accumulation of glycogen in the lysosomes at an initial velocity of 1.5 mg/day/g liver may be considered as the amount of glycogen that would normally be degraded by acid alpha-glucosidase. Therefore, assuming that the liver breaks down about 40 mg glycogen/day/g, we estimated that about 3% of the glycogen would be hydrolyzed by the lysosomal pathway.

Trace elements and complications in patients undergoing chronic hemodialysis

Abnormalities of trace elements such as aluminum, silicon, zinc, manganese and nickel were found in chronic hemodialysis (HD) patients. The relationship between serum concentration of trace elements and complications such as anemia bone disease, neurological disorder and nutritional disorder in 100 chronic HD patients was examined. Serum Al and Si levels were very high in these patients, and were negatively correlated with indicators of anemia such as RBC, hemoglobin and hematocrit values. Serum Al and Si levels in the HD patients with peripheral neurological disorder (excluding encephalopathy) and with bone disease were significantly high. The levels of serum Zn, Mn and Ni were low, and were correlated with total serum protein levels. In summary, in order to prevent some complications in chronic HD patients, it is very important to regulate levels of trace elements.

Ultrasonographically demonstrated nutcracker phenomenon: alternative to angiography

We report on a child with nutcracker phenomenon, which is a possible cause of intermittent gross haematuria of unknown origin. Early serial ultrasound examinations can demonstrate the lesions. The merits and demerits of conventional angiographic imaging are also discussed.

[Autotransfusion in urological surgery--experience with transurethral resection]

With the purpose to avoid the risk of homologous transfusion, autologous blood transfusion was performed in 26 patients who underwent transurethral resection of the prostate (TUR-P). Autologous blood (200-400 ml/time, 1-3 times, total 200-800 ml, mean 381 ml) was predeposited 4 days to 3 weeks prior to elected TUR-P and was transfused during or just after the operation. Since the start of this program in February 1988, homologous transfusion rate was decreased to 13.1%, whereas it has been 22.3% in 203 cases between January 1984 and January 1988. The mean hemoglobin level fell to 81.6% of the predeposition level. However, the hemoglobin level recovered to 90.1% one month after operation. The circulatory condition of the patients with autologous transfusions was stabler than that of the patients with homologous transfusion or no transfusion. No clinical hemostatic problems occurred. In cases with mild to moderate volume resection of the prostate, this autologous blood transfusion is recommended.

[Consideration on transfusion in urologic surgery--a retrospective study on homologous and autologous transfusions]

To obtain data for promoting autologous transfusion in urologic surgery, the cases of perioperative homologous transfusions in the past 5 years are reviewed. Although the mean perioperative homologous blood transfusion rate was not so high (10.2%), the rate in common urological surgery was comparatively high (eg. radical nephrectomy 39.4%, simple or palliative nephrectomy 21.6%, total nephroureterectomy 33.3%, renal allotransplantation 82.8%, total cystectomy 96.2%). Mean homologous transfusion volume in these surveys was 982 ml. Two successful cases of autologous blood transfusion by the predeposit method or intraoperative collecting method are presented. Transfusion-associated adverse effects, especially viral infection and immunosuppression, were discussed and the value of autotransfusion was stressed.

Clinical studies on adequate dosage of heparin during immunoadsorption with membrane plasmapheresis

Heparin has been used as an anticoagulant during hemodialysis and plasmapheresis. Recently, immunoadsorption with membrane plasmapheresis (IAP) has been used for treatment of myasthenia gravis and multiple sclerosis. Ten patients were examined. Plasma heparin levels were studied before IAP, 30 minutes, 60 minutes, 90 minutes, and 120 minutes after the start of IAP, and at the end of IAP. Prothrombin time, activated partial thromboplastin time (APTT), bleeding time, plasma fibrinogen levels, fibrin degradation products, and complete blood count were measured pre- and post-IAP. In general, plasma heparin levels lower than 1 IU/ml during plasmapheresis are adequate. The dosage of 40 IU/kg/hr of heparin administered during IAP resulted in plasma heparin levels lower than 1 IU/ml. APTT pre-IAP (36.8 +/- 3.4 sec) were nearly one-half values of APTT post-IAP (6.2 +/- 9.70 sec). In conclusion, 40 IU per kg of the body weight per hour is an acceptable dose of heparin during IAP.

Neurological and radiological studies in painful ophthalmoplegia: Tolosa-Hunt syndrome and orbital pseudotumour

Twelve patients with idiopathic painful ophthalmoplegia were studied by CT, which was found to be normal in 6 patients, but with a high density area in the orbit in the others. This abnormal high density area was not found when CT was performed at a relatively early stage of the disease, but was seen when it was performed more than 1 month after the onset of symptoms. Orbital phlebography was performed in 6 of 12 patients; 3 with normal and 3 with abnormal CT findings. An occlusion of the superior ophthalmic vein was seen in 3 patients with abnormal CT, but not in 3 patients with normal CT. All 12 patients improved with administration of corticosteroids. The results suggest that the intraorbital abnormality revealed by CT may be due to an inflammatory process in the chronic stage and/or the oedematous and infiltrating processes in soft tissues which can be caused by the occlusion of the superior ophthalmic vein or cavernous sinus.

Modulation of diethylnitrosamine-initiated placental glutathione S-transferase positive preneoplastic and neoplastic lesions by clofibrate, a hepatic peroxisome proliferator

The effect of clofibrate (CF) on proliferation of diethylnitrosamine (DEN)-initiated glutathione S-transferase placental form (GST-P)-positive preneoplastic and neoplastic lesions as studied in male F344 rats. Animals were given a single i.p. injection of 200 mg/kg body weight of DEN, and then from 2 weeks later were given a diet containing 0.3% CF (group 1), or no supplement (group 2) until week 64. Group 3 received an injection of 0.9% NaCl instead of DEN and then a diet containing 0.3% CF, like group 1. Animals in all groups were subjected to partial hepatectomy at week 3 and killed at weeks 8, 20, 32, 49 or 64. The results showed that development of GST-P-positive lesions was significantly less in group 1 than in group 2 from week 8 (P less than 0.05). However, in group 1, morphologically distinguishable GST-P-negative preneoplastic lesions increased from week 20 (P less than 0.05), and the total number of GST-P-positive and -negative lesions was significantly greater than that in group 2 from week 32 (P less than 0.05). The induction of hepatocellular carcinoma (HCC) was greater in group 1 than in group 2 from week 49. All the HCCs induced in group 2 were GST-P-positive, whereas 38.9% (7/18) of those in group 1 were GST-P-negative. In group 3, only a few GST-P-positive and/or -negative preneoplastic lesions developed by week 64. These results suggest that CF has tumor-promoting activity, and that GST-P-positive cells induced by DEN changed to GST-P-negative cells on subsequent treatment with CF.

[A case of successful surgery for atrial septal defect accompanied with angina pectoris]

A 59-year-old patient with atrial septal defect (ASD) and angina pectoris due to 99% stenosis of the anterior descending coronary artery (LAD) was successfully treated by closure of ASD and coronary artery bypass grafting (CABG) to the LAD #7 with a saphenous vein graft. Preoperatively, the right ventricle was overloaded with high pulmonary arterial pressure (52 mmHg) and anterior segmental wall motion of the left ventricle was reduced probably due to myocardial ischemia. Combined operation, ASD closure and CABG, made these impairments normal and resulted in disappearance of the chest pain and reinstatement to his former job.

Tricuspid valve Candida endocarditis cured by valve-sparing debridement

This report describes the case of a patient in whom Candida albicans tricuspid valve endocarditis was treated by excision of a large vegetation and partial tricuspid valvectomy without prosthetic valve replacement. In select patients, valve-sparing debridement may allow a long-term cure and may be the procedure of choice in the treatment of Candida tricuspid valve endocarditis.

Cerebral blood flow, oxygen and glucose metabolism with PET in progressive supranuclear palsy

Cerebral blood flow, cerebral oxygen metabolic rate and cerebral glucose metabolic rate were measured with positron emission tomography (PET) in four patients with progressive supranuclear palsy (PSP). Decreased blood flow and hypometabolism of oxygen and glucose were found in both subcortical and cortical regions, particularly in the striatum including the head of the caudate nucleus and the frontal cortex. The coupling between blood flow and metabolism was preserved even in the regions which showed decreased blood flow and hypometabolism. These findings indicated the hypofunction, as revealed by decreased blood flow and hypometabolism on PET, both in the striatum and the frontal cortex, and which may underlie the pathophysiological mechanism of motor and mental disturbance in PSP.

Kinetics of cis-dichlorodiammine platinum (II) during plasmapheresis

The pharmacokinetics of cis-dichlorodiammineplatinum (II) (cisplatin) during double filtration plasmapheresis (PP) have been studied in ten patients who received the drug as a 30 min infusion. The patients receiving the drug exhibited biphase clearance of total platinum with a rapid initial phase (40 min) and a prolonged second phase (1-24 h). Free (ultrafiltrable) cisplatin was readily detectable and the clearance curve of free cisplatin was biphasic, with a short initial phase (1 h) and a long second phase (1-24 h). In conclusion, the loss of both total cisplatin and free cisplatin in serum were not found during plasmapheresis.

Positron emission tomography in epilepsy: correlative study

Positron emission tomography (PET) was performed with the 18F-fluoro-deoxy-glucose method on 29 patients with epilepsy (generalized epilepsy, 4; partial epilepsy, 24; undetermined type, 1). The subjects were restricted to patients with epilepsy without focal abnormality on X-CT. All the patients with generalized epilepsy showed a normal pattern on PET. Fourteen out of the 24 patients with partial epilepsy and the 1 with epilepsy of undetermined type showed focal hypometabolism on PET. The hypometabolic zone was localized in areas including the temporal cortex in 11 patients, frontal in 2 and thalamus in 1. The location of hypometabolic zone and that of interictal paroxysmal activity on EEG were well correlated in most patients. The patients with poorly-controlled seizure showed a higher incidence of PET abnormality (12 out of 13) than those with well-controlled seizures (2 out of 11). The incidence of abnormality on PET and MRI and the location of both abnormality were not necessarily coincident. These results indicated that the PET examination in epilepsy provides valuable information about the location of epileptic focus, and that the findings on PET in patients with partial epilepsy may be one of the good indicators about the intractability of partial epilepsy, and that PET and MRI provide complementary information in the diagnosis of epilepsy.

[Repairing the thoracic and abdominal aortic aneurysms at the same time]

A 61-year-old man with the descending thoracic aneurysm associated with the infra-renal abdominal aneurysm was operated at the same time using the temporary bypass from right subclavian artery to right femoral artery safely. In order to observe the spinal cord function, SEP and ESP were recorded. Anastomosis of the prosthetic graft to the temporary bypass was prepared beforehand to preserve the spinal cord function during aortic cross clamping, if needed. If both aneurysms are present in the thoracic and abdominal cavity, special considerations are required, at one or two-staged operation and what adjuncts will be used to perform the repairs safely. In this case, the repair of thoracic lesion underwent well, and the repair of the abdominal one followed it. His postoperative course was uneventful.

Optimization of heparinization in clinical double filtration plasmapheresis

Heparin has generally been used as an anticoagulant during plasmapheresis. In this study plasma heparin levels were studied in nine patients before double filtration plasmapheresis (DFPP), 30, 60 and 120 minutes after the start of DFPP and at the end of DFPP. Prothrombin time (PT), activated partial thromboplastin time (APTT), bleeding time (BT), plasma fibrinogen levels, FDP and general blood cell examination (CBC) were measured pre and post DFPP. Heparin levels in plasma were lower than 1 (IU/ml) under the dosage of heparin nearly 40 IU/kg/h of heparin administered during DFPP. APTT before DFPP (36.5 +/- 8.2 sec) was nearly double the post-DFPP value (61.4 +/- 12.2 sec). In two patients who were given 30 IU/kg/h of heparin during DFPP, clotting occurred in the DFPP circuit. In conclusion, the optimized dosage of heparin was 40 IU per kg of body weight per hour during DFPP.

[Renal dysfunction in children with vesicoureteral reflux]

It is well recognized that reflux nephropathy is one of the commonest causes of end-stage renal failure (ESRF) in children. We made a retrospective study of 28 children with vesicoureteral reflux (VUR) who showed impaired renal function, as defined by either the serum creatinine of more than 1.0 mg/dl or BUN of more than 20 mg/dl. There were 20 boys and 8 girls, and the incidence of both sexes was 4.8% and 1.9% respectively. Of patients, proteinuria was detected in 22, and hypertension in 7. Five patients progressed to ESRF during his or her clinical course. About half of the patients in this series presented proteinuria or growth retardation which had led to urological check-up. Bilateral reflux was demonstrated in 24 patients, and all of the remaining 4 with unilateral reflux had hypoplastic or dysplastic contralateral kidney. Micturition cystourethrography revealed moderate or severe reflux in 86% of the ureters either at the first examination or during the follow-up periods. Urographic findings which suggested renal dysfunction included bilateral small kidney, unilateral small kidney with contralateral renal scarring, and bilateral generalized renal scarring. According to the pattern of the progression of renal dysfunction, patients were subdivided into 3 groups. Group I; patients showed bilateral renal hypoplasia on urography, and renal dysfunction progressed to ESRF before the age of 10 years despite surgical treatment. In patients of group II, gradual decrease of renal function led to ESRF at the age of puberty, although SCr was around 1.2-1.5 mg/dl when they were about 10 years old. In group III, renal function was stable at about 1.0 mg/dl of SCr during childhood. Temporary improvement of renal function was observed in only 3 of 21 children who were followed for more than 1 year after antireflux surgery. Deterioration of renal function was caused within 6 months to one year. Antireflux surgery had only little influence on the improvement of renal function in this series. We emphasize the need for early detection and management of reflux to prevent progression of renal dysfunction.

The relationship between calcium content and aluminum and silicon content in uraemic rats

The relationship between calcium (Ca) content and aluminum (Al) and silicon (Si) content in uraemic rats was examined. Significant correlations with serum [Ca] x [Pi] products and serum Al levels and serum Si values were found (r = 0.73, p less than 0.01). There were significant (r = -0.26, p less than 0.05; r = -0.46, p less than 0.05) relationships between corpuscular [Ca] x [Pi] products and corpuscular Al levels and corpuscular Si values. We found that renal tissue [Ca] x [Pi] products tend to increase with the increase of renal tissue Al content and renal tissue Si content. Serum and corpuscular Al content and Si content can be used as one of the indicators of renal osteodystrophy.

Successful immunoadsorption with membrane plasmapheresis for multiple sclerosis

Sixteen patients (mean age, 36.4 years) with multiple sclerosis were treated with immunoadsorption membrane plasmapheresis (IAP). Using an immunoadsorption column containing polyvinyl alcohol gel, IAP was performed two times a week for 2 weeks, followed by once a week for 2 months, and then every 2 weeks. The volume of perfused plasma was 3 liters for each IAP. Activity of natural killer (NK) cells and helper T cells was significantly (p less than 0.01) increased after IAP therapy. In addition, muscle power improved in all patients. Walking ability improved in four patients, standing ability in six, and sitting ability improved in seven. Most patients showed improvements in ability to lie still, sensory disturbance, visual disturbance, and urinary complications. No adverse effects were associated with IAP treatment. These findings indicate that IAP therapy is effective for multiple sclerosis.

[Importance of the conjugated antibody for the induction of selective effect of adriamycin conjugated with anti AFP monoclonal antibody and entrapped in liposomes against AFP producing tumors]

We investigated experimentally the effect of adriamycin (ADM) conjugated with anti alpha-fetoprotein (AFP) monoclonal antibodies and entrapped in liposomes (Lip-ADM = AbAFP) in vitro or in vivo. In the present study, we examined the importance of the conjugated antibody for the induction of selective therapeutic effect of Lip-ADM = AbAFP against AFP producing tumors. As the target tumors, AFP producing human hepatoma strain, Li-7, and AFP non-producing human breast cancer strain, MX-1 maintained in BALB/c nu/nu male mice were used. In order to evaluate the importance of the conjugated antibody, we prepared also ADM conjugated with normal mouse IgG, and entrapped in liposomes Lip-ADM = NIgG, of which therapeutic effects were compared with that of Lip-ADM = AbAFP. Judging from the tumor growth curve and the tumor weight, the therapeutic effect of Lip-ADM = AbAFP was greater against Li-7 than that of Lip-ADM = NIgG. On the other hand, both conjugates showed similar effects against MX-1. As the results it is suggested that the antibody which recognizes the antigen expressed on the target tumor cells can solely increase the therapeutic effect of ADM entrapped in liposomes (Lip-ADM) and that the main factors which contribute to the efficient therapeutic effect of the conjugate were the sensitibility to ADM, the affinity of the tumor cells to liposomes and the superiority of the conjugated antibody.

[Treatment of congenital urethral stenosis (urethral ring) in children. Optic internal urethrotomy in the congenital bulbar urethral stenosis in boys]

Congenital urethral stenosis in boys occurs at the junction of the entodermal primary urethra and ectodermal secondary urethra. Endoscopically this lesion is recognized as a ring-form stenosis just distal to the external urethral sphincter. It has been considered as rare congenital anomaly in American literature. But in our experience congenital urethral stenosis is an important cause of recurrent urinary tract infections, enuresis, pollakisuria or hematuria in pediatric urological practice. It also disturbs spontaneous healing of vesicoureteral reflux. The most effective treatment of this lesion is optic internal urethrotomy under direct vision. We would like to report our experience of optic internal urethrotomy for congenital urethral stenosis in boys. From 1974 to 1986, 226 boys with congenital bulbar urethral stenosis were treated in our clinic. Optic internal urethrotomy was performed using a Sachse urethrotome with a 10 or 13 Fr. sheath. Of the 176 ureters with vesicoureteral reflux, spontaneous disappearance of reflux after optic internal urethrotomy was noted in 62.5% of Grade I-II, 65.0% of Grade III, 28.9% of Grade IV and 16.7% of Grade V ureters. These spontaneous disappearance rates were significantly higher than those of primary vesicoureteral reflux in Grade III, IV and V ureters. Of the drug-resistant enuretic boys with a congenital bulbar urethral stenosis, enuresis disappeared or ameliorated in 69.4% after optic internal urethrotomy. Furthermore, urinary tract infections were mostly prevented by optic internal urethrotomy, irrespective of the presence or absence of vesicoureteral reflux. Our results support the view that congenital urethral stenosis (urethral ring) is an important clinical entity in pediatric urology.

[A six-month chronic dietary toxicity study of pyriproxyfen in rats]

Groups of 21 male and 21 female Sprague-Dawley (SD) rats were fed diets containing pyriproxyfen at concentrations of 0, 80, 400, 2,000 and 10,000 ppm for 6 months. No death was found in any group. Alopecia in the neck and/or back, and soft feces were noticed in both sexes fed 10,000 ppm. A marked decrease in body weight gain was observed in both sexes fed 10,000 ppm throughout the treatment period, accompanying a decrease in food-consumption and an increase in water-intake during the initial stage of treatment. In terms of urinalysis, proteinuria, increases in K excretion, and, in number, yellowness or browish-yellowness in appearance, were observed in both sexes fed 10,000 ppm. In females fed 10,000 ppm, increases in bilirubin, Na excretion and specific gravity, and a decrease in ketone bodies, were observed. In hematology, decreases in erythrocyte count, hemoglobin concentration and hematocrit value, were observed in both sexes fed 10,000 ppm and in males fed 2,000 ppm. Also, an increase in MCH (in males), decreases in MCHC and platelet count (in females) were observed in 10,000 ppm group. Blood biochemistry revealed increases in total protein, albumin, alpha 2-globulin fraction, blood urea nitrogen, calcium (in both sexes fed 10,000 ppm), A/G ratio (in males fed 2,000 and 10,000 ppm), total cholesterol, phospholipid (in males fed 2,000 and 10,000 ppm, and in females fed 10,000 ppm), sodium (in females fed 2,000 and 10,000 ppm), gamma-glutamyl transpeptidase activity (in males fed 10,000 ppm) and alpha 1-globulin fraction (in females fed 10,000 ppm), and decreases in glucose, GOT (in both sexes fed 10,000 ppm), beta-globulin fraction (in males fed 2,000 and 10,000 ppm, and in females fed 10,000 ppm), GPT (in females fed 2,000 and 10,000 ppm), triglyceride, potassium (in males fed 10,000 ppm), and cholinesterase activity (in female fed 10,000 ppm). In organ weight, increases in liver (in males fed 2,000 ppm and 10,000 ppm, and in females fed 10,000 ppm), kidney (in both sexes fed 10,000 ppm) and thyroid (in females fed 10,000 ppm) and a decrease in pituitary (in females fed 2,000 and 10,000 ppm) were observed. Gross pathology revealed a higher incidence of blackish-brown coloration of the liver, and a lower incidence of accentuated lobular pattern of the liver (in males fed 10,000 ppm). An enlargement of the liver was seen in a few of both sexes fed 10,000 ppm. Histopathological examination showed that the sole effect attributable to treatment of this compound was on slight hypertrophy in the liver of both sexes fed 10,000 ppm, with a higher incidence.(ABSTRACT TRUNCATED AT 400 WORDS)

Detection of membrane-bound alpha-fetoprotein in human hepatoma cell lines by monoclonal antibody 19F12

Monoclonal antibodies against human alpha-fetoprotein (AFP) were obtained by the hybridoma technique and studied with regard to their reactivities with the human hepatoma cell lines PLC/PRF/5 and KN, and a spontaneously immortalized cell line derived from fetal liver, NuE, all of which synthesize AFP. One of the monoclonal antibodies, 19F12 (IgG2b) became bound to free AFP which was used as the immunogen with an affinity constant of 3.4 X 10(8) M-1. This value was not much higher than those of two other antibodies, 19B1 (IgG1) and 9D12 (IgG2b). However, only antibody 19F12 showed definite reactivity with AFP-producing cells in analysis using flow cytometry. Immunofluorescence microscopy showed that antibody 19F12 detected AFP over the surface of NuE and PLC/PRF/5 cells with a uniform distribution, whereas definite reactivities of antibodies 19B1 and 9D12 to these cells were not detected. These antibodies did not show the specific binding to a non-AFP-producing human lung cancer cell line, PC-9, or to human peripheral blood lymphocytes. The binding ability of 19F12 to hepatoma cells was shown in both viable and fixed cells. Addition of free AFP inhibited the binding of antibody 19F12 to PLC/PRF/5 cells in a concentration-dependent manner. The specific reactivity of 19F12 to human AFP was also confirmed by immunostaining of a tissue section of human cancer proved to be AFP positive with AFP-specific antisera. In two-dimensional polyacrylamide gel electrophoresis of the antigen (from membrane fraction of PLC/PRF/5 cells)-antibody (19F12) complex, spots derived from the antibody and a spot (pI 4.7, Mr 65,000) corresponding in pI and molecular weight to AFP were detected. Western blot analysis showed that material in the membrane fraction of PLC/PRF/5 cells recognized by antibody 19F12 has the same molecular weight as human AFP derived from placenta. In a study of reactivities to PLC/PRF/5 cells treated with various enzymes, the reactivity of this antibody decreased when cells were treated with protease and trypsin and increased when lipase was used. The binding of 19F12 to AFP was not inhibited by concanavalin A. The antibody 19F12 appeared to recognize an epitope that is considered to be part of the peptide area of AFP. These results indicate that the reactivity, the amount of bound antibodies, and the distribution of monoclonal antibodies on antigen-producing cells vary, respectively, even though these antibodies were produced using the same antigen as an immunogen.(ABSTRACT TRUNCATED AT 400 WORDS)

Vanadium in patients undergoing chronic haemodialysis

The relationships between serum vanadium and serum aluminium, beta 2-microglobulin, silicon, phosphate, red blood cell count, haemoglobin and systolic blood pressure were studied in 80 chronic haemodialysis patients. Vanadium transfer during haemodialysis was also examined. Serum vanadium in 80 patients before haemodialysis was 18.4 +/- 7.6 ng/ml (normal values: 0.4 +/- 0.2 ng/ml). Significant correlations between serum vanadium and serum aluminium, silicon, beta 2-microglobulin, phosphate, red blood cell count, haemoglobin, and systolic blood pressure were found. As ultrafiltrate vanadium was greater than vanadium in the dialysate, vanadium transfers from blood to dialysate. Therefore, serum vanadium before haemodialysis significantly decreased from 18.4 +/- 7.76 ng/ml to 13.0 +/- 5.30 ng/ml, during a 5-h haemodialysis.

[Transurethral ureterolithotripsy under hydraulic ureteral dilatation]

Transurethral ureterolithotripsy was performed in 32 patients with ureteral stones. A rigid ureteroscope was used and for the purpose of ureteral dilatation a hydraulic ureteral dilator (Ureteromat) was used. In total 39 stones were treated and of these 30 stones (77%) were successfully extracted or disintegrated. The success rate according to the location of the stone was as follows; 50% for the upper ureteral stone, 55% for middle ureteral stone and 96% for lower ureteral stone. As a complication of the procedure a lower ureteral stricture was noted in one patient. Hydraulic ureteral dilatation is a useful method of ureteral dilatation in transurethral ureterolithotripsy.

Changes of manganese levels during haemodialysis

Manganese (Mn) transfer during haemodialysis and plasma Mn concentrations in haemodialysis patients were examined. Also, the correlation with plasma Mn levels and haematocrit levels and total plasma protein levels were studied. Fifteen volunteer outpatients undergoing haemodialysis showed significant increases in plasma Mn from 0.20 +/- 0.02 to 0.22 +/- 0.02 micrograms/dl after a 5-hour dialysis. The increase was mainly the result of haemoconcentration as evidenced by a significant increase in the haematocrit and total plasma protein during dialysis; however, diffusion was not found. There was a significant relationship between plasma Mn levels before dialysis and haematocrit values (r = 0.95, p less than 0.01) and total plasma protein levels (r = 0.92, p less than 0.01).

Alterations in local cerebral glucose utilization during electrical stimulation of the striatum and globus pallidus in rats

Alterations in local cerebral glucose utilization (LCGU) in conscious rats during electrical stimulation of the striatum and the globus pallidus were investigated using the [14C]deoxyglucose method. Stimulation of the globus pallidus produced a marked contraversive circling behavior, while stimulation of the striatum led only to contraversive head turning. Unilateral stimulation of the striatum increased LCGU bilaterally in the globus pallidus and substantia nigra pars compacta, but only ipsilaterally in the entopeduncular nucleus, substantia nigra pars reticulata and subthalamic nucleus. Similar stimulation of the globus pallidus increased LGCU in the globus pallidus, substantia nigra pars reticulata and compacta, entopeduncular nucleus, subthalamic nucleus, lateral habenular nucleus, parafascicular nucleus of the thalamus, deep layers of the superior colliculus and pedunculopontine nucleus, exclusively on the ipsilateral side. These results indicate that the electrical stimulation induces LCGU changes in the respective structures having both monosynaptic and transsynaptic neuronal inputs. Some changes may also be mediated by antidromic activation. They also suggest that activation of a synaptic process whether excitatory or inhibitory results in increases in LCGU. The bilateral modulatory effects of striatal stimulation may cancel out the circling behavior seen during pallidal stimulation, and cause only head turning.

Aluminum transport and dialysance during haemodialysis

Aluminum transfer and dialysance during haemodialysis and plasma aluminum concentrations in haemodialysis patients were examined. Plasma aluminum in 30 volunteer outpatients tended to decrease after 5-hour dialysis (6.35 +/- 3.02 micrograms/dl before haemodialysis; 5.41 +/- 2.60 micrograms/dl after haemodialysis). The decrease was mainly due to diffusion despite haemoconcentration evidenced by a significant increase in the haematocrit and total plasma protein during dialysis. To study the changes resulting from diffusion, we measured aluminum in the arterial blood and in the dialysate at the inflow and outflow sites of the dialyzer. There was a non-significant decrease in the plasma aluminum of arterial blood from 6.20 +/- 2.90 to 5.64 +/- 2.55 micrograms/dl, but a significant increase in the dialysate aluminum from 0.38 +/- 0.18 micrograms/dl to 1.10 +/- 0.66 micrograms/dl. Aluminum diffused across the dialyzer from the blood to the dialysate in 23 cases and into the blood in 7 others. When aluminum dialysance is high, plasma aluminum can be removed to the dialysate during haemodialysis.

Immunohistochemical study of nodular hyperplastic parathyroid glands in patients with secondary hyperparathyroidism

Thirty-seven nodular hyperplastic parathyroid glands obtained by subtotal parathyroidectomy from 11 haemodialysed patients with secondary hyperparathyroidism were examined both pathologically and immunohistochemically. Four consecutive sections of the largest section-surface of each gland were subject to 4 different stains (haematoxyline-eosin, Grimelius, and the immunohistochemical stains for parathyroid hormone and chromogranin A) for comparison of each nodule. It was found that the major part of each nodule consisted of a single cell type with a single pattern of cells. These reacted uniformly to each stain. The mechanism involved in the storage and secretion of the secretory granule appeared to be regulated at the nodule and not at the cell level. The results suggest that the nodules may come from a monoclonal proliferation of a single parathyroid cell. Our present light microscopic immunohistochemical study, failed to demonstrate completely identical immunoreactive positivity of each nodule or each parathyroid cell to PTH. Chromogranin A or secretory protein-I did not indicate the coexistence of PTH and SP-I in the same secretory granule, which was in good agreement with the electron microscopic immunocytochemical study of Arps using bovine parathyroid glands. Our present study, however, provides good evidence that chromogranin A positivity is demonstrable in the human parathyroid gland outside the adrenal medulla and sympathetic nerves.

[Clinical studies on renal function and trace elements]

The serum trace elements aluminum (Al), zinc (Zn), nickel (Ni), and manganese (Mn), and creatinine clearance (Ccr) were measured in twenty normal volunteers and 40 patients; 5 patients had mild renal dysfunction, 10 patients had chronic renal failure 5 patients had uremia and 20 patients had been undergoing chronic hemodialysis. Serum Al, Cu, Zn, Ni and Mn were measured with a flameless atomic absorption spectrophotometer. Serum Al levels increased with decrement of the Ccr value. The serum Al level was abnormally high in chronic hemodialysis patients. The serum Cu level in the patients was similar to that in the healthy subjects. Serum Zn, Ni and Mn levels decreased with the decrement of the creatinine clearance level. These results suggest that measurement of serum Al, Zn, Ni and Mn levels can be used as an indication of renal function clinically. In conclusion, serum Al, Zn, Ni and Mn levels are clinical indicators of renal function.

[Clinical statistics at the Department of Urology, Kitano Hospital (1968-1986)]

A clinical statistic survey was carried out on the patients, diseases and operations experienced at our department between 1968 and 1986. In 1968, the urological department became independent from the dermato-urological department, and in 1981 the urological ward was established. The 19 years are divided in three periods; first period: 1968-1974 (7 years), second period: 1975-1981 (7 years), and third period: 1982-1986 (5 years). The total number of new outpatients during the 19 years was 50,443. They have gradually but steadily increased and have reached recently about 4,000 per year. The total number of inpatients was 3,422 (male: 2,561, female: 861). The proportion of the elderly patients, especially male, has remarkably increased and that of patients more than 60 years old was 44.9% of all inpatients in the third period. Among the major diseases of the inpatients, tumors has got most remarkable increase of its number and proportion. And among tumors, increases of benign prostatic hyperplasia, bladder cancer, prostatic cancer were prominent and at the third period the proportion of those three has reached 81.3% of all tumors. Percutaneous nephrolithotripsy (PNL) and transurethral ureterolithotripsy (TUUL) were introduced in 1985. Recently endoscopical operations such as transurethral resection (TUR), PNL, TUUL and so forth have become a large part of the urological operations.

Relationship between serum nickel concentrations and anaemia in chronic haemodialysis patients

Thirty chronic haemodialysis patients were examined with respect to the relationship between renal anaemia and serum nickel concentrations. Red blood cell counts, haemoglobin values, haematocrit values, serum iron values, serum ferritin levels and serum nickel concentrations were measured. No significant relationships were found between serum nickel levels and serum iron values or serum ferritin levels. Dialysis anaemia was found to have a significant correlation with serum nickel concentrations in chronic haemodialysis patients.

[One-year chronic dietary toxicity study of d.d-T80-prallethrin in rats]

d.d-T80-prallethrin, a pyrethroid insecticide for sanitary use, was administered to Crj : CD (Sprague Dawley) rats at concentrations of 120, 600 or 3,000 ppm in diet for one year to assess the chronic toxicity potential and the reversibility. The summarized results obtained are as follows: 1. Chronic toxicity study 3,000 ppm : Decreases in body weight gain, food consumption, and water intake were observed. Slight alopecia in the neck and/or back was noticed during the first and second weeks, but the animals were recovered thereafter. Slight anemic changes such as decreases in hemoglobin concentration, hematocrit value, MCV and MCH were observed in the females at 52 week. Blood biochemistry revealed increases in total cholesterol (in the males and females at 13, 26 and 52 weeks), phospholipid (in the males and females at 13, 26 and 52 weeks), albumin (in the males at 13 and 26 weeks, in the females at 52 week), total protein (in the males at 26 week, in the females at 52 week), A/G ratio (in the males at 13 week, in the females at 26 week), creatinine (in the males at 52 week), urea nitrogen (in the females at 52 week), GOT (in the males and females at 52 week) and GPT (in the males and females at 52 week), and decreases in triglyceride (in the females at 26 and 52 weeks) and alkaline phosphatase (in the males at 13 and 52 weeks). In urinalysis, an increase in bilirubin was observed in the males at 52 week. Gross-pathology revealed a lower incidence of accentuated lobular pattern of liver (in the males at 26 week) and a higher incidence of enlarged liver (in the males at 52 week). In organ weight, increases in liver (in the males and females at 26 and 52 weeks), kidney (in the males at 26 and 52 weeks) and thyroid weights (in the males at 26 and 52 weeks, in the females at 26 week), and decreases in spleen (in the females at 26 and 52 weeks) and adrenal weights (in the females at 52 week) were observed. Histopathological examination revealed a lower incidence of fatty metamorphosis in the liver of females at 52 week. 600 ppm: An increase in liver weight was observed in the males at 26 week. 120 ppm: No effect was observed. 2. Reversibility study Almost all the above chronic toxicities were reversible.(ABSTRACT TRUNCATED AT 400 WORDS)