[A case of sarcoidosis presenting ataxic hemiparesis as an initial clinical manifestation]

A case of sarcoidosis presenting ataxic hemiparesis was reported. A 25-year-old man was admitted to Kanto Teishin Hospital because of slight weakness and dysesthesia in the right side of his body. His physical findings were normal. Neurological findings disclosed mild right hemiparesis (MMT 4+), cerebellar signs and mild dysesthesia in the same side. Laboratory findings were within normal limits except for elevated serum ACE and lysozyme. Chest roentgenogram showed bilateral hilar lymphadenopathy and TBLB disclosed sarcoid granuloma. Though brain CT, brain MRI and cerebral angiography were within normal limits, the neurological features were thought to be due to sarcoidosis. They disappeared along with the decrease of ACE and lysozyme. This is the first report of ataxic hemiparesis due to sarcoidosis, and it is interesting in that ataxic hemiparesis, which is one of signs of diseases in central nervous system, is the first manifest clinical feature of sarcoidosis.

[Studies on the metabolism of conjugated drugs. II. 3-Deoxyestradiol 17-sulfate. (2). Analytical procedure for determination by high-performance liquid chromatography of potential metabolites]

To investigate the metabolic pattern of such a drug having two counter functional groups in the molecule: a hydrophylic sulfate group and a hydrophobic aromatic ring, as 17-sulfate of 17 beta-hydroxyestra-1,3,5(10)-triene (3-deoxyestradiol) was incubated with rat hepatic microsomes under a reduced nicotinamide adenine dinucleotide phosphate-generating system. The metabolites assigned were mono- and dihydroxylated products hydroxylated only at the aromatic ring. The phenolic products having hydroxyl group at the position 2, 3, or 4 were detected in the male and female rats. The two catechol products having hydroxyl groups at 2, 3 and 3, 4 were detected only in the male rats. No other metabolites were formed except a phenol product hydroxylated at the position 1 in the case of the male rats. These metabolisms were confirmed to proceed without removal of the sulfate group. A simple method for the determination of these metabolites was established by using reversed-phase high-performance liquid chromatography. The devised technique involves an elution with a mixture of 0.5% NH4H2PO4 (pH 3.0) and methanol on a TSK-Gel ODS-120A column with electrochemical and/or ultraviolet detectors.

Synthesis of 6-hydroxylated bile acids and identification of 3 alpha,6 alpha,7 alpha,12 alpha-tetrahydroxy-5 beta-cholan-24-oic acid in human meconium and neonatal urine

Three 6-hydroxylated bile acids, 3 alpha,6 alpha,7 alpha,12 alpha-, 3 alpha,6 beta,7 alpha,12 alpha- and 3 alpha,6 beta,7 beta,12 alpha-tetrahydroxy-5 beta-cholan-24-oic acids, were synthesized from methyl cholate, and a sensitive method was developed for analyzing them by gas chromatography-mass spectrometry for the stoichiometric study of fetal bile acids. 3 alpha,6 alpha,7 alpha,12 alpha-Tetrahydroxy-5 beta-cholan-24-oic acid (6 alpha-hydroxylated cholic acid) was identified from human meconium and healthy neonatal urine by comparison with the mass spectrum of the reference compound. In human meconium, 6 alpha-hydroxylated cholic and chenodeoxycholic acids were determined in 1.2% and 29.0% of the total bile acids, respectively. We discuss the significance of hydroxylation at the C-1 beta and C-6 alpha positions of bile acids and their elimination in fetal and neonatal periods.

Atrial natriuretic peptide in human urine

A highly sensitive radioimmunoassay to measure atrial natriuretic peptide (ANP) concentration in urine has been established, and its clinical usefulness is presented. ANP in urine was stable at 4 degrees C for several days and was easily measured by our radioimmunoassay. The average ANP excretion in 65 healthy persons was 25.0 +/- 1.4 ng/day (mean +/- SEM) and the fractional excretion of ANP was 0.7 +/- 0.05%. In 14 patients with congestive heart failure, the average ANP excretion was 119.2 +/- 29.4 ng/day, which decreased to 53.3 +/- 11.0 after successful treatment.

Changes of molecular forms of atrial natriuretic peptide after treatment for congestive heart failure

In the present study, an attempt was made to clarify whether ANP molecular forms in the plasma of severe congestive heart failure patients differ from those in healthy persons and whether ANP molecular forms in the plasma of the patients were changed by successful treatment of cardiac disease. Twenty patients with congestive heart failure were treated at Kitasato University Hospital. They were classified as class III or IV by New York Heart Association criteria at the time of admission. Plasma ANP concentrations decreased after treatment from 356 +/- 58.2 to 72.3 +/- 14.8 pg/ml. The gel permeation chromatograms from the plasma of healthy persons showed low, or low and high molecular weight ANP peaks which correspond to the elution positions of authentic alpha-ANP or ribonuclease A (mol. wt., 13.7 kdalton). In patients with severe congestive heart failure at a severe stage, middle molecular weight ANP consisted with the elution position of authentic beta-ANP was particularly noted in addition of low and high molecular weight ANP peaks. This middle molecular weight peak disappears in most of cases by successful treatment. Molecular forms in the plasma obtained from the coronary sinus and the inferior or superior vena cava were essentially the same. These results indicate that the middle molecular weight ANP supposed as beta-ANP may particularly be secreted in severe congestive heart failure patients.

Atrial natriuretic peptide is only a minor diuretic factor in dehydrated subjects immersed to the neck in water

To determine if the atrial natriuretic peptide (ANP) is an important factor for inducing diuresis during head-out water immersion even in dehydrated subjects, six healthy volunteers were immersed up to the neck in water at 34.5 degrees C for three hrs. Significant diuresis and natriuresis occurred, but urine osmolality decreased and negative CH2O was restored in a positive direction toward zero, even though subjects were still in a state of considerable dehydration. Plasma renin activity and plasma angiotensin I and II concentrations decreased but that of plasma aldosterone remained unchanged during water immersion, and plasma ANP did not increase throughout the examination. On the basis of the data of the present study, the factor inducing diuresis during head-out water immersion in hydrated subjects appears to differ from that in dehydrated subjects, and the main factor inducing diuresis during water immersion in dehydrated subjects may be the suppression of vasopressin release and not ANP.

Hemolytic streptococcus preparation OK-432; beneficial adjuvant therapy in recurrent gastric carcinoma

The administration of a hemolytic streptococcus preparation, OK-432, is thought to be of therapeutic value in the treatment of cancer patients through a stimulatory effect on the immune system. In order to evaluate any beneficial effect of such an administration, a group of patients with recurrent gastric cancer was studied. This group was randomly subdivided into 3 groups: 1) Intradermal group (ID Group), 42 patients given an intradermal injections of OK-432. 2) Intramuscular group (IM Group), 40 patients given an intramuscular injections of OK-432. 3) Control group (C Group), 39 patients not given injections. Each group was studied in regards to the length of survival, the host immune response and the incidence of side effects. When compared to the IM and C Groups, the ID Group showed improved survival. Accompanying this improved survival, the ID Group also had greater white cell and lymphocyte counts, a greater number of T cells, and a more dramatic skin reaction to the extracted cell wall polysaccharide of hemolytic streptococcus Su-strain (Su-PS). The ID Group, following OK-432 injection, had a 4.8% incidence of fever and a 52.4% incidence of local abscess formation at the injection site. 90% of the IM Group developed fever but abscess formation was absent in all patients. From these results, it was concluded that in the patients tested, intradermal injection of OK-432 appears to be clinically superior to intramuscular injection.

Determination of 3 beta,12 alpha-dihydroxy-5-cholen-24-oic acid and related bile acids in human serum by gas chromatography-mass spectrometry

The glycine, taurine and sulphate conjugates of 3 beta,12 alpha-dihydroxy-5-cholen-24-oic acid were synthesized as authentic samples for the analysis of this unusual bile acid. A highly sensitive and specific quantitative assay of the bile acid and related compounds has been developed by selected-ion monitoring in gas chromatography-mass spectrometry of their methyl ester-trimethylsilyl ether derivatives, using the deuterium labelled internal standards: [2H6]3 beta,12 alpha-dihydroxy-5-cholen-24-oic acid, [2H5]3 beta-hydroxy-5-cholen-24-oic acid, [2H7]cholic acid and their sulphates. Calibration curves for these bile acids were linear over the range 0.01-100 micrograms/ml in human serum. Recoveries of the bile acids and their conjugates ranged from 95 to 103% of the added amounts of their standard samples. The unsaturated bile acid was identified in a significant amount of 25.2 micrograms/ml in serum of an infant with liver disease, and its sulphate comprised 55.1% of the amount of the bile acid.

Quantitative measurement of endotoxin in rainbow trout (Salmo gairdneri) serum by the chromogenic substrate method

The amount of endotoxin in serum collected from normal rainbow trout (Salmo gairdneri) and trout inoculated with viable Vibrio anguillarum or lipopolysaccharide (LPS) extracted from bacteria was determined by the chromogenic substrate method. The mean values of endotoxin in four different groups of normal rainbow trout sera ranged from 31.9 to 65.3 pg/ml. When fish were inoculated with viable bacteria (1 x 10(8], they became septicaemic and a large amount of endotoxin ng/ml) was detected in the sera. In fish inoculated with a smaller number of bacteria the amount of endotoxin was several times higher than that of normal fish in spite of failure of bacterial isolation. Although the endotoxin level in serum increased rapidly (greater than 100 ng/ml) after intraperitoneal inoculation with purified V. anguillarum LPS (540 micrograms), no fish died during the experiment. The high level of endotoxin in normal rainbow trout and the resistance of trout to endotoxin are in striking contrast to those of mammalian and avian species.

Effects of oral administration of streptococcal preparation OK-432 on thoracic duct lymphocytes

One KE of streptococcal preparation OK-432 (PIC) was given orally to 6-week old male Wistar-Imamichi rats twice weekly, and control animals received comparable volumes of saline alone. Samples of thoracic duct lymph and posterior vena caval blood were collected prior to and 4 and 8 weeks following PIC. The T cell count of thoracic duct lymphocytes was about three times greater than that of venous blood specimens, and increased significantly in animals following PIC. Controls showed only a slight increase followed by a decrease, so that by 8 weeks of treatment with PIC, the thoracic duct T cell count revealed a significantly greater number in the PIC group than in the controls. In addition, after 8 weeks the per cent T cell subpopulation in thoracic duct lymph increased significantly in the treated group, but it declined in the control group. Concerning T cell subsets in thoracic duct lymphocytes, the percentage of suppressor/cytotoxic T cells showed a significant elevation in the control group after 4 weeks compared with the treated group. No other blood or lymph variables reached statistical significance in this respect.

A case of "myopathy with tubular aggregates" with increased muscle fibre sensitivity to caffeine

A 23-year-old man with "myopathy with tubular aggregates" had suffered from exercise-induced muscle cramps for 1 year. His general and neurological findings were normal. Laboratory investigations were within normal limits except for a slightly elevated serum creatine kinase level. Muscle biopsy showed some small angular fibres and scattered type 2B fibres with prominent tubular aggregates originating from the sarcoplasmic reticulum. Since the muscle fibres contracted at a lower concentration of caffeine, increased muscle fibre sensitivity to caffeine is probably related to muscle cramps in this disorder. Tubular aggregates are then secondarily formed in the muscle fibres.

Effects of biological response modifier on thoracic duct lymphocytes in recurrent gastric cancer. Evaluation of OK-432, a hemolytic streptococcus preparation

In 9 patients with recurrent gastric carcinoma treated with intracutaneous injections of a hemolytic streptococcal preparation of OK-432 (PIC), the T/B cell ratio, the number of IgG-Fc receptor positive (T gamma) cells, the degree of blastoid transformation of lymphocytes in response to concanavalin-A (Con-A) and phytohemagglutinin (PHA), and the activity of natural killer cells (NK) in the thoracic duct lymphocytes (TDL) and peripheral blood lymphocytes (PBL) were measured. In thoracic duct lymph, the T cell to B cell ratio was higher than that found in peripheral blood. The proportion of T gamma cells and the natural killer cell activity was found to be considerably lower in TDL than PBL, though there was a higher degree of blastoid transformation of lymphocytes in response to Con-A and PHA in TDL. After the administration of PIC, there was no significant difference in T/B cell ratios and T gamma cell proportion between TDL and PBL, though the lymphocytic blastoid transformation in response to Con-A and PHA decreased in TDL but not in PBL. PIC administration appeared to augument natural killer cell activity in both TDL and PBL.

Anticancer drug distribution in lymph and blood during adjuvant chemotherapy after surgery for gastric carcinoma. A study with a combined preparation of 1-(2-tetrahydrofuryl)-5-fluorouracil and uracil

Previously the authors reported that the fat emulsion of 1-(2-tetrahydrofuryl)-5-fluorouracil, tegafur (FT-207), yielded significantly higher concentrations of tegafur in the lymph and plasma compared to tegafur enteric-coated granules (FT-G). However, the emulsification did not improve the metabolic conversion rate of tegafur to 5-fluorouracil (5-FU). A study was performed to assay the plasma and lymphatic concentrations of tegafur, 5-FU, and uracil in seven patients after radical surgery for gastric carcinoma who were given a combined oral preparation of FT-207 and uracil (UFT). Both lymph and plasma 5-FU levels after UFT were 20 times greater than those after FT-G, although FT-207 levels were not different. Patients given UFT showed significantly greater 5-FU and uracil concentrations in the lymph compared with the plasma. The results of this study suggest a potential use of UFT as an adjuvant postoperative chemotherapeutic agent for gastric carcinoma.

[Comparison of lymphocyte subpopulations in arterial and venous blood of the rat]

Lymphocyte subpopulation as well as other hematological properties were compared between arterial and venous bloods of Wistar-Imamichi rats. Lymphocyte subsets were defined with four monoclonal antibodies which were specific to the respective cell surface glycoproteins. Using these monoclonal antibodies, subsets of B lymphocytes, T lymphocytes, helper T lymphocytes, and suppressor and cytotoxic T lymphocytes in the peripheral lymphocytes were identified. The blood samples were taken from aorta abdominalis and venae cava caudalis. The population of these subsets were enumerated by a laser flow-cytometry system. The result showed that there was no significant difference in hematological properties between the arterial and venous blood except in leukocyte count and hemoglobin concentration. The difference in leukocyte counts was thought to depend mainly on the fluctuation of the lymphocyte counts. However, no significant difference was recognized in the proportion of positive cells to each monoclonal antibody. It was concluded that the difference in leukocyte counts found between the arterial and venous bloods of the Wistar-Imamichi rat did not produce any effects on the proportion of the subpopulation in the peripheral lymphocytes, and the lymphocyte subpopulations in both arterial and venous bloods were substantially equivalent to each other.

A convenient synthesis of 3 beta,12 alpha-, 3 beta,7 alpha-, and 3 beta,7 beta-dihydroxy-5-cholen-24-oic acids: unusual bile acids in human biological fluids

The unusual bile acids 3 beta,12 alpha- (V), 3 beta,7 alpha- (XIIIa), and 3 beta,7 beta- (XIIIb) dihydroxy-5-cholen-24-oic acids were synthesized conveniently from the 3-oxo derivatives of deoxycholic (I) and lithocholic (VI) acids, respectively, to provide authentic samples for the gas chromatography-mass spectrometric determination of these bile acids in the abnormal metabolism of bile acids.

Anomalous refractive indices of the amplifying medium in a waveguide CO2 laser

The relative changes in refractive index of the amplifying medium in a waveguide CO2 laser have been measured as a function of the inlet and outlet pressures, discharge current, gas flow rate, and intracavity power using an interferometric technique. The experiments have been made for two gas mixing ratios over a wide range of the inlet pressure. Saturated phenomena of the refractive index have been observed for increasing inlet pressure. The output power and the variation in impedance of the amplifying medium have been simultaneously measured. The dependence of the refractive index on the inlet pressure in the absence of the discharge, the electron density, and the estimation of errors in measurements are discussed.

[The influence of a biological response modifier on thoracic lymphocytes--a study involving clinical cases and animal experiments]

The influence of a biological response modifier on thoracic lymphocytes was studied clinically and experimentally. The thoracic lymphocytes and peripheral blood were taken from nine cases of gastric cancer relapse before and after the administration of hemolytic streptococci, OK-432 (PIC), for immunological examination. T: B cell ratio, T cell ratio and ADCC activity of the thoracic lymphocytes and peripheral blood were not changed but the NK activities of both were increased. The juvenilization of lymphocytes was reduced but that of the peripheral blood was not changed. The number and the ratio of T cells in the thoracic lymphocytes of Wistar rats were considerably increased by the administration of PIC but they were reduced in the peripheral blood. T-cell subsets of thoracic lymphocytes and peripheral blood were hardly changed by the administration of PIC. In the case immunological treatment, the thoracic lymphocytes and blood lymphocytes should be monitored because their biological specificities are different.

N1-(2 tetrahydrofuryl)-5-fluorouracil (FT-207) in the postoperative adjuvant chemotherapy of gastric cancer. Delivery of a fat-emulsified agent to the lymph

The influence of fat emulsification of N1-(2-tetrahydrofuryl)-5-fluorouracil (FT-207) on lymphatic transport was studied in seven postoperative gastric cancer patients. The water-in-oil-type of emulsion of FT-207 (FT-w/o), the oil-in-water-type emulsion of FT-207 (FT-o/w) and an enteric-coated granule of FT-207 (FT-G) each in 1-g doses, calculated in terms of FT-207, were administered orally. Lymph from a thoracic duct fistula, prepared in advance, and from the blood of a peripheral vein was collected simultaneously along a time course after administration to measure the concentrations of FT-207 and 5-fluorouracil (5-FU). For FT-w/o, FT-207, and 5-FU, concentrations were significantly higher, both in the lymph and in the blood, than those for FT-G and FT-o/w. However, no significant differences in FT-207 and 5-FU concentrations were observed between FT-o/w and FT-G. It was concluded that FT-w/o can be useful as an adjuvant chemotherapeutic drug in the postoperative treatment of gastric cancer.

Lymphatic distribution of an anti-tumor agent in postoperative adjuvant chemotherapy in gastric cancer: fat-emulsified preparation of 1-(2-tetrahydrofuryl)-5-fluorouracil in lymph

In 8 postoperative patients with gastric cancer the effectiveness of fat emulsification of tegafur as a means of improving the drug distribution in the lymphatic tissue was studied. A water-in-oil type of emulsion of tegafur (FT-w/o) and an oil-in-water type of emulsion of tegafur (FT-o/w) were orally administered. A fistula in the thoracic duct, prepared in advance, was used to collect lymph. The concentrations of tegafur and 5-FU were compared in simultaneously obtained specimens of lymph and peripheral blood. In the case of FT-w/o, the tegafur concentration at 30-60 min after administration was significantly higher in both the lymph and plasma than that found using FT-o/w. In the case of FT-w/o, the 5-FU concentration at 30-120 min after the administration was significantly higher than that found with FT-o/w in both the lymph and the plasma. Thus, FT-w/o shows excellent distribution in both lymph and blood, and is considered useful as an adjuvant chemotherapeutic agent in the postoperative treatment of gastric cancer patients.