[An autopsy case of meningeal carcinomatosis with vestibulocochlear nerve disturbance as the first manifestation]

A 54-year-old man initially complained of frontal headache, right ear pain and tinnitus in May, 1985. This was followed by right facial palsy and hearing loss, and he was admitted to our hospital. Physical findings revealed right trigeminal nerve disturbance, left facial nerve palsy and bulbar palsy. The spinal fluid showed pleocytosis, increased protein, decreased glucose, markedly increased carcinoembryonic antigen and adenocarcinoma cells. Gastric carcinoma was revealed by an upper GI series. He was treated with chemotherapy. However, he die in August, 1985. Nodular metastases were discovered at the right internal acoustic meatus and other areas. Microscopically, signet-ring cell carcinoma had diffusely infiltrated at the subarachnoid space.

Graves' disease associated with intersterno-costoclavicular ossification and pustulosis palmoplantaris--a case report and review of the literature

It was shown that intersterno-costoclavicular ossification often appears together with pustulosis palmoplantaris by Sonozaki et al., 1980. We report here a patient of Graves' disease associated with intersterno-costoclavicular ossification and pustulosis palmoplantaris, and discuss the relationship with these conditions.

Cardiorespiratory arrest in a patient with advanced diabetic autonomic neuropathy

A 53-year-old diabetic woman who had been diabetic for 14 years had recurrent episodes of cardiorespiratory arrest, which were easily resuscitated by a few chest massages. In 2 of 4 episodes a radial pulse was detected, so respiratory arrest was thought to be a primary event. Pentazocine was injected several hours prior to each of the 3 episodes. This was considered to be a precipitating factor. From the first episode of cardiorespiratory arrest, she received oxygen inhalation. When oxygen inhalation was withdrawn for 5-10 min, she became cyanotic. This was considered to be a sign of lack of hypoxic drive mediated by peripheral chemoreceptors. Ventilatory responses to hypercapnia was markedly decreased, indicating impaired central chemosensitivity. The possibility that impaired chemosensitivity could be a cause of respiratory arrest was suggested.

The OP-Rheometer system, a new device for analysis of viscosity and viscoelasticity of blood: description and clinical application

OP-Rheometer is a rotational viscometer of concentric type, which was developed to measure blood viscosity at low shear rate (0.2-40 sec-1) and viscoelasticity at 0.1-3.0 Hz in the context of clinical medicine. This system consists of a mechanical unit, a control unit (console), a data processing unit and a printer. The dynamic or steady state flow data are automatically printed out. An outer cylinder (sample container) is connected to a torsion wire assembly supported by a pair of magnetic bearings. The angular displacement is detected by a pair of variable differential transformers. In clinical application of this rheometer, authours have confirmed that the viscosity and viscoelasticity of blood from diabetic patients are higher than for normal subjects.

[Phase I-II study of 7-N-(P-hydroxyphenyl)-mitomycin C (KW2083, M83)]

A phase I-II study of KW2083, an analog of mitomycin C (MMC) was performed in a total of 22 patients. KW2083 was escalated by single intravenous administration of 40, 50, 60, 70, and 80 mg/m2 doses. Treatments were repeated every 4-6 weeks unless unacceptable toxicities occurred. The median times taken to reach nadir for each dose level were 9-12 days for leukocytes and 7-13 days for platelets respectively. The median times taken for recovery were 8-22 days for leukopenia and 10-37 days for thrombocytopenia. Variable and non-predictable hematological toxicity was observed in some cases. Biphasic hematological toxicity was observed in 4 courses. Acute toxicity occurred in 17 courses for 11 patients and consisted of nausea (44%), vomiting (13%), diarrhea (2.7%) and stomatitis (2.7%). Nephrotoxicity (elevation of BUN, 8.1% and proteinuria, 5.4%) occurred in 3 patients who had no previous impairment of renal function. Alopecia (8.1%) was also observed. Marked elevations of hepatic enzymes were noted in one patient who developed acute fulminant hepatitis with the second dose of KW2083. Objective response was observed in one of 20 evaluable patients. From this preliminary study, the maximum tolerable dose is 70 mg/m2 and the optimal dose of KW2083 was determined to be 50 mg/m2 at 6-week intervals. KW2083 has been introduced as an MMC analog of potential interest. However, hematological and non of hematological toxicities are very similar to those of MMC and does not appear that KW2083 will supersede MMC.

Curved laryngotelescope

The purpose of this paper is to report on a newly developed curved laryngotelescope whose shape allows for smooth insertion through the oral and to the laryngeal cavity. Its principle of image processing involves lenses and prisms, which results in the maximum magnification of x6. Therefore, it is very useful for microscopic examination. We can obtain a clearer picture by this device than by conventional laryngoscopes. Examination with this laryngotelescope is easily performed after only topical application of a local anesthetic and patients experience less pain.

Unfolding of tertiary structures of proteins

The unfolding pathway of lysozyme was investigated by carrying out the computer simulation. Taking into account the simultaneous change of both the dihedral angels phi and psi of a residue, we explore the detailed features of the conformational energy profiles. The triangle distance map shows that the lysozyme molecule is divided into three domains, 1-40, 41-101 and 102-129 in amino acid residue numbers (referred to as the domains I, II and III, respectively). The calculated unfolding process indicates that in the early stage of unfolding domain III located at the C-terminal begins to be detached from the other two, and then domain I can be unfolded. The long-range interactions between domains I and III stabilize the whole molecule and give the cooperative nature of the folding. The calculated unfolding pathway of lysozyme is consistent with the folding pathway proposed by Anderson & Wetlaufer [J. Biol. Chem. (1976). 251, 3147-3153] who identified the disulfide bondings in the early stage of the glutathione regeneration. A simplified treatment of unfolding for myoglobin is also discussed in the Appendix.

Phase I study of 7-N-(p-hydroxyphenyl)-mitomycin C

The Phase I study of N-7-(p-hydroxyphenyl)-mitomycin C (KW 2083, M 83) was performed. The dose-limiting toxicity was leukopenia and thrombocytopenia and a maximum tolerable dose was 70 mg/m2. Nonhematologic toxicities included nausea (44%), vomiting (13%), diarrhea (2.7%), azotemia (8.1%), proteinuria (5.4%), alopecia (8.1%) and elevated hepatic enzymes (2.7%). This Phase I study indicates that the recommended starting dose for Phase II studies for patients without significant myelosuppression would be 50 mg/m2 at 6 week intervals in an intravenous push. KW 2083 should be avoided in patients with impaired renal functions and proteinuria because of permanent renal damages caused by the drug.

A new method of measuring red cell deformability and the effects of pentoxifylline

The effect of pentoxifylline on red cell deformability was studied using a new device of a polycarbonate membrane filter ("Nuclepore') and a differential pressure type transducer. Differential pressure fluctuations due to the passage of red cells through the "Nuclepore' membrane were recorded as a differential pressure curve of red cell filtration. Red cell deformability was measured with a diluted red cell suspension (10 x 10(4)/mm3) in this buffered NaCl solution of normal osmotic pressure, 300m0sm/l as a suspending medium. Blood samples were taken from 9 healthy subjects and 26 patients with diabetes mellitus, liver disease and miscellaneous diseases. The ability of pentoxifylline to modify red cell deformability was investigated using concentrations of 20 micrograms/ml and 40 micrograms/ml in diluted red cell suspension which was incubated for 2 hours of 37 degrees C. Changes in red cell deformability were estimated from the gap between two differential pressure curves recorded in blood suspension with or without pentoxifylline. Addition of pentoxifylline increases red cell deformability in both groups of blood suspension in healthy subjects and patients. A significant increase in red cell deformability was observed in 40% of samples with the addition of 29 micrograms/ml pentoxifylline and in 77% of those with 40 micrograms/ml, respectively.

Red cell filterability in diabetes

A negative pressure red cell filteration technique using polycarbonate sieve (Nuclepore) was devised for the observation of red cell filterability (RCF) in diabetes. A significant increase of HbA1 was suggested to be closely correlated to the decrease of RCF. A greater decrease of RCF was observed in diabetics with advanced retinopathy. The increased 2,3-DPG of red cells has been observed in diabetes, but P50 changed much less than might be expected. Improved RCF was observed when Pentoxifylline was added into red cell suspensions. This suggests that Pentoxifylline will have a good effect on microcirculation where impared circulation is observed.