Cerebral edema associated with acute hepatic failure

The clinicopathological findings of cerebral edema were investigated in patients with acute hepatic failure autopsied at Okayama University Hospital between 1970 and 1980 retrospectively. Nine (64%) of 14 hepatic failure cases were found to have cerebral edema during a post-mortem examination of the brain. Clinical features of the patients with cerebral edema were not significantly different from those of the patients without cerebral edema. However, general convulsions were observed more frequently in patients later found to have cerebral edema. Moreover, the length of time from deep coma to death was much shorter in the brain edema cases with cerebral herniation than without herniation.

In vivo kinetics and thrombus accumulation of 67Ga-labeled urokinase

Highly purified high and low molecular weight urokinase (H-UK and L-UK) were labeled with 67Ga using deferoxamine (DF) as a bifunctional chelating agent. The labeling efficiency was 91.7% for the H-UK, and 90.4% for the L-UK, respectively. The 67Ga labeled UK (67Ga-DF-UK) fully retained the enzymatic activity of the parent UK. Studies on the in vivo behavior of the 67Ga labeled UK in rabbits showed a very rapid blood clearance with half-life of 4 min (67Ga-DF-L-UK) to 8 min (67Ga-DF-H-UK). Studies carried out in rabbits with induced thrombi in the femoral vein showed thrombus-to-blood 67Ga-DF-UK activity ratios, 2h after injection, of 2.00-3.08 for the H-UK, and 0.84-1.65 for the L-UK, respectively, with thrombi aged 4 to 3 days. A dose effect of the 67Ga-DF-H-UK on its thrombus accumulation was observed. Gel chromatographic analysis of plasma samples withdrawn from those animals injected with this radiopharmaceutical revealed a reduction of the 67Ga-DF-UK effectiveness due to complexation with protein inhibitors. This led to formation of high molecular weight complexes which was reflected in the very fast blood clearance. Its implication in thrombus accumulation is discussed. In conclusion, usefulness of DF for labeling UK with 67Ga or 68Ga with no alteration of UK enzymatic properties was demonstrated. The use of 67Ga-DF-UK as a diagnostic or therapeutic radiopharmaceutical is promising.

[Role of oral administration of 1-hexyl-carbamoyl-5-fluorouracil (HCFU) for multimodal treatment of inoperable cirrhotics with hepatocellular carcinoma]

1-Hexylcarbamoyl-5-fluorouracil (HCFU) was orally administered at doses of 300-600 mg daily for 7-360 days to 27 inoperable cirrhotics with hepatocellular carcinoma. They were simultaneously treated with transcatheter arterial embolization (TAE), and mitomycin C (MMC) injected into the hepatic artery and/or subcutaneous injection of OK-432. Efficient treatment according to the Koyama and Saito (PR and MR) and Karnofsky classification (I -A and I -B) was obtained in 40.7 and 29.6%, respectively, of all the patients; 81.8 and 54.5%, respectively, in the patients treated with TAE and intraarterial MMC injection and 25.0 and 12.5%, respectively, in those given MMC therapy. However, the total doses of HCFU administered (3-216 g) were not related to either efficient or inefficient treatment. Survival rate obtained 1 year following diagnosis of HCC was much better in the patients treated with TAE and/or MMC therapy (greater than 70%) than in those without these treatments (20%). TAE intervals in HCC patients given repeated TAE and intrahepatic MMC injection were slightly prolonged by oral administration of HCFU (more than 12 g). The results suggest that HCFU might be effective for prevention of HCC recurrence following TAE.

Plasma amino acid imbalance in alcoholic liver cirrhosis

Plasma amino acid concentrations and plasma glucagon and serum insulin levels were studied in male patients with compensated alcoholic and nonalcoholic liver cirrhosis. Age, nutritional status, and liver function tests were similar in both groups; none of the patients presented hepatic encephalopathy. Plasma valine and leucine concentrations were lower, and tyrosine, higher in alcoholic than nonalcoholic liver cirrhosis. As a result, the molar ratios of branched-chain amino acids (BCAA) to aromatic amino acids (AAA) were reduced markedly in this group. Although correlation coefficients comparing BCAA/AAA ratios and KICG in alcoholic and nonalcoholic liver cirrhosis were similar, a steeper regression line was observed in alcoholics. Plasma glucagon and proline levels were significantly higher in alcoholic than nonalcoholic liver cirrhosis, the former correlated with AAA concentrations only in alcoholic liver cirrhosis, but not with BCAA levels. These results indicated that alcoholic liver cirrhosis presented a more deranged plasma amino acid pattern than nonalcoholic, and the amino acid imbalances, except for depressed BCAA and elevated proline, were derived, in part, from the hyperglucagonemia.

Apolipoprotein B accumulation and development of foam cell lesions in coronary arteries of hypercholesterolemic swine

We wished to determine whether plasma low density lipoproteins (LDL) preferentially accumulate at specific anatomical sites in swine coronary arteries that are predisposed to atherosclerotic lesion development, and if so, to determine what alteration in wall structure may be responsible for this accumulation. Therefore, we measured the accumulation of apolipoprotein B (apo B), the major protein in LDL, by electroimmunoassay in seven separate segments of coronary arteries from swine fed a hypercholesterolemic or normolipemic control diet for periods of 4 to 15 weeks. Apo B accumulation was greater in segments from swine fed a hypercholesterolemic diet than in segments for corresponding time intervals from swine fed a normolipemic diet and was greater in proximal than in distal segments (nonbranch points) of coronary arteries. This accumulation of apo B generally increased with time on the hypercholesterolemic diet, already appearing elevated relative to controls at 4 weeks on the hypercholesterolemic diet, whereas the initial appearance of foam cells in these regions occurred at 6 weeks. Apo B was localized by immunofluorescence almost exclusively to areas of diffuse intimal thickening in the proximal portions of the coronary arteries and to focal areas of intimal thickening or cushions at branch points in more distal segments. In these regions, apo B was found primarily in edematous, cell-sparse zones close to the lumen surface, rather than the smooth muscle cell-rich areas making up most of the thickened intima. Apo B in these areas was associated with Alcian blue-positive areas suggested to contain sulfated glycosaminoglycans, which may be responsible for the preferential LDL accumulation. The diffuse and focal intimal thickening does not appear to have been induced by the hypercholesterolemia or the subsequent deposition of LDL, since such thickening was found at the same sites and to about the same degree in the normolipemic control animals. Thus, this study has shown that the areas of earliest and preferential accumulation of LDL are sites of intimal thickening containing deposits of sulfated glycosaminoglycan, and that these are the regions at which the first foam cell lesions eventually appear. These findings add additional strong circumstantial data linking LDL deposition in arteries to the atherosclerotic process.

Characteristic features of plasma amino acid, plasma pancreatic glucagon, serum insulin concentrations in cirrhotic patients with histories of chronic alcohol consumption

Plasma amino acid, plasma pancreatic glucagon and serum insulin levels were simultaneously measured in cirrhotic patients with (drinkers) and without a history of alcohol drinking (non-drinkers), as compared to those in alcoholics without liver disease. Clinical characteristics in drinkers and non-drinkers, such as the extent of liver dysfunction, which may affect plasma amino acid levels, were strictly matched. Plasma pancreatic glucagon levels in the drinker group were much higher than those in the non-drinker group. In the former group, the elevated plasma pancreatic glucagon levels were correlated (p less than 0.05) to total amino acid levels (the sum of 20 kinds of L-amino acid concentrations) and, elevated AAA concentrations leading to a diminished BCAA/AAA ratio. Drinkers with histories of hepatic encephalopathy presented grossly elevated glucagon levels and severely abnormal aminograms similar to those observed in hepatic insufficiency.

Effect of continued drinking on prognosis of alcoholic liver cirrhosis

The prognoses of patients with alcoholic liver cirrhosis were compared between those who continued to drink and those who stopped. Clinical criteria were strictly set so as to control other variables affecting the prognoses. Four-year survival was significantly higher in the patients who stopped drinking than in those who continued to drink. Continued drinking worsens the prognosis of patients with alcoholic liver cirrhosis.

Aarskog syndrome

A rare case of Aarskog syndrome is presented. The Aarskog syndrome is characterized by short stature with typical facial, digital, and genital anomalies.

Vascularized fibular grafting for treatment of aseptic necrosis of the femoral head--preliminary results in four cases

Vascularized grafting with segments of fibula was performed in four men with aseptic necrosis of the femoral head. The patients were restricted to relatively young individuals in whom the necrosis seemed to be confined to two-thirds or less of the femoral head and in whom the outer shell of the femoral head appeared relatively well preserved. The operative technique is described, and the interim results from follow-up ranging from one year, two months to three years, eight months are reported. Three of the four hips became asymptomatic after surgery with x-ray films showing no progression of the necrosis or deformity. In one hip, however, mild pain, bony absorption, and some progression of the deformity persisted. Although the final results in these four cases remain to be seen, vascularized fibular grafting will find a place in the treatment of early avascular necrosis of the femoral head.

[Effect of prazepam on experimental hypertensive models]

Combined effects of prazepam and trichlormethiazide (TCM) which were given simultaneously were studied in renal hypertensive rats (1-kidney type) and DOCA hypertensive rats. In this study the blood pressure was measured by the plethysmographic method. Orally administered prazepam alone did not show any appreciable effect on the blood pressure, while TCM, even when administered alone, exhibited marked and long-lasting hypotensive effects of both hypertensive rats. In addition, the hypotensive effect of TCM was apparently potentiated by the concurrent use of prazepam. In the experiment where conscious and unconstricted spontaneous hypertensive rats (SHR) were used, the pressor response and tachycardia were observed when foot shock (acute stress) was loaded. This pressor response was the "all or none" type and a threshold existed. In contrast to the pressor response, the degree of tachycardia varied depending on the intensity of the stress. The similar responses were also observed in normotensive rats, although the degrees of the responses were significantly weaker than those in SHR. Prazepam given alone obviously suppressed the cardiovascular responses mentioned above. The present results suggest that prazepam is an useful drug for the treatment of hypertension.

Distal symphalangism associated with camptodactyly

A Japanese family in which four patients in three generations had distal symphalangism associated with camptodactyly is reported. All of these patients had extension limitation of the proximal interphalangeal joints of the toes of both feet. Radiographs of the hands and feet, undertaken in three cases, showed no bone fusion of the distal and proximal interphalangeal joints. This malformation is caused by an autosomal dominant gene. To our knowledge, no previous case of distal symphalangism with extension limitation of the proximal interphalangeal joints has been reported.

Serum lipid and lipoprotein profiles in patients with xanthomas: a correlative study on xanthoma and atherosclerosis (I)

In an attempt to correlate xanthomas with atherosclerosis, the characteristics of serum lipid and lipoprotein profiles are explored in xanthoma patients. Xanthomas are classified into 5 subtypes: xanthelasma, planar xanthoma, papulo-eruptive xanthoma, tuberous xanthoma and tendon xanthoma. The clinical characteristics of xanthoma patients are summarized in the following. 1) Xanthelasma in 2 different types: one normolipemic and the other hyperlipidemic; of 30 xanthelasma patients, 5 were normolipemic, one of them had low HDL-cholesterol. 2) Tuberous and tendon xanthomas were all hypercholesterolemic, with serum cholesterol above 300 mg/dl and LDL-cholesterol above 255 mg/dl, while HDL-cholesterol was within normal range. 3) The xanthoma patients were generally not obese. 4) Their laboratory findings often showed such abnormalities as elevated levels in serum fibrinogen, LDH, CPK and uric acid. The resemblance of the clinical characteristics between xanthomas and atherosclerotic vascular disease, e.g., myocardial infarction, was striking. If the causation of their common tissue alterations by lipid accumulation is pathologically and biochemically defined, the correlation between those 2 kinds of disease can be established.

Transcutaneous bilirubinometry: preliminary studies of noninvasive transcutaneous bilirubin meter in the Okayama National Hospital

A new noninvasive bilirubinometer (Tc BM), which measures transcutaneous bilirubin level of the newborn, was developed as a joint effort by the present authors and the Minolta Camera Company, Ltd. A series of linear relationships were found to exist between total serum bilirubin concentration and yellowish skin color intensity in both term and low-birth-weight infants of Japanese ancestry. The instrument was examined for precision, accuracy, and technique-dependence. From these resulting relationships, it can be concluded that the transcutaneous bilirubin measurement is precise and accurate, and will become an alternative to the routine procedures used to measure serum bilirubin concentration in the near future. Although the values obtained during phototherapy or postexchange stage do not correlate well with serum bilirubin measurement, transcutaneous bilirubin will be accepted by the general nursery staffs because of its potential screening value.