[Isolation of Branhamella catarrhalis from sputum and clinical features of bronchopulmonary infection due to Branhamella catarrhalis]

The authors investigated the isolation of Branhamella catarrhalis from sputum and the clinical features of bronchopulmonary infection due to B. catarrhalis from January of 1983 to December of 1987 at the Hokusyo Central Hospital. B. catarrhalis was cultured from 106 (3.8%) of 5,674 sputum specimens. The isolation rate did not vary during the 5 years from 1983 to 1987. Approximately 70% of the patients had some underlying bronchopulmonary disease. The strains of beta-lactamase-positive B. catarrhalis have increased recently in our hospital. Using 4 diagnostic criteria for bronchopulmonary infection by B. catarrhalis, 24 cases were detected. MIC was measured in 97 strains of B. catarrhalis (beta-lactamase positive 63 strains, negative 34 strains). beta-lactamase positive strains had a high MIC value for beta-lactam antibiotics, but antibiotics including beta-lactamase inhibitor markedly improved sensitivity to drugs. Negative strains showed good sensitivity to beta-lactam antibiotics. Cases of bronchopulmonary infection due to Branhamella catarrhalis and beta-lactamase-productive strains are increasing, therefore it is necessary to be careful in the choice of antibiotics.

[Lung cancer associated with idiopathic interstitial pneumonia]

Idiopathic interstitial pneumonia (IIP) is known to have a tendency to be associated with lung cancer. Clinical characteristics of lung cancer associated with IIP are discussed in this article. Thirteen cases of lung cancer associated with IIP were examined from 1975 to 1988. A total of 590 cases of lung cancer and 38 cases of IIP were observed during that period. The 13 cases of lung cancer were found to be associated with IIP during the follow-up observation of our patients. Of these 13 patients, 12 men and a woman, the average age was 68.0 years old. All these 13 cases were ex- or present smokers. Five cases of lung cancer had no symptoms, but were detected by abnormal shadows on chest X-ray. Eight cases were detected symptoms. The duration from the onset of IIP to the onset of lung cancer was 36.5 +/- 23.5 months. Primary sites of lung cancer were distributed as follows. Nine cancers were in the left lung (64%) and five cancers were in the right lung (36%). Three cancers were in the hilar region (21%) and 11 cancers were in the peripheral lung field (79%). The numbers of lung cancers were equal in upper and lower lobe. The most common histological type was squamous cell carcinoma, followed by adenocarcinoma. Most cases were in stage III or IV. Three cases were operated, 4 were treated with chemotherapy, 4 were treated with chemotherapy plus irradiation, and 2 cases were treated by BRMs. The frequency of weight loss or finger clubbing in these patients was higher than in IIP patients without lung cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Novel pathways of oleic and cis-vaccenic acid biosynthesis by an enzymatic double-bond shifting reaction in higher plants

The novel pathways of oleic acid formation from cis-vaccenic (cis-11-octadecenoic) acid and of cis-vaccenic acid formation from oleic acid by enzymatic positional isomerization have been proposed in higher plants, based on stable-isotope experiments using [2,2-2H2]cis-vaccenate or [2,2-2H2]oleate as an immediate precursor. A pulp homogenate and also pulp slices prepared from developing kaki (Diospyros kaki) fruit could catalyze these hitherto unknown isomerizations. This suggests the presence of a new type of isomerase responsible for the double-bond shifting reaction without cis-trans isomerization in the middle of fatty acid carbon chains.

Modification of anoxic neuronal injury by human recombinant epidermal growth factor and its possible mechanism

A primary culture of cortical neurons was established from a 17-day rat embryo. Twenty-four hours after plating, the culture medium was changed to a chemically defined one, and human recombinant EGF (rEGF) was added to the medium at concentrations of 1, 10, and 100 ng/ml. Anoxic stress was exerted on the cultured neurons for 4 hr. Without anoxia, rEGF at a concentration of 10 ng/ml supported neuronal survival. When rEGF was not present in the culture medium, anoxic stress reduced neuronal density to one-tenth that of the nonanoxic group. The rEGF improved neuronal recovery from anoxia significantly, with survival dependent on rEGF dosage. Monoclonal antibody for EGF receptors canceled the effect of rEGF on survival of neurons in a dose-dependent manner. Therefore, rEGF functioned to support neuronal survival from anoxia through EGF receptors. Ontogeny of the EGF receptors was detected immunocytochemically with anti-EGF receptor antibody. About 70% of the cultured neurons were stained by the anti-EGF receptor antibody 3 days after change of medium, and immunoreactivity for EGF receptors was found to be located on the soma of neurons. Binding activity of EGF receptors was detected 5 days after change of medium with receptor binding assay and Scatchard analysis. High-affinity binding sites were detected only in neurons cocultured with rEGF (10 ng/ml) for 5 days. The data indicate that rEGF in sufficient concentration induces high-affinity sites of the EGF receptor and that EGF may have an antianoxic effect through the EGF receptors.

A clonal human chondrosarcoma cell line produces an anti-angiogenic antitumor factor

Previously we reported that rabbit costal chondrocytes in primary culture produced an anti-angiogenic anti-tumor factor. We also established a clonal human chondrosarcoma cell line, HCS-2/8, which had typical cartilage phenotypes. In the present study, we investigated whether HCS-2/8 cells produce an anti-angiogenic anti-tumor factor. Serum-free medium conditioned by exposure to HCS-2/8 cells in culture inhibited the proliferation of bovine pulmonary artery endothelial cells in culture. The inhibition was not due to general cytotoxicity because the endothelial cells started to proliferate after the conditioned medium was removed from the cultures. The factor in conditioned medium also inhibited DNA synthesis in bovine pulmonary artery endothelial cells, but not in B16 melanoma cells, normal rat kidney cells or chick embryo fibroblasts. Production of the factor by HCS-2/8 cells did not change during serial passages. It also inhibited angiogenesis in the chorioallantoic membrane of chick embryos induced by B16 melanoma and growth of the tumor transplanted onto the membrane. Treatment with protease destroyed the inhibitory activities of conditioned medium on angiogenesis and tumor growth. These findings suggest that HCS-2/8 cells produce a peptide factor with anti-angiogenic, antitumor activity and that the cell line should be a useful source of the factor.

A case of a clinically "silent" pheochromocytoma

A case of a clinically "silent" pheochromocytoma is presented. The adrenal mass was incidentally discovered by abdominal ultrasonography and computed tomography. In the course of hospitalization, the patient was normotensive and asymptomatic. Plasma catecholamine levels were nearly normal, whereas urinary levels of catecholamine metabolites were slightly elevated. A glucagon provocative test and 131I-metaiodobenzylguanidine scintigram were useful for diagnosing such an atypical pheochromocytoma. A discussion of clinically-unsuspected pheochromocytoma is also presented.

Effect of orally administered beta-glucan on macrophage function in mice

The effect of orally administered SSG, a beta-1,3-glucan obtained from the culture filtrate of the fungus Sclerotinia sclerotiorum IFO 9395, on the function of peritoneal macrophages in CDF1 mice was examined. Oral administration of SSG (20, 40, 80 or 160 mg/kg, daily for 10 consecutive days) enhanced the acid phosphatase activity of peritoneal macrophages. The greatest enhancing effect was observed at 80 mg/kg of SSG. Relatively long periods of administration (more than 10 consecutive days) were needed to induce significant enhancing effects. Phagocytic activity, candidacidal activity, hydrogen peroxide (H2O2) production and interleukin-1 (IL-1) production of peritoneal macrophages were also enhanced after the administration of SSG by the oral route (80 or 160 mg/kg). However, the durations of the activated state after completion of administration differed depending on the activity. Enhanced activity of lysosomal enzyme (acid phosphatase) was also shown in peritoneal macrophages taken from C3H/HeJ mice, which is a nonresponder strain to bacterial lipopolysaccharide (LPS). These results demonstrate that SSG given by the oral route can activate peritoneal macrophages in mice.

High-renin malignant hypertension secondary to an aldosterone-producing adenoma

Malignant hypertension and high plasma renin activity was found in a 39-year-old woman with an aldosterone-producing adenoma. Only 3 similar cases have been previously reported, and all patients died before or after identification of the adenoma. The present paper documents the first reported case of a successfully managed high-renin malignant hypertension secondary to an aldosterone-producing adenoma. Regardless of its sporadic occurrence and common presence with low plasma renin activity, primary aldosteronism should be considered as a possible underlying cause of high-renin malignant hypertension.

Case of spontaneous healing of occlusive dissection on percutaneous transluminal coronary angioplasty

A large pseudolumen due to dissection arose during percutaneous coronary angioplasty. The true lumen was compressed critically. However, no infarction took place because of good collaterals. During medical follow-up, the patient's angina vanished suddenly. The repeat angiography showed healing of the dissection and patency of the coronary artery.

Establishment from mouse growth cartilage of clonal cell lines with responsiveness to parathyroid hormone, alkaline phosphatase activity, and ability to produce an endothelial cell growth inhibitor

Three clonal cell lines with differences in responsiveness to parathyroid hormone (PTH), alkaline phosphatase activity, and ability to produce an endothelial cell growth inhibitor(s) during more than 3 years, more than 58 passages, in culture were established from growth cartilage (GC) of mouse ribs. In sparse cultures the three clonal cell lines, MGC/T1.4, MGC/T1.17, and MGC/T1.18, all showed fibroblast-like morphology. However, as they became confluent, MGC/T1.4 cells became polygonal and then multilayered. MGC/T1.18 cells also became polygonal, but showed contact inhibition. MGC/T1.17 cells remained fibroblastic in confluent cultures and formed nodules when cultured for more than 7 days after they became confluent. These nodules calcified in the presence of beta-glycerophosphate. Glycosaminoglycan (GAG) synthesis in the parent uncloned line, MGC/T1 cells, at early passages was about 50-75% of that of primary cultures of mouse GC cells. The GAG syntheses in the three clonal lines were much lower than that of primary cultures of GC cells. Moreover, the sizes of proteoglycan monomers synthesized by these cells were not the same as that of cartilage-specific proteoglycan. The three clonal lines mainly synthesized type I collagen. PTH increased the intracellular cyclic AMP level in MGC/T1, MGC/T1.4, T1.17, and T1.18 cells: their maximal levels, observed after 2 minutes, were, respectively, about 160, 150, 70, and 200 times that of controls. The activity of alkaline phosphatase in MGC/T1.17 cells was higher than that in primary cultures of mouse GC cells, whereas those in MGC/T1 and T1.4 cells were comparable with that of GC cells, and that in MGC/T1.18 was lower. The three clonal lines, and especially MGC/T1.4, secreted a heat-stable, nondializable growth inhibitor(s) of endothelial cells into the culture medium. Because of their different properties, these cell lines should be useful for studies on endochondral ossification, the actions of PTH on skeletal cells, and anti-angiogenesis factors.

[A case of sepsis and meningitis due to capsule-deficient Cryptococcus neoformans with SIADH]

Capsule-deficient Cryptococcus neoformans (CN-CD) infection is very rare. The authors recently experienced the case of CN-CD infection with the complication of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in a 83 year old woman. She was admitted to our hospital with the complaints of fever and general fatigue on June 10, 1987. At the time of admission, there were no abnormal findings except a mildly lowered consciousness level on physical examination, there were no abnormal neurological finding nor meningeal signs. Laboratory data revealed a mild leukocytosis and hyponatremia. Chest X-P showed a few small nodular shadows scattered in both lungs. Antibiotics therapy was of no help and hyponatremia became worse. Then with the suspicion of SIADH, Demeclocycline was administered and limitation of water intake was decreased and hyponatremia improvement was used. Yeast-like fungi was detected in the venous blood culture and in the cerebrospinal fluid (cell count: 252/3) CN-CD by India-ink preparation and bacteriological nature were determined. We made a diagnosis of sepsis and meningitis by CN-CD accompanied with SIADH. In spite of Miconazole administration intravenously and intrathecally, she died 2 months after admission. The minimal inhibitory concentration (micrograms/ml) of antibiotics against the isolated CN-CD was as follows: Amphotericin B: 0.78, 5-PC: 1.56, Miconazole less than or equal to 0.05, Nystatin: 25, Ketoconazole: 0.78.

A case of hypopituitarism and type V hyperlipidemia

A 29-year-old woman developed hypopituitarism following removal of a pituitary chromophobe adenoma, and this was complicated by type V hyperlipidemia and obesity.

Demonstration of receptors for parathyroid hormone on cultured rabbit costal chondrocytes

Parathyroid hormone (PTH) receptors on cultured rabbit costal chondrocytes were demonstrated using HPLC-purified, radioiodinated [Nle8,-Nle18, Tyr34] bovine PTH-(1-34)amide. PTH binding was found to be specific for PTH agonists and antagonists and dependent on the time and temperature of incubation. Both growth cartilage (GC) cells and resting cartilage (RC) cells were shown to have a single class of saturable, high affinity PTH binding sites with a dissociation constant of 0.6-0.7 nM. However, the numbers of receptors per cell were approximately 49,000 on GC cells and 19,000 on RC cells. After crosslinking the receptors on these cells with the radioligand, one, major 125I-labeled band of 76 kDa was separated by SDS-PAGE.

Establishment of a clonal human chondrosarcoma cell line with cartilage phenotypes

A clonal cell line with cartilage phenotypes and tumorigenicity during more than 3 years in culture was established from a human chondrosarcoma. In sparse cultures, the clonal line, named HCS-2/8, consisted of slightly elongated polygonal cells, which proliferated with a doubling time of 3.5 days. The cells became polygonal to spherical as they became confluent. After reaching confluence, the cells continued to proliferate slowly and formed nodules, which showed metachromasia when stained with toluidine blue. The nodules were three-dimensional in structure; cells were multilayered in the surface regions, overlying a thick layer of extracellular matrix, which showed metachromasia. Electron microscopically, the cells resembling chondrocytes in vivo were surrounded by an extracellular matrix consisting of thin collagen-like fibrils with numerous fine granules, presumably of proteoglycans. The cells actively synthesized proteoglycans as determined by [35S]sulfate incorporation. The hydrodynamic size of major proteoglycan monomers synthesized by the cells was that of so-called cartilage-specific proteoglycans, as determined by glycerol gradient centrifugation. Immunostaining identified type II collagen but not type I collagen. Fluorography and immunoblotting of collagens separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis also demonstrated the synthesis of type II collagen but not type I collagen. Inoculation of HCS-2/8 cells into athymic mice resulted in the formation of chondrosarcomas that resembled the original tumor. Because of having these characters, HCS-2/8 cells should be useful not only in studies on the differentiated phenotypes of human chondrocytes but also in basic studies on the diagnosis, treatment, and etiology of human chondrosarcomas.

[Biphenotypic leukemia in childhood--analysis of 19 cases]

The leukemic cells of 19 patients (pts) out of 180 children with acute leukemia expressed both CD 19 (B 4) and CD 13 (MY 7) antigens. These biphenotypic leukemias (BiL) were divided into 3 groups on the basis of clinical features, antigen profiles and karyotypes. GroupI pts (N = 6) were infants under one year of age with high initial white blood cell (WBC) count over 200,000/microliters. The blasts of this group did not express CD 10 (J 5) antigen. In 4 of these pts, the blasts initially did not express CD 13 antigen, however, they became strongly positive after short-term culture without stimulation. Cytogenetic analysis revealed a breakpoint at 11 q 23. Group 11 pts (N = 6) were often school age and had a high WBC count over 100,000/microliters and CD 10 positive blasts. The blasts of 4 pts did not express CD 13 antigen until short-term culture. Cytogenetic marker was Ph1 chromosome. Group III pts (N = 7) were often preschool age and the WBC count was lower than that of other groups. The blasts expressed CD 10 antigen with normal karyotypes or various karyotype abnormalities. Prognosis of pts with BiL was more poor than that of CD 13- common ALL, and among 3 groups survival of Group I and II was significantly shorter than that of group III. This study suggests that childhood BiL represents heterogeneous leukemias. It is important to distinguish BiL in childhood acute leukemia and further divide into the groups in order to establish an adequate therapy for prognostically poor BiL.

[Monoclonal antibodies against human erythrocyte membrane antigens and the antigens recognized by these antibodies]

Six monoclonal antibodies (KOR-E1-E6) were raised against human erythrocyte membrane antigens. Aggregating reactions of normal human erythrocytes with or without enzyme treatment and specific antigen deficient (null type) erythrocytes were used for detection of the antigens. SDS-polyacrylamide gel electrophoresis with Western blotting and immunoperoxidase methods were also used to confirm the results. The antigen recognized by KOR-E1 and KOR-E5, which was sensitive to protease, trypsin, and neuraminidase, and only expressed on human erythrocytes, was identified as Pr1h. The antigen recognized by KOR-E2 and KOR-E6 was identified as the EnaTS portion of glycophorin A, because the antigen was sensitive to protease and trypsin, but resistant to neuraminidase, and was not present on En(a-) erythrocytes. The antigen recognized by KOR-E3 that was protease-, trypsin-, and neuraminidase resistant, and absent on En (a-) erythrocytes, was identified as Wrb antigen. As KOR-E4 reacted with all erythrocytes examined, the antigen it recognizes could not be determined.

Scintigraphic demonstration of intracranial communication between arachnoid cyst and associated subdural hematoma

An arachnoid cyst found to have a communication to an associated subdural hematoma was demonstrated with the Tc-99m DTPA brain scintigraphy. Although arachnoid cysts are known to be silent, when a patient with an arachnoid cyst develops signs of increased intracranial pressure or neurological deficits, the presence of a complication, including subdural hematoma, intracystic hemorrhage or subdural hygroma, is highly suspected. In the present case, the patient with an arachnoid cyst had a subdural hematoma following minor head injury. Tc-99m DTPA brain scintigraphy showed abnormal accumulation of the tracer not only in the hematoma but in the arachnoid cyst. This observation suggested communication of the two lesions, which was confirmed at surgery.

[Monoclonal antibodies against human erythrocyte membrane antigens and their reactivities with hematopoietic cells]

Four monoclonal antibodies against human erythrocyte membrane antigens were established. The antigenic determinants of KOR-E1, E3, E6 were Pr1h antigen, Wrb antigen, and the trypsin sensitive portion of glycophorin A (EnaTS) respectively. The antigen recognized by KOR-E4 could not be determined. The reactivities of these antibodies with normal hematopoietic cells, malignant hematopoietic cell lines (N = 31), and fresh leukemic cells obtained from 128 patients with various types of leukemias were studied. All antibodies reacted only with erythrocytes among peripheral blood cells, and also KOR-E6 reacted only with erythroid cells among bone marrow cells. KOR-E3 had no reactivity with any cell lines examined, and KOR-E1 and KOR-E4 were reactive with some lymphoid cell lines. However, KOR-E6 had specific reactivities with erythroid (HEL, K562), megakaryocytic (CMK-1), multiphenotypic (KOPM-28), and basophilic (KU-812) cell lines. The antigen (glycophorin A) recognized by KOR-E6 was expressed on a small population of mononuclear cells separated from acute lymphoblastic leukemia (3/70), acute myelogenous leukemia (2/12), monosomy 7-myeloproliferative disorder (1/1), juvenile CML (1/1), and transient myeloproliferative disorder with Down's syndrome (4/12), although it could not be determined whether these cells were leukemic cells or not. KOR-E6 was reactive with a large population of leukemic blasts in erythroleukemia (2/2) and acute megakaryoblastic leukemia (3/6). Thus, KOR-E6 appears to be an erythroid marker of leukemic cells.

Mild exercise therapy increases serum high density lipoprotein2 cholesterol levels in patients with essential hypertension

In ten patients with essential hypertension who were on a prescribed regimen of supervised mild exercise, we examined serum lipids, HDL cholesterol subfractions (HDL2 and HDL3), and apolipoproteins. The findings were compared with data on age- and sex-matched hypertensives not on this regimen of exercise. Blood samples were obtained from the auricle during the multistage exercise test, and changes in levels of lactate were measured. The exercise was done for 30 minutes three times weekly for 10 weeks. A significant reduction of both systolic and diastolic blood pressure was evident at 10 weeks. Serum concentrations of HDL2 cholesterol increased significantly at 10 weeks, but there were no changes in total and HDL3 cholesterol. No significant changes were observed in serum concentrations of total cholesterol, triglyceride, and apolipoproteins, (apo) A-I, apo A-II, apo B, apo C-II, apo C-III and apo E following 10 weeks of exercise therapy. In the hypertensive controls who were not on exercise therapy, blood pressure as well as all parameters related to lipoproteins remained unchanged. Thus, mild exercise lowers blood pressure and improves the lipoprotein profile.

Hypoxic injury of rat cortical neurons in primary cell cultures. Introduction of a modified method to create the hypoxic state

A primary culture of cortical neurons was established from a 17-day-old rat embryo. Twenty-four hours after plating (day 0), the medium was changed to a chemically defined one. Hypoxia was exerted for 4 h by placing cultures in an air-tight chamber connected to a vacuum pump and a cylinder filled with 95% N2 and 5% CO2. Hypoxic stress was exerted on one of the consecutive days from day 0 to day 3. Hypoxia on days 0, 1 or 2 reduced the number of surviving neurons immediately following exposure. However, hypoxia on day 3 resulted in delayed reduction. Anit-synaptophysin antibody was used immunocytochemically to examine whether the difference is related to teh synaptic formation of cultured neurons. Neurons which had more and longer neurites were clearly stained for synaptophysin. We suspect that neurons with synaptic formation release substances from their presynaptic vesicles, and that these substances might account for the delay reduction.

What types of hypertensives respond better to mild exercise therapy?

Twenty-one patients with essential hypertension were treated with aerobic (lactate threshold) exercise (n = 21) and the change in blood pressure was compared with that in a non-exercising hypertensive control group (n = 10). After 10 weeks of exercise therapy blood pressure in the exercise group was significantly reduced, from 154 +/- 3/100 +/- 2 to 141 +/- 3/93 +/- 3 mmHg, and there was a significant reduction in plasma volume, cardiac index and plasma noradrenaline whereas there were no changes in the non-exercise group. Responders (10 mmHg or more fall in mean blood pressure) in the exercise group had a significantly higher cardiac index, serum Na:K ratio and lower total peripheral resistance in pretraining studies than non-responders. In conclusion, exercise at lactate threshold is effective in lowering blood pressure in those mild hypertensives with higher cardiac index and serum Na:K ratio.

[Prognostic factors in nonresected adenocarcinoma of the lung]

We have studied the prognostic factors of 117 cases of unresected adenocarcinoma of the lung, and have examined these cases according to the following categories: age, sex, clinical stage, performance status (P.S.), serum albumin on admission, serum CEA, the presence of complication, the present status of an abnormal chest shadow from a year ago at the same location, and differentiation of cells. Significant differences were detected in the P.S., the serum albumin and the presence of complications by survival analysis through the use of covariate-Cox models. We also have noted that the difference between stage I and the other stages of the clinical stage was found to be significant by a generalized Wilcoxon test. In conclusion, the determining prognostic factors of an unresected adenocarcinoma of the lung are the P.S., the serum albumin, the presence of complications and the clinical stage.

Insulin autoimmune syndrome with insulin-resistant diabetes at the incipient stage prior to hypoglycemic attacks

Insulin autoimmune syndrome is characterized by spontaneous hypoglycemia, glucose intolerance, hyperinsulinemia and insulin-binding antibodies in serum without previous immunization. A 31-year-old man with Graves' disease developed insulin autoantibodies after therapy with methimazole. The patient was unique in that persistent hyperglycemia with polyuria and polydipsia had continued for several days before frequent hypoglycemic attacks appeared. We were able to extract a huge amount of immunoreactive insulin (116,000 microU/ml) with acid-ethanol from his serum obtained in the diabetic stage, and serum C-peptide immunoreactivity was as high as 268 ng/ml. The insulin-binding activity of his serum was quite potent, and when 1:5,000 diluted serum was incubated with 125I-porcine insulin, 71.2% of the label could be precipitated by polyethylene glycol. The insulin-binding protein was identified as mainly IgG with kappa light chains. Insulin-binding activity was not detected in serum obtained before methimazole therapy, suggesting that the drug was responsible for the induction of antibodies in this patient. The antibodies recognized porcine, sheep, bovine and horse insulins as well as human insulin. The mechanisms by which the antibodies produced hyper- and hypoglycemia have also been discussed.

Effect of acute exercise on plasma immunoreactive-atrial natriuretic factor

The effect of acute exercise on plasma immunoreactive-atrial natriuretic factor (IR-ANF) was studied in 5 healthy young males subjected to graded exercise on a bicycle ergometer at four different work intensities (approx. 30, 50, 70, and 90% VO2max respectively). Except for the final exercise period, which was continued until exhaustion, all the others were of 30 min duration. Venous blood samples were obtained in the last 2 min of each exercise period. The plasma IR-ANF response to exercise was similar to that of heart rate and systolic blood pressure in that mild exercise in the first stage (corresponding to approx. 30% VO2 max) caused a striking increase of plasma IR-ANF concentrations with a further augmentation in the next stages and a levelling off at exhaustion. Plasma arginine-vasopressin (AVP) and aldosterone (ALDO) rose significantly only in the last two stages, and the highest concentrations were observed at exhaustion. In conclusion, acute exercise stimulates ANF secretion in proportion to the intensity of exercise, while concomitant increases in plasma AVP and ALDO occur only when the work load exceeds the blood lactate (BLA) threshold.

Analysis of the evolution of coronary artery disease--evaluation of 227 cases by restudy of coronary arteriography

Some 227 patients who showed a 50% or greater narrowing of at least one major coronary artery in the first study underwent recatheterization at a mean interval of 35.6 months. Coronary arterial lesions and the degree of narrowing [i.e., normal (absent), 25%, 50%, 75%, 90%, 99% and complete occlusion (100%)] were classified in accordance with the AHA reporting system. When the lesions in the second study showed a change of equal or more than 2 in the above 7 stages in comparison with the first study, either progression or regression was determined. Of the 227 patients, progression occurred in 73 (32%) and regression was found in 7 (3%). In the aggravated group in symptom, progression was noted in 58%, and even in the stabilized group, progression was observed in 22%. As a result of the second study, 15 (21%) out of 73 patients showing progression underwent surgical treatment, and more than half of these cases (9/15) were constituted by the stabilized group. During the above follow-up periods, myocardial infarction occurred subsequently in 14 (19%) out of 73 patients showing progression. Up to the present time, sudden deaths occurred in 8 patients, and 5 out of 8 patients were also of the stabilized group. The authors wish to emphasize from these findings the necessity of aggressively pursuing restudy even in stabilized cases showing symptoms of ischemic heart disease.

[Clinical studies of SM-4300 in combination with antibiotics against severe bacterial infections]

SM-4300, a newly developed human immunoglobulin preparation was evaluated in 24 patients with severe bacterial infections and the following results were obtained. The clinical efficacy was excellent in 4 cases, good in 7, fair in 5, poor in 3 and unknown in 5 with the effective rate of 57.9%. No serious side effect nor abnormalities in laboratory findings due to administration of SM-4300 were observed except 1 case with slight elevation of GOT and GPT.

Body surface isopotential maps in old anterior myocardial infarction undetectable by 12-lead electrocardiograms

Body surface isopotential maps were recorded in 30 normal subjects and 32 patients with clinical evidence of old anterior myocardial infarction but without ECG findings of infarction. Position of the minimum in maps was compared at 5 msec intervals from the onset of QRS between the normal and infarction groups. A significant difference in the mean position of the minimum was observed at 5, 10, 15, 20, and 25 msec (p less than 0.001). The minima for the two groups achieved their clearest separation at 15 msec. Twenty-six of the 32 infarction patients showed the minima on the anterior chest, but 29 of the 30 normal subjects showed the minima on the back. These findings suggest the highly specific usefulness of body surface maps for the diagnosis of the presence of old anterior infarction undetectable by 12-lead ECGs.

Body surface isopotential maps of normal Japanese children

Body surface isopotential maps were compared between 52 normal children and 47 normal adults. While sequential changes in body surface potential distribution were similar, 4 significant differences in body surface maps were observed between them: 1) Surface maps of normal children showed less smooth contour of isopotential lines than did those of normal adults. For example, breakthrough minimum was recognized more frequently in children (100%) than adults (65%). 2) Breakthrough minimum appeared earlier in normal children (23.2 +/- 5.0 msec) than in normal adults (29.2 +/- 4.3 msec), and more leftwards on the chest. 3) Forty-seven percent of the children showed positive potentials on the upper and right portions of the anterior chest in the terminal phase of QRS, but this pattern was not observed in normal adults. 4) The maximum at the time of the peak of the T wave appeared more leftward in normal children than normal adults.

Correlation between body surface isopotential maps and left ventriculograms in patients with old inferoposterior myocardial infarction

In 24 patients with old inferoposterior myocardial infarction, body surface isopotential maps were compared with left ventriculographic findings. In 16 patients with asynergy restricted to the inferior and/or posterolateral segment, surface potential abnormalities due to infarction were observed during specific phases of QRS and in specific portions on the chest surface depending on the location and extent of ventricular severe asynergy (akinesis and dyskinesis). However, the remaining eight patients with coexisting severe asynergy in the anterior, apical, or septal segment showed surface potential maps quite different from those of the former patients. It is suggested that body surface isopotential maps are a useful clinical tool for detecting the location and extent of ventricular severe asynergy in patients with old inferoposterior myocardial infarction.

Correlation between body surface isopotential maps and left ventriculograms in patients with old anterior myocardial infarction

In 30 patients with old anterior myocardial infarction, body surface isopotential maps were correlatively studied with left ventriculographic findings. In 25 patients with ventricular asynergy restricted to the anterior segments, surface potential abnormalities due to infarction were observed during specific phases of QRS and in specific portions of the chest surface depending on the location and extent of severe ventricular asynergy (akinesis and dyskinesis). However, the remaining 5 patients with co-existing severe asynergy in the inferoposterior segment, showed body surface potential maps quite different from those of the above 25 patients. It was suggested that body surface isopotential maps were useful in detecting the location and extent of ventricular severe asynergy in patients with old anterior myocardial infarction.

Chemico-pharmacological studies on saponins of Panax ginseng C. A. Meyer. II. Pharmacological part

The pharmacological properties of seven pure saponins isolated from Panax ginseng C. A. Meyer were studied. 1. The ginseng saponins showed weak toxicities in mice. Especially, Rg1, Rf and Rb 1, which contained glucose as a sugar component, were weaker in their toxicities than the rest, which contained arabinose and/or rhamnose. It was also noted that the saponins containing protopanaxadiol as sapogenin were more toxic than those containing protopanaxatriol. 2. All the saponins diminished ACh-induced contraction of the isolated ileum of the guinea pig. On the other hand high concentrations of Rb 2 caused contraction of the ileum by itself. 3. All of the saponins induced a decrease in heart rate and showed biphasic actions on the blood pressure in rats, while they little affected respiration. They caused blood pressure fall preceded by slight rise. Among them, Rg 1 showed the most prominent action and it produced a blood pressure rise with doses of 30 to 100 mg/kg. The pressor as well as depressor action was not influenced by the pretreatment with any of atropine, diphenhydramine, phentolamine and propranolol. 4. Rg 1 and Re showed vasodilator action in dogs, the potencies of which were 1/20 and 1/50 of that of papaverine, respectively. Rc and Rb 2 showed very weak vasodilator actions but Rb 1 did not. 5. Among the 7 saponins, Rd, Re and Rb 2 showed more potent hemolytic actions than those of the rest and the potencies were proportional to their toxicities. 6. Whereas single administration of Rf, Re and Rd significantly suppressed the conditioned avoidance response, repeated administration of them caused facilitation of the response. On the other hand, Rb 2 always showed very weak suppressant action. 7. Rg 1, Rf, Re and Rd significantly suppressed the fighting of mice induced by foot shock, while Rb 1, Rb 2 and Re little affected the fighting. 8. All the saponins showed antifatigue action. They markedly increased the movement after compulsory gait and the action was consistent and independent of their action on the movement before compulsory gait. 9. The saponins showed moderate depressant actions on the EEG and the behavior in cats. They were qualitatively similar in their actions, although Rg 1, Re and Rb 2 were more potent than the rest. They also suppressed EEG arousal response induced by electrical stimulation of the mid brain in cats.

Chemico-pharmacological studies on saponins of Panax ginseng C. A. Meyer. I. Chemical part

For the purpose of clarification of pharmacological actions of ginseng saponins we tried the isolation of ginseng saponins on a larger scale and succeeded in the isolation of eight saponins in a pure state and in sufficient amounts for the pharmacological assay. These eight saponins agreed all completely with the authentic samples of Shibata-Shoji and co-workers in molecular formula of saponins and sapogenins, sugars and TLC. The physical properties of saponins were shown. As other components of ginseng, there were isolated small amounts of panaxadiol, panaxatriol, daucosterol from the first running of column chromatography and mannitol, sucrose and glucose from the ethanol insoluble aqueous extract.