[A survey on elderly patients' knowledge of management of health care]

We conducted a questionnaire survey on the awareness of elderly patients in our hospital concerning medical management. As to the recognition of their own diseases, patients aged 80 or older, showed a lower degree of understanding than those under age 80. The proportion of patients who wished to known about their diagnosis decreased with age, although no statistical significance was recognized. Those who wished to known about their diagnosis, even if it were malignant, reduced significantly depending on the increase in age. In addition, the proportion of patients who would not like to know their diagnosis, if it were malignant, increased significantly as age increased. Proportions of patients who wanted to know other information, such as prognosis, the aims, methods and results of medical examination, the methods and adverse effects of treatment, and the names, effects and side effects of drugs, also decreased significantly as age increased. However, there were no statistical significant differences in the proportion of answers between cases of malignant and non-malignant disease. These data show that elderly patients had more anxiety or fear about malignancy, and wished to know less about medical management than non-elderly patients.

The effect of the partial pressure of oxygen on blood glucose concentration examined using glucose oxidase with ferricyan ion

Glucose oxidase with ferricyan ion (GOD-F) is widely applied in clinical settings as a glucose sensor. However, blood oxygen concentration affects this blood glucose value because oxygen, at increased concentrations, consumes blood glucose, which cannot then be measured by this sensor. We investigated the effect of PO2 on blood glucose concentration in 48 patients who were breathing high concentrations of oxygen. Arterial and pulmonary arterial blood glucose values were analyzed using the GOD-F method and, as a control, the hexokinase method. The respective PO2 values were also measured. The blood glucose concentrations measured by the GOD-F method show a significant linear relation with that measured by the hexokinase method in both arterial (y = -24.4 + 1.01x, r = 0.99) and pulmonary arterial blood (y = -3.4 + 1.01x, r = 0.96). The difference of intercepts is statistically significant, but because of the relatively large limits of agreement indicating any hidden extraneous variabilities, the error of the GOD-F method could not be assessed just by the difference. The equation defining the effect of PO2 on the percent change between blood glucose measured by the GOD-F method and that measured by the hexokinase method is -19.8/(1 + 203900/PO2(2.68) (r = 0.62). This formula generally follows our measured materials and introduces the relationship among blood glucose value, PO2, and the error of the GOD-F method. We hesitate to suggest that the arterial blood glucose concentration when measured by the GOD-F method could be underestimated by as much as 20% in patients with high arterial oxygen pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Accuracy of self-report for stomach cancer screening

Limited evidence is available regarding the accuracy of recall for cancer screenings. We compared the self-report of stomach cancer screening with medical records in 337 residents of a rural town in northeastern Japan, who were eligible for annual screening offered by the town. Frequencies of attendance within the last 5 years were asked in a self-administered questionnaire, and determined from the records of the organization conducting the screening. When the frequencies were dichotomized as ever/never screened within 5 years, the self-report agreed substantially with medical records, but tended to overestimate the actual attendance (kappa = 0.68, sensitivity = 100%, specificity = 75.6%). Past history of gastroduodenal diseases and family history of stomach cancer were associated with the overreport. Although the population studied was highly selective (rural Japanese volunteers), review of the previous studies on mammography and Pap smear also showed that self-reports tended to be exaggerated. Self-report of cancer screening should be regarded as an overestimated indicator of its true prevalence.

Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound

Viscera slide is the normal, longitudinal movement of the intraabdominal viscera caused by respiratory excursions of the diaphragm. By detecting areas of restricted viscera slide, ultrasonic imaging was used to identify anterior abdominal wall adhesions prior to laparotomy or laparoscopy. Transcutaneous ultrasound examination was performed on 110 patients. A prediction of adhesions was made for each patient and then compared to the findings during subsequent laparotomy or laparoscopy. Only patients with previous abdominal surgery or history of peritonitis demonstrated adhesions. Sensitivity and specificity of viscera slide ultrasound in predicting adhesions were 90% and 92%. Nine out of 10 false results involved misinterpretation of ultrasound images of the lower one-third of the abdomen. Ultrasonic imaging of viscera slide is highly accurate in detecting abdominal wall adhesions. This technique is most useful in guiding the insertion of trocar in laparoscopic surgery, and as a noninvasive method in studying the formation of adhesions.

Psychometric equivalence of the Hasegawa Dementia Scale-Revised with the Mini-Mental State Examination in stroke patients

Responses to the Hasegawa Dementia Scale-Revised and the Mini-Mental State Examination were examined for 49 stroke patients to investigate the psychometric equivalence between the two tests. Pearson product-moment correlation and Spearman rank-order correlation between the two tests were 0.87 and 0.78. Each test's scores significantly correlated with the Full Scale IQs on the Wechsler Adult Intelligence Scale--Revised: 0.61 for Hasegawa's Dementia Scale and 0.69 for the Mini-Mental State Examination. These values indicate that the two tests are judged comparable measures for screening cognitive impairment in stroke patients.

Characterization of effector cells against B16 melanoma in mice inoculated with allogeneic spleen cells

Inbred C57BL/6 (B6) mice which had received an inoculation of allogeneic spleen cells showed remarkable antitumor activity against syngeneic tumor challenge with B16 melanoma cells 3 days after the allogeneic cell inoculation. This antitumor activity was not specific to the inoculated alloantigen, since the challenging B16 cells are syngeneic to B6 mice and since it was induced by BALB/c spleen cells as well as C3H/He spleen cells. The antitumor activity was sensitive to an in vivo treatment with anti-asialo GM1 (AGM1) antiserum or anti-Thy.1 monoclonal antibody (mAb) just before the tumor challenge and was resistant to an in vivo treatment with anti-CD8 (Ly.2) mAb. These results suggest that AGM1+Thy.1+CD8- activated natural killer (NK) cells were generated by alloantigen inoculation and took an important part in the antitumor effect of the alloantigen inoculation.

Oligonucleotide probe design--a new approach

The use of oligonucleotides for gene amplification, as diagnostic probes or antisense-based drugs can be optimized by minimizing the possibility of nonspecific hybridization.

[Novel computerized method for designing nucleotide sequence used for DNA probes and PCR primers]

There is no consensus on how to determine optimal sequences of oligonucleotides used as DNA probes and PCR primers, which exhibit high sensitivity with minimum chance of cross-hybridization to other unrelated genes in the target tissues and cells. Here, we propose new strategy for designing oligonucleotide sequence using newly developed computer program, in which candidate oligonucleotides having similar melting temperature (Tm) are extracted from every position of the target gene, then extensive homology analysis is carried out between each candidate oligonucleotide and all the sequences in the user-defined databases using an efficient proprietary algorithm. The new computer program allows researchers to design any probes and primers easily and quickly without having detailed information of the target gene.

Ultrastructural and immunocytochemical study of the leptomeres in the mouse cardiac muscle fibre

The three-dimensional configuration and chemical composition of leptomeres in the mouse ventricular cardiac muscle fibre were electron microscopically and immunocytochemically investigated using semithin sections and specific antibodies against actin, the intermediate filament proteins desmin and vimentin, and the actin-binding proteins alpha-actinin, filamin and vinculin. The leptomeres appeared columnar in shape and periodically segmented by electron-dense disc-like septa. The electron-lucent areas between these septa were composed of fine interlinked filaments running obliquely to the major axis of the leptomere. Actin was localized in the electron-dense lines of the leptomeres but not in the fine filaments. No reaction was, however, detected for desmin, vimentin, vinculin, filamin and alpha-actinin. The present results suggest, therefore, that the leptomeres may not have a contractile function.

beta 2-GPI-dependent and independent binding of anticardiolipin antibodies in patients with recurrent spontaneous abortions

We measured anticardiolipin antibodies (aCL) in plasma samples from 214 women with a history of recurrent spontaneous abortions by an enzyme-linked immunosorbent assay (ELISA) utilizing solid phase cardiolipin (CL) and beta 2-glycoprotein I (beta 2-GPI). Sixteen patients (7.5%) were positive for beta 2-GPI-dependent aCL. Though beta 2-GPI appeared to enhance the binding of aCL, beta 2-GPI-independent aCL were also observed in these patients (4.7%). The patients were classified into three groups on the basis of their medical history, and analysis of data of individual groups revealed that the incidence of beta 2-GPI-dependent aCL was significantly higher in patients who had experienced at least one fetal loss in the second or third trimester.

Experimental assessment of spectrum analysis of ultrasonic echoes as a method for estimating scatterer properties

In vitro experiments using weak scatterers ranging in size from mean longest diameter of 26.9 to 83.0 microns were performed to test the validity of theoretical predictions for scatterer size and concentration derived from normalized power spectrum parameters of ultrasonic backscatterer echoes. Scatterers consisting of cell clusters were suspended in collagen gel and scanned by a 10 MHz transducer system. Optical measurements validated theoretical predictions that (1) slope value is a function solely of scatterer size; (2) intercept value is a function of scatterer size and concentration; and (3) midband fit value increases as scatterer concentration increases, and, to a lesser extent, as size increases. These results were obtained under relatively ideal conditions of minimal attenuation and scatterer spacing (not closer than two scatterer diameters) and were consistent with the assumptions underlying the scattering theory.

Clinical evaluation of severe ischemic limbs by tissue reflection spectrophotometry

The clinical usefulness of tissue reflection spectrophotometry in the prognosis of ischemic limbs was evaluated. The diseased group (n = 12) consisted of 7 cases of femoral artery thrombosis, 4 cases of chronic obstructive arteriosclerosis and 1 case of femoral vein thrombosis. The normal control group consisted of 14 limbs in 7 normal subjects (n = 14). Index of tissue hemoglobin concentration (IHb) was 37.3 +/- 4.5 (n = 14) in the normal control group and 38.5 +/- 16.9 (n = 12) in the diseased group, which was not significantly different. In a subgroup of patients who required amputation or developed necrosis (severe subgroup), the value was 54.2 +/- 1.7 (n = 6). This was significantly higher than the value of 22.8 +/- 8.5 (n = 6) obtained in a subgroup of patients who received the conservative treatment of thrombectomy (mild subgroup) (p < 0.05). Index of tissue oxygen saturation (ISO2) was 28.0 +/- 4.9 (n = 14) in the normal control group, and 9.1 +/- 2.7 (n = 12) in the diseased group (p < 0.05). ISO2 was 7.0 +/- 1.6 (n = 6) in the severe subgroup which was significantly lower than 11.2 +/- 1.9 (n = 6) in the mild subgroup (p < 0.05). Tissue reflection spectrophotometry therefore appears to provide clinically useful information for the prognosis of ischemic limbs.

2 cases of gastric-cancer remarkably reduced with a combined dosage of irsogladine maleate preparation and uft

Irsogladine Maleate intensifies the degree of intercellular contact so we expected that a combination of Irsogladine Maleate and UFT would cause tumor-reducing effect and normalization of the malignant cells. A combination of Irsogladine Maleate and UFT was administered to 2 patients with inoperable gastric cancer (Case 1: An 83-year-old male: Borrmann type I, Case 2: A 93-year-old female: A relatively wide early gastric cancer), marked tumor reduction was obtained in both cases. The doses administered were 4 mg/day of Irsogladine Maleate and 200 mg/day of UFT.

Small, round-structured viruses (SRSVs) associated with acute gastroenteritis outbreaks in Gifu, Japan

Two outbreaks of non-bacterial gastroenteritis occurred in Gifu prefecture in January 1989 and in January 1991. Both outbreaks were closely related to the consumption of raw oysters, and showed similar clinical features. Small, round-structured virus particles were found in patient stools in both outbreaks by electron microscopy. The role of these particles as the causative agents of the outbreaks were strongly suggested by immune electron microscopy and/or western-blotting immunoassay. When compared with SRSV-9 (Tokyo/SRSV/86-510) reported previously (Hayashi et al, J. Clin. Microbiol., 27: 1728-1733, 1989), it was found that these viral particles were antigenically similar to SRSV-9, and had a major structural protein of 63 kilodaltons (kDa). Further, the prevalence of this agent in Gifu area was examined by western blot antibody assay using 67 serum samples collected from the inhabitants in 1991. The results indicated the circulation of the same or antigenically similar agent in this area.

Technique of ultrasound examination during laparoscopic cholecystectomy

Intracorporeal ultrasonography was used as a new method to examine the bile ducts during laparoscopic cholecystectomy. A prototype rigid 7.5-MHz ultrasound probe, 10 mm in diameter and 50 cm in length, was introduced during 25 laparoscopic cholecystectomies. A dual scanning technique was developed for complete examination of the bile duct. This entailed transverse scanning via the subxyphoid trocar and longitudinal scanning via the umbilical trocar. The intrahepatic ducts were also visualized by placing the probe on the liver surface. Color Doppler imaging was useful to quickly distinguish the duct from vascular structures. Laparoscopic ultrasonography clearly delineated the bile ducts in all operations except one. The time required for imaging was significantly shorter for ultrasonography than for cholangiography. Our preliminary experience demonstrates that a complete examination of the bile ducts can be performed with intracorporeal ultrasonography in a relatively short period of time.

Leukemoid reaction associated with diabetic ketoacidosis--with measurement of plasma levels of granulocyte colony-stimulating factor

A 40-year-old man with diabetic ketoacidosis showed marked leukocytosis reaching 60,970/mm3 which subsided within 5 days to a level of 4,140/mm3. He had no evidence of infection. During the entire clinical course, no elevation of granulocyte colony-stimulating factor (G-CSF) was observed. No case of leukemoid reaction associated with diabetic ketoacidosis has been reported with the determination of plasma G-CSF levels.

Quartz crystal microbalance for the detection of microgram quantities of human serum albumin: relationship between the frequency change and the mass of protein adsorbed

We have developed a piezoelectric immunosensor for the detection of microalbumin. Human serum albumin (HSA) in the range 0.1-100 micrograms mL-1 could be detected using a flow cell; the immunosensor is sensitive enough to monitor levels of albuminuria. The immunosensor did not respond to bovine serum albumin, only to HSA, implying that the specificity for HSA was high. We investigated the relationship between the frequency change (delta F) and adsorption per unit area of piezoelectrically active quartz crystal (delta M). delta M was estimated with radioisotope-labeled anti-HSA or HSA. When anti-HSA was adsorbed onto the surface of the crystal or HSA was bound to anti-HSA supported by the crystal, values of magnitude of delta F/delta M were larger than the value predicted from theory (Sauerbrey's equation). Furthermore, magnitude of delta F/delta M for HSA was larger than that for anti-HSA.

Modification of liposomes by addition of HCO60. I. Targeting of liposomes to liver by addition of HCO60 to liposomes

The influence of HCO60 on the blood clearance and tissue distribution of soybean phosphatidylcholine (PC) liposomes, encapsulating alpha-tocopherol as a marker, was studied in rats. The liposomes were prepared by the hydration method from a lipid film containing different amounts of HCO60, and by extrusion through a 0.1 micron polycarbonate membrane filter. The blood clearance and liver uptake of alpha-tocopherol after i.v. administration increased with increasing the amount of HCO60 the liposome contained. With 80 wt% HCO60 liposomes, the accumulation of alpha-tocopherol in the liver was approximately three-fold that of the 100% PC liposomes. The uptake by lungs, spleen and kidneys did not change with the addition of HCO60. The findings obtained in a gel-filtration study suggested that alpha-tocopherol is not removed from the liposomes, with or without HCO60, by rat plasma proteins and the HCO60 micelle may form a complex with rat plasma proteins. Our findings suggest that liposomes containing large amounts of HCO60 (more than 60 wt%) will be useful for delivering drug to the liver.

[Higher production of tumor necrosis factor (TNF) elicited by a biological response modifier (BRM) in aging mice]

We investigated age-related changes in the capacity for tumor necrosis factor (TNF) production in young and aged inbred C3H/He mice by injecting them with OK-432, a biological response modifier (BRM). An intravenous injection of 0.4mg of OK-432 was found to induce TNF production and two consecutive injections of 2KE of OK-432 induced much higher TNF production. Both the single and two consecutive injections of OK-432 induced significantly higher TNF production in aged mice than in young ones. Furthermore, the TNF-productive response to the two consecutive injections of OK-432 seemed to increase with aging. Male mice tended to show a marginally higher TNF-productive response than females. The mechanism by which aged mice have a higher capacity for TNF production is not clear. The following possibilities are conceivable. 1) Macrophages which are major TNF producer cells may be activated in aged mice. 2) Specific T cells which are cross-reactive to antigenic determinants in OK-432 may be increased in number in aging mice and activate macrophages effectively to produce TNF when stimulated by OK-432. In general, immunological functions tend to decline with aging. Our present results, however, suggest that by using an appropriate BRM we may be able to induce higher TNF production in the aged. This might lead to effective prevention and therapy for tumors, which increase in incidence with age.

Modification of liposomes by addition of HCO60. II. Encapsulation of doxorubicin into liposomes containing HCO60

The efficiency of encapsulation of doxorubicin (DOX) into liposomes containing HCO60 was studied. Empty egg phosphatidylcholine (PC) liposomes containing various amounts of HCO60 were passed through a polycarbonate membrane filter (0.1 micron). Closed vesicles were formed even with liposomes containing 90 wt% HCO60. DOX was encapsulated efficiently (more than 1 mg DOX/8 mg lipids) using a pH-gradient method. HCO60 accelerated the leakage of DOX from liposomes into phosphate buffer at temperatures above 25 degrees C. HCO60 suppressed the leakage of DOX from egg PC/cholesterol (7/3, w/w) liposomes into phosphate buffer containing 50% fetal bovine serum (FBS). Studies on the interaction between liposomes and serum components using zeta potential and turbidity suggest that HCO60 prevents the liposomes from interacting with serum components.

Operative color Doppler imaging for general surgery

Operative CDI was performed during 125 general surgical operations (53 hepatic, 25 biliary, 24 pancreatic, 7 esophagogastric, 10 pulmonary, 3 kidney transplant, and 3 soft tissue operations). Operative CDI provided beneficial information in 108 of 125 operations (86.4%). On the basis of operative CDI findings, surgical management was altered in 34 of 125 operations (27.2%), most frequently hepatic and pancreatic operations. Operative CDI demonstrated advantages over B-mode imaging in (1) detection and localization of small blood vessels that are impossible or difficult to identify by B-mode imaging, (2) rapid and definitive distinction of blood vessels from other hypoechoic areas, such as tissue spaces and ducts, (3) determination of the relation of tumors to vascular structures such as vascular invasion of carcinoma, (4) confirmation of blood flow to organs after surgical procedures, and (5) clearer needle localization for guidance of needle placement by color motion marking.

Influence of liposomes on tryptic digestion of insulin. II

The mechanism of enhancement of tryptic digestion of insulin by empty liposomes was studied using HPLC analysis, gel filtration (insulin binding to the liposome and lipid transfer to the insulin) and an electrokinetic study using the zeta meter (trypsin binding to the liposome). Soybean phosphatidylcholine (PC), phosphatidic acid (PA) [PA/PC = 1/9] and stearyl amine (StA) [StA/PC = 1/9] were used as neutral, negatively charged and positively charged liposomes, respectively. Tryptic digestion of insulin was enhanced by reducing the liposome size from 150 to 40 nm when neutral empty liposomes were used. The amount of insulin bound to neutral empty liposomes increased on reducing liposome size. Nevertheless, no strong evidence of trypsin binding to neutral empty liposomes was obtained. The amount of liposome-bound insulin was greater for PC than StA/PC and PA/PC, and the amount of lipids transferred to insulin decreased in the following order; StA/PC > PA/PC > PC. These findings suggest that the positively charged liposome did not enhance tryptic digestion, because insulin was protected from tryptic digestion by surrounding lipids from positively charged liposomes (StA/PC). Trypsin bound to the PA/PC liposomes, but not to the PC or StA/PC liposomes.

Housing factors and perceived health status among Japanese women living in aggregated dwelling units

An epidemiologic survey was conducted of the 818 households in a community consisting of aggregated dwelling units in Tokyo, Japan, in order to assess the relationship between housing environment and psychological or physical health status of the female residents. Psychological health status was assessed by the 28-item General Health Questionnaire in Japanese translation. Main housing factors such as internal density (person-to-room ratio) and floor level (vertical location) of the dwelling unit did not have significant effects on the psychological health status of the sample of Japanese women, but the internal density generally did not exceed 1.5 persons per room. However, physical health status might be associated with floor level: women living at the highest levels complained of more symptoms than did those at lower floor levels, when the type of dwelling unit (i.e., high-rise, low or medium height building) was not taken into account. Poor psychological health status was found among women who were dissatisfied with the plan of their house or with the room arrangement, were anxious about earthquake or other accidents, perceived the house as inadequate for the children, were annoyed by indoor noise, and complained of outdoor noise.

[A case of paraneoplastic autonomic and sensorimotor neuropathy with dysfunction in the afferent limb of baroreflex arc]

A 65-year-old man visited our hospital with complaints of tingling sensation in the distal parts of his extremities and dysuria, which first appeared 2 months before admission. He had no abnormal findings on physical examination. Neurological examination revealed sensory impairment of glove and stocking type, mild motor weakness and muscular atrophy in the proximal parts of arms and legs, and absent tendon reflexes in knees and ankles. Fasciculation was observed on his shoulders and upper extremities, and myokymia on the abdominal wall and bilateral calves. He had hyponatremia, which was proved to be caused by SIADH. Anti-acetylcholine receptor antibody, anti-GM1 ganglioside antibody and anti-galactocerebroside antibody were detected in the serum. Chest X-ray showed mass shadows in the mediastinum, which were confirmed as malignant thymoma by needle biopsy. Orthostatic hypotension, neurogenic bladder and anhidrosis were observed by the autonomic function tests. Lesions responsible for orthostatic hypotension and SIADH were suspected in the afferent fibers from baroreceptors, since an reactive increase of plasma arginine vasopressin to orthostatic hypotension was blunted and reflex hypertension in the cold pressor test was well-preserved, while overshoot in Valsalva's maneuver was absent. It is important that afferent baroreceptor dysfunction may be associated with paraneoplastic neurological syndrome, since lesions in acute autonomic neuropathy are usually in the efferent fibers.

Influence of liposomes on tryptic digestion of insulin

The influence of phosphatidylcholine liposomes on the tryptic digestion of insulin was studied to obtain basic information on the interaction between liposomes and peptides or proteins. Protection of insulin from tryptic digestion by liposomes depended on the encapsulation efficiency and the method of preparation of liposomes. REV (reverse phase evaporation vesicles) were most effective for the protection of insulin from tryptic digestion. Tryptic digestion of insulin was accelerated by negatively-charged liposomes (containing 10% phosphatidylserine, phosphatidylinositol, or phosphatidic acid) or by neutral empty liposomes, this digestion being enhanced by progressively smaller liposome size (from 2 to 0.1 microns) in the case of neutral empty liposomes. These results suggest that this enhancement had occurred on the surface of the empty neutral or negatively-charged liposomes. Positively-charged empty liposomes (containing 10% of stearylamine) weakly suppressed the tryptic digestion of insulin. The size of the positively-charged liposomes increased after the addition of insulin, this size increase suggesting that these liposomes were fused by insulin. Presumably, insulin was protected by the lipids around the insulin molecule after the insulin-induced fusion or aggregation of positively-charged liposomes.