Quantitative assessment of ventilation-perfusion mismatch by radioxenon imaging of the lung

By the use of xenon-133 and a scintillation camera with digital data storage and processing system, a topographic relationship between ventilation distribution (V) and perfusion distribution (Q) was examined quantitatively in two groups of normal nonsmokers and one of older smokers, all healthy. In addition, subjects with a variety of cardiopulmonary disease were tested. The fractional regional ventilation (VR) and regional perfusion (QR) were plotted against the V/Q ratio on a logarithmic abscissa for the normal subjects; both were distributed log-normally with a narrow standard deviation, and were dissociated slightly from each other. However, with smoking and with increasing age, the s.d. and the dissociation became wider, suggesting an impairment of gas exchange as estimated by alveolar-atrial gas-pressure differences (A-aD), which were calculated by putting these topographic relationships into a gas-exchange program in a computer. In various cardiopulmonary diseases a good correlation was found between the estimated A-aDO2 thus obtained and the actual A-aDO2 derived from analysis of the blood gases.

Radiologic-pathologic correlations of small lung nodules with special reference to peribronchiolar nodules

A radiologic and pathologic correlation has been made of small lung nodules. At necropsy 100 excised lungs were fixed and slices from them radiographed. The radiographs were used to select individual nodules for histologic study. Nodules in bronchopneumonia, acinonodose tuberculosis, chronic bronchiolitis, and simple pneumoconiosis due to ferric dust were shown to be located around inflamed terminal or respiratory bronchioles. Intraacinar infiltration was usually diffuse, but when nodules were seen, they occurred in peripheral airspaces with no relation to bronchioles. Hematogenous metastases showed distinctly marginated nodules, some truly intraacinar. Although each type of nodule can appear as an "acinar" or "subacinar" image on chest radiographs, this radiologic-pathologic study shows that they differ significantly in their relation to the airway structures.

A newly devised cutting probe for endoscopic sphincterotomy of the ampulla of vater

A new diathermy cutting probe for endoscopic sphincterotomy has been devised. This consisted of a standard Teflon catheter with a diathermy wire and a metal-marked long tip. Using an Olympus duodenoscope and this cutting probe, endoscopic sphincterotomy has been successfully performed in 38 out of 40 patients with common bile duct stones without any serious complications. Advantages and clinical results of this instrument are presented.

Reappraisal of cholesterol solubilization in bile salt-lecithin solution and the stability of bile

On the basis obtained in a preceding study, cholesterol solubilization in aqueous bile salt-lecithin solution was investigated. The alteration of mixing sequence was found to yield differences not only in the rate but also in the magnitude of cholesterol solubilization. Both the rate and the magnitude were remarkably bigger in the system solubilizing cholesterol and lecithin mixture by bile salt than that solubilizing cholesterol crystal by bile salt with solubilized lecithin. A linear relation between the quantity of solubilized cholesterol and the concentration of bile salt except for lower concentration range was obtained for every bile salt-lecithin system. Values of k, the slope of the partial straight line, determined for cholate, chenodeoxycholate, deoxycholate and equimolar cholate-deoxycholate systems were 5.85 X 10(-2), 7.60 X 10(-2), 9.50 X 10(-2) and 7.17 X 10(-2), respectively. Cholesterol solubilizing power of bile salt was thus enhanced by the addition of lecithin. Since the solubilizing power could be given by the ratio of the solubilizate to the solubilizer, it was expressed graphically by the ratio of cholesterol to bile salt as ordinate and the concentration of bile salt as abscissa. The saturability of cholesterol solubilization in bile was purposefully exhibited in this graph by plotting assayed data of biliary lipid components.

Small-intestinal involvement in familial polyposis diagnosed by operative intestinal fiberscopy: report of four cases

Operative intestinal fiberscopy, in which the duodenal fiberscope was introduced during laparotomy for colectomy in familial polyposis via the enterotomy opening, permitted the demonstration of small intestinal polyps in six of seven consecutive cases. Four of the six patients had adenomatous polyps in the proximal jejunum, including one patient with the concomitant presence of ileal adenomas. Polyposis due to lymphoid hyperplasia in the terminal ileum was found in three patients. Preoperative upper gastrointestinal surveys revealed adenomas in the duodenums of all seven patients, adenomas in the gastric antrum in three, and multiple hamartomas in the gastric corpus in two. Thus, in familial polyposis or Gardner's syndrome, more or less the entire gastrointestinal tract seems to be involved and the term "gastrointestinal polyposis" seems to describe these conditions.

Radioscintigraphy in the diagnosis of upper airway obstruction

Radiological and scintigraphic patterns in patients with upper airway obstruction are discussed. In contrast to the multiple hot spots of radioaerosol in bronchial asthma, localized spots were demonstrated in the neck and mediastinum. The sites correspond to those of severe obstruction of upper airways confirmed by tomography and bronchography. Aerosol inhalation lung scintigraphy is recommended for the patient with wheezing and a normal chest radiograph when a localized obstruction is suspected.

A comparative clinical study for the evaluation of antianxiety agents, (lorazepam, diazepam and placebo), in neurosis

To evaluate the clinical effects of lorazepam on neurosis, a double-blind controlled trial by group comparison procedure was carried out using diazepam and placebo as control drugs. The clinical improvement and aggravation rates by means of a variety of assessment of change were compared between each of the two active drugs and placebo. The superiority, characteristics of therapeutic effects and minor side effects of lorazepam which is similar to those of diazepam, a standard benzodiazepine anxiolytic for the treatment of neurosis, were demonstrated. From this study, many important problems which might be influenced upon the outcome of the pharmacotherapy on neurotics, such as positive and negative placebo effects, aggravation and drop-out during the trial, were also evaluated.

Some methodological considerations for the clinical evaluation of neuroleptics--comparative effects of clozapine and haloperidol on schizophrenics

For the purpose of evaluating objectively the characteristics of clinical effects of clozapine and haloperidol, a double-blind comparative trial was conducted on 91 schizophrenic in-patients. The changes of symptoms were assessed by means of several psychiatric and behavioral rating scales. The results were analyzed by means of nonparametric statistical methods. Furthermore, application of multivariate analysis was considered. After 12 weeks of treatment, though no significant difference in general improvement rate was noted between the two groups, a marked different spectrum of clinical effects was observed according to the rating scales. Clozapine is superior in anti-delusional, contact-promoting and sedative anxiolytic effect, while haloperidol is superior in anti-autistic effect. Among the side-effects, extrapyramidal symptoms appeared significatly more severe in the haloperidol group. The frequency of appearance of fever, was significantly greater in the clozapine group than the other. The four dropout cases of the clozapine group were all caused by fever. Through this clinical trial, clinical availability and validity of various statistical analytical methods were reconsidered.

Regional lung function in pulmonary hypertension

Utilizing 133-xenon gas and a scintillation camera, we examined the distributional relation between ventillation (V) and perfusion (Q) in patients with pulmonary hypertension (PH) comprising mitral stenosis (MS) and left to right shunt disease (shunt). In the case of MS, Q decreased at the dependent part of lung in proportion to the degree of PH, but preserved normal V and resulted in high V/Q value at this region, which was estimated to cause and physiological dead space effect on the gas exchange function. In the case of shunt disease, even with a high degree of PH, reduction of Q at the dependent lung region was not observed with normal preservation of V, thus obviating any type of the V/Q imbalance. Since the washout of xenon gas by resting tidal volume ventilation was observed to be delayed from the dependent lung region, latent ventilatory impairment in this region due to small airway closure at tidal breathing was also suspected.

Pulmonary changes in congenital heart disease of childhood: histometrical and histological studies

One hundred and fifty lungs from the cases below 15 years of age with various congenital heart diseases and 80 controls were used for histometrical and histological studies. Cases with congenital heart disease were divided into two groups of the increased and the decreased pulmonary blood flow. In the former group, the thickness of the pulmonary arterial media was the same as that of controls in the neonatal period, and through the wall thickness gradually decreased in a pattern seen in controls, the thickness was constantly larger than that of controls. In some cases, the media increased gradually within 6 months after birth. Pneumonia and massive pulmonary hemorrhage were seen in a higher incidence in autopsy cases. Pneumonia in younger infants was histologically characteristic and possibly more correlated to their death. In the latter group, most of the cases were with the thinner medias of the pulmonary arteries. Massive pulmonary hemorrhage was not common in the latter group.

Basic studies on cholesterol solubilization in bile salt solution

Previous studies on cholesterol solubilization by bile salts have often shown inconsistencies. To obtain basic informations on this problem, cholesterol solubilization in the aqueous solution of several bile salts have been reexamined. Kinetic studies revealed that not only the rate but also the magnitude of solubilization depended on the amount of excess cholesterol and the concentration of bile salt. An appropriate proportion of added cholesterol to bile salt was evaluated as 1:5-10 (w/w), corresponding to about 200% excess amount to approximate supposed solubility. The solubilization equilibrium was rather difficult to fix and must be checked by the procedure used. A linear relation was obtained between the quantity of solubilized cholesterol and the concentration of bile salt. The slope of the straight line was designated k. As the solubilizing power could be given by the ratio of the solubilizate to the solubilizer, it was expressed numerically by k value as well as graphically by the molar ratio of cholesterol to bile salt as ordinate and the molar concentration of bile salt as abscissa in which the above relation was hyperbolic, k being as asymptote. k values obtained for cholate, chenodeoxycholate, deoxycholate and equimolar cholate-deoxycholate mixture were 3.72 X 10(-2), 6.79 X 10(-2), 8.10 X 10(-2) and 6.55 X 10(-2) respectively.

Inhalation scintigraphy with radioaerosols in bronchogenic carcinoma

Radioaerosol inhalation lung scintigraphy is discussed and its interpretation based on the segmental anatomy of the lung is presented. Correlation between bronchography and inhalation scintigraphy in 26 cases of bronchogenic carcinoma showed that partial obstruction of a major bronchus produces a clear "hot spot" with peripheral decrease of aerosol deposition, while partial or complete obstruction of the segmental bronchi causes segmentally decreased deposition distal to the site of obstruction. Even at an early stage, bronchogenic carcinoma may be detected by aerosol inhalation scintigraphy whenever the tumors are large enough to produce visible abnormalities of aerosol deposition.

Effect of vitamin B6 deficiency on collagen metabolism in rats

The effects of VB6 deficiency on collagen metabolism were studied using young and adult rats. It was observed in VB6 deficient rats, that both the amount of urinary hydroxyproline and salt soluble fraction of skin collagen decreased. Furthermore, decrease of the alpha-component and increase of the beta-component were also found in the soluble collagen. However, the activity of plasma amine oxidase was lower and the aldehyde content in the acid soluble collagen were also lower than the control group. These changes were revealed more clearly in young growing rats than in adult rats. Based on these results, it may be that VB6 participates in the allysine (alpha-amino-adipic-delta-semialdehyde) formation which is considered as the first step of collagen maturation and also in the synthesis of protocollagen peptide chains.