Prognostic value of histologic and clinical factors in 56 patients with gastrointestinal lymphomas

To investigate the prognostic value of histologic and clinical factors in lymphomas of the gastrointestinal (GI) tract, the clinicopathologic findings in 56 Japanese patients with GI lymphomas were reviewed. They included 37 patients with gastric and 19 with intestinal lymphomas. The male to female ratio was 2.7:1 in gastric and 11:1 in small intestinal lymphomas. Histologically, all but one of intestinal lymphomas were high-grade lymphomas. Gastric lymphomas comprised 47% of low-grade and 53% of high-grade tumors. Significant factors for favorable prognosis identified by Cox's multivariate analysis were female sex, the presence of reactive lymphoid hyperplasia (RLH) in the primary site, early stage of disease, gastric lymphomas, and low-grade histologic type. The important role of chronic lymphocytic infiltration for development of gastric lymphoma was suggested by the high incidence of RLH and the intermediate lymphocytic type of lymphoma.

Comparative evaluation of brain CT and ELISA in the diagnosis of neurocysticercosis

This study compares the results of cysticercus-specific IgG antibody levels, as measured by enzyme-linked immunosorbent assay (ELISA), with brain CT findings in suspected neurocysticercosis and to assess the clinical significance of ELISA. One hundred twenty-three neurologic patients were examined by both brain CT and ELISA. Sensitivity and specificity of ELISA in confirmed cases were 94% and 91%, respectively. Patients with multiple cysts without enhancement on CT, which were thought to represent viable cysticerci, were positive by ELISA. Those with cysts with enhancement or poorly defined low densities or enhancing nodules, which represented cysticerci on degeneration, were also positive by ELISA. Those with multiple spotty calcifications, which represent cysticerci in the inactive stage, were negative by ELISA. Those with mixed CT findings of the above, which represent the various stages of infection in a patient, were positive by ELISA. Those with only enhancing nodules with surrounding edema, which were thought to be other inflammatory granulomas, were negative by ELISA. If patients with only hydrocephalus on CT are positive by ELISA, they can be confidently diagnosed as having ventricular cysticercosis. The results indicate that ELISA is useful as a complementary diagnostic tool, especially in patients with equivocal CT findings of neurocysticercosis. Provision of etiologic information on a biologic basis was the advantage of this serologic test.

Malignant lymphomas in Korea

A retrospective histological study of 540 malignant lymphomas diagnosed at the Department of Pathology of the Seoul National University from 1976 through 1986 is presented. Malignant lymphoma is the 10th most common malignant tumor in Korea, comprising 3.07% of all malignancy during period of study. Among malignant lymphomas non-Hodgkin's lymphoma accounted for 82% and accordingly the Hodgkin's disease was for 18%. The most common type of non-Hodgkin's lymphoma was diffuse histiocytic lymphoma of Rappaport. Follicular lymphoma was very rare, comprising only 2.3%. T-cell lymphoma accounted for 9.6% of non-Hodgkin's lymphomas, the most frequent type being lymphoblastic lymphoma. Immunoblastic sarcoma and mycosis fungoides were occasionally seen but there was no case of pleomorphic adult T-cell lymphoma. Among Hodgkin's diseases, mixed cellularity type was the most common type, and nodular sclerosis type was relatively rare.

An evaluation of frozen section biopsy in 4434 cases

Frozen section diagnosis is a highly useful method of diagnosis. There were 4434 frozen sections, 24 false positive diagnosis, 65 false negative diagnosis and 30 deferred diagnosis. This method achieves the highest accuracy when there is a cooperation between experienced surgeon and reliable and careful pathologist. It is wise to defer the diagnosis of consult to other pathologist in difficult situation.

Cerebral sparganosis: CT characteristics

Cerebral sparganosis is an extremely rare parasitic zoonosis caused by a migrating plerocercoid tapeworm larva, genus Spirometra. Nineteen computed tomography (CT) scans of 12 patients with cerebral sparganosis were retrospectively analyzed and correlated with clinical and pathologic data. On CT scans, the following characteristics were noted: (a) unilateral involvement; (b) extensive or multifocal areas of low density along white matter bundles, with ipsilateral ventricular dilatation and localized cortical atrophy; (c) nodular or irregular enhancement with spotty calcification; and (d) change in location of enhancing nodules on sequential scans. These pathognomonic features reflect a chronic inflammatory process with both active granulomatous lesions and widespread degeneration of brain tissue, especially in the white matter. Degeneration is probably caused by migration of the long-surviving larva along the fiber tracts of white matter.

Characterization of the Cryptosporidium antigens from sporulated oocysts of Cryptosporidium parvum

The antigenic constituents of sporulated Cryptosporidium parvum oocyst antigens were characterized with antisera from mice immunized against C. parvum. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by silver staining defined the major proteins. Six of seven lectins used recognized as many as 15 bands. The lectins concanavalin A, Dolichos biflorus, and wheat germ agglutinin showed strong activity against the same eight bands with molecular weights ranging from 72,000 to greater than 100,000. An enzyme-linked immunosorbent assay was used to detect antibody to C. parvum. Antibody binding was significantly decreased by heat and enzymatic treatment with trypsin, protease, and mixed glycosidases. C. parvum antigens were further defined by the reactivity of immune sera with a C. parvum sonicate preparation separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and electrophoretically transferred to nitrocellulose paper. Antisera from orally infected mice consistently recognized four antigens with molecular weights ranging from 72,000 to greater than 100,000. These antigens also bound concanavalin A. Treatment of the antigen preparation with mixed glycosidases reduced the reactivity of antisera with most antigens with molecular weights greater than 60,000. The data suggest that the antigenic composition of C. parvum is complex and that carbohydrates alone or in association with lipids or proteins may be important in the immune response to C. parvum.

Percutaneous pulmonary valvuloplasty with a double-balloon technique

Percutaneous pulmonary valvuloplasty with a double-balloon technique was used in eight patients, aged 10-40 years, in whom valvuloplasty with a single 20-mm balloon resulted in inadequate dilatation of the stenosis. The diameters of the additional balloon varied from 10 to 20 mm. Balloons were inflated manually at about 30-45 psi (206.7-310.1 kPa) and deflated immediately after disappearance of the balloon waist. The mean peak systolic pressure gradient was 85 mm Hg +/- 37 before valvuloplasty, and it decreased to 38 mm Hg +/- 28 afterward (P less than .05). Double-balloon dilation and simultaneous computed tomography were done in two cardiac specimens from adult cadavers. At inflations at 30 and 45 psi (206.7 and 310.1 kPa), the outflow tract was elongated, and the balloons also deformed into ovoid shape at the lower pressure. The double-balloon technique appears to be safe and effective for relief of pulmonary valvular stenosis in those cases in which single-balloon technique is inadequate, especially in older children and adults.

The inferior accessory hepatic fissure: sonographic appearance

The inferior accessory hepatic fissure, a coronal or parasagittal fissure through the parenchyma of the posterior segment of the right hepatic lobe, was observed sonographically in 15 of 2000 patients. The fissure was seen as a thin, echogenic membrane stretching downward from the right branch of the portal vein to the inferior surface of the right hepatic lobe. On cadaveric sections, the fissure was an invagination of peritoneum directed laterally and slightly posteriorly from the medial inferior surface of the right hepatic lobe below the porta hepatis.

Hepatitis B vaccination of newborn infants: clinical study of new vaccine formulation and dose regimen

To investigate the efficacy in anti-HBsAg response with half the recommended adult dose in a standard vaccination schedule or with a full dose in reduced number of vaccination schedule, 201 healthy newborn infants were randomized to receive either 2.5 micrograms Hevac B vaccine at birth [1, 2 and 14 months in Group I (101)] or 5 micrograms at birth [2 and 14 months in Group II (100)]. Anti-HBsAg responses in the two groups were compared. Passively acquired anti-HBsAg positivity rates at birth were 51.5 and 45.0% in Groups I and II, respectively. Cumulative anti-HBsAg seroconversion rates in Group I were 12.2, 76.6, 82.6 and 86.4% at 2, 4, 14 and 16 months, while the rates in Group II were 2.5, 62.5, 73.7 and 91.0%, showing no significant difference (p greater than 0.05). Significant difference in seroconversion rates at the 2-month follow-up stage between passively acquired anti-HBsAg-negative and -positive groups was observed (11.9 vs. 2.6%). Significant rise in anti-HBsAg titer at 16 months following the booster at 14 months was noted: 36.4 mIU per ml before, 546.4 mIU per ml after in Group I and 25.3 mIU per ml before, 782.6 mIU per ml after in Group II. The booster, 12 months after the primary vaccination series, is therefore considered imperative for maximum effectiveness of hepatitis B active immunization.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracranial granulocytic sarcoma (chloroma) in a nonleukemic patient

Chloroma is a granulocytic sarcoma with it's characteristic greenish color. Recently there is an increased number of cases that are apparently aleukemic when the tumor mass is first presented. Recently we experienced a case of granulocytic sarcoma with characteristic green color (chloroma), which showed no evidence of leukemia in the bone marrow and peripheral blood. This patient presented headache, and was diagnosed brain tumor on computed tomography. A left parietal cranietomy was done to remove a large central dome-like mass, 8 cm, involving the dura with a slightly dusky greenish solid appearance. Compact nests of moderately mature granulocytes and immature cells comprised the tumor. Histochemical and electron microscopic studies confirmed these tumor cells as myeloid cells in varying stages of maturation. Several days after the operation, left cervical lymph nodes became palpated, and the biopsied lymph nodes revealed same neoplastic cells seen in the skull. However, bone marrow aspiration, biopsy and peripheral blood smears did not show any evidence of leukemia.

Mediastinal tuberculous lymphadenitis: CT manifestations

An analysis was done of computed tomographic (CT) scans of 23 Korean patients who had presented with a mediastinal or hilar mass on plain chest radiographs and had subsequently been found to have tuberculous lymphadenitis. Most patients were young adults. Findings of pulmonary tuberculosis were seen on plain radiographs in 14 patients. On CT, findings were of an overwhelming preponderance of involvement of the right paratracheal and tracheobronchial nodes. After injection of contrast medium, nodes larger than 2 cm in diameter invariably showed central areas of relative low density and peripheral rim enhancement. Enhanced walls were usually irregular in thickness. Some smaller nodes did not show low-density areas, but instead showed varying degrees of homogeneous enhancement. Although metastatic nodes can be of low density, experience in this study suggests that mediastinal lymphadenopathy in a young adult with the CT findings described above is characteristic enough to support a diagnosis of tuberculosis.

Crohn's disease--a case report

A case of rather typical Crohn's disease in a 10 year old girl is described. She had suffered from intractable abdominal pain, diarrhea and fever for 1 year. Eventual right hemicolectomy revealed diffuse involvement of terminal ileum, cecum and ascending colon by confluent ulcerations and transmural inflammation. Histologically there were numerous well developed non-caseating granulomas scattered transmurally and in regional lymph nodes. Deep penetrating ulcerations were characteristic. Acid fast staining failed to demonstrate any organism. The rarity of Crohn's disease in Korea and this occurrence in pediatric age prompted this report.

Relationship between Candida albicans producing proteinase (CAPP) and its environmental pH--comparison with a case of trichophyton mentagrophytes

Candida albicans produced a karatinolytic proteinase (KPase) or C. albicans producing proteinase (CAPP), a proposed new term for this enzyme, and Trichophyton mentagrophytes also produced KPase when cultivated in liquid medium containing human stratum corneum (HSC) as the nitrogen source, but were unable to do so when cultivated in sabouraud dextrose broth. Purified KPase from the culture supernatants of C. albicans had a molecular weight of 42,000 and an optimum pH at 4.0. The KPase was found to belong to the carboxyl proteinases group and its activity was strongly inhibited by pepstatin. Both fungi were able to grow by secreting KPase which digested HSC for nutrients. KPase from both fungi had high activity in each optimum pH, such as weakly acidic pH on C. albicans and neutral pH on T. mentagrophytes to adapt their surrounding environment by changing the environmental pH into their own optimum pH.

A combined regimen of etretinate and UVB modulate T6+ and HLA-DR+ epidermal cells

Using anti-T6 and anti-HLA-DR monoclonal antibodies, this study was designed to attain what would do to epidermal Langerhans cell (LC) markers in psoriatic patients when two remedies, etretinate and UVB, having controversial effects on LC were put to use simultaneously. In normal and psoriatic subjects, HLA-DR+ LC was approximately 80% of T6+ LC and a single dose of UVB equivalent to minimal erythema dose (MED), reduced LC membrane markers to approximately 30% of non-irradiated control. The recovery of LC membrane markers, after a single dose of UVB exposure were significantly faster in the group of etretinate treated psoriatic subject than only UVB irradiated psoriatic control. Taken together, seemed to exert prompt recovery of normalization of the number of LC from the depletion following the UVB.

Percutaneous removal of residual intrahepatic stones

In the Orient there is a high frequency of residual intrahepatic stones after biliary tract surgery. Percutaneous removal of residual intrahepatic stones was attempted in a group of 74 patients. Stones were exclusively intrahepatic in 57 patients, whereas 17 patients also had stones in the common bile duct. Biliary strictures were present in 60 cases (81%). A combination of techniques was used, including preshaped angulated catheters, irrigation-suction, balloon dilation of strictures, and crushing of large stones. In 36 cases all stones were removed and in 14 cases most stones were removed, for a success rate of 67.6%. Biliary stricture was the factor most often responsible for failure.

An explanation of renal hemodynamics in acute renal failure based on sequential CT in patients with Korean hemorrhagic fever

The pattern of renal enhancement and washout of contrast medium was observed on sequential follow-up CT in 12 patients with Korean hemorrhagic fever, in which acute renal failure is one of the most important clinical features. Renal contrast enhancement and contrast medium washout were delayed longer in patients with severe oliguric renal failure. The delayed washout peaked at 4-5 days and did not return to normal until 8-9 days in the patients with severe oliguria; in the patients without severe oliguria the times were 1-2 days and 3-4 days, respectively. A characteristic "cart-wheel" pattern was observed during the washout stage in patients without severe oliguria. This "cart-wheel" pattern of washout is thought to result from relief of vasoconstriction and repair of tubular function. Multifocal "wedge-shaped" nonenhanced areas of the kidney, seen on the 2 week follow-up postcontrast CT, are thought to be ischemic zones due to persistent vasoconstriction. On the 6 week follow-up postcontrast CT in one patient, scarring of the kidney was detected in the same area that did not enhance on the 2 week CT. This scarring is thought to be a result of permanent vasoconstriction.

Magnetic resonance imaging in neurologic diseases--comparison with computed tomography

Magnetic resonance (MR) and computed tomography (CT) imagings were compared in 121 patients with various neurologic diseases. MR was performed with either 0.15 Tesla resistive or 2.0 Tesla superconducting systems developed by Korea Advanced Institute of Science and Technology (KAIST), using multi-slice spin echo technique with a variety of pulse sequences reflecting proton density, T1 and T2 relaxation times. MR was more advantageous in the detection of the lesions, accurate depiction of the lesion extents, and/or demonstration of anatomic details in sagittal or coronal plane in 36 of the 121 patients. These included white matter diseases, cervical cord tumors, syringomyelia, brain stem tumors, foramen magnum tumor, acute cerebellar infarction, Chiari malformation, isodense subacute subdural hematomas, cavernous hemangioma, A-V malformation with hemorrhage and some unknown pathologies. Even though 2.0T superconducting system showed greater capability of demonstrating the anatomic details and contrast discrimination between normal and abnormal tissues, the ability of MR to separate the tumor from the edema and to differentiate among different pathologic entities remained to be further evaluated. CT was superior to MR in 13 patients with acute intracranial hematomas, small calcific lesions, inflammatory granulomas or meningiomas. CT takes less time and may be preferable in very young or elderly patients. Both MR and CT gave equivalent information in the remaining patients. MR proved to complement CT in the evaluation of many disease entities and may actually supplant CT in some.

Antimicrobial susceptibility of bacteria isolated in 1985--with special reference to prevalence of methicillin-resistant staphylococcus aureus and activities of cefazolin, cefotaxime and piperacillin

Antimicrobial susceptibility of nine species and one group of bacteria isolated from patients at the hospitals of Seoul National University, Severance, Hanyang University, and Kyungpuk University were tested by agar dilution method. S. aureus was most susceptible to cefazolin, methicillin and cotrimoxazole, and enterococci to ampicillin. Isolates of Enterobacteriaceae were most frequently susceptible to aminoglycosides and cefotaxime. Cefazolin susceptibility was markedly different from species to species. Aminoglycosides and piperacillin were more active than others against P. aeruginosa, and amikachin against A. anitratus. A large proportion of strains of several different species were conditionally susceptible to either tetracycline, ampicillin, cefazolin or cotrimoxazole suggesting the usefulness of these drugs for treatment of urinary tract infection. Activity of cefotaxime was highest against E. coli, and K. pneumoniae, while lowest against A. anitratus and P. aeruginosa. Decrease in the proportion of susceptible isolate was noted in E. coli and K. pneumoniae to cefazolin, K. pneumoniae, E. cloacae and S. marcescens to cotrimoxazole, and P. aeruginosa to tobramycin and gentamicin.

Human lymphocyte Fc receptor for IgE: sequence homology of its cloned cDNA with animal lectins

We have purified the human lymphocyte Fc receptor specific for IgE (Fc epsilon receptor) and its soluble form by using the anti-Fc epsilon receptor monoclonal antibody H107. Using an oligonucleotide probe corresponding to the partial amino acid sequence of the soluble Fc epsilon receptor related to IgE binding factor, we cloned, sequenced, and expressed a cDNA for the receptor. The Fc epsilon receptor has 321 amino acid residues with no NH2-terminal signal sequence. The receptor was separated into two domains by a putative 24-amino acid residue transmembrane region located near the NH2-terminal end. The Fc epsilon receptor showed a marked homology with animal lectins including human and rat asialoglycoprotein receptors, chicken hepatic lectin, and rat mannose binding proteins.

Transcatheter renal arterial embolization with the mixture of ethanol and iodized oil (Lipiodol)

We induced experimental renal arterial embolization with the radiopaque solution of ethanol and iodized oil (Lipiodol) in 35 rabbits to evaluate the capability of the mixture to induce renal ablation. Serial renal angiography and plain abdominal radiography were performed immediately, one week and two weeks after embolization. Neither pure Lipiodol nor a 50% ethanol solution caused renal embolization. However, infusion of 50% and 75% ethanol-Lipiodol solutions resulted in embolization equal to that caused by absolute ethanol. The 50% ethanol-Lipiodol solution was so radiopaque that we could easily observe the embolization process during fluoroscopy. Renal arterial embolization with the 50% ethanol-Lipiodol solution was successful in three patients with hypernephroma. Our results suggest that a 50% ethanol-Lipiodol solution is radiopaque and an effective agent for renal arterial embolization.

CT findings of lobar bronchioloalveolar carcinoma

The CT findings in a case of lobar bronchioloalveolar carcinoma included stretching, spreading, and uniform narrowing of the involved bronchi without obstruction.

Sonographic evaluation of inferior vena caval obstruction: correlative study with vena cavography

Sonographic findings of obstruction of the inferior vena cava (IVC) in 14 cases are described and correlated with venographic findings. The causes of the obstruction were membrane (five cases), thrombosis (three), and intraluminal tumor invasion by hypernephroma, hepatoma, and adrenal carcinoma in six. Sonographic examination revealed highly echogenic segmental obliteration or membrane in membranous obstruction and echogenic intraluminal mass in thrombotic occlusion. Absence of an identifiable patent lumen in a technically satisfactory study was another finding in thrombotic obstruction. On real-time sonograms, the normal respiratory changes of the IVC were absent when there was complete occlusion. Transhepatic collaterals, patency of other segments of the IVC, and associated malignancy were additional sonographic findings. Comparison to venography suggested that in addition to ease and safety, sonography has advantages in delineation of the cephalad extent of occlusion, dynamic evaluation of the IVC below the obstruction, and the simultaneous evaluation of adjacent organs.

Leigh's subacute necrotizing encephalomyelopathy: possible diagnosis by CT scan

A 28-month-old Korean girl developed a rapidly progressive disease, characterized by disturbance of consciousness, tremor, nystagmus, ophthalmoplegia, irregular deep respiration and vomiting. The patient succumbed 2 weeks after the onset of the illness. CT scan disclosed bilaterally symmetrical, low density lesions in the white matter and lateral basal ganglia. Distinctive histopathological findings at postmortem included spongiotic necrosis of the neuropil, marked capillary vascularity, persistence of relatively normal neurons in severely damaged zones, and comparatively little astrocytosis. The bilaterally symmetrical distribution of these changes in the putamen and periaqueductal gray matter of the midbrain were compatible with Leigh's disease.

Vitamin A and E requirements during total parenteral nutrition

Studies were undertaken to determine rational dosages of vitamin A and E during long-term total parenteral nutrition (TPN). Four kinds of vitamin prescriptions containing different amounts of vitamin A and E were prepared from commercially available products and/or hospital pharmacy products. Patients were divided into four groups according to the vitamin prescription used. Plasma vitamin levels of different patient groups were determined by a modified fluorimetric method and were compared with those of a normal subject group. The stability of vitamin A and E in TPN solution after admixing was determining by measuring the remaining vitamin contents by high pressure liquid chromatography. From the results, it was concluded that 1) about 50% of vitamin A was decomposed by sunlight (about 2000 lux) 3 hr after admixing and an orange-colored vinyl cover could protect its photodecomposition; 2) vitamin E was stable at any condition tested; 3) 2500 IU of vitamin A and 15 IU of vitamin E could meet the daily requirements; 4) the plasma levels of vitamin A and E were correlative (p less than 0.01); and 5) concomitant administration of vitamin E was essential to keep the poorer level of vitamin A in plasma.

The prospects for amino acid infusion

Amino acid preparations for intravenous infusion are indispensable materials in parenteral nutrition. We have surveyed the progress and problems related to such preparations. In recent years, the necessity of various amino acid preparations suitable for different morbid state and/or ages has been the subject of much interest. In practice, several new amino acid preparations for specific uses have been proposed.

Surface morphology of Trichinella spiralis by scanning electron microscopy

The surface morphology of larval and adult Trichinella spiralis was studied by scanning electron microsocopy (SEM) of fixed, dried, and metal-coated specimens. The results are compared with those found earlier by various investigators using light and transmission electron microscopy. Some morphological features reported here are revealed uniquely by SEM. These include the pores of the cephalic sense organs, the character of secondary cuticular folds, variations of the hypodermal gland cell openings or pores, and the presence of particles on the copulatory bell.

Urinary excretion of 3-methylhistidine in patients receiving parenteral nutrition

In an attempt to investigate the kinetics of the muscle protein during parenteral nutrition (PN) and surgical stress, the urinary output of 3-methylhistidine (3-Mehis) was measured in patients receiving PN, then the validity of urinary 3-Mehis excretion as an index for the patient's status of protein nutrition was examined. The amounts of 3-Mehis excreted in 24 hr urine in the 19 healthy males and 10 healthy females were 74.8 +/- 17.1 mg/day and 46.3 +/- 12.4 mg/day, respectively. The changes of daily urinary 3-Mehis output in 6 cases receiving PN for more than 4 weeks were also examined. The average urinary 3-Mehis excretion increased gradually during the course of PN, and by the third week was nearly twice as high as the level before PN. In a further study the influence of surgery upon the urinary excretion of 3-Mehis was examined in 9 patients. Finally, a comparison was made of the nutritional status before and 4 wks after PN in the 6 patients without surgical stress. Urinary 3-Mehis was found to be a good index of both the status of protein nutrition and the fluctuation of muscle protein catabolism.

Fine needle aspiration cytopathology of retroperitoneal lymph nodes in the evaluation of metastatic disease

Fine needle aspiration biopsy of retroperitoneal lymph nodes was performed in 47 patients with abnormal lymphograms during the course of evaluation for metastatic disease. The biopsies were positive for malignant tumor in 11 patients. Utilizing established cytopathologic criteria a definitive diagnosis could be established. Fine needle aspiration of abnormal lymph nodes detected by lymphography is an easily performed, accurate diagnostic technique.

T-cell function in atopic dermatitis. Controlled examination of concanavalin A dose-response relations in cultured lymphocytes

The Concanavalin A (Con A) stimulation response of peripheral lymphocytes in vitro was found to be decreased statistically significant (alpha = 0.005) in patients with light atopic dermatitis, Strictly matched pairs were examined. Using ten graded concentrations of Con A, dose-response relations of the pairs were demonstrated, differences were more evident at lower suboptimal concentrations. Background DNA-synthesis of the patients was elevated.

Urinary excretion of amino acids in patients receiving intravenous hyperalimentation

Urinary outputs of amino acids in nine patients receiving intravenous hyperalimentation were estimated for evaluating adequacy of dosage and composition of the infusage for the maintenance of normal metabolism of tissue proteins in the subjects. The daily outputs of the methylated amino acids (3-methylhistidine, epsilon-N-methylated lysines and guanidino-N-methylated arginines), which are thought to be derived from tissue proteins, remained in the normal ranges, suggesting that the normal metabolism of tissue proteins was sustained during intravenous hyperalimentation. Relatively large urinary excretion of threonine, serine and glycine might reflect the large dosage of glucose in the infusate and disuse of these amino acids during the treatment, especially in the patients with hepatic dysfunction. Diurnal rhythms in urinary outputs of amino acids in patients receiving intravenous hyperalimentation were not observed, except for the outputs of threonine, serine and glycine, which were large during the 3.00-9.00 h and 15.00-21.00 h periods. The absence of daily fluctuations of the methylated amino acids in urine suggested that there were no diurnal rhythms in the metabolism of tissue proteins in the subjects.