[A difficult case of a stent-stone complex removal with endoscopic lithotomy]

An 88-year-old patient had undergone endoscopic stenting for the treatment of acute cholangitis caused by choledocholithiasis. After a year and two months, he presented with cholangitis caused by common bile duct stones that formed a stent-stone complex. Another stent was observed adjacent to the old stent;however, the cholangitis relapsed in a short term. Thus, we planned to remove as many stones as possible. These stones were not free-floating and had affected the bile duct. Endoscopic mechanical lithotripsy was attempted;however, it failed. He was successfully treated using peroral cholangioscopy and electrohydraulic lithotripsy. After three months, he developed cholangitis because of the recurrence of choledocholithiasis. After removing as many stones as possible and performing endoscopic stenting, he was followed up as an outpatient. He had no symptoms for seven months after the procedure.

Formation of Au Colloid Particles in Silica Glass by Ion Implantation

Formation of Au colloid particles and their optical property have been investigated in silica glasses implanted with Au+ ions at an acceleration energy of 1.5MeV and fluence levels of 1016-1017 ions/cm2. The Au colloid particles are formed in the as-implanted glasses. It is inferred that the average radius of Au colloid particles depends on the fluence level, although the fluence level does not affect the distribution of Au atomic concentration. The heat-treatment little affects the Au atomic distribution. The Au colloid particles grow to 4.3nm in average radius during heat treatment. It is revealed that the large nonlinear optical property of the Au+ -ion-implanted silica glass is attributed to the high concentration of the Au colloid particles in the narrow region.

Implantation of 1.5 MeV Ag+ Ions in Silica Glass

Ag+ ions were implanted in silica glass at an acceleration energy of 1.5MeV. It is found that Ag atoms are present in both the metallic and ionic states. Ag atoms in the metallic state increase when the Ag atom concentration increases. It is shown that the structure of damaged glass recovers monotonically from the surface to the inside of the glass. The state of the Ag atoms does not depend on the glass structure damaged by ion implantation.

[Subdural hematoma following cardiac surgery]

We report 3 cases of subdural hematoma following open heart surgery under cardiopulmonary bypass. In 2 patients, emergency removal and drainage of a subdural hematoma was performed by neurosurgeons, and conservative management was performed in the remaining one. All patients belonged to a high risk group of bleeding due to anticoagulation therapy, and they had no episode of head trauma. Subdural hematomas may have been due to rapid alterations in cerebral volume, leading to a tearing of the dural bridging veins under cardiopulmonary bypass. Although early diagnosis and prompt treatment is very important, it is often difficult to examine neurological findings after cardiac surgery. We consider that patients who need long-term sedation under anticoagulation therapy must have their neurological status checked at least once in a few days.

An in vitro study of long-term potentiation in the carp (Cyprinus carpio L.) olfactory bulb

Long-term potentiation (LTP) of synaptic transmission is considered a cellular mechanism for neural plasticity and memory formation. Previously, we showed that in the carp olfactory bulb, LTP occurs at the dendrodendritic mitral-to-granule cell synapse following tetanic electrical stimulation applied to the olfactory tract, and suggested that it is involved in the process of olfactory memory formation. As a first step towards understanding mechanisms underlying plasticity at this synapse, we examined the effects of various drugs (glutamate and GABA receptor agonists and antagonists, noradrenaline, and drugs affecting cAMP signaling) on dendrodendritic mitral-to-granule cell synaptic transmission in an in vitro preparation. Two forms of LTP are involved: a postsynaptic form (tetanus-evoked LTP) and a presynaptic form. The postsynaptic form is evoked at the granule cell dendrite following tetanic olfactory tract stimulation and is suppressed by the NMDA receptor antagonist, D-AP5, enhanced by noradrenaline, and occluded by the metabotropic glutamate receptor agonist, trans-ACPD. The presynaptic form occurs at the mitral cell dendrite following blockade of the GABA(A) receptor by picrotoxin and bicuculline, or via activation of cAMP signaling by forskolin and 8-Br-cAMP.

Long-term potentiation and olfactory memory formation in the carp (Cyprinus carpio L.) olfactory bulb

Long-term potentiation of synaptic transmission is considered to be an elementary process underlying the cellular mechanism of memory formation. In the present study we aimed to examine whether or not the dendrodendritic mitral-to-granule cell synapses in the carp olfactory bulb show plastic changes after their repeated activation. It was found that: (1) the dendrodendritic mitral-to-granule cell synapses showed three types of plasticity after tetanic electrical stimulation applied to the olfactory tract-long-term potentiation (potentiation lasting >1 h), short-term potentiation (potentiation lasting <1 h) and post-tetanic potentiation (potentiation lasting <10 min); (2) Long-term potentiation was generally induced when both the dendrodendritic mitral-to-granule cell synapses and centrifugal fiber-to-granule cell synapses were repeatedly and simultaneously activated; (3) long-term enhancement (>1 h) of the odor-evoked bulbar response accompanied the electrically-induced LTP, and; (4) repeated olfactory stimulation enhanced dendrodendritic mitral-to-granule cell transmission. Based on these results, it was proposed that long-term potentiation (as well as olfactory memory) occurs at the dendrodendritic mitral-to-granule cell synapses after strong and long-lasting depolarization of granule cells, which follows repeated and simultaneous synaptic activation of both the peripheral and deep dendrites (or somata).

Genome analysis of Agrobacterium tumefaciens: linkage map and genetic features of the left region of the linear chromosome

In addition to a unique tumor-inducing (Ti) plasmid, the plant pathogenic bacterium Agrobacterium tumefaciens has an unconventional chromosomal organization. Our previous studies on A. tumefaciens MAFF301001 revealed that it possesses a 2 Mb linear and a 2.8 Mb circular chromosome plus a 206.479 kbp Ti plasmid (pTi-SAKURA). In this study, a linkage map for the left half of its linear chromosome covering a 900 kbp region was constructed and the number of potential genes existing in the region was estimated. The linkage map consists of 31 BAC and 8 lambda phage recombinants without any gaps. It confirmed the size and all the structural landmarks indicated in the corresponding region of our previously constructed physical map for the linear chromosome. Sequencing analysis of the end-regions of each linking clone led to the identification of 6 genes and another 27 potential genes or ORFs, including genes and/or gene clusters responsible for homologous recombination (ruvB), trehalose/maltose sugar transport (thuR, thuG) and alanine catabolism (dadR). Two virulence-related gene homologues (attK and celB), previously reported in the circular chromosome of a different strain of A. tumefaciens were found in this region. These findings will provide a ready-to-use linkage map for further functional analysis of the linear chromosome.

Lipid peroxidation end products-responded induction of a preneoplastic marker enzyme glutathione S-transferase P-form (GST-P) in rat liver on admistration via the portal vein

The in vivo induction mechanism of a preneoplastic marker enzyme, glutathione S-transferase P-form (GST-P), by a number of carcinogens and some noncarcinogens such as anti-oxidants [Proc. Natl. Acad. Sci. U.S.A. 85 (1984) 3964] has remained to be solved. Among the various administration routes tested, GST-P became immunohistochemically demonstrable in the liver centrilobular zone 3 after 24-48h on administration of prostaglandin J2's, 15-deoxy-Delta(12,14)-PGJ2, PGJ2 and Delta(12)-PGJ2 to male rats via the portal vein, whereby the animals had been pretreated with Soya oil intraperitoneally to exhaust fatty acid binding proteins. Unsaturated aldehydes, 4-hydroxynonenal, crotonaldehyde and acrolein, given by the same route induced putatively preneoplastic single cells positive for GST-P. As these lipid peroxidation end products are the substrates as well as inducers of the enzyme, its physiological function could be their detoxication. These results indicate that GST-P expression can be mediated through lipid peroxidation possibly accounting for induction observed with a wide variety of carcinogens. In addition, present method may also be of use as a direct, simple, rapid, and sensitive in vivo test in examination of other biological responses.

Influence of age and comedication on steady-state clonazepam serum level-dose ratios in Japanese epileptic patients

BACKGROUND

In antiepileptic drugs, the marked inter- and intrapatient variability of the level-dose ratio makes it difficult to predict serum concentrations from the administered per kg dose. It is therefore important to identify factors, such as age and comedication, that could contribute to this observed variability.

OBJECTIVE

To investigate the effect of age and comedication on clonazepam (CZP) level-dose (L/D) ratios.

METHOD

A retrospective evaluation of data from 137 epileptic patients who had received clonazepam.

RESULTS

The CZP L/D ratio increased slowly with age up to 15 years in patients on monotherapy. Associated antiepileptic therapy affected the CZP L/D ratio, which was significantly reduced in patients on polytherapy as compared to patients on monotherapy.

CONCLUSION

The study therefore suggests that routine monitoring of CZP serum levels is extremely useful, especially in the paediatric age group, and in patients who require associated antiepileptic medication.

[A survey on occupational health nursing activities and evaluation in TOHOKU area]

We did a mail survey in 1998 in Tohoku district. We sent questionnaires to approximately 300 Occupational Health (OH) nurses and got 132 replies. Occupations of respondents were 66 public health nurses and 57 nurses. More than 70% did not have a managerial position. About 40% were respondents without colleagues in nursing occupations. Full time occupational physicians were in 40% of companies, and semi-full time occupational physicians were in 60%. Respondents citing good coordination in the former were 60%, and in the latter were 80%. Of all business activities occupying OH nursing employees, persons who performed more than 90% of the tasks numbered more than 30%. Persons not satisfied with present employment positions were 80%. Reasons for dissatisfaction in declining order of incidence were work duties, contract conditions for employment, and personal relations. Planning and summary of OH nursing activities were carefully done highly. For the OH nursing activity evaluation, we examined guidelines for business locations by observing them from the OH nursing aspect and the OH nursing job itself. Guidelines considered for business locales from the OH nursing vantage point show numerically, for example, rates of examinees with abnormal findings, work absenteeism, etc, and expectations as to whether or not health conditions are conspicuously reflected in productivity. Conversely, from the OH nursing vantage point for guidelines on business locales, while receiving affirmative economic evaluation of occupational health and safety measures, progress (process) should also be included in the object of evaluation. Furthermore, guidelines should be mindful of the need to have qualitative and quantitative changes in health behavior of workers and perspectives on health.

The complete nucleotide sequence of a plant root-inducing (Ri) plasmid indicates its chimeric structure and evolutionary relationship between tumor-inducing (Ti) and symbiotic (Sym) plasmids in Rhizobiaceae

The Ri (root-inducing) plasmid in Agrobacterium rhizogenes and Ti (tumor-inducing) plasmid in Agrobacterium tumefaciens have provided the fundamental basis for the construction of plant vectors and transgenic plants. Recently, the determination of the first complete nucleotide sequence of the Ti plasmid (pTi-SAKURA) has been successful. To understand the general structure of these oncogenic T-DNA transfer plasmids, the whole nucleotide sequence of a mikimopine-type Ri plasmid, pRi1724, was analyzed. The plasmid is 217,594 bp in size, and has 173 open reading frames (ORFs) in total, which are asymmetrically distributed. Except for 27 ORFs, which are unknown, 173 ORFs were classified into 12 groups as follows: three for DNA replication, nine for plasmid modification, 22 for conjugation, 26 for virulence, 11 for T-DNA gene, 19 for mikimopine/mikimopine-lactam transport, ten for an unknown opine metabolism, seven for transcriptional regulator, five for sugar transport, five for glycerol metabolism, four for chemoreceptor and 32 for others. The elucidated chimeric structure of pRi1724 interestingly indicates that the evolution of Rhizobiaceae plasmids seems to have kept interactions among the plasmids; especially, the genes and elements for a conjugal transfer of pRi1724 had clearly closer kinship to those of a Sym (symbiotic) plasmid, pNGR234a in Rhizobium sp. than those of Ti plasmids. By using sequencing and Northern analysis, we examined the metabolic pathway and gene expression of mikimopine, which is probably an Ri-specific opine.

Lordosis-inhibiting effect of progesterone in male and female rats with septal lesions

The inhibitory role of progesterone (P) in regulating lordosis was investigated in male and female rats with septal lesions (SL). Male rats with SL showed lordosis quotients (LQ) as high as female rats with SL and female control rats without brain surgery after injection of 50 microg/kg estradiol benzoate (EB) followed by 0.5 mg P 44 h later. Even when primed with 5 mg P 1 h prior to the 50 microg EB-injection, the mean LQs were still high in all groups. When the dose of EB was decreased to 5 microg/kg, all rats showed high-score LQs. In contrast, all animals in both male and female in which 5 mg P was injected 1 h before 5 microg EB, showed low LQs. These results suggest that P is effective in suppressing lordosis enhanced by estrogen in either male rats or females. Furthermore, the high dose of estrogen overcomes the inhibitory action of P on lordosis in both sexes.

Pharmacokinetic interactions among phenobarbital, carbamazepine, and valproic acid in pediatric Japanese patients: clinical considerations on steady-state serum concentration-dose ratios

With antiepileptic drugs, the marked inter- and intrapatient variability of the concentration-dose ratio makes it difficult to predict serum concentrations from the dose administered per kilogram. The effects of comedication on steady-state serum concentration/dose ratios of antiepileptic drugs were evaluated retrospectively in 669 pediatric patients. To avoid complex pharmacokinetic interactions among multiple antiepileptic drugs, the data on serum concentrations in the current study were collected from patients who were co-administered only one additional antiepileptic drug (phenobarbital-carbamazepine, phenobarbital-valproic acid, or carbamazepine-valproic acid) or who received monotherapy. The concentration/dose ratio for the antiepileptic drugs increased significantly with body weight in children up to 15 years old. Associated therapy with antiepileptic drugs affected the concentration/dose ratio. Therefore, routine monitoring of serum concentrations of the antiepileptic drugs is extremely useful, particularly in children and in patients who require associated antiepileptic medication.

[A case of intracerebral and subarachnoid hemorrhage of unknown origin with preceding headache]

We report a case of a 31-year-old female with multiple intracerebral hemorrhage and subarachnoid hemorrhage. She presented with headache one week before hemorrhage, and a CT scan performed at that time showed no abnormal findings. Neurological examination on admission revealed mild disturbance of consciousness, papilledema, and mild left hemiparesis. CT scans demonstrated intracerebral hemorrhage in the right caudate head and left frontal subcortex, and diffuse subarachnoid hemorrhage. Cerebral angiogram and laboratory examination revealed no abnormal findings. Erythrocyte sedimentation rate, C reactive protein and antiphospholipid antibody were within normal ranges. The patient underwent removal of hematoma by craniotomy. One week after the operation, a subcutaneous hematoma in the area of the craniotomy was found. Cerebral angiography demonstrated an aneurysm of the right superficial temporal artery, which was remote from the craniotomy. This aneurysm was surgically removed and examined. Histopathological examination revealed the presence of a pseudoaneurysm but no inflammation. Although primary angitis of the central nervous system was suspected to be the cause of this disease, a definite diagnosis could not be obtained.

Genome structure of Ri plasmid (2). Sequencing analysis of T-DNA and its flanking regions of pRi1724 in Japanese Agrobacterium rhizogenes

We sequenced 42.6 kb including T-DNA and its flanking regions which corresponds to about 1/5 of entire length of a mikimopine-type Ri plasmid, pRi1724 in A. rhizogenes. We identified 37 ORFs (Open Reading Frames) including genes in total. Among them, 20 ORFs are probably new genes. Those ORFs have similarity with those in Agrobacterium and 9 ORFs of them was newly found on Ri plasmids.

Analysis of unique variable region of a plant root inducing plasmid, pRi1724, by the construction of its physical map and library

Ri plasmids in Agrobacterium rhizogenes specifically induce the hairy root syndrome on various dicotyledonous plants. Its T-DNA transfer system as well as those of Ti plasmids have successfully provided the fundamental technique to introduce exogenous genes into plants. To study the Ri genome structure, we constructed a complete BamHI physical map and a lambda library of pRi1724 of A. rhizogenes strain 1724. By using these, we carried out the complete sequence of the 74-kb region between the right border of T-DNA and tra operon, which is the highly variable region (VAR) among Ri and Ti plasmids. As a result, we found three kinds of putative ABC-type transport operons, histidine utilization operon, glycerol utilization operon and two chemoreceptor genes. In addition, a virulence-related gene, tzs was located independently of the vir region.

A newly designed underwater antenna and its application to underwater radio-telemetry for measuring electroencephalographic activity from the rainbow trout freely swimming in natural environments

A novel underwater antenna (which we named an 'aquaerial') for telemetering the biological signals from freely swimming fish in freshwater natural environments is presented. It is designed for receiving a 90-100 MHz carrier wave and consists of plural unit receiving antennas (UAs). The plural UAs are placed underwater to cover the area where the target fish carrying the transmitter is swimming. The UAs are equally spaced and have a directional coupling amplifier to supply the signals received to the coaxial cable. The optimal length of the UA was found to be 16.5 cm (a half wavelength in water) and optimal spacing was 2 m (one wavelength along coaxial cable) when 95 MHz was used as the carrier frequency. Using this 'aquaerial', long-term monitoring of EEG signals from the olfactory bulb of the rainbow trout (Oncorhynchus mykiss) swimming freely in natural environments was achieved.

Treatment of large complex cranial bone defects by using hydroxyapatite ceramic implants

Hydroxyapatite ceramic implants were used in the reconstruction of very large and complex-form cranial bone defects in nine patients. The bone defects were the result of craniectomy after infections and other complications such as severe brain edema, after neurosurgery, and as a result of trauma, subdural hemorrhage, and surgery for brain tumor. The size, shape, and curvature of the hydroxyapatite ceramic implants were determined based on high-precision, full-scale models fabricated through a laser lithographic molding method by using computed tomographic data. The use of this method allowed the fabrication of hydroxyapatite ceramic implants of shapes that accurately matched the area of bone defect, allowing for a minimum of adjustment during the operation even with a complex-form implantation. Not only were good cranial contour reconstructed and aesthetically satisfactory results obtained in the cases treated by incorporating this series of techniques, but neurologic conditions present in some cases were also improved to some extent. The postoperative course has been steady for all nine patients, with no blood transfusions required during or after the operations and no implants requiring removal because of infection or other postoperative complications. The average length of postoperative hospitalization for the nine cases was 11.7 days, remarkably short considering the clinical conditions.

Inhibitory effect of microfibril wheat bran on azoxymethane-induced colon carcinogenesis in CF1 mice

Microfibril wheat bran (MFW), a processed dietary fiber prepared by milling of coarse wheat bran (WB), is softer and has a more pleasant taste than WB. In this study, we examined the inhibitory effect of MFW on azoxymethane (AOM)-induced colon carcinogenesis in female CF1 mice and compared its effect with that of WB and cellulose (CL). The mice were fed a modified AIN 76 A diet supplemented with either MFW, WB, or CL at a final concentration of 20% (w/w). Six weekly s.c. injections of AOM (10 mg/kg body weight) were administered per mouse commencing 1 week after the start of the feeding period. Control mice were injected with saline only. Thirty-three weeks after the initial injection, the mice were sacrificed, examined for tumors, and the cecal contents were analyzed to determine the moisture content and the concentrations of short-chain fatty acids (SCFA). The average number of total tumors per mouse in the MFW (2.9 +/- 0.6, P = 0.017) and WB (5.3 +/- 1.3, P = 0.373) diet groups was lower than that of the CL diet group (7.5 +/- 1.3), though there was no significant difference in tumor incidence (94.7%, 90.0% and 94.7%, respectively) between the groups. More than 90% of the tumors in each group were adenocarcinomas. The incidence of adenoma and that of carcinoma in situ in the MFW diet group (5.3% and 0%, respectively) were also lower than those in the CL diet group (26.3 and 26.3%, respectively; P = 0.180 and P = 0.046, respectively). Analysis of the cecal contents revealed a significantly higher moisture content and significantly higher concentrations of SCFA, butyrate in particular, in the MFW and WB diet groups. The results of this study indicate that the source and texture of dietary fiber can influence tumor development in CF1 mice, and more specifically that MFW is a promising and useful dietary supplement with properties serving to protect against the development of colon cancer.

Effect of direct application of estrogen aimed at lateral septum or dorsal raphe nucleus on lordosis behavior: regional and sexual differences in rats

The role of estrogen in lordosis-inhibiting systems in the lateral septum or the dorsal raphe nucleus was investigated in female and male rats. Ovariectomized rats received implantation of 22-gauge guide cannulae to the bilateral or right side of the lateral septum (LS and rLS, respectively), the dorsal raphe nucleus (DRN) or bilateral cortex (CX). In castrated male rats, bilateral implantations of the cannulae to the LS were carried out (mLS). Three behavioral tests in total were performed at 2-week intervals. In the first test, all animals were subcutaneously injected with 1.5 microg/kg estradiol benzoate (EB). Forty-four hours after EB, 0.5 mg progesterone (P) was injected and a behavioral test was started 4 h after P. These hormonal regimes were used in all tests. In the second test, 2 h before EB injection, 27-gauge cannulae filled with estradiol (E2) were inserted into the DRN, LS or CX through the guide cannulae and were kept there for 4 h. In the third test, cholesterol was implanted instead of E2 into these areas. In the first test, most females showed low levels of lordosis quotient (LQ) and most males showed no lordosis. In the second test, mean LQs in the LS or rLS groups of females increased but not in the DRN and CX groups. In the mLS group no increase of LQ was observed. When cholesterol was implanted in the third test, mean LQs in all groups were as low as in the first test. These results suggest the possibility that estrogen releases the inhibition when it acts on the LS, but not on the DRN female rats. On the other hand, inhibition in the male LS may not be released by the direct action of estrogen.

[Management of mycobacteriosis in general hospital without isolation ward for tuberculosis patients. 4. Actual status of the management of tuberculosis patients in a university hospital without isolation wards for infectious diseases]

We retrospectively evaluated clinical findings and the actual status of management of 69 tuberculosis patients admitted to the Fujita Health University Hospital, a hospital without isolation wards for infectious diseases, between 1991 and 1994. Forty-nine patients were smear-positive and 22 patients were smear-negative and culture-positive. Twenty-five cases (36.2%) were classified as type II (cavitary) and 29 cases (42.0%) as type III (non-cavitary) according to the GAKKAI classification of findings on chest X-ray films for pulmonary tuberculosis. Physicians in charge did not diagnose twenty-four patients (34.8%) as tuberculosis on admission. Physicians in charge tended not to suspect smear-negative patients of tuberculosis. Most of the patients with cavities on their chest X-ray films were strongly suspected of tuberculosis on admission, but in some of them, tuberculosis was not considered at all. Smear-positive patients with strongly suspected tuberculosis were diagnosed with the disease within three hospital days, while it took about three weeks in patients who were not considered as tuberculosis on admission to be diagnosed as tuberculosis. In the case of smear-negative patients, it took about one month and two months respectively to diagnose the case as tuberculosis. About half (51.1%) of the smear-positive patients were admitted and treated in single-bed rooms while 44.7% were attended in multiple-bed rooms for 11 days before they were transferred to single-bed rooms. When acid-fast bacilli were detected, 57.4% of the smear-positive patients were transferred to hospitals with isolation wards for infectious diseases, while the remaining smear-positive patients were treated in single-bed rooms at the university hospital. About one-third (31.7%) of the smear-negative patients had already left the hospital when specimens were found to be culture positive for tubercle bacilli. In conclusion, it is utmost important for physicians to suspect to tuberculosis for the early diagnosis of the disease.

Inhibitory effect of progesterone on androgen-induced lordosis in ovariectomized rats

Androgen has a potency to induce female sexual behavior in ovariectomized rats. This study investigated the inhibitory effect of progesterone (P) on lordosis behavior facilitated by androgen. Ovariectomized female rats were given 100 to 800 micrograms/kg testosterone propionate (TP) or 5 micrograms/kg estradiol benzoate (EB). Forty-four hours after administration of the TP or the EB, all females received 0.5 mg P, and the first behavioral test was carried out four hours later. TP-treated animals showed lordosis responses in a dose dependent manner. Two weeks after the first test, the animals were retested by using the same hormonal regime as in the first test, except that an additional 5 mg P was administered 1 h prior to the TP or the EB. As a result, significant reductions in sexual receptivity were observed in the TP-treated as well as in the EB-treated females. These results indicate that progesterone can inhibit androgen-induced lordosis behavior in female rats.

[Actual status of the management of tuberculosis patients in a university hospital without isolation wards for infectious diseases]

We retrospectively evaluated clinical findings and the actual status of management of 69 tuberculosis patients admitted to the Fujita Health University Hospital, a hospital without isolation wards for infectious diseases, between 1991 and 1994. The largest age group was 60s (27.5%) followed by 70s (24.6%), 80s (15.9%) and 50s (13.0%). Eight patients (11.6%) were in the 20s. Forty-nine patients were smear-positive and 22 patients were smear-negative and culture-positive. Fourteen patients (20.3%) had a past history of pulmonary tuberculosis. Twelve patients (17.4%) also had diabetes mellitus, ten patients (14.5%) had cancer, ten patients (14.5%) gastric ulcer and five patients (7.2%) renal failure. Positive skin reaction to PPD was not found in eleven patients (15.9%) and seven of these patients were quite elderly (over 70 years old). Twenty-five cases (36.2%) were classified as type II (cavitary) and 29 cases (42.0%) as type III (non-cavitary) according to the GAKKAI classification of findings on chest X-ray films for pulmonary tuberculosis. Twenty-four patients (34.8%) were not diagnosed as tuberculosis on admission by physicians in charge. Physicians in charge tended not to suspect smear-negative patients of tuberculosis. Most of the patients with cavities on their chest X-ray films were strongly suspected of tuberculosis on admission, but in some of them, tuberculosis was not considered at all. Smear-positive patients with strongly suspected tuberculosis were diagnosed with the disease within three hospital days, while it took about three weeks in patients who were not considered as tuberculosis on admission to be diagnosed as tuberculosis. In the case of smear-negative patients, it took about one month and two months respectively to diagnose the case as tuberculosis. About half (51.1%) of the smear-positive patients were admitted and treated in single-bed rooms while 44.7% were attended in multiple-bed rooms for 11 days before they were transfered to single-bed rooms. When acid-fast bacilli were detected, 57.4% of the smear-positive patients were transfered to hospitals with isolation wards for infectious diseases, while the remaining smear-positive patients were treated in single-bed rooms at the university hospital. About one-third (31.7%) of the smear-negative patients had already left the hospital when specimens were found to be culture positive for tubercle bacilli. In conclusion, it is utmost important for physicians to suspect tuberculosis for the early diagnosis of the disease.

Effects of a high-fat diet on azoxymethane-induced aberrant crypt foci and fecal biochemistry and microbial activity in rats

To shed light on the association of dietary fat with the development of colon cancer, we studied the ability of azoxymethane (AOM) to induce aberrant crypt foci (ACF) and biochemical changes in rats fed high- or normal-fat diets. Six-week-old male Fischer 344 rats were placed on a high-fat [7% (wt/wt) soybean oil + 15% (wt/wt) beef tallow] or a normal-fat (7% soybean oil, AIN-93G) diet. Rats fed each of these diets were given two weekly subcutaneous injections of AOM (15 mg/kg body wt) or saline at seven and eight weeks of age. Fecal samples were obtained at 10 weeks of age, and animals were sacrificed for ACF scoring and analysis of cecal contents at 13 weeks of age. We observed greater numbers of ACF in the high- than in the low-fat group. Biochemically, rats fed the high-fat diet showed dramatically elevated fecal and cecal long-chain free fatty acid levels and intestinal alkaline phosphatase activity. These animals also showed increased cholesterol and decreased coprostanol levels. We did not detect significant differences in the fecal and cecal concentrations of total and soluble bile acids or total neutral sterols (cholesterol + coprostanol) between the two groups. Thus a high-fat diet does show certain striking effects on colon biochemistry in rats.

Cerebral radiation necrosis with accumulation of thallium 201 on single-photon emission CT

A patient who had previously undergone resection of a malignant glioma followed by radiation therapy was found to have a focus of a high accumulation of thallous chloride Tl 201 on single-photon emission CT scans, suggesting recurrent tumor. Resection of this area was performed and the specimen showed radiation necrosis, including such reactive changes as reactive astrocytes and lymphocytes in the necrotic tissue. This case illustrates a diagnostic pitfall in the use of 201Tl single-photon emission CT for distinguishing radiation necrosis from recurrent tumor in patients treated for malignant glioma.

[Production of free bile acids by bacterial deconjugation from conjugated bile acids derived from peptone in a medium]

In the course of studies of in vitro bile acid transformation by lactic acid bacteria, we noticed that the medium used contained conjugated bile acids. HPLC analysis of the medium for each component indicated that these bile acids had originated from a peptone (Bacto Peptone, Difco). The concentration of these bile acids in a medium containing 2% Bacto Peptone was greater than 200 microM, higher than the concentration of bile acids usually added in in vitro bile acid transformation studies. Therefore, in such studies, it would be necessary to distinguish between the production of free secondary bile acids by bacterial deconjugation and that by 7 alpha-dehydroxylation. Since bile acids affect not only bacterial growth but also many metabolic activities, particular attention should be given to the use of Bacto Peptone in the medium.

Lordosis-inhibiting effect of progesterone in female rats with lesions in septum, preoptic area, or dorsal raphe nucleus

Radiofrequency lesions in the septum (SL), the preoptic area (POAL), or the dorsal raphe nucleus (DRL) were made in ovariectomized rats. In a control group of 16 females, ovariectomy, but no brain surgery, was performed. All animals except half of the control rats received injections of 5 mg progesterone (P) 1 h prior to the injection of 5 micrograms/kg b.w. of estradiol benzoate (EB). Instead of 5 mg P, oil was administered to half of the controls. Forty-four hours after EB, all females received 0.5 mg P. A sexual behavior test was performed 4 h after the last injection of P. The result was that oil-treated control rats showed high lordosis quotient (LQ) and soliciting behavior. In contrast, low scores of LQ and no soliciting behavior were observed in all of the 5 mg P-treated rats, even if the SL, POAL, or DRL was made. These results suggest that the septum, the preoptic area, and the dorsal raphe nucleus are not essential for the female sexual behavior-inhibiting mechanisms of progesterone.

Inhibitory effect of progesterone on sexual receptivity in female rats: a temporal relationship to estrogen administration

The inhibitory effect of progesterone (P) injected at various times on female sexual behavior was investigated in estradiol benzoate (EB) treated ovariectomized rats. Four behavioral tests were carried out at two-week intervals. All females received 5 micrograms/kg b.w. EB and 0.5 mg P 44 hr after the EB. In the P-control group, an additional 5 mg P was administered at the same time as the injection of EB in four tests. Instead of P, oil was given concurrently with EB in the Oil control group. In the experimental groups, female rats were treated with 5 mg P from 1 to 40 hr before (PB group) or after (PA group) the EB-injection. A sexual behavioral test was started 4 hr after 0.5 mg P. The results show that low levels of lordosis and soliciting behavior were observed in the P group, compared to the Oil-control group. In the PB groups, lordosis quotient (LQ) was low when P was given from 1 to 24 hr before EB. Moreover, animals in which P was given 27-40 hr before EB showed lower LQ than Oil-control animals, but higher LQ than rats in the P-control group. In the PA groups, when P was administered from 1 to 24 hr after EB, low levels of lordosis response were observed, whereas animals which received P 27-40 hr after EB showed a high score of LQ, being comparable to that in the Oil control. These results suggest that the period of 24 hr before and after EB injection is a critical period for inhibitory action of P on female sexual behavior in female rats.

Correlation of histopathological factor of brain tumor and high thallium-201 uptake in single photon emission computed tomography

This study was undertaken to investigate the relationship between several histological features and the degree of TI-201 uptake in brain tumors. T1-201 SPECT was performed on 52 patients with intracranial lesions. Histological examinations were carried out to determine the gradation of tumor cell density, vascularization, small-cell density, and matrix loosening, and the presence of necrosis, atypia, mitoses, and endothelial proliferation. The histological findings were classified into three categories. While the early uptake of T1-201 depended on the degree of necrosis of glial tumor, the delayed T1-201 uptake was closely related to the degree of necrosis, tumor cell density, and small-cell density, and may thus be of value for estimating the viability and degree of malignancy of glial tumors. In the non-glial tumors, the early and delayed T1-201 uptakes were closely related to all histological parameters, with the increase of necrosis and vascularization in the tumor tissue being particularly closely related to high uptake levels.

[Foramen magnum meningioma of ventral type]

We reviewed the clinical findings and the surgical results of five cases of patients with foramen magnum meningioma of ventral type who underwent preoperative magnetic resonance imaging (MRI) and tumor removal by the posterolateral approach. Patients showed a variety of neurological symptoms and signs including dysesthesia of extremities, but the neurological diagnosis could not determine the dominant side of the tumor. MRI determined the dominant side of the tumor and this side was chosen as the side of the surgical approach. By MRI findings of the extent of the tumor in the posterior fossa and the spinal canal, patients were classified into three cases of craniospinal type and two cases of spinocranial type. The result of tumor removal by the posterolateral approach was a total removal in the two cases of spinocranial type and a "near-total" removal in the three cases of craniospinal type. There was no surgical mortality and the surgical morbidity was negligible. The foramen magnum meningioma of ventral type, especially of the spinocranial type, can be managed safely and satisfactorily by the posterolateral approach.

An improvement in the embryo quality and pregnancy rate by the pulsatile administration of human menopausal gonadotropin in patients with previous unsuccessful in vitro fertilization attempts

OBJECTIVE

To examine whether the pulsatile administration of hMG improves IVF outcomes in patients with previous unsuccessful attempts using IM injections of hMG.

DESIGN

A prospective randomized study.

SETTING

In vitro fertilization program at a university hospital.

PATIENTS

Eighty-eight endocrine-normal ovulatory women under 40 years of age, with normal male partners and a history of unsuccessful IVF treatment by the IM administration of hMG.

INTERVENTIONS

Patients were assigned randomly to receive either IM (bolus group) or pulsatile administration of hMG (pulsatile group) after pituitary desensitization by a GnRH agonist.

MAIN OUTCOME MEASURES

The proportion of retrieved oocytes with a polar body, the number of fertilized oocytes and embryos, the proportion of morphologically superior embryos, and the rate of pregnancy per initiated cycle were compared.

RESULTS

The proportion of retrieved oocytes with a polar body and the number of fertilized oocytes and embryos were similar in both groups. Significantly more embryos had superior morphology in the pulsatile group (77%) than the bolus group (52%). The rates of overall and clinical pregnancy per initiated cycle were significantly higher in the pulsatile group (39% and 30%, respectively, n = 44) than in the bolus group (18% and 11%, respectively, n = 44).

CONCLUSION

In women with failed IVF attempts using IM administration of hMG, the pulsatile administration of hMG produces superior embryos and, hence, a higher pregnancy rate.

[A novel method of ovarian stimulation for in vitro fertilization (bromocriptine-rebound method) increases developmental potential of oocytes and pregnancy rate]

A novel method of ovarian stimulation for IVF is reported. Endocrine-normal ovulatory women with a history of unsuccessful IVF attempts by means of a long protocol of a GnRH agonist/hMG regimen (L regimen) were studied. Ovaries were stimulated by the three regimens described below. The bromocriptine-rebound (BR) regimen consisted of bromocriptine (B) 2.5mg/day administered daily beginning on day 4 of the preceding cycle and buserelin acetate administered beginning in early high phase. Administration of B was discontinued in the low phase of the IVF cycle and daily administration of hMG was begun 7 days later. HCG was administered when dominant follicles reached 16-18 mm in diameter. The bromocriptine-continuous (BC) regimen was the same as the BR regimen, except that B was administered until the administration of hCG. The L regimen was the same as the BR regimen, except that no B was administered. The pregnancy rate per oocyte retrieval was significantly higher on the BR regimen (56% in 70 cycles) than the L regimen (33% in 46 cycles), and lowest on the BC regimen (29% in 7 cycles). The rate of fertilization and cleavage per oocyte and the proportion of morphologically-good embryos were significantly higher on the BR regimen (59.1% and 57.3%, respectively) than the L regimen (46.3% and 48.0%, respectively), and lowest on the BC regimen (49.0% and 41.7%, respectively). Serum PRL concentrations (ng/ml) at the time hMG was started were 14.9 +/- 1.5, 7.9 +/- 1.7 and 2.5 +/- 0.7 on the BR, L and BC regimens, respectively. The results of this study show that the BR regimen increases the developmental potential of oocytes and the pregnancy rate, probably because of increasing serum PRL levels to within the normal range.

[Cerebral diplopia and triplopia--a proposal for responsible lesion and mechanism]

We reported 2 cases of multiple images of cerebral origin. Case 1 was a 26-year-old right-handed woman, who showed a defect in the peripheral part of right visual field, with photopsia in the defective field, and cerebral diplopia within the perimetry-determined preserved part of the right hemifield. This was associated with a small infarction in the deep and anterior part of the area 17. The phenomenon was well-illustrated by her own detailed drawing. Case 2 was a 67-year-old right-handed man, who, following a hypoxic accident, developed monocular triplopia. MRI revealed laminar necrosis in the areas 18 and 19 bilaterally. Triplopia was reproducible when he fixed his attention upon the circumscribed afterimage given by a strobo-flash. This would serve as counterevidence against the Bender's hypothesis that this phenomenon was caused by the pseudofovea. In both cases, multiple images occurred only to objects upon which they fixed their gaze, only in the specific sector of the visual field. Both experienced diplopia and triplopia only after a few seconds of fixation. When they turned away the gaze, the extraimages disappeared. We proposed a new hypothesis for this phenomenon, i.e., it is caused by the impaired lateral inhibition, selective to the magnocellular system in the area 17 or other early visual cortices.

[Effects of the maturity of human oocytes on fertilization and embryonic development: application of oocyte maturation in medium containing follicle-stimulating hormone]

A total of 2,145 oocytes from 355 IVF cycles were classified as overmature (O), mature (M), transitional (T), immature (I) and abnormal (A) according to the morphology of the corona radiata. The rates of fertilization (%F) and embryonic development (%D) per oocyte were the highest in the M group, and decreased significantly with the decreasing maturity of the oocytes (T and I) and were the lowest in the A group. Decreases in %F and %D were also observed in the O group. %F and %D were significantly higher in oocytes with a polar body (PB) than without a PB. Mature oocytes classified according to the morphology of the corona radiata had significantly higher %F and %D than those classified according to the morphology of the cumulus oophorus. %F and %D were increased when T-oocytes without a PB and I-oocytes were matured in vitro for 18-24 hours in medium supplemented with FSH. A normal female baby was delivered, following IVF-ET of two T-oocytes matured in vitro with FSH.

Study on the primary visual cortex of visually impaired subjects by means of 123I-IMP SPECT and MRI

We conducted a study of rCBF in the primary visual cortex of visually impaired subjects who have not been subjected to external stimulation for a long period, by means of 123I-IMP SPECT and MRI. The four subjects had lost their sight due to brain tumors (n = 2), glaucoma (n = 1) and trauma (n = 1). 123I-IMP SPECT showed no differences between the visually impaired group and a visually sound control group on visual analysis as well as semiquantitative analysis. MRI of the visually impaired subjects showed no organic changes, such as atrophy, in the occipital cortex. In conclusion, visually impaired subjects have no decrease in rCBF and no anatomical changes in the primary visual cortex.

Early diagnosis of small intestine rupture from blunt abdominal trauma using computed tomography: significance of the streaky density within the mesentery

Enhanced computed tomography (CT) was done in 430 patients within 3 hours after blunt abdominal trauma. Thirteen patients were found to have ruptures of the small intestine. Nine of them had "the streaky density within the mesentery" and the position was identified by tracing the alimentary tract on each CT slice. The sensitivity and specificity of this sign was 69 and 100% respectively. The sensitivity for diagnosis of small intestinal rupture by the presence of this sign and/or free air was 85%. This was significantly higher than that of free air alone (p < 0.05). Eight patients had a rupture on a mesenteric site. Histopathological findings of the area with this sign included bleeding and cellular infiltration along the mesenteric vasculature. This appearance may be related to direct injury and chemical irritation of the mesentery caused by intestinal rupture. The streaky density appears to be a significant finding for small intestinal rupture.

Administration of human chorionic gonadotropin for in vitro fertilization-embryo transfer based on the serum luteinizing hormone (LH) concentration: the importance of synchronization with endogenous LH rises

OBJECTIVE

To examine whether synchronized administration of hCG at the onset of the endogenous LH rise promotes successful IVF.

DESIGN

A prospective randomized study.

SETTING

In vitro fertilization program at a university hospital.

PATIENTS

A total of 208 IVF cycles in 148 patients.

INTERVENTIONS

Serum LH concentrations were measured daily and hMG was administered daily. Independent of follicle size and E2 concentration, hCG was administered as soon as the LH concentration exceeded the J level, defined as the minimum value + (the day 3 value-the minimum value) x 1/3(J group). Alternatively, hCG was administered when the serum LH concentration turned to increase but was still less than the J level, or 1 day after the serum LH concentration exceeded the J level (non-J group).

RESULTS

The rates of total and ongoing pregnancy per cycle were significantly higher in the J group (35.6% and 26.0%, respectively, n = 104) than in the non-J group (21.2% and 12.5%, respectively, n = 104). Pregnancies in the J group were achieved over a wide range of dominant follicle diameters (13 to 25 mm), E2 levels (198 to 1,700 pg/mL; conversion factor to SI units, 3.671), and E2 level per follicle > or = 12 mm (24 to 225 pg/mL per follicle) recorded on the day of hCG administration.

CONCLUSION

Synchronized administration of hCG in accordance with endogenous LH rises produces a high rate of pregnancy in IVF.

[A fundamental study on accumulation of [125I]IBZM in the rat striatum and on effect of non-labeled ligand]

Iodo-125-labeled iodobenzamide ([125I]IBZM) is used as a specific binding radioligand to dopamine D2 receptors with high affinity and selectivity. The radioligand was homogenously distributed in the whole brain initially after administration, and rapidly washed out from the dopamine receptor-poor area followed by persistent retention in the striatum. Regression curve generated from striatum/cortex PSL ratio indicated the constant washout rate from striatum and cortex respectively. In the pretreated rat by cold benzamide (2 mg/kg), the accumulation of the radioligand was significantly suppressed in the striatum (48.8%). Iodine-125-labeled iodo-benzamide has the promise for investigation of dopamine D2 receptors in the living brain.

Hydatidiform mole with a surviving coexistent fetus following in-vitro fertilization

A case of a hydatidiform mole with a surviving coexistent fetus following in-vitro fertilization and embryo transfer is reported. The diagnosis was established at 12 weeks gestation and pregnancy was maintained until 31 weeks, during which time transient hyperthyroidism and lung metastasis developed. No difference was observed in pronucleus formation and early embryonic development between the two embryos, which resulted in a complete mole and a normal fetus. DNA finger-print analysis, karyotype analysis and histopathological examination confirmed that the pregnancy was a twin of a complete mole and a normal conception. DNA fingerprint analysis was performed with a single-locus probe cocktail. All DNA bands from the tumour were of paternal origin, and the bands from the placenta were of paternal and maternal origin.

[A case of penetrating chest injury with tension hemothorax by gunshot]

The patient, a 36-year-old male, was admitted with massive hemoptysis. He had two gunshot wounds in the right lateral abdomen and supraclavicular fossa. His chest X-ray showed right tension hemothorax. Emergency thoracotomy and laparotomy were performed. Massive bleeding from the right pulmonary artery (A4+5), lacerations in the diaphragm and injuries of the liver were found. We performed right middle lobectomy, S3 segmentectomy and plication of the diaphragm and liver. He was discharged uneventfully.

[Symptomatic laterality and magnetic resonance imaging (MRI) of the putamen in striatonigral degeneration (SND)]

Asymmetric onset of parkinsonism appears not uncommon in SND. This study quantitatively investigated anatomical asymmetry of the putamen using MRI in relation to symptomatic laterality. Our study comprises six patients with SND, two men and four women, ranging in age from 50 to 77. Duration of illness ranged from 1 to 4 years. The Yahr stage was IV in 3 patients and I, III, or V in the others. The diagnosis of SND was made on medical history, neurological examination and MRI. All patients had asymmetric onset of parkinsonism. They subsequently had variable cerebellar ataxia and/or autonomic failure. All of them responded poorly to L-dopa therapy. MRI revealed the pontine and cerebellar atrophy and abnormalities of the putamen in most of the patients. MRI was performed using a 1.5 Tesla in 5 patients and 0.5 Tesla in one. Inversion Recovery (IR) image were utilized as T1-weighted images and proved optimal in showing anatomic detail. Spin-echo sequences were used to provide T2-weighted images. For measurement of the putaminal area and length in SND patients and 12 normal controls, we used two horizontal slices. One is passing through dorsal portion of the putamen, and the other through the ventral putamen. All the patients had the onset of hemi-parkinsonism and the symptoms progressed dominantly on the side of onset. With T1-weighted IR sequences, putaminal atrophy was demonstrated in all patients, more intense on the contralateral side to more symptomatic limbs. The anatomical asymmetry and the symptomatic laterality were less pronounced in advanced patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Identifying the ciliary sulcus for suturing a posterior chamber intraocular lens by transillumination

We describe herein a technique for locating the ciliary sulcus for suturing a posterior chamber intraocular lens. Transscleral illumination with a light-guide fiber placed underneath the iris reveals the ciliary sulcus as a bright area near the limbus, and it allows for a straight needle with 10-0 polypropylene fiber to be easily inserted through the sulcus after making two pairs of radial scleral incisions to fixate the 10-0 polypropylene fiber. We think that this procedure can minimize complications of suturing a posterior chamber intraocular lens and shorten the operation time.

[Efficacy of myocardial preservation using HTK solution in continuous 120 min cross-clamping method--a comparative study with GIK method]

The aim of this study is to investigate the efficacy of HTK solution in the 120 minutes cross-clamping method in comparison with conventional intermittent cardioplegia using GIK solution. Fifty-four open heart surgery were performed with cardioplegic solution using either HTK solution (HTK) or GIK solution (GIK). In the HTK, HTK (3L) was infused for the initial dose and 1L was added every 60 min after 120 min of cross-clamping. In GIK, 1L of GIK solution was intermittently infused initially and then every 30 min together with continuous cold blood perfusion. The effect of two cardioplegic solution was evaluated by postoperative cardiac function (CI, %SF), released enzymes (CPK), histology and dosage of catecholamine. Postoperative CI was 3.67 +/- 0.76 in HTK, and 4.34 +/- 1.04 in GIK (NS). % SF was 26.0 +/- 5.26 in HTK and 25.6 +/- 0.76 in HTK, and 4.34 +/- 1.04 in GIK (NS). %SF was 26.0 +/- 5.26 in HTK and 25.6 +/- 9.2 in GIK (NS). The CK-MB (IU/dl) level after reperfusion was significantly decreased in HTK at 60 and 180 min after reperfusion. Histology at 60 min of ischemia revealed a significant increase of edema of mitochondria in GIK. Postoperative catecholamine dose was 2.65 +/- 1.3 in HTK and 10.3 +/- 3.4 in GIK (p < -0.01). PH of myocardium was well maintained around 7.4 during cross-clamping in HTK, however, it was decreased in GIK. In conclusion, The HTK method offers a reliable cardiac protection due to effective buffering using Histidine in comparison with GIK.