We measured ADA activity of lymphocytes in the joint fluid and the peripheral blood for studying whether the immune system is correlated to the purine metabolic system. Method: T-and B-cells in lymphocyte were separated from the peripheral blood and the joint of patients with RA. Enzyme assay is following. The sample is sonicated for 25 sec. at 20KHz and is added to reaction mixture (0.2 mM Tris-HC1 buffer (pH 7.4),3.0 mM [8-14C]adenosine and the enzyme sample). Incubati on times were 30 min. at 37°C. After incubation the reaction mixture is applied over DEAE-cellulose paper. Radioactivity of the sample is measured with liquid scintilation counter. Result: 1. ADA activity of T cells (n mol/hr 106 cells) in the joint fluid is higher than that of B cells. (T: B = 1.6: 1) 2. ADA activity of T cells in peripheral blood is higher than that of B cells. (T: B=1.4: 1) 3. ADA activity of T and B cells in the joint fluid is 1.69 times as high as that in the peripheral blood. And we could get some ideas that the immune system would be related to the purine metabolic system.

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Purine metabolism is important in lymphocyte differentiation and proliferation. These enzyme activities in lymphoid malignancy were investigated extensively. The purpose of this report is to compare measurements of purine enzyme activities and subtypes of acute leukemias of children. Adenosine deaminase (ADA), purine nucleoside phosphorylase (PNP), adenine phosphoribosyltransferase (APRT) and hypoxanthine-guanine phosphoribosyltransferase (HGPRT) activities were measured in mononuclear cells of patients with acute leukemia and lymphoma. ADA, APRT and HGPRT activities were measured by radioisotope method and PNP activity was measured by Kalcker's method. T-ALL have significantly higher ADA activity, lower PNP activity and relatively lower APRT, HGPRT activity, so T-ALL have highest ADA/PNP ratio and lower APRT/HGPRT ratio. Null-ALL have high ADA activity, relatively low PNP activity and APRT, HGPRT similar to normal mononuclear cells. Therefore, in the null-ALL, ADA/PNP ratio was high and APRT/HGPRT ratio was similar to normal mononuclear cells. AML showed similar results to null-ALL. NHL have lower PNP activity and relatively low ADA activity, so NHL have relatively low ADA/PNP ratio. These findings suggest that ADA/PNP ratio may be useful for T-cell lineage biochemical marker.

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Serum uric acid levels were determined in 10 patients with hypothyroidism and the following results were obtained. 1. Hyperuricemia was found 1 of 2 in male and 2 of 8 in female. 2. There was the tendency to show the higher values of serum uric acid in untreated hypothyroid patients compared to control group. 3. Hype ruricemia in women was after menopause. 4. The average decrement of serum uric acid concentration in 10patients after the thyroid treatment was 1.4 mg/100ml. 5. Hypothyroid patients showed a tendency of decreased urinary excretion of urate and unstable uric acid clearance. 6. The almost parallel decrease between uric acid and cholesterol, TSH was found after the treatment of thyroid.

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Serum uric acid levels were determined in 25 hyperthyroid patients and compared to those in 11 normal subjects. Serum uric acid levels in hyperthyroidism were higher than that in normal. As hyperthyroid function returned to normal by antithyroid agent, high level of urate decreased in the normal range. There were negative correlation between serum uric acid level and serum creatinine, but no relationship between serum uric acid level and serum T3. The cause of hyperuricemia in hyperthyroidism was unknown, but was supposed to be due to urate overproduction.

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Hypouricemia, a disorder of uric acid metabolism, is one of rare diseases. Although, many investigators have stated that the diagnosis of hypouricemia should be given in less than 2.0mg/dl of serum uric acid (Sur), the basic problem in the definition for hypouricemia remains to be clarified. Furthermore, to our knowledge, several conditions in clinical viewpoint to accept as a disease induced by the metabolic disturbance have not been described. In contrast, the mechanism in renal function for uric acid metabolism and secretion have been widely investigated. In the present paper, the definition for a disease and the clinical procedure were investigated in 8 patients with the disturbance of uric acid metabolism. All patients studied showed 0.94 to 3.21 of Sur and markedly high Cur value. The patients were classified into two groups under the condition of pyrazinamide administration; namely,1) deficiency of renal tubular reabsorption showing no inhibitory effect of pyrazinamide on urinary secretion of uric acid and 2) significant inhibition of tubular reabsorption by pyrazinamide, revealing in urinary hypersecretion of uric acid. The same classification as mentioned above was established by inosine-loading test. A patient who showed normal level of Sur for female (2.89 mg/dl) was made a diagnosis of renal reabsorptive defect from the results of pyrazinamide suppression and inosine-loading test. Therefore, it reasonably suggested that a diagnosis of hypouricemia can not be made by a single information of Sur leyel. On the other hand, checking for clinical procedure in 8 patients was performed for 1 to 7 years. From the results of changing pattern in BUN, creatinine andurinary protein levels, all patients with hypouricemia studied in the present paper seemed to have normal renal function. As a clinical finding, recurrent urolithiasis was recognized in 4 out of 8 patients. The incidence of relapse was significantly high in comparison with 22 per cent of relapse in patients with urinary stone in our clinic. Then, suitable prophylactic for the relapse should be evaluated.

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Hypouricemia associated with liver disease has been implicated in some patients with severe liver disorder. A case of transient hypouricemia associated with drug-induced intrahepatic cholestasis was reported. A 58 year-old female had been diagnosed as diabetes mellitus at the age of 43 and her blood suger level had been controled by diet. From the beginning of May,1981, she was treated by Acetohexamide because of poor control of diabetes mellitus. She was admitted to Tottori University Hospital on June 1,1981 with chief complaints of fever, anorexia, nausea and vomitting for 2 weeks. Jaundice was also developed 6 days before admission. Laboratory findings revealed intrahepatic cholestasis and hypouricemia. Three weeks after admission, serum uric acid concentration recovered to the normal level as liver function test became normal. In Acetohexamide test, no change was observed in the level of serum uric acid. It is suggested that the cause of hypouricemia in this patient may not due to Acetohexamide but due to intrahepatic cholestasis. In addition to these observations of the case, we examined the uric acid concentration in normal subjects (586 cases) and Uric Acid Research Vo 1.6 No 1 ( 1982 ) 101 admitted patients (1,220 cases). As the result of this examination, it is observed that hypouricemia in admitted patients was markedly more than that in normal subjects.

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The association of the electrocardiographic ischemic heart changes and the various conditions which were considered to be the probable risk factors of this disease, was studied on 3,692male subjects who received general medical health checks in Fukuoka University Hospital. Among the listed ten items, excess daily alcohol intake more than 80 ml (540 ml of Japanese "Sake"), overweight more than 110%, abnormal glucose tolerance test including diabetic and borderline type, hypertriglyceridemia above 150 mg/dl, and hypertension (diastolic pressure above 90 mm Hg, and/or systolic pressure above 140 mm Hg) were proved to associate ischemic heart changes with significantly high incidence, the more the above factors of high grade, the higher the incidence of ischemic changes. The prevalence of ischemic heart changes in cases with hyperuricemia above 8.0 mg/dl was higher than those with normal serum uric acid levels (less than 7.0 mg/dl), although not significant. One of the cause of the high incidence of ischemic heart changes in hyperuricemic patients, was considered to be the complication of the other risk factors, because in the cases with hyperuricemia, complication of multiple risk factors of high grade was more frequent than in those with normal uric acid levels.

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