Serum apoprotein A-1 and A-2 levels were determined by TIA (Turbidometric Immu-noassay) in patients with various liver diseases. Significant decreases in apoprotein A-1 and A-2 levels were obserbed in such patients. The decreases in A-2 levels were more prominent than the decreases in A-1 in chronic liver diseases, but not in acute hepatitis. The A-1/A-2 ratio increased significantly in chronic liver diseases according to the degree of liver damage and correlated significantly with serum choline-esterase activity, suggesting that the A-1/A-2 ratio was valuable as a marker of degree of liver damage in chronic liver diseases. Further study including the patients with fulminant hepatitis other than severe chronic liver diseases is needed to evaluate the value of A-1/A-2 ratio as a prognostic marker as well as a marker of degree of liver damage in severe liver diseases.

View full abstract

The clinical significance of rapid turnover proteins (RTP) in chronic liver diseases was studied in 10 patients with chronic hepatitis, inactive (CHI), 13 with chronic hepatitis, active (CHA), 19 with compensatory stage liver cirrhosis (LC), 11 with hepatoma accompanied by liver cirrhosis (HCC), and 10 normal subjects. Three kinds of RTP, retinolbinding protein (RBP), prealbumin (PA) and transfferin (Tf), were measured and compared between the groups. In comparison with the normal subjects, RBP was significantly reduced with the pathological progression in all the disease groups. PA also showed almost the same tendency of decrease. When compared with the usual liver function test parameters measured simultaneously, namely, albumin (A1b), hepaplastin test (HT), total bilirubin (TB) and pseudocholinesterase (ChE), both RBP and PA were most closely correlated to A1b. The above findings confirmed that both RBP and PA were helpful not only as nutritional indices but also as indicators of the hepatic reserve. On the other hand, Tf was significantly reduced in only the HCC group and demonstrated an essentially different pattern of behavior from the first-mentioned two proteins. This was considered to be an important finding that suggested the possible metamorphosis of host iron metabolism in association with the development of hepatoma.

View full abstract

To elucidate the exercise tolerance, 18 patients with healed tuberculosis (mean age=52.1 years, C group), 12 patients with old pleuritis or previous operations (mean age=64.2 years, P1+Op group) and 9 normal subjects (mean age=57.2 years, N group) were studied during exercise by bicycle ergometer.
The workload (W1) was set initially at 100 watts and increased to 600 watts depending on the subjects tolerance. Arterial blood gases, blood lactate and heart rate (HR) were measured before and during the exercise. In C group and N group, PaO₂ increased during W1 with 300 to 600 watts but in P1+Op group, PaO₂ decreased during W1 with 150 or 400 watts and PaCO₂ increased during W1 with 100 to 150 watts. The initial high blood lactate during exercise was found at 400 watts in N group, at 300 watts in C group and at 100 watts in P1+Op group. We presumed the anaerobic threshold (At) at lactate level 40mg/dl during exercise. About At in each group, W1 and HR were 400 watts and 130/min. in N group, 300 watts and 127/min, in C group and 100 watts and 127/min. in P1+Op group.

View full abstract

By using OKT monoclonal antibodies including OKT₄ (inducer/helper), OKT₈ (suppres-sor/cytotoxic) and OKI_a1, T lymphocyte subsets were examined in peripheral blood lymphocytes of patients with tuberculosis during its treatment.
The following results were obtained.
1. At active stage, there were a decrease in OKT₄ (36.8%), slight decrease in the ratio of T₄/T₈ (1.35) and an increase in OKT₈ (29.5%) as compared to their values at inactive stage.
2. We found a decrease in OKT₄ and the ratio of T₄/T₈ before treatment and an increase in values at 2-12 months after treatment.
3. We observed a minimal increase in vital capacity in cases with a decrease of OKT₄ and of the ratio of T₄/T₈ before treatment.

View full abstract

The extent of myocardial ischemia was evaluated in 20 patients with Duchenne's muscular dystrophy (DMD) by using Bull's eye method of thallium-201 myocardial SPECT. It was examined in relation to skeletal muscle involvement, age, left ventricular (LV) ejection fraction and ventricular premature contractions (VPCs).
Myocardial ischemia was detected in all of patients with DMD. Ischemic lesion was mostly detected in the apical side of the LV lateral wall and interventricular septum, while the extent of myocardial ischemia had no correlations with either the stage of functional disability of skeletal muscle or age. The more Ischemic ratio was higher, the more LV ejection fraction decreased. The total number of VPCs was relatively small and it did not have any relation to myocardial ischemic ratio. These results suggest that younger DMD patients having extensive myocardial ischemia and/or ventricular tachycardia will have a high risk of cardiac death.

View full abstract

Twenty patients (16 female and 4 male) with moderate or massive obesity were treated with the very low calorie diet (VLCD), Optifast. Ten patients were hospitalized and others were outpatients. Optifast consisted of 70g of protein, 30g of carbohydrate, 2g of fat and sufficient amount of vitamines and minerals. Total calorie intake from Optifast was 420 Cal, daily. In addition, patients were instructed to drink more than 2.0 1 of water without calorie. All patients had such complications as hyperlipidemia, hyperuricemia or hypertension possibly linked with obesity. The VLCD treatment was carried out at least for 2 weeks and continued for the period as long as the patient could stand. In the hospitalized patients, body weight, blood pressure, urine volume and urinary ketone body were measured every day. Outpatients measured their body weight everyday at home and their blood pressure and urinary ketone body were examined at visiting the hospital once a week or every two weeks. Blood chemistry (liver and renal functions, serum lipids etc), the count of peripheral blood cells and plasma somatomedin C levels were measured regularly during the VLCD treatment. Although the period of VLCD treatment was different from patient to patient, a significant reduction in body weight was observed in all patients. No serious problems to discontinue the treatment were seen. All the complications possibly caused by obesity were improved with a reduction in the body weight. Plasma somatomedin C levels were not changed during the VLCD treatment which indicated that no significant changes in the nitrogen balance were present. From these results, we conclude that VLCD (Optifast) treatment has much benefit and safety to reduce body weight in obese individuals. However, the strict selection and the regular observation of the patient should be done by doctors during the VLCD treatment. It is also considered that this treatment should not be employed for the cosmetic reasons.

View full abstract

Between April 1985 and May 1987, thirty-one biopsies and two total mastectomies were performed for clinically occult mammary lesions, detected by mammography as clustered calcifications within the breast. One patient with two total mastectomies who had bilateral nonpalpable breast cancers did not undergo biopsy. Four benign biopsies showed that it was very difficult to differentiate radiologically between benign and malignant calcifications.
Six cancers (5 patients) were demonstrated within clinically occult mammary lesions. These six cases (100%) were treated by total mastectomy. Four of them were treated by axillary dissections. One of them with bilateral nonpalpable breast cancers did not agree to undergo axillary dissection. All of the cancers were multicentric and microinvasive. One of the four axillary dissections had positive nodes.
Therefore, it is recommended that nonpalpable breast cancer should usually be treated by total mastectomy with axillary dissection.

View full abstract

In the period from June 1986 to December 1987, 32 patients underwent surgery for endometrial cancer after preoperative transrectal ultrasonography. Transrectal ultrasonography provides precise images of the endometrium and cervical canal, therefore the degree of myometrial invasion and cervical invasion by endometrial cancer can be estimated.
In order to determine the accuracy of the ultrasonic method, the results were compared with the histopathologic findings from excised specimens.
Ultrasonographic diagnoses of the myometrial invasion and cervical invasion were in accordance with the pathological findings in 83% and 73% of the cases, respectively. The preoperative diagnostic capability of endometrial cancer was improved with this method.
Transrectal ultrasonography is considered to be a very useful method for preoperative diagnosis of endometrial cancer.

View full abstract

Both cytochrome P-450 and thymidine phosphorylase activities, those of fluoropyrimidine (especially ftoraful activating) metabolic enzymes, were estimated in various organs of human and rodents, using ftoraful (FT) as a sub state. As a result, it was demonstrated that in the rats, cytochrome P-450 enzyme activity was remarkably higher than that of human. In contrast, thymidine phosphorylase activity was extremely dominant in human compared to the rodents. As described in the previous paper, such species specific difference in enzyme activities were also observed in thymidine phosphorylase and uridine phosphorylase activities in 5-fluorouracil activation.
Moreover, tissue distribution of dihydrouracil dehydrogenase, a rate limiting enzyme of the degradation of 5-fluorouracil, was different between human and the rats as described previously.
These findings, including the metabolic characteristics of various tumors, might indicate the importance of consideration for the species specific differences for the understanding of experimental data.

View full abstract

In vitro effects on serum enzyme activities were examined for 11 anti-cancer drugs: cyclophosphamide, actinomycin-D, bleomycin, mitomycin-C, etoposide, cis-platin, methotrexate, fluorouracil, carmofur (HCFU), deoxorubicin and vincristine.
The drugs were added to the sera with the concentrations of either maximal, 5 or 10 folds of the maximal concentrations previously reported for each drug.
Interferences, in vitro, were observed with the assays for cholinesterase and amylase activities by addition of HCFU, at a serum concentration of 123μg/ml. No significant effects were observed for other drugs.

View full abstract

We report a 10 year old boy suffering from infectious mononucleosis syndrome associated with the abnormality of lymphocyte subsets in the peripheral blood for more than two years. The cytotoxic T lymphocytes remained at high percentage of the peripheral blood lymphocyte subsets. The T₄ to T₈ ratio remained less than 0.5. The specific antibody to EB virus was not elevated at the convalescent phase and slightly elevated 2 years after recovery of the disease. Despite of these abnormalities in the immunological findings, the patient has been healthy and never shown the tendency to infection.

View full abstract

A 50-year-old woman was admitted to our hospital complaining of low grade fever and multiple arthralgia. On admission, she had a conjunctivitis in the right eye, an abdominal tumor with mild tenderness in the right lower quadrant and an erythema nodosum on the bilateral knees. Laboratory data indicated severe inflammatory signs (for example, WBC 12100/mm³, CRP 6⁺, ESR 93mm/1h). Barium enema showed the spastic ascending colon with multiple diverticula and the spastic terminal ileum with an irregular surface, but the longitudinal ulcer and the cobble stone appearance could not be found. Colonoscopic study showed normal mucosa of the colon, but a colonoscope could not be inserted into the terminal ileum. Ultrasonography and CT-scan at the right lower quadrant showed the terminal ileum with a narrowed lumen and a two-layered thick wall. The inner layer of the wall was considered as a muscular layer and the outer was considered as a fibro-fatty proliferation in the mesentery. The microscopic findings of the biopsied specimen from the cecum showed an epitheloid cell granuloma with a giant cell in the submucosa. Six weeks after the treatment of prednisolone and salazopyrin, Colonoscopic study showed the normal mucosa in the terminal ileum.
Therefore, this case was diagnosed as an early stage of Crohn's disease. Ultrasonography and CT-scan studies seemed to be useful in diagnosing this disease.

View full abstract

We report two cases who developed rectal cancer after pelvic irradiation. Both patients had histological changes associated with irradiation within the site adjacent to neoplastic area. We analyzed clinical courses and pathological findings of the 18 cases including previously reported 16 cases in Japan and our 2 cases. The average interval between irradiation and development of rectal cancer was 18.5 years. More than half of the patients (66.7%) had clinical and or histological radiation colitis. Occurrence of mucinous adenocarcinoma was 10.1%. The 5-year-survival was 25%.

View full abstract

A 58-year-old man in Kagoshima Prefecture was admitted because of hemosputum and cough. A chest X-ray film revealed a coin lesion in the right lower lung field. Right middle and lower lobectomy was performed with the preoperative diagnosis of benign tumor and a suspicion of lung cancer.
Macroscopically, the tumor was a well-defined mass of 30×25×25mm in size and accompanied with pleural indentation. Histopathologically, the lesion was an inflammatory granuloma and Dirofilaria worm (immature female) was found in the necrotic mass. Immunological method gave a positive result. In the literatures, 44 cases including our case have been reported in Japan.

View full abstract

The patient, an 84-year-old female, was admitted because of very large calcification in the left parietal love.
1) A case of pathologically confirmed benign meningioma with massive calcification is introduced as a case of brain stone arising from this tumor.
2) The suitability of the term brain stone is discussed.
3) The course of the disease had been observed for 15 years since the first examination with biopsy only, and the growth of the tumor was.
4) At present, patient is performing daily living activities without epileptic seizures and other difficulties.
5) This case strongly suggests that, we must be careful in deciding whether or not surgical intervention is indicated, since benign meningiomas grow slowly like this case (from 0.6cm to 2.1cm in diameter during 12 years).

View full abstract

The profoundly retarded children often cry loudly at night. Needless to say we take care of them and try to find the causes of their crying. Only two nurses at night shift, however, are not enough to settle the matter.
Anticonvulsants are required in most of the profoundly retarded children and adverse reaction of the drugs sometimes occur. If we prescribe tranquilizer in addition, they may produce another side effect. So we administered Kanpo-medical extracts, Kanbaku-taisoto (Gan-Mai-Da-Zao-Tang) or Yoku-Kan-san (Yi-Gan-San) to these children.
We also administered Kami-syoyo-san (Ja-Wei-Xiao-Yao-San) to the retarded, agressive girl who ran about wildly before menstruations. The outcome was good enough to satisfy us.
The application of the traditional chinese differential medicine to these children is not always easy. We depended the selection of the medicine on the composition of the decoctions. Though this is not an orthodox way, Kanpo-medical extracts are useful enough to improve anxiety states of the profoundly retarded children.

View full abstract

We performed cataract surgry in a patient with congenital aniridia.
A 69-year-old male complained of decreased vision in both eyes. Ophthalmological examination revealed microcornea, corneal opacity, aniridia and cataract. Intraocular pressure was normal. His family history showed autosomal dominant inheritance pattern. His visual acuity was 0.01 in both eyes, which were surgically treated with extracapsular cataract extraction. Postoperative corrected vision was 0.1 in both eyes.
When cataract extraction is required in a case with congenital aniridia, the choice of surgical procedure depends upon the age, intraocular pressure and stability of the zonules. It is important to preserve the posterior capusule in order to prevent postoperative glaucoma.

View full abstract