Determinations were made together with GLDH, aldolase (ALD), lactic dehydrogenase (LDH), GOT, GPT, isocitric dehydrogenase (ICD), alkaline phosphatase (ALP) and leucine aminopeptidase(LAP) activities in the sera of human cases of hepatobiliary diseases, rats with acute CCl4 hepatic disturbances, with a common bile duct ligation or tumor bearing rats. Thus, a diagnostic value of GLDH activity was 'estimated as to hepatobiliary diseases with special reference to differentiation between benign and malignant hepatic duct obstruction. The results obtained of GLDH activity were as follows 1) On Schmidt's determination method the activity in normal subject's sera proved to be 0.55±0.237mu. 2) The average in acute hepatitis was 1.86mu, showing many cases of a slight increase. Abnormalities accounted for 68%. Its activity returned to normal earlier tha n other enzyme activities. Its pre-fatal value in fulminant hepatitis was considerably as high as 2.30mu. 3) The average in chronic hepatitis (active type) was 3. Omu,57% of which showed only a slight increase. Chronic hepatitis (inactive type) cases showed 1.54mu. Abnormalities were found in 71% and 46% in active and inactive type respectively. 4) The activity was slightly as high as 1.24mu in compensated ci@rrhosis of the liver and a normal range of 0.84mu in decompensated cirrhosis of the liver. Abnormalities of 47% were shared by both. 5) The activity increased to 2.66mu and 2.48mu in primary cancer of the liver and metastatic cancer of the liver respectively. Abnormalities accounted for 56% in the former and 83% in the latter. 6) Cholelithiasis directly after onset showed 5.82mu, being increased to 6.5 times the normal. But it showed a normal range of O.56mu, when improved. 7) No significant difference was found in the activity betw@een benign and malignant biliary duct obstruction. 8) Apparently the first attempt was made to study ICD/GLDH and LDH/GLDH in addition to GOT/GLDH and GPT/GLDH. Acute and chronic hepatitis (active type)showed high GOT/GLDH, GPT/GLDH and ICD/GLDH but low LDH/GLDH, w h i l e chronic hepatitis (inactive type) and cirrhosis of the liver showed a considerably low GPT/GLDH. Primary cancer of the liver show GPT/GLDH of 36.1, but metastatic cancer of the liver showed a markedly low GPT/GLDH of 7.6 with its hi gh LDH/GLDH of 884.8. Thus, GPT/GLDH and LDH/GLDH proved to be a useful aid to the diagnosis of metastatic cancer of the liver. The ratios in cholelithiasis directly afte r onset were all below normal and found increased when the disease was improved. 9) The activity was the highest reaching 3.9 times the normal, on the thi@rd day after intervention in acute CCl4 hepatic disturbance rats. It showed a peak 25.8 times the normal on the fifth day in common bile duct ligation rats. Both rats showed wer e increase in GLDH than in ALP and LAP. Neither ascites type Yoshida sarcoma nor DAB hepatoma rats showed any increase in the activity. Yoshida ascites hepatoma A H 130 and AH601 showed an increase 1.7 times and 2.8 times the normal on the thi rd day after intervention. It was considered that an marked increase of the activity in common bile duct ligation rats afforded experimental evidence to an increase of GLDH clinically encountered in cases of cholelithiasis directly after onset.
Correct and adequate nutrition of the surgical patient is a most important therapeutic measure for obtaining good convalescence. In catabolic conditions a sufficient caloric supply without the risk of overloading the patient is required to diminish the negativity of the nitrogen balance. The most important sugar source in parenteral nutrition is glucose. There do exist, however, condition with an impaired glucose utilization, such as postoperative catabolism, in which insulin independent sugars should be preferred instead of glucose for parenteral nutrition. Since the parenteral use of maltose as a carbohydrate was first reported by Weser et al., an additional information on the clinical value of parenterally administered maltose has been provided by Japanese investigators. This study was undertaken to evaluate the effect of a surgical stress on the utilization of various sugars in experimental animals by the use of 14C-labeled sugars. Male guinea pigs, after exposure to surgical stress, were given an intraperitoneal injection of maltose-U-14C or glucose-U-14C. The operated and non-operated animals were compared as to their utilization of the labeled sugars by the measurement of expired 14CO2. Experiments were divided into A and B. In experiment A, immediately after operation, the animals received uniformely labeled (l4C) sugars. Experiment B animals received uniformely labeled (l4C) sugars at 24 hours after operation. The following results were obtained: In both experiment A and B, peak 14CO2 excretion was attained at 2 hours for the glucose-injected animals and at 3 hours for the maltose-injected ones. In experiment A the non-operated control group injected with the sugars after a 24 hours starvation, the recovery rate of the expired 14CO2 during 8 hours was higher in the glucose-injected animals than in the maltose-injected ones. In the operated group, however, the maltose-injected ones showed a higher recovery rate than the glucose-injected ones. Comparison between the operated groups and non-operated groups in the cumulative recovery rate at 8 hours revealed that the operation produced a difference of only 7.8% for the maltose-injected animals as contrasted with 25.1% for the glucose-injected ones. In experiment B, the recovery rate of expired "CO2 showed similar tendencies to that of experiment A. The differences in the recovery rate between the operated groups and control groups were 10.9% for the glucose-injected and 3.8% for the maltose-injected groups.
In the preceeding paper, it was obvious that adminstered maltose, as measured by maltose-U-14C, is efficiently metabolized as a source of calories after surgical stress with an impaired glucose utilization. Furthermore, a solution of maltose could provide twice as many calories per unit volume as an eguimolar solution of glucose. For this reason, it was thought to be recommended to use maltose as a carbohydrate source instead of glucose in the intravenous hyperalimentation. In this paper, to clarify the influence of maltose as a caloric source on albumin metabolism following studies were undertaken. Male rabbits, after exposure to surgical stress, were maintained by the intravenous hyperalimentation using hypertonic maltose, glucose and hypertonic amino acid throughout the postoperative periods, and operated and non-operated animals were comparared with the distribution of 125I labelled albumin. The following results were obtained: The disappearance curves of plasma radioactivities of rabbits subjected to surgical stress were more rapid than in non-operated animals. But there were no significant differences between glucose-treated and maltose-treated groups. The percentage of the labelled albumin remaining in the body and cumulative urinary excretion rate tended to fluctuate more in the groups subjected to the surgical stress than the control subjects. The decrease of radioactivities from blood stream after surgical stress was the slighter in the maltose groups than in the glucose groups. In the control subjects, there were no significant differences between maltose and glucose groups in the degradation rate, albumin turnover rate, intra- and extravascular albumin space. However, after surgical stress, the degradation rate, the albumin turnover rate and extravascular albumin were increased, and the intravascular albumin was decreased. These changes in maltose treated groups were not so remarkable as in glucose treated ones. In the maltose groups subjected to surgical stress, it was disclosed that the halftime- turnover was 3.8 days, the circulating albumin was 8.1g and that the extravascular albumin was 63.7 g. It is obvious from this experiment that maltose should be recommended in intravenous hyperalimentation because of the favourable effect of maltose on the albumin metabolism following surgery.
Considerable interest has been focused on the dynamic metabolism of the carbohydrates during and following surgery. The catabolism and responsibility of various hormones have been considered as manifestations of a“reaction to injury”. In the preceeding two papers, it was obvious that infused maltose is efficiently metabolized as a source of calories after surgical stress. From the results of animal studies, the following investigation in human subjects were carried out to ascertain whether the metabolic disturbance caused by surgical stress can be influenced favourably by maltose infusion. In order to ascertain the consequences of the above investigation, twelve non-diabetic patients with gastric cancer were infused with isotonic maltose or glucose. The following results were obtained: Both IRI and HGH secretion were not stimulated markedly and remained at equilibrium state by infused maltose in non-diabetic patients. It was disclosed that there was slight elevation in blood glucose by infused maltose, but not in IRI and HGH whereas glucose markedly stimulated blood glucose, IRI and HGH. Plasma FFA was not changed significantly by infused maltose. However, comparing the values of urinary excretion between maltose and glucose, urinary excretion of maltose was always larger than that of glucose. And both maltose and glucose were excreted in urine following maltose administration. The exact mechanism responsible for the excessive excretion of maltose remains to be clarified.
Scimitar syndrome nominated by Neil et al. in 1960 is considered as one type of abnormal blood flow in the partial pulmonary vein which is caused by abnormal flow of right pulmonary venous blood into inferior vena cava. On a chest X-ray film, an abnormal shadow like crescent sward of the blood vessel, so called“scimitar sign”or“scimitar shadow”, which is due to abnormal flow of pulmonary vein, is observed over the right lung. In addition, shift and rotation of the heart to the right, hypoplasia of the right lung and abnormal invation of arteries of systemic circulation are often associated with the disease. Recently, we have observed a case with hypoplasia of the right lung and a cardiac shadow on a chest X-ray film taken over his right thoratic cavity as well as an abnormal shadow, like crescent sward, running from the right of the cardiac shadow towards diaphragma. The observation will be reported in this paper.
The purpose of the present study is to investigate peroxidase diffusion processes in the optic nerve of albino mice with light and electron microscopes in order to elucidate the blood-optic nerve and fluid optic-nerve barriers. Mice were given intravenous injection of 3mg horseradish peroxidase (HRP) in 0.5m1 of isotonic saline or intraventricular (the lateral ventricle of the brain) injection of 0.12∼0.15 mg HRP in 0.02∼0.03 ml of isotonic saline. After mice were sacrificed, Graham-Karnovsky method (1966) was used to demonstrate the localization of HRP. In addition, isotonic saline, same doses as described above, was injected into the same places as controls. Subsequently the routine method for electron microscopy was followed. Epon sections ( 1∼1.5/μ) stained with toluidine blue solution and reacted frozen sections (10∼30/μ) were observed with light microscope. Ultrathin sections were stained with lead and uranyl or with uranyl only. Some of thin sections were observed without stain. In some cases, uranyl en bloc staining was applied.
In 44 cat eyes, retinal branch vein occlusions were experimentally produced by endodiathermy. The course of fundus changes after the occlusion were observed by ophthalmoscopy, color fundus photography and fluorescein angiography. The eyes were enucleated at different stages after the operation and series of sections, trypsin digestion preparations and ultrathin sections were prepared and histopathological studies were executed using light microscope and electron microscope. The results obtained are as follows: 1) Retinal hemorrhages were observed as dots, blots, ringformed and/or preretinal hemorrhages but not as flame-shaped ones. Retinal edema in the area of the occluded vein was more remarkable when accompanying artery was also involved in circulatory disturbance. 2) Collateral channels were formed mostly by 3 to 7 days after the occlusion, which became gradually larger in calibre and finally uniform in calibre as a whole. 3) Capillary closure and microaneurysmal dilations of capillaries appeared in case of branch vein occlusion with accompanying arterial insufficiency but they were not observed in case there were no arterial insufficiency at all. 4) As a conclusion, it is presumed that not only venous occlusion but also remarkable circulatory disturbance of accompanying artery are necessary for the development of clinical features of retinal branch vein occlusion.
Up till now, opinion has varied as to the question whether the incidence of tendon lesions of rheumatoid hands in the Japanese people are similar to that in western people. In order to solve this question the author made a clinical research. To make an accurate diagnosis the author collected a series of clinical symptoms for the tenosynovitis of the wrist and fingers from many reports, literature and his clinical experiences as well. Among them the following are included as important items for diagnosis: the swelling of tendon sheath, trigger and crepitus, limitation of finger motion, swelling or nodule formation of the diseased tendon, and carpal tunnel syndrome with respect to volar wrist tenosynovitis. In this paper, reviewing 131 rheumatoid patients (definite R. A. - 3, classical R. A. - 128) the author obtained the following statistical and clinical results.1. Among 131 R. A. patients tenosynovitis in the hands was seen in 78 cases. Extensor tenosynovitis was seen in 25 cases which corresponds to 19% of all cases, flexor tenosynovitis of the volar wrist was seen in 6 cases which corresponds to 4.6% and digital flexor tenosynovitis was seen in 61 cases,46.6%. These findings mean that the incidence of tenosynovitis is not rare in our country.2. Among the inflammatory signs of tenosynovitis, swelling is most important, paticularly in its early stage, which sign tends to respond promptly to conservative treatment just the same as in synovitis of the joint. In its late stage trigger sign and crepitus become more important. The discrepancy which was obviously found in this series between the incidence of tenosynovitis of the flexor and the extensor tendons is due to the anatomical difference in the tendon and tendon sheath structure of the extensors from the flexors.3. A high incidence is seen in the digital flexor tenosynovitis of the radial three fingers probably due to more frequent usage of these three fingers. The tendon rupture was most likely to occur at the site of a bony prominence, for instance at Lister's tubercle or a dorsolateral prominence of the ulnar head. A single lesion of extensor tenosynovitis does not become a cause for severe functional disturbance which, however, does take place once the tendon is ruptured. On the other hand, in case of flexor tendons tenosynovitis is apt to invite limitation of finger joint movement resulting in finger joint contracture and also development of finger deformities.
Among a series of 78 cases of rheumatoid tenosynovitis 22 cases (26 hands) were surgically treated. Tenosynovectomy was performed in 21 hands (dorsal wrist in 15 hands, volar wrist in 2 hands, digital flexors in 12 fingers of 6 hands) and reconstructive surgeries using tendon transfer or tendon grafting combined with tenosynovectomy were done in 4 hands (dorsal wrist in 3 hands, one hand in volar wrist) and a reconstruction using tendon transfer only was done in one hand with dorsal wrist. Intermediate follow-up study in an average follow-up of 20.5 months was perfomed on 14 cases of tenosynovectomies (10 hands of dorsal wrist,2 hands of volar wrist,10 fingers of digital flexors) and also a study of an average of post-operative observation of 21.8 months was done on 5 cases in which reconstructive surgeries (tendon transfer for extensor tendon rupture in 4 hands, long bridge free tendon graft for flexor tendon rupture in one hand) were performed. The follow-up results of tenosynovectomies were evaluated by the criteria set up by the author as discribed below. Improvement: inflammatory signs subsided, finger function improved or not changed. No change: inflammatory signs subsided, but finger function worsened. Worsening: inflammatory signs reduced, but remained, finger function not changed or worsened. Among the cases of extensor tenosynovitis,“Improvement”was seen in 12,“No change”in 0 and“Worsening”in 0. Flexor tenosynovitis in volar wrist presenting carpal tunnel syndrom was improved in 2, no change in 0 and worsened in 0. Among 10 fingers of digital flexor tenosynovitis 7 were improved,3 showed no change and no cases worsened. In these 3 fingers the extension movement of the fingers is limited but the inflammatory signs are completely eliminated and daily activity is normal. No postoperative complication, for instance adhesion or rupture of the operated tendons, was found. In constructive surgery cases the results using long amplitude tendons such as indicis proprius or superficial flexor tendons were better than the results using amplitude tendon for instance extensor carpi radialis tendon. thereextensor ashort
As for the tendon lesions of the rheumatoid hand the reports of pathohistological studies are very limited except the works of Kellgren and Ball, Ehrlich et al and Potter and Kuhns. There still remain several problems not yet settled in the field of pathohi- stology, especially in the pathogenesis of tendon nodule and its relation to the development of tenosynovitis. The author made a pathohistological research using specimens removed from thirty-two patients operated on by himself, which includes the treatment of 22 hands of extensor tenosynovitis,18 fingers of digital flexor tenosynovitis and three cases of flexor tenosynovitis of the wrist. Ordinary staining such as H. E., Azan-Marolly, van Gieson, Toluidin-blue, Weigert-fibrin and Silver stainings were performed for microscopic examinat ion. The following conclusions were drawn not only from pathological findings but also from clinical features and operative findings. 1. From the findings of forty-three tendon lesions the lesions could be classified into the following three groups: 1) tenosynovitis in 34,2) tendinitis in one,3) co-existence of tenosynovitis and tendinitis in 8. This suggests that the tendinitis does not always occur as a secondary product from the tenosynovitis. 2. Microscopic manifestations of the findings of tenosynovitis are in many respects very similar to the synovitis of the joint of rheumatoid arthritis, but the findings of tenosynovitis are rather simple in histological manifestation as compared to joint synovitis. 3. Histologically a nodule-like swelling or a nodule formation in the tissue of tendon substance is most characteristic. These nodule-like tendon lesions were classified into three types by the author,1) proliferated granuloma in epitendineum which is seen in 4 tendons,2) a. proliferated granuloma in peritendineum which is seen in 4 tendons,2) b. degenerative changes in tendon substance in one tendon. In addition to the above findings the author noticed that the inflammatory findings both in epitendineum and peritendineum were very similar to those in articular synovial tissue.
Here reported two cases of aplastic anemia caused by Azathioprine (AZ) which was administered as an immuno-suppressor. Case 1: 44 y. male. Pancytopenia was found during AZ therapy of chronic hepatitis, bone marrow puncture showing“dry tap”. Discotinuation of AZ and administration of corticosteroid, ACTH as well as anabolic steroid successfully recovered the blood disorder. Case 2: 24y. male. The patient was under Allopurinol treatment for gout. As complicating chronic nephritis (nephrotic type) was found, administration of corticosteroid and, afterwards, of AZ was added to the therapeutic regimen. Two months after, anemia and leukopenia gradually proceeded, although the platelet count remained within normal range. Discontinuation of AZ as well as of Allopurinol brought about recovery of the blood picture. In these two cases, the probable disturbance of AZ metabolism, in case 1 because of chronic hepatitis, and by Allopurinol in the other, might enhanced the deteriorating effect of AZ on the hematopoiesis, suggesting that basic diseases, especially liver dysfunction, or drug interactions may play some role in the pathogenesis of the secondary aplastic anemia.