(Supervised by Prof. Tada k i Matsumura)Changes of cerebrospinal fluid (CSF) pH caused by NaHCO3 infusion have been studied. There has been no reports on continuous changes of CSF pH followed by hypertonic solutions except of NaHCO3 during respiratory acidosis. The purpose of this study was to det ermine the CSF pH change following in continuous infusion of hypertonic solutions in rabbits. CSF pH was measured by Ion Sensitive Field Effect Transistor (ISFET)Study was made upon the following 3 groups. Group I: Rabbits were injected 7% NaHCO3 at a speed of 10ml/kg/hr,20ml/kg/hr and 40ml/kg/hr under the condition of normocapnia. Group II: Rabbits were injected 7% NaHCO3 at a speed of 10ml/kg/hr and 40ml/kg/hr under the condition of hypercapnia. Group III: Rabbits were injected hypertonic solutions of 20% Mannitol and Glycerol's at a speed of 10ml/kg/hr under the condition hypercapnia. As a control study, isotonic solutions of NaCl and 5% Glucose were injected. And the following results were obtained. 1) CSF pH droped first by 1 minute and then elevated by 30minutes after inhaling CO2. 2) Under hypercapnia, blood pH and CSF pH rised up by injection of 7% Na HCO3. Blood pH rised up more quickly at a speed of 40ml/kg/hr than at a speed o f 10ml/kg/hr, however there was little difference in the rise of CSF pH between at a s peed of 10ml/kg/hr and 40ml/kg/hr. 3) Under normocapnia, the injection of 7% NaHCO made CSF pH down and blood pH up at the biginning. 4) Under hypercapnia, the injection of isotonic solutions made blood pH little change, and CSF pH up gradually. 5) Under hyp e rcapnia, the injection of hypertonic solutions made blood pH and CSF pH down at the same time.
Twenty-three parent-child pairs (41 patients in total) and fourtyseven sibling pairs (5 pairs were implied in the previous cohort at the same time) were selected arbitrarily from patients'records in four mental institutions in order to compare clinical pictures, course and prognosis between the schizophrenic members in the same family. Moreover, reaction to and side-effects of psychotropic drugs were discussed on some of the materials. As some of these patients belonged to both cohorts at the same time, the total number of them in this study was 125in number. 1) The schizophrenic patients of atypical group were rather frequently found among the parent-child pairs, especially in parents, while those of typical group were quite popular among the sibling pairs. This finding Seemed to indicate the difference in the mode of inheritance between the cohorts. 2) The extreme predominance of mother-child combioation in this study seemed due to the above-mentioned arbitrarity of selection of materials. In about half of the parent-child pairs, the coincidence was observed in regard to clinical pictures at the onset, clinical forms and degree of personality deterioration. But the rate of coincidence was higher if one limited the patients only to either typical or atypical group, and particularly it should be noted that no child belonging to atypical group was born to parents of typical group. Tendency to anteposition was recognized among children, as the onset was earlier, the course more chronic, typical features and forms more predominant and the prognosis seemed more unfavorable in them. 3) While, among sibling pairs, more than half of the pairs indicated coincidence a s to the clinical pictures, the course and the prognosis. The rate of coincidence here was more apparent than in parent-child pairs. The coincidence was observed in three fourths of sibling pairs of atypical group, although typical-atypical combinations were also seen in lesser degree. On the contrary, almost all of the pairs of typical group indicated the coincidence. As a whole, the rete of coincidence was not so high, if clinical forms and pictures were here taken into consideration. Many of siblings did not coincide from various clinical points of view, when age-difference between both of the pair was more than eleven. 4) Finally, the comparisons of reactions to the drugs and of the sideeffects thereof were fairly difficult on account of polypharmacy, of difference of doctors in charge and of different periods of treatment. The coincidence was however more apparent in regard to ineffectiveness than to effectiveness in both cohorts. But the appearance of extra-pyramidal signs seemed to coincide fairly well in the pairs, where the anti-parkinsonian drugs were not administered.
The neuropsychological structure of dementia in Alzheimer's disease has been investigated on six patients, of which five have been followed for several years. While, the purpose of this study is to contribute to the understandings of a contradictory fact that the focal signs do appear even in such panencephalic brain disease. For the convenience of discussion, the period of investigation was divided into two stages, namely, those before and after hospitalizations. Then the clinical symptoms in both stages were studies; particularly forgetfulness and other symptoms in the former stage and focal signs and other general symptoms in the latter stage were described in details. Those focal signs consisted of Korsakow's syndrome, characteristic speech disturbances, disturbances of written language, acalculia, apraxia and agnosia. As the result of this investigation, the following findings were obtained concerning the structure of dementia in this disease. 1: Symptoms in the stage before hospitalization. Notable forgetfulness at the onse t, observed in all patients, would construct Korsakow's syndrome together with disorientation and confabulation which apppeared sooner or later in the progression of the disase. Other abnormalities, considered as the precursors of apparent focal signs in the later stage, began to be manifest episodically or as paroxysms even about this time. Though no post-mortem circumscribed damage was found in some of the cases, these symptoms of this stage were supposed to be due to intermittent claudication in cerebral centers caused by certain vascular disorders. 2: Symptoms in the stage during hospitalization. a. Speech disturbances: Word am nesia and, further in later stage, alogia were observed. It seemed quite difficult to regard word amnesia as amnestic aphasia if high age of the patients and the presence of amnestic symptoms in them were taken into consideration. Alogia, seemingly akin to jargon aphasia, had also similarities to schizophasia in phenomenology. Agraphia and alexia observed in these patients seemed rather due to apractic and, particularly, to agnostic disturbances than to general amnestic symptoms. In spite of the presence of acalculia,72multiplication was relatively intact, as it connected closely with audito-motor function. b. Apraxia: Constructive apraxia and dressing apraxia were often found in the patients. Various apractic symptoms observed in them should be discussed chiefly from the view-point of disturbances in temporo-spatial arrangement (order of performance) in which visuo-spatial function was impaired in particular. Visual function seemed to play an important role in the genesis of constructive apraxia in these patients, sb it was also called visual apraxia properly. While, dressing apraxia could here be divided into the following four types; failure in selection of clothes, failure in dressing order, other difficulties in dressing and overlap of clothes. But, the fundamental causes of dressing apraxia might be derangement of order of performance, disoriention and visuo-spatial agnosia. c. Agnosia: Visuo-spatial agnosia was often observed in them. Topographical disturbances and most of Balint syndrome were especially apparent. The disturbances of motor function such as psychic palsy of gaze and visual ataxia might be implied as partial components of the agnosia. 3: Conclusion. Vari ous types of aphasia, apraxia and agnosia have hitherto been reported as the focal signs in Alzheimer's disease. However, it might be possible to contribute these symptoms to a unitary disturbance, according to the above-mentioned consideration of the author. In other words, this disturbance might be a functional one in connecting and integrating visual function with motor activity, and, therefore, it might also be considered at least as the result of a fairly circumscribed lesion in the brain.
Ten cases of colitis which were induced by the administration of AB-PC, AM-PC, CEX or TC + MNC and encountered during the past 2 years in our department are reported. Chief complaint of all cases was bloody diarrhea which was preceded by watery diarrhea and associated with severe lower abdominal pain and developed within 1 to 5 days after the administration of antibiotics. Most cases had more than 10 passages a day. Bloody diarrhea lasted for 4 to 9 days and disappeared within 6 days after the discontinuation of antibiotics. No remarkable increase in ESR was observed but all cases had fever of 37.2 to 38.9°C. Colonoscopic examinations revealed the mucosal edema, redness and scattered hemorrhagic erosion at flexura lienalis to sigmoid colon. By biopsies non-specific inflammatory reactions such as congestion, hemorrhage and cell infiltration were observed.
A posterior release has been applied at our Department for sever e congenital club foot patients which needed operative treatment. In order to evaluate the post-operative walking pattern from the Electrophysiological and Kinesiological point of view (EK evaluation) in addition to conventional clinical evaluations, the author attempted to standardize the electromyographic (EMG) gait pattern of ankle muscles in Japanese people,147 healthy adults of both sexes, ranging in age from 19 to 35 years were used.
We studied 15 patients (age 27-72 years old) with acute myocardial infarction who were admitted to Kansai Medical University within 14 hours (Mean 5.3 hours) after the onset of chest pain. Total obstruction was seen in 11 patients and spontaneous recanalization in 4 patients at the time of acute coronary angiography. Percutaneous transluminal coronary recanalization was performed in all patients. A bolus of isosorbide dinitrate (5 mg) was infused into the ischemia-related coronary artery. Five minutes later, a bolus of urokinase (120000 unit) was infused into the same coronary artery and coronary angiography was performed. When recanalization of th e coronary artery was not found, urokinase was administered at a rate of 250-400 u/kg/hour to the maximum dose of845000 units. Among 11 patients with total obstruction, recanalization oc curred in one patient with isosorbide dinitrate and in 10 patients, recanalization occurred with urokinase. Chest pain alleviated after reperfusion in all patients. In 4 patients whom spontaneous reanalization was found at acute coronary angiography, intracoronary urokinase infustion did not result in the improvement of the stenosis. Angiography was repeated 30-40 days after the acute study in 11 patients. Improvement of coronary artery stenosis was found in 6 patients. Although aleviation of chest pain was seen with percutaneous transluminal coronary recanalization, further study will be needed to evaluated the efficacy of this method in improving cardiac function.
Objectives of this paper were to elucidate essential electrical discharge patterns of lower limb muscles and their variabilities during a normal gait cycle. Subjects employed in the experiments were 217 healthy adults of both sexes, ranging in age from 18 to 22 years, and they had no disorder in the lower limb or the central nervous system in their medical history. Electromyograms (EMGs) were recorded from the Tibialis anterior (Ta), the Gastrocnemius lateral head (Gl), the Vastus medialis (Vm), the Gluteus maximus (Gm), the Rectus femoris (Rf), the Medial Hastrings (MH), and the Biceps femoris (Bf) by conventional method using surface electrodes. Angular changes of the ankle, knee and hip joints and time signals at the heel and the toe contacts with the ground were simultaneously recorded with the EMGs. The essential EMG pattern s of the lower limb muscles during a normal gait cycle were conclusively summarized: 1) The ankle joint muscles; i) The marked discharge of the Ta was observed in the period from the end of the swing phase to the early part of the stance phase, and in the period from the end of the stance phase to the early part of the swing phase. ii) The Gl showed the main discharge in the latter half of the stance phase, and showed almost complete electrical silence in the former half of the swing phase.2) The knee and hip joint muscles; i) The discharge of the Vm started at the latter half of the swing phase and increased abruptly just before or after the heel contact. The marked discharge of the Vm lasted into the first double leg support period. ii) The discharge of the Gm started at the latter half of the swing phase and increased just before or after the heel contact. The Gm showed the continuous discharge during the former half of the stance phase. iii) The main discharge of th Rf was similar to that of the Vm, and the Rf did not show distinguished activity in the former half of the swing phase. iv) The MH and the Bf showed the marked discharges from the the latter half of the swing phase to just before or after the heel contact, but little or no discharge in the former half of the swing phase. In addition to the essential EMG pattern s, the variations in the EMG patterns which were found to be within ranges of the normal activities were as follows: 1) The ankle joint muscles ; i) The distinguished discharge of the Ta at about the mid-swing phase appeared in about 85% of the subjects. ii) The discharge variation of the G1 was hardly observed during the gait cycle.2) The knee and hip joint muscles; i) The discharge of the Vm was seen around the mid-stance phase and in the second double leg support period in about 20% of the subjects. ii)The discharge variations of the Gm were similar to those of the Vm. iii) The discharge of the Rf appeared around the mid-stance phase in less than 20% of the subjects and at the end of the stance phase in about 80%. iv) In about 60% of the subjects the marked discharges of the MH and the Bf in the latter half of the swing phase decreased or disappeared abruptly around the heel contact; however, in the other 40%, the discharges continued until the midstance phase. The discharges of the MH and the Bf at the end of the stance phase were observed in less than 20% of the subjects. The marked discharges of the MH and the Bf decreased or disappeared abruptly at the moment when the Rf abruptly increased its electrical activity around the heel contact, and the spike sessation lasted until the moment when the Rf decreased its activity. It was suggested that the spike inhibition in the MH and the Bf might be due to an antagonistic inhibition caused by facilitation of the Rf.
The longitudinal muscle strip of portal vein, excised from adult wistar rat weighing 200 to 250g, was suspended in an organ bath (50m1) containing Locke's solution saturated with pure oxygen at 37°C (pH: 7.4); 0.5g of initial tension was loaded to the preparation and the change of tension produced by the drug was isometrically recorded. Effects of guanethidine were studied on spontaneous contractions, potassium-depolarized contraction and calcium-induced contraction after potassium-depolarization in the preparation. The results obtained were as follows.1) Guanethidine in a low concentration of 2.5 X 10-6 g/ml enhanced the tensio n developement induced by high potassium-Locke's solution and by calcium chloride which was added to the potassium depolarized preparation.2) Acetylcholine and noradrenaline induced contraction of the preparation, of which contraction was enhanced by the presence of guanethidine (1.25 to 2.5 x 10-6 g/m1). From the results, it was assumed that guanethidine may posses s an action to increase the permeability or inflow of calcium ions through the smooth muscle membrane in the rat portal vein.
The pathway of the blink reflex elicited by auditory stimulation was investigated by means of destructions and transections in some parts of the central nervous system. The reflex was recorded as microvibrations of the eyelid (auditory-evoked eyelid microvibration, AMV). 1) Bilateral electric lesions in the midbrain reticular formation resulted in a marked re duction or a disappearance of AMV. 2) Lesions in the inferior colliculus reduced the amplitude of AMV, while lesions in the medial geniculate body had no effect. 3) Temporal suppression of the cerebral cortex by KCI solution did not reduce the amplitude of AMV, but sometimes increased it. The same result was obtained after mechanical destruction including the hippocampus. 4) The transecti ons of the brainstem at both the intercollicular and upper medullary level did not affect AMV. On the other hand, AMV disappeared after the transection at the postcollicular level. 5) The se results suggest that the reflex pathway of AMV exists between lower midbrain and upper medulla, including the classical auditory pathway, peripheral to the inferior colliculus. AMV has a close relation to the function of the midbrain reticular formation, but does not have a direct relation to the cerebral cortex. 6) AMV will be useful in evalua ting the function of the brainstem. Furthermore, MV (photo-evoked eyelid microvibration) is preferable to record in combination, to certify the localization of the lesion in the brainstem.