In this endresults study the clinical materials used were 147 joints: 103 knees with an average follow up period of 9.6 years,25 elbows with an average follow up about 10 years and 19 ankles with an average follow up about 11 years. They are diagnosed as classical RA. Preoperative findings such as duration of disease, number of major joints involved, age, sex distribution, stage and class of the preoperative patients are not descrived here. However, these patients demonstrated similar data as they reported in the past literature. Postoperative improvement was investigated concerning the follow ing items which were inflammatory signs such as pain and swelling, R. O. M., degree of patient's satisfaction with surgery, the stage of the joint and the class of the patient. Their findings in the 3 joints were comparcd with the preoperative findings and also compared with each other. It was found that the results were best in the elbow then in the knee and then in the ankle joint. There is no remarkable difference between these 3 joints concerning postoperative improvement in inflammatory signs. In all 3 joints excellent reduction in inflammation was achieved. Differences did exist between these 3 joints regarding improvement in postoperative R. O. M.. Postoperative preservation in R.0, M. was best in the elbow, then in the knee and then in the ankle. As to the degree of patient's satisfaction with surgery: Satisfaction was noted in 61% of knee patients,84% of elbow patients,68% of ankle patients. Partial satisfaction was noted in 22% in the knee patients,16% in the elbow patients,16% in the ankle patients. Displeasure with the results was noted in only 17% in the knee joint,0% in the elbow patients,16% in the ankle patients. The structual damage progressed in every joint postoperatively. But in fact joint s which were in stage 3 preoperatively and then progress to stage 4 were 0% in the elbow,12.5% in the knee,56% in the ankle. The stage of the operated joint remained unchanged in the majority of the elbow and the knee joints. The class of the postoperative patients was fairly well maintained and they did not easily become incapacitated. It is evident that these “endresults” are more excellent than the results in the survey conducted by multicenters in the U. S. A. as well as in the United kingdom. These findings lead the author to conclude that these innovative s ynovectomies in the elbow, knee and ankle joints have passed the test of time and each of them has now proved to be a trustworthy and useful surgical method in the surgery of rheumatoid arthritis.
Using Y. Mori's procedure (1981), the author performed an experimental study of myelography of the lumbar spine at L5-S1. The normal lumbo-sacral spine of a human cadaver was sectioned in a coronal plane passing the pedicles and devided it into the two parts. The anterior part was a vertebral body and the posterior part was a laminar portion. The intradural space was filled with a physiologic saline solution and about 3 ml of myodil as a contrast medium was introduced in it, then the dural sac was closed with a clamp at its top. A series of experiments were then performed by narrowing the space of the spinal canal under the following conditions.
The immunoelectron microscopic (IEM) studies of HSV-1 infected Vero cells were conducted for the purpose of analysing the fine localization of virus related proteins and their intracellular transportation. For this purpose, horseradish peroxidase (HRP) labeled anti-HSV-1-Fab′(Rabbit, HRP-Fab′) and anti-HSV-1-IgG (Rabbit, HRP-IgG) were prepared. The results were compared histochemically between two labeled antibodies, and the following results were obtained. 1. It was shown that the HRP-Fab′ penetrated deeper into the cell than IIRP-IgG. The former penetrated not only into the cytoplasm but also into the nucleus. By using HRP-Fab′, the HRP reaction products were so sharp that clear distribution of the HSV-1 antigens were obtained. 2. Immediately after the virus adsorption, membranes of cytoplasm and vesicles obtained virus specific antigens. Concerning the virus invasion, two systems have been shown. One was viropexis by phagocytosis and the other was virus-cell membrane fusion. 3. Increased intranuclear staining seen from 2 hr post-adsorptio n suggested the accumulation of the virus related protains in the nucleus. 4. Intranuclear fine granular deposits occupied the wide area of the nucleus. I consider this structure is the same that of the intranuclear inclusion body observed in the specimens under the light microscope. 5. These fine granular deposits increased their density. But two groups of cells were distinguished according to the grade of increased fine granular deposits. In the first group of cells, deposits were increased and in the other, further increase was not observed during the virus replication course. Virus particles appeared in the nucleus in the latter group of cells after 6 hr post-adsorption. 6. Virus particles matured using innernuclear membrane or membrane structure of cytoplasm, and were transported into intracytoplasmic vacuoles or into extracellular space. 7. The advantages of HRP-Fab′ usage in IEM were discussed.
For the purpose of investigating EEG changes provoked by antiepileptic drugs, six different compound, namely phenytoin, valproate sodium, phenobarbital, primidone, carbamazepine and ethosuximide, were orally given to healthy male volunteers and EEGs recorded post-one, three and six hours were quantitatively analyzed. Periodegram program using zero-crossing and power spectra program using FFT algorism were employed for the routine analysis, but the results obtained from the former method were appropriate in the present study and they have been mainly used for the discussion as follows. 1. Phenytoin and phenobarbital which are anti-convulsive agents used for controlling generalized motor convulsion and valproate sodium which is essentially anti-petit-mal agent with potent anti-convulsant action produce an increase of fast activity in EEG. 2. EEG changes induced by ethosuximide that is anti-petit-mal substance is summarized as an increase of slow activity. 3. EEG changes due to carbamazepine which is remedy for psychomotor seizures showed a mood elevator type responce consisting of slow and fast activities. 4. Primidone is known as having a wide therapeutic spectrum which may be resulted from its metabolite such as phenobarbital but it is impossible to expect the appearance of phenobarbita l within six hours after the oral administration of primidone. The induced EEG changes are an increase of slow activity in contrast to the phenobarbital induced increase of fast activit y. 5. The present auther have presented several different theories on action mechanism of these antiepileptic drugs and discussed their relationship to the EEG changes produced by each drugs. 6. The mean values of maximal serum concetration were 3.8μg/ml for PHT 200mg group, 5.9μg/ml for PHT 400mg group, 54.2μg/ml for VPA 400mg group, 70.8, ug/ml for VPA 600mg group, 1.2μg/ml for 60mg PB group, 3.7μg/ml (PB 0.0μg/ml) for PRM200mg group, 14.0μg/ml for ESM 500mg group, 2.0μg/ml for CBZ 100mg group, 2.9μg/ml for CBZ 200mg group.
In recent, the simillarity in immunopathology between IgA nephropathy and Henoch-Schönleir purpura nephritis (HSP nephritis) has been in discussion. The auther carried out this study to clarify some differences in two diseases from clinicopathological viewpoint. From June,1980 to September,1983,175 renal biopsies were pe rformed in children, and 2z cases of IgA nephropathy and 20 cases of HSP nephritis were brought to examinations undo light microscopy (LM), immunofluolescence microscopy (IF) and electron microscopy (EM). Also among on some cases were observed by immunoelectron microscopy (IEM) Sequentia biopsies were also performed in 7 cases of IgA nephropathy and 5 cases of HSP nephritis ir order to know whether any differences do appear in the course of these diseases. The following results were obtained.
One of the factors in the success of cardiac surgery is how well the myocardium is protected while the ascending aorta is occluded and the natural coronary blood flow is suspended. Five methods for myocardiac protection which are employed clinically were comparatively examined with a cardiac perfusion apparatus for isolated hearts of large animals in terms of left ventricular function and myocardiac metabolism. The apparatus was designed to exclude factors other than myocardium, including neural and secretory activities as well as to stabilize preload and afterload. Hearts were isolated from 56 mongrel dogs, classified into Groups 1,2,3, and controls, and treated as follows for 30,60, or 90 minutes. The hearts of Group 1 were subjected to surfac e cooling in a physiologic saline at 10°C. Group 2 was subgrouped into 2-a and 2-b: the hearts of the first subgroup were perfused intermittently at 30-minute intervals with a lactated Ringer's solution (50 ml) at pH 8, as well as subjected to surface cooling; those of the second subgroup were intermittently perfused with a lactated Ringer's solution containing potassium (25 mEq/1). Group 3 was also subdivided into 3-a and 3-b: the first was a continuously perfused with GIK solution following cardioplegia induced by Young's solution; in the second group, diluted and cooled blood (Ht 20-25%,10°C) was used for the continuous perfusion. The perfusion rate was 10-15 ml/min for both subgroups. Myocardial ATP was measured 30,60, and 90 minutes after the beginning of the treatments by biopsy of the right ventricular free wall. The ATP content, which decreased with time in all the dogs, was significantly higher in Group 3-b than in the other 4 groups even 90 minutes after the treatments. Following the myocardial biopsy, left ventricular function was measured with the cardiac perfusion apparatus for isolated hearts using autologous blood. Left atrial pressure (LAPmin) and the angle of the left ventricular function curve (ASW) at the time of the earliest-observed ejection 30,60, or 90 minutes after the treatments were obtained on the left ventricular function curve of each group and comparatively studied. The left ventricular function of the hearts in Group 1 was similar to that in other groups after the 30-minute treatment, but a significantly higher LAPmin and a significantly lower ASW than Kl.5in other groups were observed after the 60-minute treatment. In Group 2-a, the left ventricular function declined with time during the 60-minute treatment. In Groups 2-b,3-a, and 3-b, by contrast, no significant difference was observed even after the 90-minute treatment. The above results suggest that the surface cooling method is the least effective in protecting the myocardium, followed by the intermittent perfusion method with lactated Ringer's solution. The three other methods, namely, potassium cardioplegia, continuous coronary perfusion with GIK solution after Young's solution-induced cardioplegia, and continuous coronary perfusion with diluted blood, showed similar effects. According to the measurement of myocardial ATP content, however, the third seems to be slightly better.
Applying the mecholyl (Funkenstein) test, which is known as being usable for the prediction of prognosis or responsiveness to therapies of psychoses, to 47 patients with epileptic seizures and to 10 normal volunteers, the present author has studied the results from several clinical view points. From the principal component analysis of 10 parameters of the mecholyl test, it has become evident that there are four compontents; the 1st component related to the responsivenese of a subject, the 2nd one related to the recuperatability of blood pressure, the 3rd one related to the repulsiveness and stableness of blood pressure and the 4th one related to the systolic blood pressure, in the patients. In the normal volunteers, the systolic pressure contributes to the 2nd component and the 4th component is considered as the residuals, while it seems to be an independent component but contributes also to the 1st component. Since Gellhorn index exclusively contributes to the 1st component, while Suwa index fairly much contributes to the 2nd component, the latter can reflect more parameters. Few parameters showed a sex and age-related difference but statistically not significant as a whole. From the study of typological classifications according to Suwa, Gellhorn and Okinaka, there were many normotensive and hypotensive reaction types. Above all, Suwa's classification has been found to be the most discriminative against abnormal responses, such as hyper and hyporeactors. From the study on clically classified patients' groups with discriminat function analysis using the 10 parameters, the discriminations between yonng patients and aged patients, between those who received a therapy within one year from the onset of epilepsy and the others, at a correctiveness of 100%. In the study on EEG abnormalities, the lower the degree of abnormalty the more the sympathetic hyperreactor, while the higher the degree of abnormality the more the parasympathetic hyperreactor. In particular, there are few N types and many P types in patients with spike or sharp wave foci. The incidence of S type occupies a certain fixed proportion regardress of the EEG abnormalities. As to clinical seizure types of the patients, there was no N type reaction in the cases of psychomotor and other partial seizures only. It was possible to discriminate at a correctiveness more than 80% between generalized motor convulsion and psychomotor seizure. It may suggest that there are a difference of autonomic nervous functioning between patiants of centrencephalic and those of focal cortical seizures. There were relatively ma ny sympathetic hyperreactors and few hyporeactors in patients who were not clinically improved by the medication. Therefore, a hypotensive reaction can be a favorable sign and hypertensive one may be unfavorable sign as far as prognosis is concerned. Discriminant analysis is quite effective for clinical improvement scores and its corr ectiveness exceeds 80% in generalized motor convulsion and reaches to 100% in psychomotor seizure. The reason, why correctiveness of discrimination in the epileptic patients as a whole was low, seems to be due to the differences of important parameter between different seizure types. Consequently, it is clear that each mecholyl parameter contains various informations, including information about prognosis of the epilepsy. For the purpose of extracting the necessary information, the discriminant analysis is more effective than typological classifications such as Suwa's and Gellgorn's. The difference can be considered as having been resulted from that the Suwa's and Gellhorn's indeces use only four parameters but the discrminant function uses all the seven paraiscriirs.
It is well known that there are frequent appearances of cerebellar ataxia due to diphenylhydantoin (DPH) intoxication and it is true that there are a certain number of papers suggesting organic damages of cerebellum in the case of postmortem examination of epileptic patients. The author has carried out three series of experiments using rat; i. e., an embryo rat experiment, an infantile rat experiment, and a matured rat experiment, each consisting of daily observation of general conditions and postmortem investigations with optical and electron microscopes, particularly regarding to the age-dependency of DPH side effect to the rat brain. 1. The embryo rat has presented no particular disturbance to the develop ment of cerebellum either in the experimental group in which DPH were given subcutaneously to pregnant mother rats or in the other group in which DPH were given orally from the pregnant stage through lactaing stage. In the latter group the electron-microscopic examination showed some dubious findings of cerebellar damage more often than in the control group, while the former group presented almost no change and even if a certain change was provoked by DPH administration it was reversible and quickly recuperated by discontinuation of the medication. 2. DPH was given orally for 80 days in the case of infantil e rat, while it was given intraparitoneally in the case of matured rat for 14 days mainly because the rat would be come atactic, comatous and fatal within a few weeks. In both the groups, there were no evidence of loss of Purkinje cell, which was found in the case of epileptic patient. However, there were a few rats in which dark neuron and spheroid were noticed though the induced changes were relatively mild in general. 3. It must be noted that the matured group presented very earlily the DPH - induced changes when compared with infantile group. The difference could be due to the difference of administration method, the author was convinced for several reasons that the matured rat are more sensitive to DPH medication than embryo and infantile rats. It does not mean the DPH-induced changes were severe in the matured rat. From the results menitoned above, the present author has concluded as follows: As to the appearance of severe cerebellar damages in the reported case of epilep tic patient, the duration of DPH administration could be important, but the concurrences of several differenct factors such as the fundamental disorders of epilepsy, the frequent repetitions of convulsive seizure and the possible residues of vascular lesions appear to be decisive, for the time being
(Na+, K+) ATPase (holo-enzyme) and its a and β subunits were purified from canine kidney by using lectin-Sepharose affinity chromatography, and the antibodies against them were raised in rabbits. The antibody against the holoenzyme inhibited not only kidney but also liver (Na+, K+)A TPase activities almost completely. Distribution of (Na+, K+)A TPase on the cell sur faces of prefixed and isolated canine hepatocytes was investigated by quantitative ferritin immu noelectron microscopy using these antibodies, and the following results were obtained. 1) (Na+, K+) ATPase exists on the bile canalicular as well as on th e sinusoidal and lateral surfaces of hepatocytes. 2) The av erage particle density on the bile canalicular surface was -2.5 times higher than on the sinusoid-lateral surface. 3) The total number of t h e enzyme on the sinusoid-lateral surface was, however -3 times higher than that on the bile canalicular surface, because the canalicular surface represents only 13%, while the sinusoid-lateral surface 87% of the total hepatocyte surface. 4) We suggested that (Na+, K+) ATPase on the bile canalicular pl a sma membrane is responsible for the bile acid-independent bile flow, while that on the sinusoid-lateral surface for the various active transport processes.
During the process of developing of the ICR-cataractous rat as an established strain, a substrain was found, which showed an early occurrence of thymus atrophy accompanied with the skin lesions. In order to make an elementary elucidation on the constitutional factors of these disorders, we observed changes in the weight and the organ/body weight ratio of thymus and histological findings of it as well as of the skin. An accelerated process of the thymus atrophy was sho wn at the early stage of two months age in both sexes, especially in the males, being more significant after the age of three months. In regard to the histological findings, a significant atrophy of the thymus parenchyma including its cortex, was observed, being consistent with those of the organ weight or the organ/body weight ratio. At five months of age, the thymus parenchyma was completely replaced by swollen lymph nodes in some cases. After two months of age, there appeared also the encrusted or erosive skin lesions occurring symmetrically in the cervical (including retro- or subauricular regions), the scapular and besides the dorsal regions (except the lumbar region). They could be, in part, ascribed to secondary scratching effects. However, we simultaneously observed, on the histological level, characteristic lesions such as a significant acanthosis of the epidermis especially around the hair follicles, as well as thickening of the keratohyalin zone and hyper-, para-keratosis, slight to moderate spongiosis, extension of the inflammatory infiltrate into the epidermis, inflammation of the dermal zone, hyperplasia of the sebaceous glands and perifolliculits, especially showing infiltration of mononuclear cells into the follicular region. These lesions may be regarded as a disease entity of “dennatitis” because they showed a marked similarity with the atopic or seborrheic dermatitis seen in humans. Therefore, the ICR/d-strain rat may be useful as a good disease model for elucidating the occurrence mechanisms of such dermatItis.