The most proximal portion of the left middle cerebral artery was occluded through the transorbital approach to produce an experimental ischemic model in dogs. It was confirmed that the middle cerebral artery was successfully occluded without any damage to the brain tissue, the anterior cerebral artery or the internal carotid artery. The 25 adult dogs used in this experiment were sacrificed between the 2nd and 21st day after the arterial occlusion, and microvascular and histopathological studies were done.
The histopathological study revealed that the severity and range of infarction was variable. Infarcted areas involving the centrum semiovale and lenticular nuclei, which are mainly fed by the peripheral branches of the lenticulostriate arteries arising from proximal portion of the middle cerebral artery were found in 14 dogs. Extensive wide infarctions of the cortical and subcortical areas in addition to the peripheral territories of the lenticulostriate arteries were detected in 8 other dogs. No infarct was seen in the remaining 3 dogs. The results indicate that the peripheral area of the lenticulostriate artery is likely to be the most easily infarcted region in this experimental model.
In 19 of 25 dogs, microangiography using 60% barium sulfate (Micropaque) was performed from the 2nd to the 16th day after the arterial occlusion. A remarkable midline shift to the contralateral side was a predominant finding in 2 dogs examined within 3 days of the arterial occlusion. Extravasation of contrast medium with hypervascularity in the occluded hemisphere was observed in 5 of the 8 dogs examined 4 to 7 days after the arterial occlusion. In one of the 5 dogs with these findings, extravasation was restricted in the centrum semiovale. More extensive extravasation including not only the centrum semiovale but also the internal capsule, caudate nucleus and cerebral cortex was found in 3 other dogs. In another dog, extravasated micropaque perforated via the centrum semiovale into the lateral and third ventricles. In the remaining 3 dogs examined in the same period, extravasation and hypervascularity were not so significant as in the other 5 dogs. In 7 dogs examined more than 7 days after the arterial occlusion, no notable changes in the microangiographical findings such as extravasation or hypervascularity were noted.
The results indicate that extravasation and hypervascularity are observed 4 to 7 days after the arterial occlusion in this experimental model, which suggests that vascular vulnerability might be increased to the greatest extent in this period. If true, this hypothesis may give one reason why spontaneous recanalization or surgical reconstruction of occluded vessels in this subacute period not infrequently causes hemorrhagic infarction, followed by further deterioration of symptoms and signs.

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The purpose of the present study is to clarify the effect of stimulation of the reticular formation of the medulla oblongata (MORF) on cerebrovascular tone.
Using 32 cats, blood pressure (BP), intracranial pressure (ICP) and cerebral blood volume (CBV) were continuously measured. The animals were divided into 4 groups: G₁, normal ICP; G₂, increased ICP due to subarachnoid hemorrhage; G₃, superior cervical ganglionectomy, and G₄, spinal cord transection at C₂. In all animals, the MORF was stimulated after the dorsomedial nucleus of the hypothalamus and the reticular formation of the midbrain were destroyed. The BP was also increased with an intravenous administration of angiotensin II. The vasomotor index (VI), defined by ΔICP/ΔBP, was calculated and compared between the two situations, i.e., MORF stimulation and angiotensin II administration.
BP, ICP and CBV increased simultaneously immediately after MORF stimulation. In G₁, G₂ and G₃, the VI with MORF stimulation was significantly higher than that with angiotensin II. The increase in ICP with MORF stimulation was also observed in G₄, although the BP showed no consistent changes in this group.

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At Okayama University Medical School, the clinical application of magnetic resonance imaging (MRI) started in August 1984, and 16 patients with aortic aneurysm have been imaged by short spin echo (TR400msec, TE40msec) with a Toshiba MRT-15A (resistive type of magnet with a strength of 0.15T).
MRI demonstrated the intimal flap and enabled the differentiatian between true and false lumens from the signal intensity. Thrombi were shown with high intensity and were differentiated from fast blood flow, but in some cases clots could not be distinguished from slow flow.
MRI in which multiple planes are imaged directly without contrast medium, is a very useful imaging modality for the evaluation of aortic aneurysm.

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In order to find a sensitive electrode position and to examine the criteria for the diagnosis of LVH, discriminant analysis was applied to body surface isopotential maps recorded by Yamada's method. The subjects consisted of 35 patients with hypertension, 25 with aortic regurgitation, 20 with hypertrophic cardiomyopathy and 45 normal controls. The subjects were divided into two groups, those with and those without LVH, according to the echocardiographically-obtained LV mass calculated by Devereux's method. Using discriminant analysis, we investigated the S and R waves to verify which position was the most sensitive for the diagnosis of LVH. The amplitude of the S wave was examined at 28 points from the right midclavicular line to the left midclavicular line including V₁-V₃, and the amplitude of the R wave was examined at 33 points from the left midclavicular line to the left scapular line including V₄-V₆. The sensitive positions were: for the S wave, the right sternal border in the third intercostal space (D5), and for the R wave, the fourth intercostal space along the left midaxillary line (I-4). Lead D5 was to the right and above V₁, and lead I-4 was abobe V₆. The diagnostic criteria of LVH indicates high sensitivity (82.5%), high specificity (87.5%) and high accuracy (85.0%), and is better than the Sokolow-Lyon's criteria, SV₁+RV₆≥3.5mV.

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The purpose of this study was to compare body surface isopotential maps with echocardiographically-obtained IVST, PWT, LVDd and LV mass in 45 cases of hypertention (HT), 25 of aortic regurgitation (AR), 20 of hypertrophic cardiomyopathy (HCM) and 45 normal subjects. In most cases, Rmax (the highest point of maximum) was located at V₄ and V₅, though occasionally above, below or left of V₄ and V₅. Smax (the highest point of minimum) was located below V₂ and V₃. The Rmax voltage and Smax voltage were significantly greater in the three disease groups. The Rmax voltage correlated roughly to the LVmass (r=0.55), as did the Smax voltage (r=0.67). Though there was no correlation between IVST and the time reflecting septal activation (time for Rmax to move to the left midclavicular line) in maps, the time in HCM was much longer compared to that in HT. Furthermore, the maximum voltage of the R wave in the left back leads (left scapular line) correlated to PWT (r=0.69, p<0.01).
These results indicate the usefulness of bedy surface isopotential maps for presuming underlying disorders of LVH and for estimating the left ventricular posterior wall thickness.

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The normal range of body surface isopotential mapping was investigated in 176 healthy Japanese volunteers (93 males and 83 females). Mean maps of the QRS wave were prepared on the basis of sex and age. In addition, analyses were made of the differences in relation to the maximum positive potential and the maximum negative potential for each induction point, the breakthrough recognition rate and the breakthrough recognition time as a function of sex and age.
With regard to the temporal changes in the map after the initiation of ventricular stimulation, no differences were seen in the pattern of the distribution of the zero potential line or the positions of the peaks and troughs as a function of sex and age. In every age group, both the positive and negative potentials were larger in males than in females.
There was a tendency for the breakthrough recognition rate to decrease with increasing age in both the male and female subjects. No differences were detected in the breakthrough recognition time as a function of sex and age. The range of the time was 21.3±5.829.7±7.4 msec (mean 25.6±6.3 msec). The breakthrough minimum recognition time ranged from 24.4±6.4 to 33.0±6.6 msec (mean 29.2±7.1 msec).
Comparison was made of the maximum positive potential and maximum negative potential at each of the 87 induction points as a function of sex and age. With regard to the maximum positive potential, a tendency to decrease was seen from the left anterior chest area to the back in the males with increasing age. Conversely, in the females, there was a tendency for the maximum positive potential to increase from the left anterior chest area to the left lateral chest area with increasing age. The maximum negative potential tended to decrease in the anterior upper chest area with age in both the sexes, while in the anterior lower chest area this potential tented to increase with age in both sexes.
In view of the above results, when employing body surface isopotential mapping to diagnose various types of heart disease, it can be concluded that it is necessary to perform the diagnosis on the basis of normal standards which take into consideration the sex and age of the patient.

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A case of having two or more foreign bodies simultaneously in the airway and gastrointestinal tract is rare. The authors reported a case of two foreign bodies. A 54-year-old man who carelessly swallowed thumbtacks visited our clinic. An X-ray examination revealed thumbstack in the right bronchus and another in the stomach. The former was removed with a ventilation bronchoscope, and the latter was excreted spontaneously 2 days later. The authors have experienced 84 cases of esophageal foreign bodies and 47 cases of tracheobroncheal ones in the last 10 years. Cases of foreign bodies in both locations showed a higher frequency in males, and the majority of the cases were of children 3 years old or less. Coins were the most common esophageal foreign body, and peanuts were most common tracheobroncheal foreign body.
The most frequent location of the foreign bodies was the cervical constriction in cases of esophageal foreign bodies, being twice as frequent as the right bronchus. Two cases of multiple foreign bodies have been treated in our clinic, and both of them were of 2 coins in the upper esophagus.

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Changes in the spatial ventricular gradient (VG) in Frank lead vectorcardiograms after the treadmill exercise test were examined for the purpose of clarifying primary ST, T changes accompanying complete right bundle branch block (CRBBB). The subjects consisted of 20 healthy controls, 21 isolated CRBBB patients, 52 ischemic heart disease (IHD) patients with normal ventricular conduction and 16 IHD patients with CRBBB.
In healthy controls and isolated CRBBB patients, the magnitude of the VG decreased after exercise. Few changes were observed in the azimuth and elevation. In IHD patients, regardless of whether they had CRBBB or not, the magnitude of the VG at rest was less than in controls, and the VG deviated from the ischemic area. After exercise, changes in the azimuth and elevation were significantly larger in IHD patients, regardless of having or not having CRBBB, than in controls. Post-exercise changes in the VG azimuth of more than 20°, and VG elevation of more than 15°, provided high sensitivity and specificity for detecting IHD associated with CRBBB. Tokunaga divided patients with CRBBB into two groups. In group A, the duration of the S wave from lead II in standard 12-lead electrocardiograms (ECG) was equal to or larger than 0.08 sec, while in group B, it was equal to or less than 0.08 sec. In the present study, patients with lesions of the left anterior descending artery belonged to group A, while those with lesions of the right coronary artery belonged to group B. The ST-segmest depression in lead X or Y in Frank lead scaler ECGs had a sensitivity rate of no more than 50% in detecting coronary artery disease in the presence of CRBBB. The ST depression limited to lead Z gave a high false positive rate.

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A metabolic relationship between the liver and kidney exists in conbination with the urea cycle. We found different concentrations of serum guandino compounds between patients with acute renal failure and those with acute hepatic failure. We made an experimental model of acute hepatic failure in rats by injecting 1, 000mg/kg of D-galctosamine i. p. and evaluated the metabolic changes in the liver and kidney by measuring guandino compound levels using high performance liquid chromatography. We concluded that when the urea cycle was disturbed, the metabolism in the kidney was activated, and the synthesis of GAA (guandino acetic acid) was accelerated for the purpose of excreting ammonium. Also, we thought it possible to evaluate the metabolic compensative ability of the kidney by determining (serum Arginine)/(serum GAA). In the liver and kidney of rats, we found high levels of GBA (guanidino butyric acid), the metabolic pathway of which is unknown. With the progress of liver damage, the release of GBA into the serum was observed.

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A possible correlation between changes in local cerebral blood flow (lCBF) and histological changes was examined using the middle cerebral artery (MCA) occlusion model in 19 adult dogs. Local CBF was measured by the hydrogen clearance method. The most proximal portion of the left MCA was clipped through a transorbital approach. The animals were divided into two groups according to the duration of clipping. Group I (subacute group) consisted of 8 dogs in which an anastomosis of a maxillary artery to a middle cerebral artery branch was made seven days after the occlusion of the MCA. Group II (acute group) consisted of 11 dogs in which circulation to the brain was restored by releasing the clip which was applied on the MCA for 4 hours. In group I, the average lCBF value in the cortex rose from 34.2±9.2ml/100g/min before anastomosis to 64.7±24.1ml/100g/min following anastomosis. The average lCBF value in the subcortical regions before anastomosis was 37.4±12.6ml/100g/min, and the value increased to 53.8±11.5ml/100g/min following anastomosis. Hemorrhagic infarction was found by histological examination in 6 out of the 8 dogs. The hemorrhage was superimposed in the infarcted area only in the 6 dogs whose lCBF value was raised above 55ml/100g/min by the anastomosis. The cause of such hemorrhagic infarction may be related to a raised perfusion pressure of the infarcted region with increased vascular vulnerability. In group II, a filling defect in the cortex adjacent to the sylvian fissure was observed in fluorescein angiograms (FAG) after MCA occlusion. Recirculation was obtained following release of the clip. The average lCBF value in the cortex with a filling defect after MCA occlusion was 42.3±5.9ml/100g/min, 24.1±11.6ml/100g/min and 42.7±18.8ml/100g/min before, during, and after the 4-hour occlusion of the MCA, respectively. Values of lCBF below 12ml/100g/min were rare during occlusion, and continued up to an hour at most. The usual values of lCBF were above 15ml/100g/min. The histological examination showed neither edema nor hemorrhage. The critical value of lCBF indicating safe revascularization after a 4-hour MCA occlusion is likely to be about 15ml/100g/min.

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Four hundred thirty-two middle-aged to elderly adults were examined by means of real-time ultrasonography as a mass screening method for liver and gallbladder diseases. Among them, 36 cases of diffuse liver disease and 22 cases of gallstones were detected. The results of the ultrasonic examinations were compared with the data obtained from blood laboratory examinations of hepatic function and lipid metabolism as well as with certain questionnaires on the history of such diseases, etc.
Although some of the cases diagnosed as diffuse liver disease by ultrasonography showed abnormalities in the blood laboratory examinations, others showed normal data. Most of them were found to have a hsitory of liver disease, however. Ultrasonography revealed morphological changes in the liver due to chronic diffuse liver damage occurring in the inactive phase when blood laboratory data were normal. The significance of ultrasonic mass screening for liver disease lies its ability to reveal cases of morphologically changed livers whether they show abnormalities in blood laboratory examinations or not. As most cases of liver cancer have a hsitory of diffuse liver disease, it may be important to detect cases of diffuse liver disease by means of both ultrasonography and blood laboratory examination.
Cases diagnosed as gallstones by ultrasonography did not have a definite tendency to show any abnormality in the blood laboratory examinations or have a history of gallbladder disease or clinical symptoms. Consequently, most of them could be designated as “silent gallstones” by ultrasonography, a very effective means of discovering them. As gallstones are suspected to be one of the decisive factors of gallbladder cancer, their early detection may be important in preventing it.
Ultrasonic mass screening examinations are considered a reliable screening method for diffuse liver disease and gallstones.

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Diurnal variations in blood pressure, heart rate and pressure rate product were analyzed in 68 hospitalized diabetics (male 42, female 26) and 33 hospitalized controls (male 21, female 12) to investigate the influence of diabetic autonomic neuropathy on hemodynamics. The severity of autonomic damage was assessed by measuring the variabilities in R-R intervals of 100 consecutive heart beats in ECGs during quiet and deep breathing in the supine position and with the Schellong test. According to the results, the diabetics were divided into three groups: Normal ANS (31 patients without diabetic autonomic neuropathy), Abnormal PS (27 patients with parasympathetic damage alone) and Abnormal PS+S (10 patients with both parasympathetic and sympathetic damage). The blood pressure and heart rate of all subjects were recorded for 24 hours under near-basal conditions using an ambulatory blood pressure recording device (Pressurometer^® II, Del Mar Avionics, USA). The patterns of diurnal variations and the diurnal variabilities in blood pressure, heart rate and pressure rate product were analyzed in 22 control, 21 normal ANS, 20 abnormal PS and 10 abnormal PS+S patients. The effects of atropine sulfate (2.0mg daily, p. o.) were also studied in 11 control, 10 normal ANS and 11 abnormal PS patients to determine the effect of parasympathetic nerve damage on the variations. Hourly mean heart rates during the daytime and mean 24-hour heart rates were not different among the groups. However, with the progress of autonomic neuropathy, there was a significant reduction in the diurnal variation in heart rates, with greater mean night heart rates and greater hourly minimum mean heart rates. On the other hand, with the progress of autonomic neuropathy, there was a significant increase in the diurnal variation in the systolic blood pressure. However, diastolic blood pressure varied to the same extent regardless of the severity of autonomic nerve damage. The diabetics with autonomic neuropathy had significantly greater hourly mean and mean 24-hour systolic and diastolic blood pressure, and pressure rate product. The diurnal variation in the pressure rate product was similar to the heart rate results. Indices of the diurnal variations in heart rate and systolic blood pressure in controls and normal ANS patients approached those of abnormal PS patients after atropine sulfate administration. This result suggests that damage to the cardiac parasympathetic nerve plays a major role in the changes in the diurnal variations in heart rate and systolic blood pressure observed in diabetics.

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