We studied the sinus node function of 78 cases with I-III degree AV block and 8 cases with bundle branch block (BBB) . The sinus node function was assessed in each degree (I, II, III degree and BBB) and each site of block (AH, HV, intra His, mixed and intraventricular conduction) . In 63 cases, we also investigated the sinus node function after pharmacologic autonomic blockade (PAB) (intrinsic sinus node function) in order to avoid influences of the autonomic nerves. Sinus node dysfunction (SND) was found in 28 cases out of 86 (33 %), showing no significant differences in each degree and each site of block. With regard to site of block, many SND cases were included in HV block (42%) and mixed block (54%) . The max CSRT was prolonged in III degree, HV, and mixed block, and in these 3 groups there were some cases showing a remarkable prolongation similarly as SSS. SND increased after PAB from 20 cases (32%) to 30 (48%) out of 63. With regard to degree of block, SND increased after PAB particularly in III degree AV block from 42% to 77% and advanced AV block from 20% to 47%. With regard to site of block, significant increase was observed in intra His (IH) bundle block from 8% to 62%, SND were also increased in HV block from 45% to 65%. According to the assessment by % autonomic chronotropy, III degree, advanced, IH and HV block were inclined toward sympathicotonia before PAB, and it is possible that sinus node function is underestimated. On the other hand, others were under the condition of parasympathotonia. Therefore, after implantation of pacemaker in AV block, SND may be prominent in some cases. We concluded that it is essential to assess the intrinsic sinus node function before implantation of a pacemaker in order to select proper physiologic pacing.

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The mouse macrophage-like cell line J774.1 spontaneously produces differentiationinducing factor (s) (DIF) . Three different human myeloid leukemic cell lines (ML-1, U937, HL-60) treated with the conditioned medium of J774.1 cells (JCM), expressed various differentiation-associated properties including growth retardation, morphological maturation, NBT-reducing activity, Fc receptor, phagocytic activity, and nonspecific esterase activity. Most of the DIF activity produced by J774.1 cells was neutralized by monoclonal antibody against human recombinant tumor necrosis factor. We next investigated the effects of various polysaccharide fractions of the pine cone extract on DIF production by J774.1 cells. The neutral polysaccharide fraction (Fr. I) did not stimulate DIF production by J774.1 cells (ED₅₀>1000μg/ml) . The activity of the acidic polysaccharide fractions to stimulate DIP production increased with their acidity (Fr. II (ED₅₀, 34μg/ml), Fr. V (ED₅₀<3μg/ ml) ) . Four NaOH-extractable polysaccharide fractions (Frs. VI-IX) showed similar activity. Among them, Fr. VI, which formed a precipitate at acidic pH, was the most potent (ED₅₀<3μg/ml) . These acidic polysaccharide fractions similarly stimulated the production of cytotoxic factor (s) by J774.1 cells. The result suggests that the antitumor activity of these acidic polysaccharides might be a result of stimulation of the production of DIP/TNF by the activated macrophages.

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The mechanism of hypotensive effects of MAO inhibitors is not clear. We investigated the changes of blood pressure in normotensive rats following injection of MAO inhibitors either intraperitoneally or intracerebroventricularly. Male Wistar rats weighing about 200 g were used. The systolic blood pressure and the heart rate of unanesthetized rats were measured with equipment of Natume KN 201-I. When clorgyline (5 or 10 mg/kg), deprenyl (10mg/kg), pargyline (10mg/kg) and saline (0.5ml) were injected intraperitoneally, each one of 5 groups of rats, only clorgyline (10 mg/kg) depressed blood pressure 2 hrs after administration. Intracerebroventricular clorgyline (200 erg/10μl) also decreased blood pressure 2 hrs after administration, whereas deprenyl (200 fig/10μl), pargyline (200 μg/10μl) and saline (10μl) make no significant change. Thus, only clorgyline, a selective inhibitor of MAO-A, was hypotensive, and it is suggested that this is related to the effect of brain noradrenaline, substrate of MAO-A, on blood pressure.

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The pelvic deformity resulting from the Chiari pelvic osteotomy appears to present apotential problem for female patients anticipating pregnancy who have completed their growth phase. We conducted a study to investigate this problem for the patients above 18 years old who underwent a Chiari pelvic osteotomy in our hospital. The shift of the bone fragments in frontal view X-ray of the hip joints were primarily studied. In the Maltius X-ray studies, the shape of the pelvic outlet was measured. In the Maltius X-ray studies, the transverse daiameter ratio was decreased in all patients with an average decrease of 8.5 % from the preoperative to post-operative period. In patients with a favorable clinical evaluation, the shift rate was 45 to 55 %, the rate of improvement of the CE angle was 25 to 35 degrees, the angle of the osteotomy was 10 to 15 degree, and the level at the osteotomy was 8 to 10 mm. When the pelvic deformity is taken into considaration, the standard method for the Chiari operation may be defind as a shift rate of less than 50 %, and improvement of the CE angle of less than 30 degrees. When the shift rate exceeds 50 %, the possibility of chepharo-pelvic disordor may be strongly suspected. The limit for the indication of the Chiari operation as a single procedure is a CE angle of 0 degrees. When the CE angle is less than 10 degrees with poor adaptability and unfavorable acetabular coverage, this operation appears to be the best indication. In all cases, an explantation for the pelvic deformity is required.

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The myofibrous organization was studied in the anterolateral muscles of the abdominal wall (obli quus externus abdominis; OEA, obliquus internus abdominis; OIA, transversus abdominis; TA, and rectus abdominis; RA) in 14 human subjects (8 males and 6 females, age 46-90 years) . The muscle samples were embedded in celloidin and the sections were stained with hematoxylin and eosin. The following results were obtained. 1) The thickness of the muscle layer was the most predominant in the OIA (4.2 mm), followed by OEA (3.0mm) and TA (2.2mm), but in higher ages, the TA was superior to OEA. The thickness in males was superior to females in each layer. 2) On the number of the muscle fibers per sq. mm, the OEA (1189) and TA (1134) were more than the OIA (880) and RA (851), and in the OEA and OIA, the number was superior in females to males, while in the TA and RA, the sex differences were not observed. 3) On the fiber size, the OIA (1061.5 μm²) was larger than the OEA (800.1μm²), TA (796.3 μm²) and RA (825.4μm²) and these values belonged to the moderate group in the human muscles. And those of the males were superior to females except for TA. In the higher ages of the males and in the females, the TA was predominant to OEA. There was a significant correlation between the fiber sizes, in the OEA, OIA and TA, on the other hand, the fiber size of the RA was not correlated to that of the other abdominal muscles. 4) On the density of the muscle fibers, the lateral abdominal muscles were about 85 % and the RA was 66.9 % and the former was high and the latter was moderate in the human muscles. Thus, based on the myofibrous organization, the OIA was the most predominant, followed by the OEA and TA in the lateral abdominal muscles, but the tendancy of the atrophy was observed in the OEA with increasing age. These results suggested that the OIA was the most important muscle and the OEA was its supporting one for the function of the lateral abdominal muscles and the TA worked mainly for the maintenance of the abdominal organs, the regulation of the intra-abdominal pressure and the expritation and the function of the RA was heterogenious to the other abdominal muscles.

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Acupuncture analgesia is induced by stimulation of the acupuncture point, not by that of the non-point. In previous our studies, differentiation of the acupuncture point (Tsusanli, the anterior tibialis muscle) and non-point (abdominal muscle) was possible to be distinguished by their connected different central pathways, since 1) lesion of the dorsal part of the periaqueductal central gray (D-PAG) abolished the acupuncture point stimulation-produced analgesia, and potential was evoked in the D-PAG by acupuncture point stimulation, not by non-point stimulation, while potentials were evoked in the lateral part of the PAG (L-PAG) by stimulation of the acupuncture point as well as non-point, 2) lesion of the L-PAG unaffected on the acupuncture point stimulation-produced analgesia. 3) L-PAG evoked potentials were depressed by repetitive stimulation of the acupuncture point and non-point, 4) the pathway connected to the non-point is inhibited by the analgesia inhibitory system which was activated by stimulation of either acupuncture point or non-point, 5) after lesion of the analgesia inhibitory system, analgesia was induced by non-point stimulation, and this analgesia was abolished by L-PAG lesion. The present experiments were undertaken to study whether the differentiation of the acupuncture point and the non-point obtained by stimulation of the anterior tibialis muscle and the abdominal muscle is acceptable for another point (Ho-Ku, the 1st dorsal interosseous muscle) and the non-point (triceps muscle) . Pain threshold was measured by percent increase of the tail flick latency (TFL) . Stimulation of the Ho-Ku point with intensity to cause muscle contraction at 1Hz produced analgesia. This analgesia was naloxone reversible, was blocked by D-PAG lesion, and revealed the individual variations in effectiveness which was highly correlated with those of intra-peritoneal 0.5mg/kg morphine analgesia and those of Tsusanli point stimulation-produced analgesia. Potential was evoked in the D-PAG by Ho-Ku point stimulation, not by stimulation of the triceps muscle, which was abolished by naloxone. Repetitive Ho-Ku point stimulation did not affect on the D-PAG evoked potential. On the other hand, potentials evoked in the LPAG by stimulation of either Ho-Ku point or triceps muscle, were depressed gradually by peripheral 1 Hz repetitive stimulation within 10 minutes, just like as that caused by Tsusanli and abdominal muscle stimulation. Stimulation of the dorsal part of 4 th finger root produced slight analgesia in 13 of 53 in responder animals of Ho-Ku point stimulation, and evoked the potential in the D-PAG with high threshold like as in non-responder animals. The results obtained in the Ho-Ku and triceps muscle stimulation is acceptable for our previous findings that the acupuncture point and non-point can be differentiated by their connected different central pathways obtained in the Tsusanli and abdominal muscle stimulation.

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Since hypophysectomy abolished analgesia caused by acupuncture point stimulation, the pathway from the acupuncture point to the final region which transfers the information to the hypophysis is defined as the acupuncture afferent pathway, and since the descending pain inhibitory system blocked the entering of the pain impulse to the central nervous system, this system is defined as the acupuncture efferent pathway. Lesion of either pathway abolished acupuncture, and stimulation of either pathway produced-analgesia. Acupuncture afferent and efferent pathways can be distinguished by the facts 1) stimulation-produced analgesia of afferent pathway (A-SPA) was abolished by hypophysectomy, while that of efferent pathway (E-SPA) was not, 2) the nature of A-SPA and E-SPA were quite different, i.e., A-SPA was naloxone reversible, long lasting after stimulation and exhibited individual variations in effectiveness which is parallel to that of the acupuncture analgesia, while E-SPA was not naloxone reversible and was limited during stimulation. In previous our studies, the posterior part of the hypothalamic arcuate nucleus (HARN) was found to be the acupuncture efferent pathway, however, it was reported that the HARN exhibited acupuncture afferent nature. In present study, the anatomical relationship between regions exhibiting afferent and efferent natures was investigated. Analgesia was estimated as percent change of the tail flick latency of rats. The electrode implantation to the brain for stimulation and lesion were done according to König brain map. Lesion of the middle part of the HARN abolished acupuncture analgesia. The effects of naloxone and hypophysectomy were different depending upon the stimulated sites in the HARN, i.e., complete, partial and no block of analgesia. In histological examination, the site of complete block in SPA after naloxone or hypophysectomy was found in the middle part, and that of no block in the posterior part of the HARN, and that of partial block was found between middle and posterior HARN. Microinjection of morphine or β-endorphin to the posterior part of the HARN produced analgesia which was blocked by concurrent intraperitoneal methysergide and intrathecal phentolamine, and was not influenced by adrenalectomy. While SPA of the anterior hypothalamus which belonged to acupuncture afferent pathway and supposedly connected to the middle part of the HARN was augmented 6 hours after and was abolished 12 hours after adrenalectomy. From these results, it was concluded that the both acupuncture afferent and efferent pathways exist in the HARN.

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Acupuncture analgesia (AA) caused by low frequency stimulation of the acupuncture point was equivalent to intraperitoneal 0.5 mg/kg morphine analgesia (MA) . Both AA and MA were abolished by either intrathecal or intraperitoneal naloxone. It is obvious that crossed tolerance exists between AA and MA because neither AA nor MA could be obtained in morphine tolerant rats. On the other hand, stimulation of the non-point with same stimulus conditions as done in the acupuncture point did not produce analgesia at all under normal states. After destruction of the analgesia inhibitory system (AIS) such as lateral part of the centromedian nucleus of the thalamus (L-CM) or after application of cholecystokinin antagonist, proglumide, the non-point stimulation induced analgesia with nature of dexamethasone reversible, not naloxone reversible. Our previous studies revealed that the MA and AA reappeared in morphine tolerant rats after AIS destruction, and morphine tolerance did not fully develop in prior AIS destructed rats. In present experiments, the effect of proglumide on the morphine tolerance instead of the AIS lesion was investigated. Pain threshold was measured by percent increase of the tail flick latency (TFL) . Morphine tolerance was obtained by intraperitoneal application of 50 mg/kg morphine first day, and then followed by that of 100 mg/ kg/day for a week. Proglumide was applied intraperitoneally with a dose of 20μg/kg. After application of proglumide in morphine tolerant rats, analgesia reappeared in AA and MA which were completely antagonized by dexamethasone. These results implied that the antagonistic action of proglumide on the morphine tolerance is attributed to the inhibitory action of proglumide on the AIS, not to the direct action of proglumide on the morphine tolerance itself.

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Observation of blood pressure changes is useful for detecting toxemia and circulatory disorders, such as hypertension, in health management during pregnancy. On the basis of blood pressure measured throughout pregnancy, the pattern of pressure change in individual normal pregnant women was investigated and is reported here for the first time. We also analyzed whether background factors of individual pregnant women were related to blood pressure, and whether average blood pressure in the late course of pregnancy was related to the baby's body weight at birth. The subjects of this study were 355 normal pregnant women who experienced delivery at Y Clinic in 1986. The blood pressure was measured by the same physician in the fifth to the tenth month of pregnancy. 1) The pattern of blood pressure change during pregnancy in each pregnant woman was similar to that of the average blood pressure change in the group, regardless of the level of blood pressure in each person. 2) In evaluating blood pressure in individual women, it may be necessary to consider about±17 mmHg (systolic) and±15 mmHg (diastolic) as normal limits. 3) The systolic pressure was directly correlated with height and body weight, while the diastolic pressure was directly correlated with age and body weight. The experience of delivery only slightly influenced blood pressure. 4) No significant correlation was noted between the average blood pressure in the late course of pregnancy and the baby's body weight at birth.

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Negative inotropic effects of disopyramide (DPA) on canine Purkinje fiber and ventricular muscle, and guinea-pig papillary muscle were investigated. DPA induced a dosedependent decrease in Vmax of action potential and increase in action potential duration (APD₉₀) without changing resting membrane potential in canine Purkinje fiber and ventricular muscle. DPA suppressed spontaneous contraction and contraction induced by electrical field stimulation in guinea-pig papillary muscle. The contractile response gradually increased during stimulation at 2Hz or 5Hz up to about 75 sec, and was level thereafter. The amplitude of contraction was decreased about 25 % by 10^-5 M DPA at 2 Hz and at 5 Hz. Results suggest that DPA has a negative inotropic effect and this effect may be related to Na⁺ -dependent Ca²⁺ movement, as in Na⁺-Ca²⁺ exchange.

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Determining the three-dimensional state, site and scope of dissection in preoperative diagnosis of dissecting aneurysm is important for determining the surgical policy. With X-ray CT, which is already in wide use, all that can be obtained are the picture images of the transverse section, so diagnosing the region near the aortic arch is difficult. The case reported here had a giant dissecting aneurysm that extended from the arch to the descending aorta. In this case the use of NMR-CT, capable of taking multi-directional pictures of the longitudinal section, in combination with DSA or X-ray CT helped in the preoperative diagnosis.

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We report here a case of incarceration of the penis. The patient was a 32-yearold, in married male. He placed a steel ring around his penis in jest, and was unable to remove it. He visited our hospital on account of the incarceration and swelling of the penis and urinary retention. The steel ring was successfully removed by using an air saw owned by a fire brigade station. The time of incarceration was about 8 hours. He left our hospital on the twelfth day after removal of the ring and relief of the incarceration. There were no signs of rupture of the urethra or impotence.

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In the three apoplexia patients, prostaglandin E₁ (PGE₁) was administered intravenously twice a day for ten days, and changes in peripheral circulation, assessed by plethysmography, thermography, and RI angiography, were investigated before and after treatment. In two of three patients with peripheral circulatory disturbance, the blood flow increased in diseased extremities after PGE₁ therapy. In another patient, who suffered from numbness and parestesia rather than circulatory disorders, sensory disturbance was alleviated after PGE₁ administration. Efficacy of the clinical use of PGE₁ in cerebro-vascular disease was suggested, and we were prompted to attempt further evalutaion.

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