This study was designed to investigate the effects of neonatal severe hypoxia on subsequent brain development, and test whether vitamin E might protect against hypoxia in the developing mouse brain. Mouse pups were divided into three groups (hypoxic, vitamin E treated, and control) . The hypoxic group was subjected to hypoxia twice daily by exposure to an atmosphere of 5 % O₂ in N₂ for 8 hours during the first day of postnatal life. In the vitamin E treated group, 100 mg/kg of DL-α-tocophenol acetate were administrated before the hy-poxic insult. These was no difference between the control and treated groups in body weight or whole brain weight. However, the content of DNA, RNA and protein of the whole brain of the hypoxic group was transiently reduced until 15 days of age. Vitamin E content in the whole brain tissue was significantly decreased immediately after hypoxic insult, and there was no subsequent gradual increase, which was seen in the control group. On the other hand, lipid peroxide contents of the whole brain tissue in the hypoxic group was significantly higher than that in the control group, and remained high until 20 days of age. In the vitamin E treated group, the biochemical components of whole brain recovered more rapidly than in the hypoxic group. On the other hand, lipid peroxide content in whole brain tissue was slightly decreased compared to the hypoxic group, but this was not statistically significant in these groups 20 days after hypoxic insult. From the results, it might be reasonably concluded that DNA and protein synthesis in the neonatal mouse brain were transiently impaired by induced severe neonatal hypoxia, and administration of vitamin E as a free radical scavenger can not prevent the ill effects.

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Effects of dibutyryl cyclic AMP (DBcAMP) on the respiratory and circulatory systems were studied in adult mongrel dogs. The dogs were divided into 3 groups according to the dose of DBcAMP : group A, 0.05 mg/kg/min, group B, 0.2 mg/kg/min ; group C, 0.6 mg/kg/min. DBcAMP was infused into each group for 30 min, and parameters were measured at 20 and 30 min. Stroke volume index, cardiac index and LVdp/dtmax increased significantly and dose-relatedly above the control values. Systemic vascular resistance decreased dose-dependently. Heart rate was unchanged in groups A and B, but increased significantly in group C. Mean arterial pressure was unchanged in all groups. The pulmonary circulation did not change significantly. pH, PaO₂, PaCO₂ and Qs/Qt were also unchanged. SvO₂ increased remarkably in group C. The results show that DBcAMP produces positive inotropic effects and dose-dependently causes dilatation of the peripheral vessels. DBcAMP did not, however, affect pulmonary circulation nor blood gas data as greatly as was expected.

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Analgesia caused by low frequency (1Hz) stimulation of an acupuncture point (AA), and that caused by similar stimulation of a non-acupuncture point after lesion of the analgesia inhibitory system (NAA) lasted for some time after termination of the stimulation, after effect. The manner of development and after effects of both kinds of analgesia were investigated byr relations between duration of stimulation and status of each analgesia, during and after stimulation. Acupuncture and non-acupuncture points, the tibial and abdominal muscles respectively, were each stimulated through a pair of needles inserted into the muscles. The analgesia inhibitory system was lesioned by insertion of a 0.4 mm diameter electrode into the lateral centromedian nucleus of the thalamus. Analgesia was evaluated by percent increase of tail flick latency. Development was the same for both AA and NAA regardless of the stimulation period, and was classified into three types. Type 1: Maximum analgesia appeared after termination of 5-10 min stimulation. Type 2: Maximum analgesia appeared at the end of 15-45 min stimulation, and lasted for some time after termination of the stimulation. Type 3 : maximum analgesia appeared 45 min after the onset of 60-120 min stimulation, maintained the maximum level during the stimulation, and the duration of the after effect was almost the same as that for Type 2. Classification was the same for AA and NAA with respect to duration of after effect and time from maximum analgesia to end of analgesia. Analgesia caused by three intermittent applications of stimulus (45 min stimulation. 15 min interval) was almost the same as analgesia caused by continuous stimulation for 180 min. The results imply that both AA and NAA have two modes : The first is development of after effect, which follows any stimulation that lasts for more than 5 min ; and the second is maintenance of analgesia.

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Stimulation of a non-acupuncture point instead of an acupuncture point does not normally produce analgesia. However, stimulation of a non-acupuncture point did produce analgesia after lesion in the analgesia inhibitory system, or treatment with proglumide, an antagonist of cholecystokinin (CCK) . Hence a transmitter in the analgesia inhibitory system might be cholecystokinin. In the present study it was found that neuronal activity in the lateral centromedian nucleus of the thalamus (L-CM), a part of the analgesia inhibitory system, was enhanced by non-acupuncture point stimulation and reached maximum about 10 minutes after onset of the stimulation. The enhancement was canceled by pretreatment with 20μg/kg proglumide (i. v.) . However, the inhibition due to proglumide was transient when the proglumide was applied after onset of the stimulation. Analgesia produced by non-acupuncture point stimulation (NAA) could be detected after microinjection of 6 ng L-365, 260 a CCK-B receptor antagonist, into the L-CM and part of the posterior hypothalamus (I-PH) ; the analgesia was significant (p<0.01-0.05) after injection of 60 ng. Maximum increases of tail flick latency after microinjection of 60 ng L-365; 260 into the L-CM and I-PH were 26.0±5.7% and 27.3±2.9 %, respectively. However, a very large dose (600 ng) of this antagonist did not produce analgesia. Slight NAA was produced by 60 ng of L-364, 718, a CCK-A receptor antagonist. From these results it was concluded that the analgesia inhibitory system is activated by stimulation of the acupuncture or non-acupuncture point, and the transmitter in this system might be CCK which has a high affinity for the CCK-B receptor.

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From the rise and fall of ulceration in cancerous lesions of depressed early gastric carcinoma, the depressed floor showed several kinds of morphological change. Most depressed gastric carcinoma was easily diagnosed as malignant lesion, but type III early gastric carcinoma is sometimes difficult to detect as carcinoma. The purpose of this study was to investigate the outstanding points of type III early gastric carcinoma in depressed carcinoma. The subjects were 136 depressed type gastric carcinoma cases with ulceration. Comparative study was carried out between type IIc+ (III) and type III + (IIIc) as depth of ulceration and cancer location. The results were as follows ; 1. Most type III + ( IIc) carcinoma had ul-IV ulceration and type II c+ (III) had ul-II ulceration in the cancerous lesion. 2. Type III+ (IIc) carcinoma was located mostly in the M zone, in the lesser curvature, type IIc+ (III) was in the M zone anterior or posterior wall, and type IIc+ (III) with ul-IV ulceration was located in the M zone, in the lesser curvature. 3. Type IIc+ (III) carcinoma tended to be located in the surrounding gastric mucosa, in the pyloric gland zone, and type III + (IIc) was in an intermediate zone. Consequently, type III+ (IIc) carcinoma (Hawser's ulcerative carcinoma) and type IIc+ (III) are in the same category, with characteristics affected by depth of ulceration and location.

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Consecutive bone marrow clot sections from 6, 225 patients were studied for 10 years. We examined the incidence of lymphoid nodules and their morphological data. Lymphoid nodules appeared more frequently in females (7.27%), in patients older than forty (7.57%), and in certain diseases, such as collagen diseases and their analogs (13.76%), and anemia (10.56%) (p<0.01) ; and less frequently in the presence of leukemia (p<0.01) . The incidence of germinal centers was low (0.11% of all cases, 1.24% of lymph nodes) and all these cases were females. The number of lymphoid nodules ranged from 1 to 34, and less than 3 in 91.4% of the cases (average, 1.99±2.54%) . The maximum dimension of lymphoid nodules was 82 to 989 μm (average, 313±126 μm) . The area of lymphoid nodules was 4×10³ to 285×10³ μm² (average, 54×10³±45×10³ μm²) . The total area of lymphoid nodules (the sum of lymphoid nodule area per case) was 4×10³ to 2, 917×10³ μm² (average, 106×10³±195×10³ μm²) . The area of lymphoid nodules was directly related to the age of the patients (r=0.129, p<0.01) . The count of peripheral lymphocytes was higher in cases without than in cases with lymphoid nodules (p<0.01) . The level of serum globulin was higher in cases with lymphoid nodules than in cases without. No correlation was found between the measured value of the lymphoid nodules (number, maximum dimension, area and total area) and the number of peripheral lymphocytes, the value of serum globulin. Lymphoid nodules were more frequent in the clot sections than in biopsies (p<0.01) . Bone marrow lymphoid nodules may be influenced by many different factors, and immunological reaction is thought to be the most important factor.

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It is important to compare the layer structure in an ultrasonic image with histopathological findings in the gallbladder wall to diagnose the quality of hypertrophic lesions in the gallbladder wall, and to understand the depth of gallbladder cancer. The layer structure in an ultrasonic image of the gallbladder wall generally falls into five categories: 1 layer/higher echo, 1 layer/comparable or lower echo, 2 layers, 3 layers, and 4 or more layers. Normal gallbladders, in which the wall is less than 3 mm, show almost 3 layers. In gallbladders in which the wall is thicker, lesions that ultrasonographically show 1 layer/comparable or lower echo, or a 2-layer structure, and irregularity in the layer structure and in the inner surface of the gallbladder should be suspected of cancer. Histologically, some abscess or granuloma type lesions show an ultrasonic image similar to that of cancer, and require differentiation from cancer. In the 3-layer structure of chronic cholecystitis, the second layer is considered to be related to fibrosis of the tunica propria muscularis, and the connecting tunica subserosa, which is difficult to differentiate from cancer in evaluating the depth of cancer.

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We studied the effects of moxibustion, electroacupuncture and kampo-hozai ohre-ngedoku-toh, a Chinese herb prescription, on delayed type hypersensitivity (DTH) to picryl chloride (PC) in immunoenhanced mice. Six to nine week old male ddY mice were used. The ear swelling induced by PC-DTH was enhanced by pretreatment with cyclophosphamide (Cy, 100 mg/kg) 2 days before PC sensitization through the selective inhibition of suppressor T cells. Stimuli were applied to the point equivalent to the Mingmen point of the human body (on the post median line, between the 2 nd and 3 rd lumbar spinal processes), which is regarded in Chinese medicine to be closely related to immunity. Marked augmentation of enhanced ear swelling induced by Cy was observed when moxibustion (10 mg moxa/ mouse) and electroacupuncture (2.5 Hz, 15 min.) was applied once daily for three days before PC sensitization. Significant inhibition of the enhanced ear swelling induced by Cy was observed when electroacupuncture (5 Hz, 10 min.) and oral administration of ohrengedoku-toh (made in our laboratory) were applied for three days before the PC challenge. The results suggest that treatment with oriental medicine affects cellular immunization and the effect of Cy given as an immunopotentiating agent can be either augmented or inhibited by moxibustion and electroacupuncture, depending on the time of treatment, but ohrengedoku-toh was only immunosuppressing.

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Effect of bombesin (BBS) on rat pancreatic exocrine function and involvement of endogenenous cholecystokinin (CCK) were studied in vivo and in vitro. A specific CCK antagonist, L-364, 718, strongly inhibited the amylase response to CCK-8 in pancreatic acini in vitro, but had no influence on the response to BBS. CCK-8 was about 6.2 times as potent as BBS. From concious rats infused continously with BBS at six doses (10-1, 000pM/kg/h), pancreatic juice was collected and assayed. The effects on exocrine from two groups treated with BBS (50 and 300pM/kg/h) after pretreatment with and without L-364, 718 were compared, and plasma CCK concentration was measured by RIA after each treatment.
Infusion of BBS at 10pM/kg/h evoked a slight increase in pancreatic juice volume. protein output, and bicarbonate output, and at 300pM/kg/h, it produced maximum response. Above 300pM/kg/h, it caused slight decline. Pretreatment with L-364, 718 did not significantly change these effects of BBS. Plasma CCK concentration was not affected by infusion of BBS.
The results indicate that the effects of BBS on the properties of pancreaic exocrine in the rat are not mediated by endogeneous CCK, and might be affected by direct stimulation.

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To compare the inclination of the auricular long axis of microtia with that of normal ears, the angles formed by the auricular attachment line, auricular long axis and nasal bridge line were recorded for 69 patients with microtia and 30 normal subjects. Angle X formed by the auricular attachment line and the nasal bridge line, angle Y formed by the auricular attachment line and the auricular long axis, and angle Z formed by the auricular long axis and the nasal bridge line were measured in these patients to determine if differences existed between male and female patients, different age groups, and between patients and normal subjects. The following results were obtained. 1) There was no significant difference in angles X, Y and Z between male and female patients with microtia. 2) Angles X and Y in patients with microtia were not signiffcantly different from those in normal subjects, but angle Z in patients with microtia was significantly larger, and slanted about five degrees further forward than that in normal subjects. 3) In microtia patients aged five years or older, angles X, Y, and Z remained essentially the same and were unaffected by age.

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CDDP concentrations in serum, ascites and urine were serially measured in patients with carcinomatous peritonitis to investigate the differences of CDDP concentration by intravenous or intraperitoneal administration. While a small amount of free CDDP, which was thought to be the active form of CDDP was detected in ascites after intravenous administration of CDDP, a high level of free CDDP was found in ascites after intraperitoneal administration. Intraperitoneally injected CDDP was detected in serum, showing that the drug was transferred into the peripheral circulation gradually, and so it was reasonable to expect therapeutic effects of CDDP not only in the abdominal cavity but also on various other organs. When intravenous administration of sodium thiosulfate, as a rescue therapy for renal damage, was combined with intraperitoneal administration of CDDP, its influence on free-CDDP level in ascites was negligible, although CDDP bound with sodium thiosulfate was detected in ascites. It was suggested that intraperitoneal administration of CDDP was reasonable therapy for patients with carcinomatous peritonitis. And in the cases with renal dysfunction, simultaneous administration of sodium thiosulfate with CDDP seemed to be the preferred method.

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The infection of compromised hosts by resident bacteria has become a serious problem, because the infection is very severe and nosocomial infection occurs. We introduced an automated system, AUTOSCAN-4 (Baxter, CA), for identification and susceptibility tests for clinically isolated bacteria in July 1990. Detailed and accurate results of identification and susceptibility can be produced by the system. We have accumulated statistics of the identification and susceptibility of clinically isolated bacteria at Showa University Hospital, during the year from July 1990 to June 1991. Pathogenic bacteria were isolated and 1/3 to 1/2 of the specimens (about 3, 500 specimens per month) were identified. Staphylococcus aureus was isolated from 300-500 specimens and had the highest frequency of occurrence. Next was Pseudomonas aeruginosa obtained from 200-400 specimens. According to the susceptibility test, about 70% of S. aureus isolftes were identified as Methicillin Resistant Staphylococcus pureus (MRSA), and 15% of P. aeruginosa isolates were extremely drug-resistant against various antimicrobial agents. MRSA was isolated from 100-150 patients out of a total of 1, 000 inpatients in the hospital per month. Twenty to forty percent of the patients infected with MRSA were also infected with P. aeruginosa. This indicates the difficulty of antimicrobial treatment of these multi infected patients.

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A 55-year-old female complaining of upper abdominal pain with high levels of serum pancreatic enzymes was admitted to our department. She had had recurrent episodes of this for three years. Although a normal ventral pancreatogram was obtained by endoscopic retrograde pancreatography, we failed to get a dorsal pancreatogram because no accessory papilla was found. However, the dorsal pancreas was observed by conventional ultrasonography and computed tomography. On endoscopic ultrasonography (EUS), the ventral pancreas was shown to have a normal echo level and the dorsal pancreas was detected with a high echo level, which suggested chronic pancreatitis. This case was thus diagnosed as having pancreas divisum with dorsal pancreatitis, and disturbance of the drainage system in the dorsal pancreas due to immature accessory papilla seemed to be one of the etiological factors for dorsal pancreatitis. EUS permits observation of the ventral and dorsal pancreas, separately, and therefore may be useful in examination for pancreas divisum.

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A case of chronic pancreatitis accompanied by hyperlipidemia is reported. A 56-year-old male patient complaining of pain in the epigastrium and left hypochondrium was admitted to our hospital. His alcohol abuse had been moderate for about 35 years. He had previously experienced the same episodes and been diagnosed as having hyperlipidemia. The elevation of pancreatic enzyme levels in serum and urine, and hyperlipidemia were observed at his admission. The lipoprotein analysis revealed predominant increases of chylomicron and pre-β lipoprotein, a condition that was compatible with Fredrickson type V hyperlipidemia. The diagnosis of ERCP was chronic pancreatitis group II. Increase of dietary fat intake during admission provoked hyperlipidemia and the attack of pancreatitis recurred. These facts suggested that the hyperlipidemia may have been important in the development of chronic pancreatitis in this case, although the influence of alcohol abuse could not be neglected.

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A 57-year-old female visited our hospital complaining of occasional nausea, vomiting and abdominal fullness with sudden onset and spontaneous relief. Barium meal test revealed a gastric polyp (Yamada IV) in the posterior wall of the antrum. This gastric polyp was observed with the endoscope to periodically prolapse into the duodenal bulb and then reposition. Endoscopic polypectomy was performed after which her complaints disappeared. Histological examination of the gastric polyp showed metaplastic foveolar hyperplasia. Group 2. Although endoscopy is a routine examination in digestive diseases, prolapse of a gastric polyp into the duodenal bulb is rare. We had reported a similar case of falling off of the gastric polyp followed by massive bleeding due to necrosis of the stalk. It was concluded that upper abdominal symptoms with sudden onset and spontaneous relief seemed to be characteristic of cases with gastric polyp prolapsing into the duodenal bulb. Rapid polypectomy, if possible, is recommended in those cases.

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A 61-year-old man was admitted to our hospital because of severe cough and dyspnea that had continued 40 days. The chest roentgenogram revealed left hydrothorax. Cytological diagnosis of the sanguineous pleural effusion was class II. Both plain chest roentgenogram and computed tomography (CT) excluded abnormalities in the lung fields, and in the mediastinum. The abdomen was distended, but the liver and spleen were not palpable. Abdominal ultrasonography and CT scan revealed an irregular mass in the spleen, which was shown by angiography to be hypovascular. A diagnosis of primary splenic malignant tumor was made. Through celiotomy, a child's head size splenic tumor was noted. The tumor was adhesively attached to the diaphragm, retroperitoneum, transverse colon, and greater curvature of the stomach, and was involved into the pancreas tail. There was no lymph node involvement. The spleen and the pancreas tail were removed completely. The extirpated spleen was 24×11×10cm in size and weighed 1, 560g. Pathological diagnosis was malignant lymphoma of the large cell immunoblastic type. CHOP treatment in 5 courses was conducted as postoperative chemotherapy. The patient has been in vigorous health without tumor recurrance for 32 months after the operation.

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