To clarify the effects of anticoagulant on coagulation, fibrinolysis, and vasculoen-dothelial dysfunction during hemodialysis (HD), randomized, prospected, comparative, clinical trials were performed on regular HD patients. Thirteen HD patients with hypercoagulability (determined by 250 % excess factor VIII activity and/or factor VIII related antigen level) were randomly divided into two group, one dialyzed with unfractionated heparin (UH), the other with low molecular weight heparin (LMWH) as an anticoagulant. For 8 months, coagulation, fibrinolysis and vasculoendothelial markers were measured monthly, immediately before HD. Dosages, determined by minimum requirement for preventing the coagulation of extracorporeal blood, were 95±19U/kg for UH, and 38±7IU/kg for LMWH in each treatment (p<0.01) . Although anti-Xa activity (aXa) with LMWH was greater than that with UH 1 hour after starting HD, activated partial thromboplastin time (aPTT) did not inffer between the two groups. After HD there was no significant difference in aXa between the two groups, whereas the duration of aPTT was prolonged in the UH group, compared to that in the LMW H group. Modified antithrombin III (ATM) values, which represented the total antithrombin III activity bound with serine protease, were greater in both groups than in healthy subjects. ATM began to decrease in the LMWH group, but not in the UH group two months after starting the study, and this difference continued throughout the rest of the study period. In both HD groups, α₂ plasmin inhibitor-plasmin complex (PIC) levels were higher than in healthy subjects, and decreased in the LMWH group, at 1, 4 and 5 months with no significant change in the UH group. The results suggest that UH, at least in part, contributes to abnormally increased coagulation and fibrinolysis activity, and the abnormality can be partially recovered by the use of LMW H as an HD anticoagulant.

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Two kinds of cell lines, SASY-4 and SASY-1, were isolated from osteosarcoma and chondrosarcoma, respectively. The characteristics of these cell lines were analyzed and compared with those of other human osteosarcoma cell lines (Sans-2, Mg63, HOS, YR-2) and a human fibrosacroma cell line (HT1080) . Saos-2, YR-2, SASY-4, had numerous alkaline phosphatase (ALP) -positive cells, and SASY-1 had few ALP-positive cells. There were few ALP-positive cells in Mg63, HOS and HT1080. ALP activity was highest in enzymes and Saos-2, YR-2, SASY-4, and SASY-1 followed in that order. Enzyme activity was extremely low in Mg63, HOS, and in HT1080. Treatment of the cells with parathyroidhormone (PTH) induced a marked increase in cAMP production in YR-2 and Saos-2, and a slight increase in SASY-1 and SASY-4. There was no cAMP response by PTH stimulation in Mg63, HOS or HT1080. Immunohistochemical staining demonstrated that all cell lines produced type I collagen, whereas only SASY-1 cells produced type II collagen. Radioimmunoassay revealed that all cell lines produced undetectable levels of osteocalcin in the culture media under conventional culture conditions. After treatment of the cells with 1, 25 (OH) ₂D₃, only Mg63 cells produced osteocalcin. The results indicate that expression levels of osteoblastic phenotypes vary among the various human osteosarcomas. Production of type II collagen may serve as a simple but convenient marker for distinguishing chondrosarcoma cells from osteosarcoma cells.

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This study focuses on cases of recurrent myocardial infarction, and the time between a previous occurrence and recurrence as a means to elucidate factors related to the length of this interval and thereby help prevent recurrence. The subjects were 78 patients hospitalized at Showa University Hospital, who met the criteria of male with records of the time from a previous myocardial infarction until a recurrence. The average interval from a prior myocardial infarction until a recurrence was 67.0 months. Items surveyed included : sex, date of birth, date of previous myocardial infarction, date of recurrence, employed/unemployed, total serum cholesterol level, serum neutral lipid level, obesity level, presence or absence of hypertension, presence or absence of diabetes, smoker/nonsmoker, presence or absence of hyperuricemia, and family history if any. CATDAP-02 was used to analyze possible relations between the occurrence-recurrence interval and the items surveyed. The results indicated statistical significance of relations of total serum cholesterol and obesity levels with the time from the occurrence of a myocardial infarction to recurrence. A +10 % to +15 % obesity level was considered related, with + 13 % especially related, but the conventional +20 % standard was only weakly related to the time between occurrence and recurrence. A total serum cholesterol level of 180mg/dl to 200mg/dl was related, and this relation was stronger at 180mg/dl, in particular. No relation was evident at 220mg/dl, which has been conventionally used as a criterion. The findings suggest the need to maintain lower than the usually indicated levels of obesity and total serum cholesterol after myocardial infarction.

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A 71-year-old man who had undergone implantation of a transvenous pacemaker system for complete heart block became aware of increasing swelling of the generator pocket of his anterior chest eight years after exchange of the generator. As infection was suspected, and the remaining life of his battery was less than one year, he was admitted to Showa University Hospital for operation. There was no operative finding of acute inflammation around the generator pocket, except for remarkable thickness of connective tissue. However some exudate and yellowish gel-like substance found in the pocket contained the attenuated bacteria of Staphylococcus epidermidis. The patient is now doing well with no local recurrence of infection for 15 months after the operation. It is rare for infection to appear a few years after the last surgical pacemaker procedure, but pacemaker patients should be followed-up for a longtime against the possible occurrence of complications, including infection.

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