The expression of carcinoembryonic antigen (CEA) and related antigens in 40 formalin-fixed paraffin embedded tissues of 4 histological types of lung carcinomas was examined immunohistochemically using five monoclonal antibodies (MoABs) which distinguished different epitopes on CEA, and the correlation with serum-CEA (s-CEA) level and tissue-CEA (t-CEA) was also investigated. Four MoABs detecting different peptide epitopes of CEA and another MoAB recognizing the carbohydrate part of CEA were used. Although each MoAB showed different frequencies of immunohistochemical expression according to the histological types, a similar tendency was generally suggested in four MoABs that recognized peptide epitopes of CEA except for one MoAB that recognized a carbohydrate epitopes of CEA. There was no difference among the five MoABs in regard to the staining localization exhibited by MoABs, but there was a difference among the four histological types. Elevation of s-CEA did not always occur in patients with lung cancers showing positive reaction to t-CEA, especially in adenocarcinoma and squamous cell carcinoma, but all patients with lung cancers showing intense positive reaction to t-CEA showed high degrees of elevation of s-CEA.

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Hyperbaric chamber dives at various equivalent depths below sea level, i.e. 7, 14, 19 and 31 atmosphere absolute (ATA) with helium-oxygen or helium-nitrogen-oxygen have been performed at the Japan Marine Science and Technology Center. A two-dimensional (topo-graphic) disply of the scalp EEG was used during simulated underwater experiments to deter-mine; 1) Whether there are any characteristic EEG patterns in high pressure nervous syndrome (HPNS), 2) the relationship between the EEG changes and the compression rate, and 3) the relationship between the EEG changes and the characteristic signs and symptoms of HPNS. A two-way analysis of variance and a distribution analysis technique revealed that the topographic brain patterns depended on the diving depth and indicated the most affected brain areas during compression and decompression. Significant correlations between the diving depth and the EEG potentials were observed at different brain locations. Alpha waves showed a diffuse cortical distribution. Theta wave activity was more localized in the frontal midline region. These waves developed paroxysmally in relatively brief bursts supplanting or intermixing with normal background EEG rhythms. In our subjects, frontal midline theta activity was associated mostly with some of the characteristic features of HPNS, such as a transient episode of laughter or euphoria at depths greater than 21 ATA. An intimate correlation between frontal midline theta wave and laughter was observed. Frontal midline theta waves may be related to emotional activities induced by helium under high pressure. There were significant individual variations in susceptibility and subjective signs and symptoms. The EEG is of great value in studying man's physiological reactions in an undersea environment and also very important in selecting divers who are relatively more tolerant of a severe hyperbaric environment.

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Twenty-four patients with poor risk factors underwent an extra-anatomic bypass operation for aortoiliac occlusive disease and subclavian steal syndrome. A femoro-femoral bypass was performed on 5 patients, an axillo-femoral bypass on 15, a subclavian-subclavian bypass on 2 and an ascending aorta-femoral bypass on 2. There was only one operative death and there were 2 late deaths (8.3%). The patients were 20 males and 4 females with a mean age of 69.3 years. Among risk factors, high age (70 year old) was present in half of the patients, ischemic heart disease in 9, and cerebral vascular disease in 8. Seventy-five percent of the patients were suffering from two or more dysfunctions. During the limited follow-up period from 8 to 94 months (mean 46.1 months) there was a 96% patency rate. We had good results using externally supported ring graft and by the administration of prostaglandin E₁ and ticlopidine during the pre and postoperative period.

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Effects of styrene and styrene oxide on δ-aminolevulinic acid dehydratase in rats were investigated, in vivo and in vitro. In the in vivo study, rats were exposed to styrene or styrene oxide intraperitoneally for seven days. δ-Aminolevulinic acid dehydratase in the erythrocyte was inhibited by both styrene and styrene oxide. The inhibition by styrene oxide had a clear dose-response relationship, but that by styrene did not. In the liver, however, these substances did not inhibit δ-aminolevulinic acid dehydratase. In the in vitro study, styrene oxide inhibited δ-aminolevulinic acid dehydratase both in the erythrocyte and in the liver, but styrene failed to inhibit it. These results suggest that styrene is metabolized to styrene oxide, and this metabolite inhibits δ-aminolevulinic acid dehydratase. It is also thought that the discrepancy of inhibition between the erythrocyte and the liver is due to a difference of distribution and metabolism of the substances.

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Although propylene oxide, which is similar in chemical structure to ethylene oxide, is expected to produce neuropathy, there is no convincing evidence of the degeneration of the peripheral nervous system. To determine the exposure concentration of propylene oxide necessary to produce neuropathy in male Wistar rats, we subjected them to repeated exposures of propylene oxide at concentrations of 500, 750, 1000, 1500 and 2000 ppm. The test rats were subjected to a single 6 hour exposure of propylene oxide at a concentration of 1500 parts per million 5 times a week for 3 weeks. They developed a significant decrease in body weight, abnormal posture of the hindlegs and axonal degeneration of myelinated fibers in the peroneal and sural nerves, the nerves to the soleus muscle, and in the fasciculus gracilis of the spinal cord. Therefore, it was concluded that propylene oxide induces neuropathy in rats characterized by axonal degeneration, similar to that produced by ethylene oxide, and that the exposure to the higher concentration of propylene oxide is more necessary to produce neuropathy than in the case of ethylene oxide neuropathy in rats.

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The cutaneous vibration and thermal-cooling thresholds were evaluated on the palmar side of the distal phalanx of the right index finger and on the plantar side of the distal phalanx of the right great toe in 70 control subjects without sensory symptoms and signs, aged from 13 to 83 years, by using a Vibration Sensitivity Tester and a Thermal Sensitivity Tester (Sensortek, N. J., USA). Both vibration and thermal-cooling thresholds of the index finger, and vibration threshold of the great toe were statistically significantly increased with age. Based on the data obtained from these subjects, the lower and upper limits of 95% confidence limit of the predicted value of each of the thresholds for each decade were calculated. These values are useful for the detection of the abnormal cutaneous vibration and thermal-cooling thresholds not only in general neurology, but also in occupational neurology.

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We investigated the effect of the ingredients in serum-free cultures, in which serum was completely replaced by albumin, cholesterol and transferrin, on the growth of murine granulocyte/macrophage progenitor cells (colony forming unit in culture: CFU-C) stimulated by serum-free PWM-SCM and the influences of purified granulocyte-macrophage colony stimulating factor (GM-CSF) in serum-free cultures. The results were as follows: 1) The number of CFU-C colonies reached a peak after 4 days of incubation. 2) A linear relationship was observed between the number of CFU-C colonies and the number of inoculated bone marrow cells. 3) Serum-free cultures could support CFU-C colony growth to the same degree as that in serum-containing cultures. Also, no significant differences were found in the types of colonies grown in both cultures. 4) Bovine serum albumin (BSA) and cholesterol were considered to play the most important roles among the ingredients in serum-free cultures. 5) Purified GM-CSF supported CFU-C colony growth in serum-free cultures and mole than a half of the colonies formed were GM-colonies. These results showed the usefulness of our serum-free cultures for studying the granulopoiesis in vitro without the infiuences of various substances in the serum.

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Susceptibilities of Gram-negative bacterial strains isolated at the University Hospital in 1987 to six β-Lactam antibiotics (azthreonum cefmetazole, ceftizoxime, Iatamoxef, aminobenzyl-penicillin and piperacillin) and two aminoglycoside antibiotics (gentamicin and amikacin) were examined by agar dilution and the agar diffusion method. Results obtained from both methods correlated well in most of the strains. Most of the strains belonging to Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae and Proteus mirabilis were sensitive to the β-lactam antibiotics except aminobenzyl-penicillin and piperacillin. They were also sensitive to aminoglycoside antibiotics. Most strains of Citrobacter freundii Enlerobacter cloacae and Serratia marcescens were sensitive to azthreonum, Iatamoxef and aminoglycosides, but were less sensitive to other β-lactams. Acineiobacter calcoaceticus was generally resistant to β-lactams except ceftizoxime, but was sensitive to aminoglycosides. More than half of the strains of Pseudomanas aeruginosa were sensitive to azrhreonum, piperacillin and aminoglycoside antibiotics and only latamoxef was active in Pseudomanas maliophilia.

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For the purpose of diagnosing non-A, non-B hepatitis, an indirect immunoperoxidase method using the monoclonal antibody 48-i was carried out. Human liver biopsy specimens of 74 cases with various hepatic diseases containing non-A, non-B hepatitis were investigated by using optical microscopy. Moreover, cases with non-A, non-B hepatitis were clinicopathologically examined. Peroxidase-positive hepatocytes were found In 13 cases of the 74 cases. The thirteen cases were as follows; 8 cases with acute hepatitis (non-A, non-B type), 2 cases with chronic hepatitis (non-A, non-B type), 2 cases with acute hepatitis (B type), I case with chronic hepatitis (B type). The frequency of positive peroxidase staining was high (80%) in acute hepatitis (non-A, non-B type), but it was not significant statistically. On histological examination, acidophilic condensation was frequently seen in liver specimens of cases with acute hepatitis (non-A, non-B type). Furthermore, the correlation between acidophilic condensation and peroxidase positive staining was statistically seen. It is suggested that the peroxidase staining by using monoclonal antibody 48-1 is useful for diagnosis of acute hepatitis (non-A, non-B type).

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Hyperbaric chamber dives at 31 ATA with helium-oxygen were performed at the Japan Marine Science and Technology Center in 1987. During simulated underwater experiments, auditory brain stem responses were recorded in 4 professional divers for assessment of brain stem function. All divers had no clinical symptoms at 150 m below sea level, and their ABRs also showed no significant changes. During the 150－250 m depth saturation dives, all divers complained of various symptoms such as euphoria, ataxia, joint pain, tremor and dyspnea, while,Ⅰ－Ⅲ andⅠ－Ⅴ interpeak latencies on their ABRs increased with a tendency of recovery. Furthermore, the changes of both interpeak latency were independent of each other. These results indicate that transient dysfunction clinically or subclinically occurred at the processes between 150- 300 m below sea level. Moreover, independent changes of Ⅰ－Ⅲ and Ⅰ－Ⅴ interpeak latencies in this study may mean that the pathways reached to the generation sites of wave Ⅲ and Ⅴ were different.

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A 56-year-old woman in Kitakyushu City was operated on after diagnosis of mediastinal tumor with myasthenia gravis. Besides the thymoma, a small nodule was palpated in the lower lobe of the left lung and biopsied. A segmented worm was found in sections of this granulomatous nodule. A cross section of the degenerated worm (400×310μm) showed a 3-layered tegument and internal cuticular ridges with high lateral chords. The muscle layer consisted of high and polymyarian muscles. Based on these characteristics, this worm was identified as an immature dog heartworm, Dirofilaria immitis. The recent sharp increase of dirofilariasis cases reported in Japan is discussed.

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Multicentricity of hepatocellular carcinoma (HCC) is considered, especially in patients with liver cirrhosis. This paper describes an operative case of a male patient with probable multicentric development of HCC in precirrhotic fibrosis. The main tumors inside the capsule were completely necrotic due to transarterial embolization (TAE). Histologic examination disclosed discrete tiny nodules of HCC that were not detected grossly. They showed highly differentiated trabecular arrangements: Edmondson Ⅰ. A scirrhous type was noted in the center of the tumors. At the borders of the tumors the carcinoma cells exhibited replacing growth patterns and it was thought that they developed multicentrically. Partial resection must be performed as extensively as possible in a case such as the present one.

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We report two cases of severe withdrawal symptoms after abrupt discontinuation of a long-term normal-dose benzodiazepines (BZD) administration. Case 1, a 61-year-old man, suffered from delirium on the 7th day after abrupt discontinuation of nitrazepam, 10 mg/day. Case 2, a 49-year-old woman, suffered from auditory hallucination on the 4th day and visual cognitive disorder on the 5th day after abrupt discontinuation of nitrazepam, 5 mg/day, and triazolam, 0.5 mg/day. A withdrawal syndrome after discontinuation of normal-dose BZD is uncommon, and a psychotic withdrawal reaction is even more uncommon. We show how a continuous administration of BZD for a period of longer than 6 months and the presence of severe insomnia are risk factors predictive of a psychotic reaction. We also explain the predictive method used to determine the onset time of such a severe state. In the case of a psychotic state, we recommend intravenous diazepam injection. To prevent withdrawal reaction, we also recommend a gradual reduction after administration of normal-dose BZD.

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