ドブタミン, ドパミンの混合投与の右心機能への影響を臨床的に明らかにする目的で, 開心術後12-24時間の安定した時点で10症例において, 至適循環動態を保つ両薬剤の等量混合投与 (1群) から開始して, 両薬剤総量一定でドブタミンとドパミンの投与比率を2群 (1.5 : 0.5), 3群 (2.0 : 0), 4群 (0.5 : 1.5), 5群 (0 : 2.0) と変化させて投与し循環動態を比較検討した.右室駆出率を温度応答速度の早いサーミスターを装着した肺動脈カテーテルで測定, 右室の拡張終期容量, 収縮終期容量, 拡張終期圧, コンプライアンス等の循環諸量を求めた.ドブタミン投与比率の高い群 (2, 3群 : ドブタミン, ドパミンの投与比率が1.5 : 0.5, 2.0 : 0) と比較してドパミン投与比率の高い群 (4, 5群 : ドブタミン, ドパミンの投与比率が0.5 : 1.5, 0 : 2.0) は, 右室駆出率, 一回拍出係数, 右室コンプライアンス, 心拍数が低下し, 右室拡張終期容量係数が変化せず, 心室 (右室, 左室) 充満圧, 肺血管抵抗係数, 全末梢血管抵抗係数が増加した。ドブタミン単独投与群 (3群) は1, 2群 (ドブタミン, ドパミン等量投与か1.5 : 0.5) に比較して心拍数が有意に高い以外に改善効果がなく, 開心術直後でドブタミン, ドパミンの総量が20 microgram/kg body weight/minute (mcg/kg/min) 以内の投与量にあってはドブタミン, ドパミンの等量投与か, ドブタミン : ドパミン1.5 : 0.5の比率の投与が陽性変力効果強く心拍数の増加が少なく, 循環動態的に優れていることが明らかとなった.また, ドパミンの投与比率の高い4, 5群ではドパミンの容量依存的に右室コンプライアンスが低下し, ドパミンの作用特性と考えられた.

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The neuroanatomical distribution of the somatostatinergic system in mice and human brains was studied by immunocytochemistry. The co-localization of choline acetyltransferase and somatostatin, and the pathological changes of the somatostatinergic system in dementia of Alzheimer type (DAT) were also examined. Cryostat sections were stained by the avidin-biotin complex method (ABC) and the double immunoenzymatic staining method combining the peroxidase-anti-peroxidase method (PAP) and the avidin-biotin-alkaline phosphatase complex method (ABC-AP). Periodic acid Schiff staining (PAS), periodic acid-methenamine-silver staining (PAM), Hirano staining and β-protein immunostaining were also used in order to localize senile plaque amyloids.
Somatostatin-like immunoreactive (SSI) neurons were widely distributed in various regions of the central nervous system of mice. The cells had small-or medium-sized cell bodies and some processes. SSI neurons were found in the following regions : the olfactory tubercle, piriform cortex, basal ganglia, substantia innominata, cerebral neocortex, amygdaloid complex, hippocampus, zona innertia, bed nucleus of the stria terminalis, periventricular gray of the third ventricle, nucleus arcuatus, some areas of the thalamic nuclei, and the hypothalamus. Varicose or dot-like SSI fibers formed dense networks in the neocortex, olfactory tubercle, nucleus accumbens, basal ganglia, substantia innominata, amygdaloid complex, some thalamic nuclei, median eminence, lateral geniculate body, area postrema, nucleus of solitary tract, spinal trigeminal nucleus, and dorsal horn of the spinal cord.
Choline acetyltransferase-like immunoreactive (ChATI) cell bodies were found in the following regions : the olfactory tubercle, nucleus accumbens, lateral preoptic region, basal ganglia (caudate, putamen, globus pallidus), basal forebrain (medial septal nucleus, diagonal band of Broca, substantia innominata (basal nucleus of Meynert)), medial habenular nuclei, pedunculopontine tegmental nucleus, somatic and viceral motor nuclei in the brainstem and spinal cord. In the neocortex, there were a few small weakly-staining neurons. The localizations of ChATI neurons were classified into four major groups : 1) basal ganglia, 2) basal forebrain, 3) pontine tegmentum, and 4) spinal and cranial nerve motor nuclei. ChATI neurons were medium-or large-sized multipolar cells. The cell bodies were divided into a deeply-staining group (basal ganglia, basal forebrain, pontine tegmentum), and a weakly-staining group which had ChATI nerve terminals (spinal and cranial nerve motor nuclei). Areas with dense networks of ChATI nerve fibers included the olfactory tubercle, basal ganglia, neocortex, hippocampus, amygdaloid complex, interpeduncular nucleus, and superior colliculus.
Double immunoenzymatic staining demonstrated the clear separation of both immunoreactivities in the central nervous system. ChATI neurons were stained blue and SSI neurons were stained brown. Black-stained cell bodies suggesting the co-localization of both immunoreactivities were not seen in the four major cell groups of the ChATI neurons, or in the other regions.
In human brains, SSI neurons were found in the cerebral cortex (IInd to VIth layers), basal ganglia, hippocampus, and substantia innominata. These SSI cells were small and medium-sized. The large neurons in the nucleus basalis of Meynert (nbM) were not stained. However, these neurons had many SSI nerve terminals. Anti-choline acetyltransferase antibody only stained the large neurons in the nbM. It is speculated that cholinergic fibers project from the ribM in human brains.

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Many arguments have been made as to whether the occurrence of torpedo (axonal swelling of the Purkinje cell) is a physiological age-related change or a pathological one. However torpedo has not been investigated by the quantitative analysis of many cases. It is the purpose of this paper to clarify whether torpedo is a physiological or pathological change, through morphometric analysis. We morphometrically-analyzed torpedoes in specimens from 47 men and 37 women aged from 29 to 92 years. Formalin-fixed sections of the cerebellum were embedded in paraffin and stained with the Bodian method. Then we counted the number of axonal torpedoes and calculated the torpedo density (number/length of the Purkinje cell layer) in aging and various diseases such as cerebral vascular diseases, hypertension, heart disease, malignancy and dementia.
The results are summarized as follows :
1. Torpedo was observed in all specimens from cases aged from 29 to 92 years.
2. However torpedo density was minimal in the specimens from patients under 60 years and it increased significantly with age, suggesting that aging is the most important factor in the formation of torpedoes.
3. Compared to age-matched controls, patients with cerebral vascular diseases had a significantly higher torpedo density, up to the age of 80. This suggests that cerebral diseases influence torpedo density.

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We used muscle strips from rabbit proximal stomach to study developmental changes in response to putative agonists. Strips from neonatal (1 day old) and weanling (11 weeks old) rabbits were stimulated by agonists and the contractions were recorded. Maximal stress and ED₅₀ were calculated from the dose response curves. Maximal stress increased with age for bethanechol, high extracellular K⁺, substance P, substance K, and neuromedin K, but not for serotonin, cholecystokinin-octapeptide, or neurotensin. Bombesin stimulated larger contractions in neonates. Gastrin, motilin and morphine had no effect at either age. ED₅₀'s for substance P and for serotonin in neonates were 24 to 800 times less than those seen in weanlings.
These data suggest that developmental changes in gastrointestinal motility seen in the neonatal period might be due to modulation of muscle responses to agonists.

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Regional cerebral blood flow (rCBF) was measured at rest using the ¹³³Xe inhalation technique in 40 DSM-III-diagnosed schizophrenics (22 males, 18 females : mean age 35.0 years, range 20-49 years) and 31 age-and sex-matched normal controls (16 males, 15 females : mean age 34.3 years, range 21-49 years). The absolute value (AV) and the percent value (PV) of the rCBF in schizophrenics were compared with those in controls. Correlations between rCBF and the Brief Psychiatric Rating Scale (BPRS) scores or the performance of Wisconsin Card Sorting Test (WCST) were examined in schizophrenics.
Schizophrenics showed significantly lower AVs in all brain regions examined and a significantly lower PV in the left superior frontal region than controls. The hyperfrontal rCBF distribution which was found in both hemispheres in controls, was absent in the left hemisphere in schizophrenics. In schizophrenics, superior frontal blood flows were significantly negatively correlated with the negative symptom scores of the BPRS but not with the total scores and the positive symptom scores of the BPRS. In schizophrenics, inferior frontal blood flows were significantly correlated with the number of sorting categories achieved.
These results indicate that rCBF in schizophrenia is reduced in the whole brain and especially in the left superior frontal region. These findings suggest a frontal lobe dysfunction in schizophrenia.

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The distribution and arrangement of microtubules (MTs) in the skeletal muscle cells of rat and mouse diaphragms were examined by thin-section electron microscopy. In the central portion of the muscle cells, most of the MTs run longitudinally between the myofibrils and beneath the sarcolemma, and some MTs traverse predominantly at the level of the I-band, especially the A-I junction, showing a lattice-like arrangement. At the cell periphery, where the nuclei and Golgi apparatus are located, MTs are aggregated in the perinuclear region, from which they radiate to take a longitudinal course beneath the sarcolemma and to run in a transverse direction at the I-band level. At the ends of muscle cells, MTs are abundant running along the long axes of the processes. MTs are often found to be closely associated with the membranous organelles including mitochondria.
Quantitative analyses indicate that MTs are remarkably numerous in the peripheral zone of muscle cells as compared to the deeper and central zones. Interestingly, the MT-density was almost the same in both typical red and white muscle cells. MTs are significantly high in density at the cell ends, although the MT-density varies considerably between different cells. The results obtained from morphological and quantitative analyses are discussed with special reference to the possible involvement of MTs in the intracellular transport as well as structural support.

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Seventeen patients with liver cancer were treated with the method of infusion of Lipiodol-Cisplatin (LPD-CDDP) suspension. Serum concentration of CDDP were analyzed with atomic absorption spectrometry in 16 patients. Tissue concentrations of CDDP were measured in two patients.
Plasma levels of CDDP decreased in a biexponential manner, the half-life of the first phase was as long as in intravenous one-shot injection therapy, and also LPD-CDDP sandwich therapy. On the other hand the half-life of the late phase was longer than those. Tumor tissue level of CDDP was the same an normal liver tissues in one patient, but in the other patient the tumor tissue level of CDDP was higher than in normal tissue. These depositions of LPD in CT findings present the tissue concentration of CDDP. It was clinically confirmed that CDDP passes gradually into the systemic circulation after hepatic intra-arterial injection of the LPD-CDDP suspension.

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The cause, treatment and prophylactic measures of postoperative pancreatic fistula were examined in 45 patients who underwent pancreaticoduodenectomy. The incidence of pancreatic fistula was 24.4% (6/11) and 14.7% (5/14) respectively, in patients with and without jaundice just prior to the operation, being significantly lower in the latter group. The correlation of fistula with duct diameter in the remaining pancreas, was 31.5% (6 out 19 cases) in patients with less than 2 mm ductal diameter. The incidence of fistula was decreased when the duct diameter was larger and no occurrence was recognized in 5 cases with ductal diameter of more than 6.1mm. As a pancreatic fistula is intractable, tube insertion into the pancreatic duct should be made firmly during operation to prevent its occurrence.

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Post operative adhesional ileus is a critical problem in the patients receiving intra-abdominal surgery. Intestinal decompression using a long tube is useful, but many cases relapse and the resultant long periods of hospitalization restrict quality of life.
Four patients with recurrent postoperative adhesional ileus and two patients with severe intestinal adhesions were treated by the total intestinal splinting method. The postoperative courses were excellent and resulted in a normal quality of life.

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Angiographic findings were investigated for 17 cases of pancreatic carcinoma. Obstruction (41.2%) and irregular encasement (61.2%) were demonstrated indicating the inoperability. These cases were classified into three groups depending on the extent of vascular involvement on vessels around and/or within the pancreas : no case in group I, 4 cases in group II and 13 cases in group III. There was no case on which radical operation was performed and palliative operation only was performed on one case (25.0%) out of group II and 2 case (15.4%) out of group III.
In our experience, only the cases without remarkable angiographic findings (group I) would be resectable, unless the operative technic would not be improved.

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A 76-year-old woman was admitted to our hospital because of a bleeding tendency. The complete blood cell count disclosed bicytopenia and the myelogram showed hyperplasticity. Abnormality in the cell morphology was noticed in both the peripheral blood and in the bone marrow. Ferrokinetic study revealed an increased plasma iron turnover rate and an ineffective iron turnover rate. Blast cell content in the bone marrow as less than 5%, and the content of ringed sideroblasts was less than 1%. Consequently, we diagnosed her disease as refractory anemia and began supplement therapy. However the patient died of septic shock due to gasproducing Escherichia coli, after five months of treatment.
This was a case of non-clostridial gas gangrene, but at the onset we could not detect crepitation and no gas image was seen on X-ray examination. Therefore diagnosis was difficult and the treatment was unsuccessful.

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近年食生活の欧米化に伴い, 疾病も欧米化の傾向が認められる.糖尿病も食事療法やインスリン療法が発達し, かなりコントロールされるようになってきており, 以前の様な典型的な経過をとらない傾向にある.我々は糖尿病性の腎症による尿毒症で死亡した1例を経験したので報告する.

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