Previous reports have indicated the efficacy of granulocyte-depleted blood (GDB) for the prevention of coronary reperfusion injury. Experiments were conducted on a canine extracorporeal coronary circulation model, in order to evaluate the minimal effective duration of GDB reperfusion. Coronary circuit was occluded for 90 minutes, and then reperfused for 6 hours. The coronary responsiveness to acetylcholine remained normal when the heart was initially reperfused with GDB for 15 minutes or longer, but was markedly reduced when the initial GDB reperfusion lasted only for 5 minutes. Fifteen minute reperfusion with GDB following initial reperfusion with untreated whole blood failed to maintain coronary responsiveness. When the duration of the initial GDB reperfusion was 15 minutes or longer, the myocardial infarction was significantly reduced in size and none of the electron microscopic evidences of severe endothelial cell damage characteristic of reperfusion injury was observed.
Thus, coronary perfusion using GDB for 15 minutes at the initial stage of reperfusion obviously suppressed reperfusion injury.

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The author studied the relationship between clinical features and immunohistochemical findings in 15 patients with cardiac myxoma. The size of myxoma was not correlated with either cardiac function or embolic complications. Bat embolism occurred more frequently in lobulated and papillary myxoma than in rounded myxoma. The symptoms of autoimmmune-like diseases were present in 14 patients. Immunohistochemical studies revealed a high rate of IL-6 expression in myxomas. The author speculates that IL-6 excreted by the tumor may play a significant role in the development of clinical features which resemble those of autoimmune diseases. In addition, myxoma cells stained positive with such mesenchymal cell markers as desmin (53%), vimentin (20%), factor VIII (13%), S-100 (33%), no squamous epithelium (NSE) (7%), and cytokeratin (7%). These observations might suggest that cardiac myxomas arise from mutipotential mesenchymal cells.

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Pulse wave conduction velocity (PWV) was measured in 163 fatients with atherosclerotic disease, 144 patients with diabetes mellitus, and 51 normal healthy individuals in order to study the diagnostic value of PWV and to identify the contribution of diabetes mellitus to sclerogenesis. In both the disease groups and in the normal controls, PWV increased linearly with the advancing age. The slope of the regression line was steepest for arteriosclerosis obliterans, followed by diabetes mellitus, cerebral infarction, ischemic heart disease, cerebral bleeding, and the normal controls, in decreasing order. However, PWV is of limited diagnostic value because of wide overlapping between the disease groups and the controls. On the other hand, the results of this study indicated a considerable contribution of diabetes mellitus to the progression of atherosclerosis. In diabetic patients, acceleration of the PWV paralleled with the duration of the desease and was prominent in the presence of complications. Among patients under hemodialysis, the PWV was significantly greater in diabetics than non diabetics. Thus, diabetes mellitus was found to be a causative factor in the etiology of macro-microangiosclerosis.

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The relations between blood pressure and calcium metabolism/parathyroid function were studied in the deoxycorticosterone acetate (DOCA) -salt hypertensive rats with or without parathyroidectomy (PTx). After left uninephrectomy, male Wistar rats were divided into three groups : (1) DOCA group rats (n=14), which were planted subcutaneously with 25mg DOCA tablet on the day 0 and 14 and given orally 1% NaCl dissolved in water for 28 days ; (2) DOCA-PTx group rats (n=12), which were parathyroidectomized on the day 0 and given orally 1% NaCl dissolved in water for 28 days ; (3) control rats (n=14), which were given only tap water. Blood pressure, measured by the tail-cuff method, were markedly higher both in the DOCA and DOCA-PTx group rats than in the control group rats on the day 28 (215±10, 209± 10, 137±2mmHg respectively). Urinary Ca²⁺ excretion increased both in the DOCA and DOCA-PTx group rats. Serum Ca²⁺ concentration was not decreased in the DOCA group rats (1.22±0.02mmol/l) but markedly lower in the DOCA-PTx group rats (0.84±0.06mmol/l) than that of the control group rats (1.26±0.02mmol/l). Plasma parathyroid hormone concentration was higher in the DOCA group rats (25.9±2.9pg/ml), but lower in the DOCA-PTx rats (7.4±0.7pg/ml) than that of the control group rats (16.0±2.2pg/ml). These results suggest that the increase in plasma parathyroid hormone concentration in the DOCA-salt hypertensive rats may be secondary reaction due to urinary calcium loss and parathyroid hormone may have no significant role in the genesis and development of hypertension

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The purpose of this study was to study neurophysiological mechanisms underlying the facilitatory effect of voluntary contraction upon the motor evoked potential (MEP) by transcranial electrical stimulation of human motor cortex. The MEPs were recorded from the lower limb muscles while applying percutaneous electrical stimulation to the cervical spinal cord. The spinal cord stimulation was expected to elicit identical amount of synchronous descending input to motoneuron pool. Spinal cord stimulation reduced the threshold intensity to evoke MEP of the tibialis anterior muscle and enhanced the amplitude of MEP during voluntary contraction than when relaxed. However, voluntary contraction did not change the MEP latency. Thus, voluntary contraction coupled with spinal cord stimulation increased the excitability of spinal motoneuron but did not facilitate effect on the latency of the MEP. The author postulates that the amplitude enhancement of MEP to cortical stimulation during a voluntary contraction occurs at least in part at the spinal level, but the latency decrement of MEP could not be explicable by the neural event solely at the spinal cord level.

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The purpose of this study was to examine the relationship between myocardial blood flow and myocardial viability in the ischemic canine myocardium after reperfusion. Transient ischemia was induced by 60-, 90-, and 180- minute occlusion of the left anterior descending coronary artery. Myocardial blood flow (MBF) was measured in the areas in which regional contractility was severely impaired (echocardiographically akinetic or dyskinetic) in the early reperfusion period by ¹⁵O-water positron emission tomography (PET) 12 hours and 4 weeks after reperfusion. An MBF ratio of ischemic to nonischemic regions 12 hours after reperfusion was inversely correlated with the amount of histologically determined tissue necrosis (r=-0.74). The regional contractility recovered 4 weeks later in the areas where an MBF ratio was 0.48 or greater, but did not recover in the areas with a lower MBF ratio. Thus, myocardial viability can be appropriately predicted in the early phase of myocardial perfusion by PET with ¹⁵O-water even in the absence of metabolic imaging.

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A longitudinal incision was made in the avascular portion of the menisci of 54 dogs. In one knee of 34 dogs a synovial graft was sutured into the wound, and in the other 20 dogs a muscle graft and Dacron mesh were sutured. The wound in the other knee was sutured as a control.
In the group of menisci in which the synovial graft was used, 10 of the 34 lesions healed, and the longitudinal lesion had been repaired by fibrous tissue at 6 weeks. No healing occurred in the other groups or the controls.
The meniscal lesions occurred without vascularization. A fibrin clot attached to the grafted synovium appeared to act as a scaffold and stimulus for the reparative process.

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We investigated factors influencing the prognosis of patients with ruptured abdominal aortic aneurysm (AAA) who underwent operations during the past 10 years. In 97 patients with AAA, 22 (22.7%) ruptured. The mean age of the patients with ruptured AAA (n=22, 70.2 y) was higher than that of the patients with non-ruptured AAA (n=75, 67.6 y). Especially, the mean age of the female patients with ruptured AAA (79.8 y) was higher than that of the male patients with ruptured AAA (67.4 y). The rate of hospital death among patients with ruptured AAA (50%) was significantly higher than that among patients with non-ruptured AAA (4 %). The mean interval from onset to surgery in the hospital death patients (25 hr) was shorter than that in the surviving patients (29 hr). Preoperative shock was more frequently in hospital death patients than in surviving patients. Hospital death patients were transfused significantly more than surviving patients. Postoperative complications, such as renal failure, central nervous system disturbance and multiple organ failure, were frequently observed in hospital death patients. To improve the survival rate of patients with ruptured AAA, we must make an effort to reduce postoperative complications. Mass screening of high risk patients with AAA is also needed to predict patients with non-ruptured AAA.

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Tissue-type plasminogen activator (t-PA, 24 million I.U. of alteplase) was administered intravenously to 14 patients with acute myocardial infarction within 6 hours of the onset of symptoms, and its clinical efficacy was evaluated by comparison with 22 untreated controls. Compared with the control group, the patients receiving t-PA had shorter durations of chest pain (7.1±0.9 vs. 11.9±0.7 hr ; p<0.01) and ST elevation (45.4±9.5 vs. 80.5±7.9 hr ; p<0.01). The interval between the onset of symptoms and the maximum creatine kinase level (Max CK) was reduced by treatment with t-PA (16.8±1.5 vs. 22.8±1.6 hr ; p<0.05). Both groups exhibited a similar incidence of ventricular extrasystole and ventricular tachycardia, although patients treated with t-PA required a larger total dose of lidocaine than the control group (11, 401±2, 230 vs. 6, 493±930mg ; p<0.05). During the chronic phase, there were no differences in the patency rate of the infarct coronary artery and the left ventricular ejection fraction in the two groups, but the incidence of ventricular aneurysm was lower in the t-PA group. No serious complications, such as hemorrhage, occurred. Intravenous administration of t-PA combined with appropriate antiarrhythmic therapy appears to be safe and beneficial for acute myocardial infarction.

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The significance of prostate-specific antigen (PSA) measured with a Tandem PSA kit in 2230 serum samples examined by mass screening for prostate cancer was investigated.
In 1985-1991, subjects were examined by digital rectal examination (DRE) and prostatic acid phosphatase (PAP), and in 1992, subjects were examined by DRE, transrectal sonography (TRUS) and PSA using an E-test TOSOH II Kit.
1) The cut off value was determined between non-cancer subjects and prostate cancer patients. When the cut off value was 5.5ng/ml, the sensitivity, specificity and accuracy as a prostate marker were 73.9%, 95.3%, and 94.6%, respectively.
2) The relationship between serum PSA coscentration, prostate size estimated by TRUS and age was investigated. The serum PSA was directly correlated with patient age and prostatic volume. The serum PSA concentration increased by 0.04ng/ml/year.
3) The PPV (positive predictive value) of PSA (26.1%) is better than that for DRE (7.4%) or TRUS (8.1%). Thr sensitivity of PSA, DRE and TRUS is 73.9%, 49.6% and 21. 4%, respectively

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We experienced 12 patients with cadiopulmonary arrest on arrival (CPA) over a six-year period. The CPA rate was 2.6% of all patients (460) treated in our emergency division. Eleven (91.7%) of the 12 patients were male. The mean age of the patients was 43 years and ranged from 18 to 72 years. The exogeneous causes of CPA consisted of hemo-pnéumothorax due to a traffic accident in three patients, suicides in two patients and airway obstruction in one patient. All of the endogeneous causes were cardiac disease (acute heart failure in three patients, myocardial infarction in two patients and ventricular fibrillation in one patient). The episode was witnessed in ten of the twelve patients, however, cardiopulmonary resuscitation (CPR) was only performed by three bystanders. Heart beat recovered in two patients with myocardial infarction who died within two days after admission.
To improve the prognosis of patients with CPA, all citizens need to learn a CPR technique. It is important to provide a direct transportation system for critical patients, who is selected by emergency medical technicians, to a secondary or tertiary institution.

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The present study was designed to elucidate the effect of topical cooling for preventing liver injury during extended hepatectomy with hepatic vascular exclusion. Adult mongrel dogs (9.5-17.5kg, n=19) were used in this experimental study. Seventy-five % of the liver was resected in each dog. The animals were divided into three groups. : The control group without inflow clamp at hepatectomy, the clamp group with hepatic inflow clamp for 60 minutes at hepatectomy, and the cooling group with topical cooling using ice slush during inflow clamp (core temperature of the liver ; 13.3 ± 0.3°C). GPT, GOT, LDH as the marker of hepatocyte injury and purine nucleoside phosphorylase (PNP) as the marker of non-hepatocyte injury were measured. Results were as follows : The seven-day survival of the animals in the cooling group was better than that in the clamp group. The serum levels of GPT, GOT, LDH showed no significant differences between the clamp and the cooling groups. PNP activity of the cooling group was significantly lower (P<0.01) than that of the clamp group immediately after hepatectomy. These findings suggest that topical cooling of the liver prevents non-hepatocyte injury at the time of extended hepatectomy with hepatic vascular exclusion.

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Cervical cystic lymphangioma usually develops in patients under two years old. We encountered a 33-year-old female with cervical cystic lymphangioma. Right cervical swelling at the age of 3 years disappeared after puncture but recurred at the age of 33 years. Inflammatory reaction in the swollen area after an exploratory incision interfered with making a clinical diagnosis. MRI was useful in diagnosing of this lesion, and was also convenient in determining the extent of the lesion. Complete excision is recommended to prevent recurrence.

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Adenocarcinoma of the right lung was incidentally diagnosed by screening chest CT for pulmonary emphysema. The tumor was located in posterior S² adjacent to the trachea. The tumor shadow was within the upper mediastinal shadow and invisible on a routine chest X-ray film. Despite poor lung function (FEV_1.0; 1.07l), right upper lobectomy with lymphadenectomy R₂ b was successfully performed. Control of pain by continuous epidural anesthesia and bronchial toilet by bronchofiberscopy were effective for the postoperative management.

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A 27-year-old man was admitted to our hospital complaining of high fever, severe cough, severe fatigue, and emaciation, and had rejected all examinations and medical treatment at the previous hospital. We made a diagnosis of acquired immunodeficiency syndrome (AIDS) with pneumocystis carinii pneumonia, candidiasis, and mycobacterial infection (WHO stage, 4C), because the CD4 count was 6/ul ; Western blot analysis showed the presence of a band at gp 40 and the absence of band at p 25 ; Candidiasis and mycobacterial infections were observed on the lung/tongue and lung, respectively ; lung CT scan showed a typical diffuse intestinal pneumonia shadow and a nodule with a cavity. We started the patient on ACT, IN/RAP/E, ST, and fluconazole. This treatment was effective in reducing his high fever and lung shadow, however, acute drug-induced myelosupression and liver injury were detected. Two weeks after withdrawing of drugs, the patient had recovered from myelosuppression and drug-induced liver injury but his hepato-splenomegaly and fever were getting worse. Histological examination of liver and bone marrow biopsy speciments showed that he had atypical mycobacterial infection of the liver and bone marrow. Mycobacterium avium complex infection was finally diagnosed on the basis of a sputum culture. Because of its sensitivity to them, we treated the patient with ofloxacin and roxithromycin. Didanosine and pentamidine isetionate were used for the treatment of AIDS and pneumocystis carinii pneumonia. These drugs did not have any side effects and the patient ultimately became well enough to be dischanged from our hospital and to return to his hometown. During the patient's hospital stay, neutrophil functions (phagocytosis, bactericidal function) measured on four occasions were always below the normal range. This impaired meutrophil function may be one factor in the susceptibility of AIDS patients to opportunistic infection.

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