Radiation exposure of patients undergoing digital subtraction angiography was measured using Anderson Rando Phantom and five types of commercially available DSA systems. The absorbed dose in DSA was significantly higher than that of conventional angiography and varied among each system. Surface maximum dose reached 202mGy (20.2rad) by 20 second exposure in a certain type of system. Patient surface maximum dose using this system was estimated to be 175mGy (17.5rad) in intraarterial DSA and 250mGy (25.0rad) in intravenous DSA per examination. Absorbed dose of examining physicians was also significantly high when injection was performed by hand, being 0.34mGy (34mrad) in lens, 0.4mGy (40mrad) in thyroid gland and 0.27mGy (27mrad) in fingers respectively in single examination. The above results indicated the necessity of developing techniques of low dose DSA. By modifying the exposure program of currently available system, clinically satisfactory images were obtained using substantially lower dose even compared with that of conventional angiography.

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In order to study the pathogenesis of pulmonary amniotic fluid embolism following abruptio placentae, the author has attempted to investigate the changes of maternal lungs of 51 rabbits, in near-term gestation, following the experimental process for 48 hours. In the group 1(21 rabbits) retroplacental hematoma was produced by artificial separation of the placenta from the uterine wall, when a large amount of platelet aggregations and fibrin thrombi were formed in the small pulmonary arteries, less than 800μm in external diameter. There occurred in the perivascular connective tissues, edema, lymphangiectasia and inflammatory cell infiltration simultaneously. Then, dominant in the small arteries free of thrombus formation, there was seen leukocyte accumulation and, thence, small amount of meconium was seen plugging in the capillaries and venules, indicative of occurrence of amniotic fluid embolism. On the other hand, in the lungs of 17 rabbits which received intravenous injection of tissue thromboplastin (1mg/kg), the fibrin thrombi with accumulation of leukocytes were observed in the small arteries. In the 13 rabbits received intravenous injection of porcine gastric mucin (5mg/kg), leukostasis was seen in the pulmonary arterioles and venules. Conclusively, we have guessed that tissue thromboplastin as well as meconium mucin in the amnionic fluid might have played an important role upon the pathogenesis of pulmonary amniotic fluid embolism.

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The pulmonary lesions induced by complement activation in 62 female albino rabbits have been studied for the clarification of the mechanical relationship between pulmonary intravascular leukostasis and variation of leukocyte count in the peripheral blood. When zymosan suspension (1mg/kg) was infused, numerous neutrophils and platelets were seen aggregating in the pulmonary small arteries, venules and capillaries with zymosan particles phagocytosed by aggregated neutrophils and monocytes. Simultaneously the platelets showed pseudopod formation and degranulation. The interalveolar capillay endothelial cells became edematous with or without degeneration of cytoplasm, marked by interstitial edema in the interalveolar septa. On histological analysis with the Image Analyser, there was found an increase in the number of leukocytes in the interalveolar capillaries until 2 hours after the infusion of zymosan and decreased thereafter. Whereas peripheral leukocytes showed transient leukopenia in the first 2 hours, but regained up to the normal range thereafter. It became clarified that leukopenia occurred as a sequel to the pulmonary intravascular leukostasis caused by complement activation secondary to intraveous infusion of zymosam. We guess that the pulmonary intravascular leukostasis probably can be inhibited by one shot infusion with methylprednisolone (40mg/kg). Methylprednisolone might have played some role upon the stabilization of lysosomal membrane and disaggregation of leukocytes.

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Abdominal radiographs taken by the computed radiography (CR) system were evaluated comparing with those by a conventional film/screen method. The image quality of (1) plain abdominal radiographs, (2) upper GI series, (3) barium enema and (4) drip infusion cholecystocholangiographs obtained by this system was analysed using the statistical threestep (A, B and C) evaluation program. The improvement of the image quality due to the wide dynamic range of this system was confirmed particularly in the visibility of fine mucosal pattern (area gastricae), converging mucosal folds, flank stripes, stones in the gallbladder fundus. The radiation dose could be significantly reduced due to the high sensitibity of this system. Thus, diagnostically acceptable images were obtained with approximately 1/5 of the routine dose for the conventional radiography except in the cases of the lateral view of the rectum.

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Fragile sites (FS) are specific points on chromosomes to be expressed as non-staining gaps when chromosomes are exposed to a specific chemical agent or to some condition of tissue culture. Some of them are defined as heritable or rare FS, the incidence of which range from one in 40 to several thousand individuals. They have been classified into three groups: 1) folate-sensitive FS, 2) distamycin A (dist A) -inducible FS and 3) bromodeoxyuridine (BrdU) -requiring FS. Since they have been found in patients with mental retardation, habitual abortion or a malignant tumor, biological significance of FS has been a matter of concern. Especially, the X chromosome with FS on Xq27, i.e. fragile X (fra X) or fra (X) (q27), has been shown to be the single leading cause of X-linked mental retardation; patients who have fra X show fra X syndrome. It is, then, important to study the incidence of individuals carrying heritable FS, both fra X and autosomal FS, in Japanese population, but there have, as yet, been few investigations. The present report is a result of preliminary inspection of the prevalence of heritable FS in 150 institutionalized mental retardates (97 males and 53 females). To detect all heritable FS currently known, peripheral blood samples were cultured for 72 hrs under different conditions, namely in medium RPMI 1640 supplemented with 10% fetal bovine serum (FBS), in the same medium but treated with 50μg/ml distA or 7μg/ml BrdU for the last 24hrs, and in medium Ham's F10, which was deprived of folic acid and thymidine, supplemented with 5% FBS. Among 150 mentally retarded patients, we found 8 male cases of fra(X) (q27), one of which had fra(17)(p12) in addition to fra X, 3 cases (one male and two females) of fra(17) (p12), one male case of fra(20) (p11.2) and one female case of fra (8)(q24.1). Twenty-two cases (17 males and 5 females) of Down's syndrome and 3 cases (one male and 2 females) of cat cry syndrome were also found. All patients with FS were karyotypically normal. Fra X syndrome composed about 10% of karyotypically normal mentally retarded males. Incidence of autosomal FS seemed not to be different from that in general population, suggesting that they are not relevant to the mental retardation.

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The clinical importance of the persistent ST-elevation was investigated in patients with electrocardiographic antero-septal myocardial infarction (ASMI). This study was consisted of 37 patients with newly developed transmural ASMI (Age: 56.4±11.2 yrs,; 30 males and 7 females). Patient were divided into 3 groups according to the findings of their electrocardiograms obtained at one month after the onset MI: group A: convex typed ST-elevation above 2.0 mm in two or more than two leads among V_1 to V_4. group B: convex typed ST-elevation above 2.0 mm in one lead among V_1 to V_4, or concave typed ST-elevation above 2.0 mm in two or more than two leads among V_1 to V_4 group C: either convex or concave typed ST-elevation of less than 1.0 mm in four leads (V_1 to V_4). The extent of ST-elevation in each group remained unaltered through six month observation after MI. Two dimensional echocardiographic study, indicated that group A showed a high score of total wall motion index (TWMI), suggesting severe left ventricular dysfunction. No essential improvement was observed in TWMI throughout six months after MI. Two of seven patients (29%) in group A showed multivessel disease in coronary angiogram (CAG). In group B, TWMIs obtained one and three months after MI were essentially the same as those in Group A. However, TWMI in group B tended to improve at six months after MI. Two of eight patients (25%) in group B had multivessel disease. In group C, a score of TWMI was much lower than in Group A and Group B. Moreover, TWMI in group C also tended to improve throughout six months after MI. No patient in group C showed multivessel disease in CAG. Ventricular aneurysm was observed in three cases in Group A. This finding may indicate that ventricular aneurysm would be formed after MI only in a patient with a marked and extensive ST-elevation and that a marked and extensive ST-elevation would not be always indicative of the presence of aneurysm. It can be concluded that the extent of electrocardiographic ST-elevation in precordial leads at one month after MI is useful predictor for evaluating left ventricular function at three and six months after ASMI.

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The mammary glands of pregnant and lactating mice contain lipase (MGL: mammary gland lipase) other than lipoprotein lipase (LPT). MGL could be separated from LPL at a relatively low pH (pH 6.0). While the main lipolytic activity in the extract prepared fromlactating gland was associated with the fractions having a molecular weight of about 200,000, as analyzed by gel nitration, the activity in extract prepared from pregnant gland was observed only in those having molecular weights of 50,000-70,000. The gel filtration profile of the extract of pregnant gland was similar to that of the extract of the lactating gland pre-heated at 50℃ for 10min; the molecular weight of MGL in the lactating gland changed to that of the MGL in pregnant gland. These results show that the molecular weight of MGL increase at or during parturition.

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Uterine sarcoma is relatively lower in incidence, and its prognosis is unfavorable. The clinical course of nine cases of uterine sarcoma, which we have experienced during the last decade, were reviewed and their histologic types were studied. Of these nine cases, five were diagnosed as malignant tumor by patho-histologic examination before the surgical operation. Eight patients are still alive, of. which three are surviving with recurrent or persistent tumors for more than 4 years and 11 months in the longest case. Besides the clinical stage and the selected treatments for the individual cases, the histological type of newgrowth and its differentiation seem playing an important role upon the survival period of patients.

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The respective coefficient of variation in the R-R interval of ECG (CV_<R_R>%) was measured in 34 patients under dialysis due to renal insufficiency, including 24 cases with chronic nephritis and 10 cases with diabetic nephropathy, to study its usefulness as an autonomic function test. As a result, it was found that a reduction of CV_<R_R>% was noted not only in diabetic patients but in patient with nephritic dialysis. The reduction of CV_<R_R>% had a strong correlation with hypotension not caused by fluid removal during dialysis. The relationship between CV_<R_R>% and autonomic symptoms such as orthostatic hypotension, abnormal bowel action, etc., is well known in diabetes. In case of dialysis due to renal insufficiency, some uremic autonomic neuropathies were also observed, which suggests that such vasomotor disturbances could be a cause of such a sudden reduction of blood pressure not derived from fluid removal during dialysis. It can be considered that the measurement of CVR_<R_R>% is useful as an autonomic function test for patients under dialysis, and to call attention to blood pressure control during dialysis as an objective index.

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Although the methods of prenatal diagnosis and detection of carriers in a few genetic diseases have been markedly adovanced, the Mendelian segregation ratio is still useful for the estimation of genetic risk when these methods are not able to be employed. In this report, equations for estimating genetic risk are proposed under the assumption of simple X-linked "dominant" inheritance, taking into account such genetic parameters as, the mutation rate, gene frequency, penetrance and prenatal selection. The influence of these parameters, in paraticular the latter two, on the edtimated genetic risk was examined and the following results were obtained. The influence of penetrance on the genetic risk was very large. Low penetrance increased the genetic risk of new borns in many cases when it was uncertain whether the mother of a new born male and the parents of a new born female were a carrier of deleterious alleles or not. The genetic risk slightly decreased in all cases, when prenatal selection existed.

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Effects of acute and chronic administration of maprotiline (MT) on the firing rate of locus coeruleus (LC) noradrenergic (NA) neurons and hippocampal pyramidal cells were studied in rats using single-unit recording techniques. Acute i.v. administration of MT produced a significant decrease in LC firing rates. 50% inhibition dose (ID50) of MT was 2.24±1.31 (mean±SD) mg/kg. The firing rate of LC NA neuron following chronic MT administration, 20mg/kg/day i.p., 14 days, was not significantly different from that of untreated rats (22.43±9.5 spikes/10sec, 25.2±17.5 spikes/10sec respectively). Acute i.v. administration of clonidine produced a complete suppression of LC discharge in untreated rats, but chronic MT treatment caused a significant decrease in clonidine-induced suppression of LC discharge. The decrease in feedback inhibitory effects actually shown by the recovery of the spontaneous discharge to the baseline level of control rats is probably due to the subsensitivity of somatic α_2 autoreceptor in presynapse. In the hippocampal pyramidal cells, which recieve the inhibitory inputs from the LC NA neurons, chronic MT treatment enhanced the inhibitory effects of both electric stimulation of LC and additional i.v. administration of MT, suggesting the increase in net transmission.

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It is not uncommon to encounter the patients having the retension of ascites, since internal treatment is recently giving way to surgical treatment in unresponding cases. A peritoneocaval shunt pump was implanted in a patient with intractable ascites and effective results were obtained. This will be reported below. A 69-year old female had been diagnosed in 1979 as having cirrhosis of the liver. Recently, the patient demonstrated marked ascitic retention even with administration of diuretica as of furosemide and spironolactone. Since no reaction was seen, the patient was diagnosed as intractable ascites and a peritoneocaval shunt pump was implanted on November 6, 1986. The patient's preoperative body weight was 63kg and the abdominal girth was 113cm. Laboratory data indicated a daily urinary production of about 500ml. Postoperative urinary production gradually increased concomitantly with the increase in ascites infusion and reached 2000 to 3000ml/day after pumping was started. The patient steadily lost body weight and abdominal girth. Urinary production increased almost four times the preoperative amount. The patient was discharged from the hospital 30 days after the implantation. This peritoneocaval shunt pump is a symptomatic measure, however, operations with local anesthesia are possible; risks are low; and it is an effective treatment in which clinical effects can be anticipated. It is firmly believed that the clinical application of this pump will expand greatly.

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