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Article type: Cover
1988 Volume 19 Issue 4 Pages
Cover13-
Published: December 30, 1988
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Article type: Cover
1988 Volume 19 Issue 4 Pages
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Published: December 30, 1988
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Yoshikazu YOSHINO, Hiroshi IRIE, Kenzo GOTO, Keiichiro AKAI
Article type: Article
1988 Volume 19 Issue 4 Pages
407-411
Published: December 30, 1988
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Abnormality in the receptor of the cell might have some bearing on the selective cellular damage in systemic degenerative diseases. In relation to deranged metabolic turnover of the folate cycle in amyotrophic lateral sclerosis (ALS), we have been interested in nuclear triiodothyronine receptors (NTa-R) of the brain. Values of NT_3R have so far been known in the fresh brain of experimental animals. We now report that the assay of NT_3R can be made in autopsied human brain. About lg of grey matter was cut out from the postcentral gyrus of the cerebrum, stored at -80℃, of 8 patients who died of non-neurological diseases. The postmortem interval of storing cerebral hemispheres into the freezer was 3 to 10, average 7 hours. Cell nuclei were separated in bulk by the method of Lφvtrup-Rein & McEwen, and T_3-binding assay was carried out by the method of Silva et al. DNA was measured by the method of Giles & Myers which is based on Burton's method. Specific bindings comprised more than 92% of total bindings. Scatchard analysis showed that B_<max> (mean±sd) of NT_3R was (253±33)×10^<-17>mol/μg DNA(n=8), and Kd was (7.5±0.8)×10^<-10>mol/l(n=8). These values were similar to those reported in fresh rat brain. Measurements of NT_3R in degenerative diseases including ALS will be the subject of our next study.
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Haruhisa YOKOYAMA, Yasuhiko TOMITA, Motohide OGASHIWA
Article type: Article
1988 Volume 19 Issue 4 Pages
413-418
Published: December 30, 1988
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Thirty-nine elderly patients (over 75 years of age) underwent surgery for chronic subdural hematoma and were studied in terms of clinical symptoms, computed tomographic (CT) findings, and postoperative outcome. The chief presenting symptoms were disturbance of consciousness in 27 cases and motor weakness in nine. Only three patients complained of symptoms of increased intracranial pressure (ICP). Eight of the ten patients who had signs of elevated ICP prior to admission recovered well, according to the Glasgow Outcome Scale. The level of consciousness on admisssion was strongly correlated with outcome. The mean Glasgow Coma Scale Scores were 14.0 in the 18 patients who showed good recovery; 12.4 in the 13 with moderate disability; 11.3 in the three with severe disability; 6.0 in the three who were vegetative; and 8.0 in the two patients who died. The site and size of the hematoma and the position of midline structures were studied on CT scans. Neither the site nor the size appeared to influence recovery. Patients with bilateral hematomas had better recovery (good in nine; poor in one) than those with unilateral hematomas (good in 22; poor in seven). Shifting of midline structures, especially the midbrain, had a significant, adverse effect on the outcome. Of the 12 patients whose CT scans showed a midbrain shift, one was severely disabled, three were persistently vegetative, and one died. Most of the 24 patients without a midbrain shift did well postoperatively; only two were severely disabled. In the elderly, the cerebrospinal fluid cavities are large. Therefore, in the early stage, the hematoma does not affect the adjacent cortex. In cases of unilateral chronic subdural hematoma, there is sometimes no neurological deficit even though CT scans show a shift of midline structures. However, when neurological deficit is observed, there is almost always a severe midline shift. In younger brains, impairment of consciousness is usually caused by increased ICP and preceded by other increased ICP signs and symptoms. In geriatric cases, disturbance of consciousness suggests direct affection to the midbrain by the hematoma. Because the aged brain has lost elasticity, the midbrain shift often dose not recover, so that disturbance of consciousness carries a poor prognosis even though the hematoma has been evacuated. For this reason, surgery should be performed as soon as possible, not only in elderly patients with disturbed consciousness but also in those whose CT scans show a midbrain shift, regardless of neurological status.
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Chihoko MAEMURA
Article type: Article
1988 Volume 19 Issue 4 Pages
419-432
Published: December 30, 1988
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Alterations of the glomerular basement membrane and localization of immune deposits along the peripheral capillary wall were examined by transmission electron microscopy in renal tissues taken by biopsy from 60 patients with IgA nephropathy in which diagnosis was confirmed by the conventional and immunofluorescent light microscopic examinations. Based on these observations, the pathogenesis of hematuria and proteinuria in IgA nephropathy was discussed. Among changes in the basement membrane structure, the followings were predominant 1) attenuation found in 16 cases-diffuse type in 8 cases and segmental type in 8 cases, respectively, 2) thickening found in 27 cases-spike formation in 14 cases, subepithelial doubling in 13 cases, and cyst formation in 2 cases, respectively, and 3) gaps found in 6 cases. Patients with lesions of the basement membrane as above described revealed a marked hematuria (more than 50 red blood cells per high power fields), which was significantly severer than that found in patients without the basement membrane change. Immune deposits along the peripheral capillary wall were observed subendothelially in 26 cases (43 %), subepithelially in 14 cases (23%), and intramembranously in 35 cases (58%), respectively. Mesangial interposition was found in 15 cases (25%) in which subendothelial deposits were observed in all cases. No correlation was detected between immune deposits and hematuria, while proteinuria (over than 1g per day) was detected in close association with immune deposits localized subendo- or subepithelially. These electron microscopic observations indicate that a considerable number of patients with IgA nephropathy have not only mesangial lesions but also basement membrane lesions and/or immune deposits along the capillary wall, and the latter lesions have close correlation to the occurence of hematuria and/or proteinuria.
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Kimio ONOZAWA, Kin-ichi NABEYA, Choo KAKU, Osamu KIMURA, Toshiki KAWAG ...
Article type: Article
1988 Volume 19 Issue 4 Pages
433-437
Published: December 30, 1988
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Investigations were made on recurrent mortality cases of superficial cancer of the esophagus. Of 21 cases of superficial esophageal cancer, 4 cases died of recurrence. The recurrent mortality rate was 11.8% for 2 years, and 27.4% for 5 years. The depth of cancer invasion was divided into ep, mm and sm, and then, the recurrent mortality cases were all in cases of sm: recurrent mortality rate in ep, 0%; in mm, 0%; and in sm, 22.2% for 2 years and 46.7% for 5 years. It was assumed that the main factors responsible for unsatisfactory prognosis in sm cancer of the esophagus were anatomically due to abundance of blood vessels and lymphatic vessels in the esophageal mucous membrane layer and surgically due to the difficulty in the systematic lymph node dissection of the esophagus. When the prognosis was evaluated by endoscopic types, the prognosis was satisfactory in superficial flat types and superficial erosive types, and unsatisfactory in superficial elevated, superficial ulcerative and superficial combined types.
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Chouo KAKU, Kimio ONOZAWA, Toshiki KAWAGUCHI, Hikaru NAKAGAWARA, Toshi ...
Article type: Article
1988 Volume 19 Issue 4 Pages
439-446
Published: December 30, 1988
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In eastern European countries, volvulus of the sigmoid colon is a relatively common disease, but the incidence of this disease in Japan is not so frequent. In Europe and America, nonoperative reduction of this disease has often been performed. On the other hand, urgent operative reduction has been common in Japan. However, nonoperative reduction by use of colonofiberscope has been recently increasing in Japan and the rate of success of this treatment is very high. Since diagnosis of volvulus of the sigmoid colon is comparatively easy, when there is no evidence of intestinal necrosis or peritoneal irritation, we should actively attempt nonoperative reduction for this disease. We had 7 cases of volvulus of the sigmoid colon and a case of volvulus of the cecum. We attempted the nonoperative reduction by colonofiberscope in 3 cases and succeeded in all cases. Therefore, nonoperative reduction, especially by colonofiberscope, is considered to be useful in the treatment of volvulus of the sigmoid colon.
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Kunihiko ANDOH
Article type: Article
1988 Volume 19 Issue 4 Pages
447-454
Published: December 30, 1988
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Alkaline phosphatase (ALPase) activity was examined and compared by light and transmission electron microscopy in the rabbit lamellar bone in association with experimentally induced osteomyelitis. Staphylococcus aureus was injected into the proximal tibia of the young rabbit (Dekel and Francis, 1981). Its metaphysis portion was taken out 0, 2, 4, 6, and 10 weeks after injection. Specimens were prefixed, demineralized with EGTA, sectioned, then incubated for the demonstration of ALPase activity employing the lead citrate method (Mayahara et al. 1967). Osteomyelitis developed already 2 weeks after Staphylococcus injection. ALPase activity was observed manifestly in osteoblasts, and diffusely in the interce1lar matrix of the normal control. By electron microscopy, activity was localized primarily in the plasma membrane of the osteoblasts and the matrical collagen fibers. In osteoblasts taken out 2 weeks after the injection, intensely positive activity tended to be restricted to the plasma membrane facing the bone marrow. In osteomyelitic bony tissue, osteoblasts locating at the border between the bone lamella and the bone marrow often revealed a polarity in terms of the distribution pattern of ALPase activity.
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Junichi FUKUSHIMA, Kin-ichi NABEYA, Tateo HANAOKA, Kimio ONOZAWA, Yosh ...
Article type: Article
1988 Volume 19 Issue 4 Pages
455-460
Published: December 30, 1988
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This is a case report of 69 year-old male, who had been suffering from sudden onset of severe pain extending from anterior chest to back upon drinking water, a day prior to admission. Following day, his pain decreasing in severity, however, esophagography demonstrated leakage of mid portion. The diagnosis of the spontaneous rupture of the esophagus was made. The intrapleural drainage and lavage were then carried out. Consequently, the closure of the rupture was confirmed esophaographically on 32 days after the onset of symptom. As a general rule, spontaneous rupture of the esophagus is usually required early diagnosis and surgical procedure in emergency. In recent, conservative management of the spontaneous rupture is known to be effective and increases reports in literatures. It is true that conservative therapy of the spontaneous rupture of the esophagus is not a wrong procedure, if it is indicated. We report a case of successful treatment of the spontaneous rupture of the esophagus conservatively.
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[in Japanese]
Article type: Article
1988 Volume 19 Issue 4 Pages
461-462
Published: December 30, 1988
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[in Japanese]
Article type: Article
1988 Volume 19 Issue 4 Pages
462-463
Published: December 30, 1988
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[in Japanese]
Article type: Article
1988 Volume 19 Issue 4 Pages
464-465
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[in Japanese]
Article type: Article
1988 Volume 19 Issue 4 Pages
465-466
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[in Japanese]
Article type: Article
1988 Volume 19 Issue 4 Pages
466-467
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Article type: Article
1988 Volume 19 Issue 4 Pages
468-469
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Article type: Article
1988 Volume 19 Issue 4 Pages
469-470
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Article type: Article
1988 Volume 19 Issue 4 Pages
470-471
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Article type: Article
1988 Volume 19 Issue 4 Pages
472-473
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Article type: Article
1988 Volume 19 Issue 4 Pages
473-474
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Article type: Article
1988 Volume 19 Issue 4 Pages
474-475
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Article type: Article
1988 Volume 19 Issue 4 Pages
476-477
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Article type: Article
1988 Volume 19 Issue 4 Pages
477-478
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Article type: Article
1988 Volume 19 Issue 4 Pages
478-479
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Article type: Article
1988 Volume 19 Issue 4 Pages
480-481
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Article type: Article
1988 Volume 19 Issue 4 Pages
481-482
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Article type: Article
1988 Volume 19 Issue 4 Pages
482-483
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Article type: Article
1988 Volume 19 Issue 4 Pages
484-485
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Article type: Article
1988 Volume 19 Issue 4 Pages
486-487
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Article type: Article
1988 Volume 19 Issue 4 Pages
487-488
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Article type: Article
1988 Volume 19 Issue 4 Pages
488-489
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Article type: Article
1988 Volume 19 Issue 4 Pages
490-491
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Article type: Article
1988 Volume 19 Issue 4 Pages
491-492
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Article type: Article
1988 Volume 19 Issue 4 Pages
492-493
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Article type: Article
1988 Volume 19 Issue 4 Pages
493-494
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Article type: Article
1988 Volume 19 Issue 4 Pages
495-496
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Article type: Article
1988 Volume 19 Issue 4 Pages
496-497
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Article type: Article
1988 Volume 19 Issue 4 Pages
497-498
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Article type: Article
1988 Volume 19 Issue 4 Pages
498-500
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1988 Volume 19 Issue 4 Pages
500-501
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Article type: Article
1988 Volume 19 Issue 4 Pages
502-503
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Article type: Article
1988 Volume 19 Issue 4 Pages
503-504
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1988 Volume 19 Issue 4 Pages
505-506
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Article type: Appendix
1988 Volume 19 Issue 4 Pages
507-508
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Article type: Appendix
1988 Volume 19 Issue 4 Pages
509-
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Article type: Appendix
1988 Volume 19 Issue 4 Pages
509-
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Article type: Appendix
1988 Volume 19 Issue 4 Pages
509-
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Article type: Appendix
1988 Volume 19 Issue 4 Pages
App12-
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Article type: Index
1988 Volume 19 Issue 4 Pages
i-iii
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Article type: Appendix
1988 Volume 19 Issue 4 Pages
App13-
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Article type: Appendix
1988 Volume 19 Issue 4 Pages
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