Despite the recent progress in the biochemical knowledge on porphyrin metabolism, quantitative determination of porphyrin concentration in the urine and blood had not been generally practised in a clinical medicine. However, it is of much scientific interest and of high clinical value to investigate on iron-and porphyrin metabolism in various kinds of blood disorders. In this report, data on serum iron level, unsaturated serum iron binding capacity and free red blood cell protoporphyrin level in various kinds of anemia are presented and the clinical meaning of the increased free red blood cell protoporphyrin concentration in iron deficiency anemia is discussed. The results obtained in this study are summarized as follows. 1) Depletion in serum iron level and elevation in unsaturated iron binding capacity were characterstic pattern of iron deficiency anemia. On the contrary, an unsaturated serum iron binding capacity in a case with hemochromatosis was evidently decreased. 2) An elevated free red blood cell protoporphyrin level was observed charactristically in iron deficiency anemia, and also in cases with lead poisoning. In a case with pernicious anemia, a free red blood cell protoporphyrin level was definitely decreased. 3) From the results of our experiments, it is strongly suggested that the free protoporphyrin in erythrocytes markedly increased in iron deficiency anemia might be utilized for heme synthesis, provided a suitable condition could be prepared for. 4) In cases of iron deficiency anemia, it was observed that an unsaturated serum iron binding capacity seemed to vary in good proportion to a free red blood cell protoporphyrin concentration, while a hemoglobin concentration, red blood cell count and serum iron level seemed to be variable independently to some extent. 5) Several cases were observed who still showed a high free red blood cell concentration or a high unsaturated iron binding capacity, even after a red blood cell count, hemoglobin concentration and serum iron level returned to normal as a result of iron therapy. Such cases were likely to have episodes of repeated relapses. Two such cases were illustrated. 6) A comparison of the hematological data in twelve cases of pretreated idiopathic hypochromic anemia with that in the same numbers of anemia due to blood loss revealed that the free red blood cell protoporphyrin concentration was definitely higher in the former than in the latter, while the other data not significantly differed each other.
In an attempt to clarify the allergic mechanism for the pathogenesis of focal infection, immunological tests were performed on rabbits with extracts obtained from their foci used as antigen, following the animals were injected with streptococcus into the abscess which had been produced by Alloilonat administered. From the results of Schultz-Dale's test, skin test, precipitation test and Prausnitz-Küstner's tests, it was found that an antibody against products of inflammatory focus was present in sera and tissues of rabbits with focal infection. This antibody was different from any antibody against culture filtrates of streptococcus. The development of this focal antibody was the highest 4 or 5 weeks after the beginning of experimentation. It was revealed that an antigenic factor in extracts of foci consisted in their protein fractions especially in euglobulin fraction. Clinically it was also demonstrated that the focal antibody was present in sera of patients with chronic tonsillitis, acute rheumatic fever and erythematodes. Furthermore, a new antigenic factor different from a focal or bacterial antigen, was found in sera of patients with acute rheumatic fever. This factor disappeared after the treatment with prednisolone. It was not present in sera of patients with tonsillitis. A similar antigenic factor was also demonstrated in sera of rabbits with focal infection 4 or 5 weeks after the beginning of experimentation. It is concluded that the allergic mechanism related with focal antigen should be taken into consideration when the pathogenesis of focal infection is discussed.
As an antidote for alkylphosphate poisoning, oximes have been proved to be the most effective drug available at present. The method of the clinical application of PAM (pyridine-2-aldoxime methiodide), one of oximes, against parathion poisoning was already established by the authors. The remaining problem of PAM was the way how to apply it to an extremely severe case of parathion poisoning, for example to an attempted suicide case. With the purpose to solve this problem, the authors conducted animal experiments and same clinical studies; and obtained the following results: 1) one or two grams of PAM in the form of aqueous; solution is at first to be injected intravenously, followed by intravenous irrigation; 2) for the i. v. irrigation, the use of 2.5% PAM solution, readily available on the market, given at the rate of 0.5g PAM an hour is most effective, producing no side-effect; 3) the disappearance of muscular fasciculation is the most helpful sign to decide the amount of the irrigation; 4) in the early stage, the inhibited blood cholinesterase recovers very soon, but. later the rate of recovery becomes slow. Therefore, quite a sufficient amount of PAM may be recommended at the beginning of the treatment; 5) within the limit of our experiences, the concomitant administration of atropine and PAM is in any way not superior to the sole PAM injection and 6) gastric lavage, artificial respiration, oxygne inhalation, and other procedures are to be resorted to in the course of the PAM therapy. The efficacy of PAM against alkylphosphates, the drugs now obtainable besides ethyland methylparathion, has been examined from the standpoints of both the effects of PAM on the mortality of mice by alkylphosphates and the rate of reactivation of the rabbit. blood cholinesterase inhibited by alkylphosphosphates. PAM is effective on poisonings by EPN, TEPP, pestox-3, malathon, diazinon, and dipterex. The effect of PAM against EPN poisoning has also been ascertained in human cases. DAM (diacetylmonoxime) and MINA (monoisonitrosoacetone), reportedly to be the most effective oximes, are in fact less effective against the alkylphosphate poisonings such as mentioned above when compared with PAM.
Untill now there has been no thorough electromyographical study of asthma attacks. However the author has worked on this subject using a co-axial needle electrode. I registered discharges of M. intercostalis externus and the intercartilagineous part of M. intercostalis internus, as principal inspiratory muscles, and M. scalenus anterior and M. sternocleidomastoideus as accessory inspiratory muscles, the interossial part of M. intercostalis internus as a principal expiratory muscle, and M. obliquus abdominis and M. rectus abdominis as accessory exspiratory muscles. I observed the changes in discharges of the above muscles during deep respirations at the time of no attack, dyspnea, attacks provoked by acetylcholine inhalation, and after the administration of Adrenaline by inhalation in the course of an attack. I made these findings: 1) During an attack all inspiratory muscles, both principal and accessory, showed a rapidly augmenting pattern, and all exspiratory muscles a slowly augmenting pattern. 2) Attacks could be divided from the electromyographical point of view as slight, light, moderate and strong attacks. a) A slight attack shows an increase of activity in the case of M. scalenus anterior only of the inspiratory muscles, and no increase of activity among the exspiratory muscles. b) A light attack shows a strong discharge in the cases of M. intercostalis externus, the intercartilagineous part of M. intercostalis internus., M. sternocleidomastoideus and M. scalenus ant. but no discharge in the case of abdominal muscles. c) A moderate attack shows an increases of activity in the case of all respiratory muscles and M. obliquus abdominis but not of M. rectus abdominis. d) A strong attack shows strong activity in the case of all inspiratory and expiratory muscles including M. rectus adbominis. 3) I could classify A. B. C. D. E. and F. types according to the form of discharge and show which muscle adopted which type of discharge form in slight, light, moderate and strong attacks. 4) Attacks provoked by acetylcholine showed the same tendency in discharge as natural attacks. 5) When attacks are alleviated the inspiratory muscles adopt a slowly augmenting pattern and the expiratory muscles a rapidly augmenting pattern or a steady state pattern. 6) The author dwelt on the intensive discharges which continued into and sometimes through the expiratory phase in the case of the inspiratory muscles during an attack. 7) The author deliberated on the discharges characteristic to asthma attacks and concluded that the determining factor is the bronchial irritation in the upper part.
Investigations have been made on the influences of diet factors on the recovering speed of liver insufficiency. Rabbits with experimental liver insufficiency are used in this study. Non-protein nitrogen, etc. (non-protein nitrogen, urinary nitrogen, amino-nitrogen, residualnitrogen, polypeptids, etc.) in various organs recover to the normal values within four to five weeks when the animals are fed with ordinary diet. It takes six to seven weeks, however, if the animals are given high fat diet, and some do not recover even after seven or eight weeks when fed with high carbohydrate diet. On the other hand, many will recover in three to four weeks when fed with high protein diet. It takes two, or three weeks more for protein in organs to recover to the normal. Analysis of free amino-acid in various organs has been done by means of paperchromatography. When the quantity of free amino-acid increases remarkably in two to three days right after the insufficiency, the kinds of amino-acid which appear in liver, kidney and muscle become also remarkably many. The increased amino-acids decrease after one or two weeks, and the kinds of amino-acid lessen to the normal as the total quantity of amino nitrogen decreases to the normal. These findings are marked in rabbits fed with high fat diet and equivocal in those fed with high protein diet. Therefore, we can say that the change of protein and its decomposed products is least and recovers most rapidly when high protein diet is given.