Glomerular basement membranes (GBM) and tubular basement membranes (TBM) were prepared from human kidney and their chemical compositions were studied. Electron microscopic figures showed no contamination of the cellular components or collagen fibers, indicating a high degree of purity of the preparations. Low contents of phospholipid supported this indication. Amino acid compositions of the human GBM and TBM resembled that of the bovine GBM, containing hydroxyproline, hydroxylysine, half-cystine, methionine and a large amount of glycine as the characteristic amino acids. The human GBM and TBM had similar carbohydrate compositions consisting of glucose and galactose, as the major sugars, together with mannose, L-fucose, hexosamine and sialic acid. Glucosylgalactosylhydroxy-lysine and a small amount of galactosylhydroxylysine were detected in alkaline hydrolyzates of both membranes. The human GBM and TBM separated into more than ten subunits having molecular weights ranging from 2.5×104 to more than 2.5×105 on polyacrylamide gel electrophoresis in the presence of sodium laurylsulfate and 2-mercaptoethanol. The electrophoretograms of both membranes resembled that of the bovine GBM. These observations indicate that the human TBM has a similar chemical structure to those of the human GBM and the bovine GBM.
Daily pancreatic flow and daily outputs of bicarbonate and amylase in pure pancreatic juice were observed in 15 postoperative patients who underwent upper abdominal surgery. Exocrine pancreatic secretion under the stimulation by endogenous or exogenous hormones was well correlated with the extent of pancreatic fibrosis estimated by the histometrical treatment. Exocrine pancreatic secretion in Billroth II type of gastrectomy was depressed to 60-70% of the patients' with Billroth I type of gastrectomy. In distal pancreatectomy the depression in the exocrine pancreatic secretion almost corresponded with the resected volume of pancreas. Exocrine pancreatic secretion in pancreatodoudenectomy was highly depressed beyond the expected value from the resected volume and fibrosis of the pancreas. This was interpreted as partly due to the elimination of hormonal mechanism by duodenectomy and partly due to the denervation of the secretory fibers by surgical manipulation.
Responsiveness of urinary cyclic AMP and phosphate to 200 units of parathyroid extract was evaluated in 5 normal subjects, 2 patients with idiopathic hypopara-thyroidism, 4 patients with pseudohypoparathyroidism and 3 patients with primary hyperparathyroidism. Among them, 3 patients with pseudohypopara-thyroidism were examined prior to and during therapy with vitamin D. Two patients with primary hyperparathyroidism were examined before and after removal of adenomas. In control subjects, percent increase in cyclic AMP after parathyroid extract administration was 7265±3312%, and in phosphate 290±72%. It was found that in idiopathic hypoparathyroidism the response of cyclic AMP was in the normal range, though that of phosphate was higher than normal. In pseudohypoparathyroidism, as distinguished from what Drezner et al. called pseudohypoparathyroidism type II, the response of cyclic AMP was uniformly low, while that of phosphate was variable. Similar results were obtained during treatment with vitamin D. In primary hyperparathyroidism, the responses of both cyclic AMP and phosphate were lower than normal. After removal of adenomas, the response of phosphate became normal, but the response of cyclic AMP rose to a subnormal level in one patient, and remained low in the other. For the diagnosis of pseudohypoparathyroidism, the response in cyclic AMP was considered to be a more reliable index than that in phosphate whether the patient was being treated with vitamin D or not.
After analysis of 33 cases of neonatal hepatitis and 90 cases of biliary atresia, a score test from history, physical findings and daily laboratory examinations was studied for the differential diagnosis of these two diseases. The biliary atresia takes plus score, whereas the neonatal hepatitis takes minus score. The score test is of great value for the differential diagnosis between these two diseases.
Gut glucagon-like immunoreactivity (GLI) was extracted from plasma of dogs and was compared for its molecular size and insulin releasing activity with GLI present in the intestine. Plasma was obtained from the portal vein of dogs, of which the pancreas was removed as rapidly as possible during the glucose administration into the intestine. Plasma GLI of intestinal origin was extracted by a modification of Kenny's method. The amount of GLI extractable from plasma in each dog ranged from 4.30 to 25.74 ng. The extract of plasma during glucose absorption was observed to have two peaks on gel filtration, corresponding to Peak I and Peak II of GLI extracted from the gastrointestinal tract. The intrapancreatic infu-sion of the Peak II GLI extractable from plasma promoted remarkable insulin release in dogs, like pancreatic glucagon. In contrast, the Peak I GLI from plasma caused an equivocal rise of insulin in the pancreatic vein. It is concluded from the experiment that gut GLI extracted from plasma shows the same elution pattern on gel filtration and the same insulin releasing activity as GLI extractable from the gut.
To determine the surgical indication of biliary atresia, we analyzed the history, physical findings and laboratory examinations of 90 cases of biliary atresia operated upon at the Second Department of Surgery, Tohoku University Hospital during the past 10 years, from 1963 through 1972 inclusive. A score table from the data of these examinations was made for the determination of surgical indication. According to this score table, all of the patients who showed good excretion of bile took plus score, whereas a half of the patients who showed poor or no excretion of bile took minus score. Although the remaining patients who showed poor excretion of bile took plus score, these cases had some elements for good excretion of bile. From these results, the patients who takes plus score is considered to be a good indication for operation. The score test is of great value for determination of the surgical indication of biliary atresia.
The isolated right atrium of the dog was perfused with arterial blood introduced from a carotid artery of a support dog. The selective injection of dopamine, tyramine and norepinephrine into the cannulated sinus node artery induced doserelatedly positive chronotropic and inotropic effects. However, for an equal increase in sinus rate, dopamine caused less increase in tension development than nor-epinephrine. Tyramine caused least increase in contractility. Effects induced by dopamine were not blocked by treatment with tetrodotoxin which blocked those induced by nicotine. Desmethylimipramine treatment significantly suppressed dopamine-induced effects and completely blocked tyramine-induced ones but rather enhanced norepinephrine-induced ones. Alprenolol inhibited effects of dopamine, tyramine and norepinephrine. From these results, it is concluded that positive chronotropic and inotropic effects of dopamine are partly due to tyramine-like effect which causes the release of norepinephrine from sympathetic storage sites.
The quantity and composition of acid glycosaminoglycans (mucopolysaccharides) were compared between a fibrotic lung and normal lungs. The acid glycosaminoglycans were isolated by proteolysis, fractionation with ethanol and precipitation with cetylpyridinium chloride, and were identified by chromatography, electrophoresis and incubation with mucopoly-saccharide-lyases. Evidence was obtained for the presence of hyaluronic acid, chondroitin sulfate A(C), dermatan sulfate and heparan sulfate. Quantitation of individual glycosaminoglycans by using specific mucopolysaccharide-lyases revealed that the quantity of dermatan sulfate in the fibrotic lung exceeded that in the normal lungs.
A study of 68 patients subjected to re-surgery for residual or recurrent gallstones provided the following results: Among the 68 patients, the stones were recurrent in only 4, residual in 38, and uncertain but mostly suggesting residual in the other 26 cases. In many of the residual stone cases, the previous operations were cholecystectomy alone, retrospectively suggesting insufficient search for residual stones and other abnormalities in the biliary tract during the operations. Of the 4 recurrent stone cases, 3 of them showed bile duct stricture, papillary stenosis and idiopathic choledochus dilatation, respectively, while the remaining one, though free of any sign of bile stasis, had a gallstone formed around a silk-thread core. The indications for additional sphincteroplasty and biliodigestive anastomosis in re-operations were strictly consistent with those in the first operations. Seven operative fatal cases (10%) were mostly those of long persistent gallstones with serious hepatic failure. The follow-up studies in 53 patients showed as many as 51 cases returning to the preoperative occupation without any significant complaints. These results emphatically suggest that retained gallstone cases should be referred to surgical treatment as early as possible.
The sensitivity of the eccrine sweat glands to adrenaline and noradrenaline was examined in 9 patients with pheochromocytoma and 12 patients with primary aldosteronism by Wada's method for determining threshold concentrations of local sweat response to intradermal injection. In pheochromocytoma most of the patients characteristically showed considerably reduced sensitivity to catecholamines in the sweat glands. Sensitivity was rapidly restored after the extirpation of the tumor in all cases. In primary aldosteronism the sweat gland sensitivity varied over a very wide range from subnormal to supernormal levels. These were restored to normal range after extirpation of the adrenocortical adenoma. In both diseases it was found that the sensitivity of the sweat glands to catecholamines and the vascular system to noradrenaline altered almost in parallel.
Digital plethysmographic responses to auditory stimuli in 15 healthy men and 82 patients with vibration disease were analyzed in order to clarify the functional conditions of autonomic nervous system in this disease. The auditory stimuli given to healthy men caused a rapid decrease in the amplitude of the plethysmograms. After cessation of the auditory stimuli the decreased amplitude recovered to the control value within 30 sec. In the patients with vibration disease, however, the recovery of the decreased amplitude was delayed. The plethysmographic changes in the patients with vibration disease were divided into 4 types: normal (N), intermediate (I), delayed (D) and poor response (P) types. Each type of I, D and P was altered to type N by treatments consisting of therapeutic exercises, hot spring cures and so on. All healthy men showed type N. There were no significant differences between the time courses of the recovery of the plethysmographic changes and the amplitudes of the plethysmograms before the auditory stimuli. The results obtained seem to indicate that the autonomic nervous system in the patient with vibration disease is in disorder, and that the digital plethysmography with auditory stimuli is instrumental to detect the functional changes in the autonomic nervous system.
Hypertension resulting from chronic pyelonephritis has been shown in clinical as well as experimental cases, although some authors deny that there is a pathogenic relationship between the two. To throw light on this problem the present authors conducted a series of experiments with mongrel dogs, in which chronic pyelonephritis was induced and postoperative changes in blood pressure and plasma renin activity were observed over a period of 3 months. The pyelonephritis infection was brought about by a method involving vesicoureteral reflux and ureteral dysfunction, as described in a previous paper. Preoperative and postoperative levels of systolic pressure were compared, but no definite trends were found for the first 3 weeks after operation. At 30, 60 and 90 days the pressures were found to have risen by 21.2±11.2 mmHg, 21.7±14.6 mmHg and 17.1±16.7 mmHg, respectively. Thus there was a significant elevation (p<0.01). No appreciable change in the plasma renin activity was found, however, at any stage. From these results it was concluded that experimentally induced chronic pyelonephritis in dogs caused a rise in blood pressure. No connection between the pyelonephritis and the renin angiotensin system was found.
In monkeys with beta-adrenergic blockade caused by administration of propranolol, we found that the conductance of the total respiratory system markedly decreased following in-travenous administration of methacholine. The presence of beta-adrenergic blockade was judged from inotropic effect on the heart, levels of blood glucose and lactic acid, and the reaction of eosinophils after adrenalin injection.