Of 274 operated cases of cerebral aneurysm, temporary occlusion of the cerebral arteries was used in 215 cases (79%). Of the 215 cases, 177 (82%) showed no sequelae. The maximum safe time limit for temporary occlusion at the bilateral A1 portion of the anterior cerebral arteries was 48.5 min at 26°C, 47 min at 27°C, and 42 min at 28°C; at the M1 porition of the middle cerebral arteries, it was 30 min at 26°C, 35 min at 27°C, 36 min at 27.5°C, 40 min at 30°C and 19 min at normothermia; and at the dominant A1 portion in cases of hypoplasia at the contralateral Ai portion, it was 82 min at 26°C, 86 min at 27.5°C, and 63 min at 28°C. Consequently, when performing direct surgery on aneurysms of the anterior communicating artery, unilateral clamping of the A1 portion prevents rupture during surgery and has the advantage of prolonging the occlusion time. Neurological sequelae may have been caused by the temporary occlusion of the cerebral artery in one case, and by the temporary occlusion or the surgical operation in six cases. Of the 22 fatal cases, only one was thought to be due to the temporary occlusion of the cerebral artery. Intermittent release of the clamping for 5 to 10 min is considered to be effective in prolonging the safe time limit of temporary clamping of the cerebral arteries in surgery of cerebral aneurysm under moderate hypothermia.
The transport efficiency of the dog's pelviureteral system was examined during pacemaker blockade induced by pentobarbital. For an analog representation of transport efficiency, changes in balance level between the input and the output were registered and recorded on a polygraph together with perfusion rate, renal pelvic pressure, ureteral electromyogram and bolus volume. Pentobarbital dramatically blocked the pacemaker activity of the renal pelvis, and the ureter simultaneously became aperistaltic. During the period of pacemaker rest, the balance level was maintained at a high level in all dogs studied, indicating that a part of the perfusion fluid was accumulated in the pelviureteral system. Furthermore, the accumulated fluid overflowed through the aperistaltic ureter as a free flow. These results are discussed in relation to the transport efficiency of normal peristaltic transport.
Normal human urine was treated with cetylpyridinium chloride (CPC), and the CPC-supernatant was passed through columns of Dowex 50×2 (H+ form) and Dowex 1×2 (Cl- form) in succession. The concentrated effluent containing neutral saccharides was then gel-filtered through a column of Sephadex G-10. The resulting effluent was divided into 5 subfractions (SFs. 1-5). Comparison of hexose contents of the subfractions indicated that healthy individuals regularly excreted neutral oligosaccharides in urine with a similar pattern regardless of age or sex. Component A isolated from SF2 was characterized as glucosylgalactose by paper chromatography before and after acid hydrolysis of the intact one and its reduction product.
Plasma renin activity (PRA) was studied in 61 patients under long-term dialysis treatment. They were divided into three groups, low (0.1-5.0 ng/ml), normal (5.1-30.0 ng/ml), and high renin groups (more than 30.1 ng/ml) according to the levels of PRA. The difference in clinical features in the three groups and the factors influencing the secretion of renin were investigated. 1) With regard to the pre-dialysis PRA (resting PRA), low renin levels were found in 13.1 per cent of patients, normal in 65.5 per cent, and high in 21.4 per cent. 2) The pre-dialysis PRA (resting PRA) was significantly correlated with the ΔPRA/removed-sodium, but not with the removed sodium or removed water by the preceding dialysis. 3) Severe retinal changes were observed in patients with high resting PRA values. In contrast, fundoscopic findings were mild in patients with low resting PRA values. 4) Eleveted resting PRA values were obtained in younger subjects under 29 years of age, while the PEA levels were very low in patients of advanced ages (over 60 years). The latter showed low levels of ΔPRA/removed-sodium. 5) Though the ratios of ΔPRA/removed-sodium were very low in patients under hemodialysis for over 3 years, the resting PRA levels did not decrease with the duration of dialysis treatment, because renin secretion was stimulated strongly by the excessive removal of sodium and water in these later periods of hemodialysis. 6) With regard to the post-dialysis PRA, low renin levels were found in 6.8 per cent of patients, normal in 55.9 per cent, and high in 37.3 per cent. Post-dialysis PEAS were significantly correlated with the pre-dialysis PRAs and the ΔPRA/removed-sodium. From these results, it may be concluded that high PRA is a risk factor producing the hypertensive complications and ΔPRA/removed-sodium is a most important factor controlling the levels of PRAs (pre-dialysis PRA and post-dialysis PRA). Furthermore, age, removed sodium, removed water and the duration of dialysis also might be concerned with the secretion of renin.
The peripheral nerves of alloxan and streptozotocin diabetes rats six months after the induciton of diabetes were morphologically investigated. The effect of insulin treatment was also examined. Prominent segmental demyelination and remyelination were observed in both alloxan and streptozotocin diabetes rats by isolated nerve fiber studies. Axonal degeneration and globular swelling were also recognized in some nerve fibers. Transmission electron microscopic findings were characterized by the figures of destructed myelin sheaths and axons. Reduplication and thickening of basal lamina of vasa nervorum were noted in the diabetes rats. Scanning electron microscopy revealed three dimensional architectures of degenerated nerve fibers and rough surface of Schwann cells in the diabetes rats. Insulin treated diabetes rats showed less structural changes of nerve fibers. It was indicated that the peripheral nerve lesions of experimental diabetes rats were caused by metabolic impairment of both axons and Schwann cells. Insulin treatment seemed to be effective on the experimental diabetic neuropathy.
The photic drivings (PDs) in response to the following visual stimuli were studied in 108 cases, of which 84 (78%) were epileptics; ages ranged from 5 to 57 years old. An intermittent photic stimulation (IPS) of 5 cycles/sec by a stroboscopic light was given to the subjects with eyes closed and open. Following these stimuli, red-flicker and flickering-pattern of 5 cycles/sec and 20 cd/m2 were given successively to the subjects with eyes open using a “visual stimulator”. The PDs evoked by IPS to the eyes closed and those by red-flicker were similar in the wave form and amplitude. In most of the cases, however, both stimuli failed to evoke apparent PDs (over 25 μV in amplitude), i.e., in 81% and 72%, respectively. IPS to the eyes open and flickering-pattern showed comparable effects in evoking PDs; they evoked high amplitude PDs (over 50 μV in amplitude) with a frequency of 19% by the former and 28% by the latter. In 95 out of 108 cases, both IPS to the eyes closed and red-flicker failed to evoke apparent PDs. In rare cases, IPS to eyes closed evoked high amplitude PDs; in 7 out of these 8 cases, red-flicker also evoked high amplitude PDs. In 18 out of 20 cases in which high amplitude PDs were evoked by IPS to the eyes open, flickering-pattern was also effective in evoking high amplitude PDs. Based on these findings, similarities between IPS to the eyes closed and red-flicker, and similarities between IPS to the eyes open and flickering-pattern in evoking PDs are discussed. It is concluded that flickering-pattern and red-flicker are superior to IPS to the eyes open and closed, respectively, for examining the low frequency PDs.
CB-154 (2-Br-α-ergocriptine) stimulates growth hormone (GH) release in normal subjects. In acromegaly, however, this agent often decreases plasma GH level paradoxically. In order to examine the mechanism of the so-called “paradoxical decrease” in plasma GH with CB-154, GH responses to CB-154 were compared with GH responses to thyrotropin-releasing hormone (TRH), arginine, and luteinizing hormone-releasing hormone (LH-RH) in 20 cases of acromegaly. CB-154, as well as L-dopa, elicited decrease in GH in those patients whose GH secretion was more responsive to TRH and less responsive to arginine. These results suggest that, like L-dopa, CB-154 has similar dual actions of TRH antagonistic GH decrease and GH-RF (GH-releasing factor) facilitative GH increase. Moreover, it was speculated from this study that CB-154 has no significant effect on LH-RH release. The value of (increase ratio of GH on TRH)/(increase ratio of GH on arginine) can be used as an index for the indication of chronic CB-154 therapy in patients with acromegaly.
A preoperative patient with pheochromocytoma was satisfactorily treated with oral labetalol, while a conspicuous increase in urinary output of catecholamines (CA) and of vanillylmandelic acid (VMA) was observed after labetalol therapy. Exaggerated increases in urinary CA and in VMA were also confirmed in normal volunteers immediately after oral labetalol. These effects of labetalol on urinary CA and VMA, however, were proved to be largely due to the interference with the usual photometries rather than due to its stimulation of CA release. Therefore, it should be emphasized that clinical evaluations of CA and its metabolites must be performed before labetalol therapy to avoid an erroneous diagnosis of pheochromocytoma.
As a means to approach the question regarding the exact effect of lung denervation, hemodynamic studies were carried out in 49 dogs which had undergone either unilateral or bilateral lung autotransplantation. In 14 chronically survived animals of 20 with unilateral lung reimplant, unilateral pulmonary artery occlusion test was carried out. In the 29 with either one-stage or two-stage bilateral lung reimplants, serial hemodynamic studies were performed along with histologic examinations of the transplanted lung at autopsy. In the chronic survivors with the bilateral transplants, rapid and continuing infusion of 3, 000 ml of plasma expander was performed within 10 min through intraatrial catheter and various hemodynamic values were measured simultaneously. The animals with one-stage bilateral lung reimplants showed a varying degree of pulmonary edema in both lungs in the early postoperative period, and some of them succumbed to respiratory failure with a gradual decease in PaO2 but the other animals recovered from these pathologic states within 10 postoperative days and survived chronically. Hemodynamics of those longterm survivors showed high pulmonary vascular resistance early after surgery but this value returned nearly to the preoperative level in a distant postoperative period. On occlusion of contralateral pulmonary artery in unilateral lung replantation an increase in pulmonary arterial pressure was invariably observed. Their relationship was steep and almost linear against a given increment of cardiac output when cardiac output vs. pulmonary arterial pressure was plotted in each animal. These facts suggest that transplant differs from the normal lung in tolerance of the vasculature in an event of an increase in pulmonary blood flow. In the plasma expander infusion test, the dog with bilateral lung autotransplants demonstrated that pulmonary arterial pressure showed a parallel and linear increase with an increase in cardiac output until lung transplant became edematous, while in the control animal total pulmonary vascular resistance decreased with an increment in pulmonary arterial pressure during the course of increasing cardiac output. It can be interpreted from these results that changes have occurred in mechanism of pulmonary circulation of the transplant; the transplanted lungs cannot vasodilate totally with an increase in blood flow.
Thalamic pulvinotomy has been performed on 32 patients in severe chronic pain and a follow-up study was made. Among 10 patients with whom unilateral invasion was made, 4 were “excellent” in relieving pain, 2 “good”, 2 “fair” and 2 “poor”. Among 22 cases of bilateral invasion 17 were “excellent”, 2 were “good”, and 3 were “poor”. Thus, in the cases of bilateral invasion effects of the operation were more prominent than in the cases of unilateral invasion. Further, transient psychic symptoms following the operation has been analysed in relation to position of pulvinar destruction and to underlying diseases.
Thyroid functions were studied in 11 patients with subacute thyroiditis accompanied by signs and symptoms of hyperthyroidism, and were compared with 13 patients with untreated thyrotoxicosis in which serum T4 was elevated to the identical level. Serum T3 was also elevated in subacute thyroiditis but to a significantly lower extent than in thyrotoxicosis. Therefore the ratio of T4/T3 was significantly higher in subacute thyroiditis than in thyrotoxicosis. Although duration of thyroid swelling was shorter in the group treated by prednisolone than by aspirin, the accelerated ESR, thyroid tenderness and fever subsided almost similarly in the two groups. Serum T4 and T3 levels declined more rapidly in treatment with prednisolone compared with aspirin. In patients treated by aspirin initial increase in T3 level occurred transiently with simultaneous decrease in the T4/T3 ratio. These changes suggest the increase in peripheral conversion of T4 to T3. Even in severe cases of subacute thyroiditis associated with hyperthyroidism, aspirin treatment is an effective therapy and there is no recurrence following -withdrawal of the medication.
In 4 cases of insulin dependent diabetics, blood levels of glucose, C-peptide reactivity (CPR), free fatty acid, and catecholamines were followed after the intravenous tolbutamide response test. Plasma CPR was low and did not respond to tolbutamide injection, and blood levels of glucose and free fatty acid did not change during the test. Fifteen min after the tolbutamide injection, plasma epinephrine plus norepinephrine and norepinephrine levels fell to 87.5% and 67.4% of the initial values, respectively. These results suggest that decrease in the blood glucose and free fatty acid levels usually observed after tolbutamide injection is not the direct action of drug, but is secondary to insulin secretion, and tolbutamideinduced decrease in catecholamines may contribute to the secretion of insulin from the pancreatic β-cells.
Microencapsulated Mitomycin C with ethylcellulose was infused into isolated dog kidneys through the renal artery. The capsules were lodged mainly at cortico-medullary junction, where the drug was released from the capsules. Vascularity of kidney was reduced moderately.