ASAKI, S., NISHIMURA, T., SATOH, A., OHARA, S., SHIBUYA, D., OGITSU, Y. and GoTo, Y. Endoscopic Hemostasis of Gastrointestinal Hemorrhage by Local Applicationof Absolute Ethanol: A Clinical Study. Tohoku J. exp. Med., 1983, 141 (4), 373-383 The procedure of endoscopic hemostasis with topical injection of absolute ethanol has been developed and applied since 1975 for the control of postoperative hemorrhage associated with diathermic polypectomy. Since June 1979, upper gastrointestinal hemorrhages other than varices have also been subjected to this procedure. This method is based on the principle of dehydration and fixation of the tissue with absolute ethanol. In this procedure, the bleeding vasculatures are dehydrated and fixed with consequent vasoconstriction and necrosis of the vascular wall including its endothelial lining, thereby thrombogenesis and hemostasis are facilitated. The troubled blood vessels fixed in vivo are disintegrated and disappeared. Rebleeding from the ulcer has been extremely rare with this method since the necrotized tissue seldom defoliates but often constitutes a part of the white coating and protects the base of ulcer. Treatment by this method has been successful in all 23 cases of upper gastrointestinal hemorrhage associated with endoscopic diathermy, and none has developed rebleeding. The hemostasis has also been successful in 51 cases (72 hemorrhagic lesions) with fresh blood clots adhering to the lesion, exposed blood vessels in the lesion or an actively bleeding lesion out of 126 cases referred for emergency endoscopic examination because of upper gastrointestinal hemorrhage during the 3-year period from June 1979 to May 1982. After hemostasis, however, 3 patients received an elective operation and one patient was also operated due to perforation of the gastric wall. Rebleeding occurred in 3 cases more than a week after the hemostasis; one of these was the above described operated case of perforation. The rebleeding occurred in stress ulcers following surgery for femoral fracture. The other two were at the terminal stage of malignancy and complicated with DIC respectively. Of the patients treated by this method, 8 died by causes other than gastrointestinal hemorrhage. All the rest of 39 cases attained cure of ulcer by the non-surgical treatment alone.
ASAKI, S., SATOH, A., NISHIMURA, T., OHARA, S., SHIBUYA, D., SATOH, H. and GOTO, Y. Combination Therapy of Gastric Atypical Epithelium and ElevatedType Early Gastric Cancer with High Frequency Current and Laser. Tohoku J. exp. Med., 1983, 141 (4), 385-396-A total of 11 lesions, consisting of elevated type early gastric cancer and atypical epithelium of more than 2cm in diameter which were found in 9 cases, were jumbo biopsied using high-frequency current and the specimens obtained were examined histologically. Based on the results, the final diagnosis was established in terms of the benign or malignant nature of the lesion, some modifications were made in the irradiation method in accordance with the depth of invasion of the gastric cancer, and the adequacy of the irradiation therapy was examined. Then, the remaining tumor was irradiated with laser. This combination therapy of high frequency current and laser can make up for the drawback associated with laser therapy which does not permit collection of specimens for pathohistological study.
MORISAKI, N., SHINOMIYA, M., MATSUOKA, N., SAITO, Y. and KUMAGAI, A. In Vivo Effects of Cis-5, 8, 11, 14, 17-20:5 (n-3) and Cis-4, 7, 10, 13, 16, 19-22:6 (n-3)on Serum Lipoproteins, Platelet Aggregation, and Lipid Metabolism in the Aorta ofRats. Tohoku J. exp. Med., 1983, 141 (4), 397-405 -Highly purified cis-5, 8, 11, 14, 17-20:5 (n-3) or cis-4, 7, 10, 13, 16, 19-22:6(n-3) was administered to rats for 2 weeks, and serum lipoprotein lipid levels, platelet aggregation, and lipid metabolism in the aorta in vivo were investigated. 20:5 (n-3) decreased the level of low density lipoprotein phospholipid. 22:6 (n-3) increased the level of high density lipoprotein cholesterol and decreased those of low density lipoprotein triglyceride and phospholipid. Both 20:5 (n-3) and 22:6 (n-3) markedly inhibited platelet aggreation. 20:5 (n-3) decreased the acid and neutral cholesterol esterase activities, but did not affect either acyl-CoA synthetase or acyl-CoA: cholesterol acyltransferase activity. 22:6 (n-3) had no effect on any of these enzyme activities. From these results, the roles of 20:5 (n-3) and 22:6 (n-3) in the formation of atheromatous lesions and the mechanism of the decrease in cholesterol esterase activity by 20:5 (n-3) were discussed.
KASAMA, T., AIDA, Y., OSHIRO, K., GOTO, M., UCHIDA, M. and OHKUNI, H. Studies on the Antigenicity of Glucagon. Tohoku J. exp. Med., 1983, 141 (4), 407-415 - In order to test the safety of glucagon (GG), the immunogenicity of GG was studied in rabbits and guinea pigs. Any sensitization, as revealed by anaphylactic shock, Arthus reaction, passive cutaneous anaphylaxis (PCA) or radioimmunoassay, was not demonstrated in animals immunized with GG alone. The anti-GG antibodies were detected by PCA and radioimmunoassay in two of the five animals immunized with GG mixed with Freund's complete adjuvant. Anti-GG IgE antibody production in mice was found in one of the ten mice given 570μg and threeof the six mice given 1, 000μg of GG with alminum hydroxide gel (Alum), but other doses of GG with Alum produced no IgE antibody. These results indicate that the antigenicity of GG is very weak.
KASAI, Y., ABE, K., YASUJIMA, M., TAJIMA, J., SEINO, M., CHIBA, S., SATO, K., GOTO, T., OMATA, K., TANNO, M. and YOSHINAGA, K. Acute Effects of MK421, aNew Angiotensin Converting Enzyme Inhibitor, in Man. Tohoku J. exp. Med., 1983, 141 (4), 417-422 Acute effects of MK421 were examined in 11 male normal volunteers. Oral administration of 5mg of MK421 did not induce any changes in blood pressure or pulse rate. Plasma renin activity increased significantly from 7.3±2.9ng/ml to 22.2±7.1 (p<0.05), whereas plasma aldosterone concentration did not change. Blood kinin, or urinary excretion of kallikrein and of prostaglandin E did not chage. However, urinary excretion of sodium increased significantly from 44.0±6.8mEq/4 hr to 56.5±6.5 (p<0.02) following the administration of MK421. The present results show that an increased renin release induced by MK421 is independent of change in blood pressure, and also suggest that MK421 may have a direct action on the renal tubules.
KATO, T., WOKALEK, H., SCHÖPF, E., HOVESTADT, I., ERNST, M., RIETSCHEL, E and FISCHER, H. Zymosan-Induced Chemiluminescence of Granulocytes inIncubated Human Whole Blood. The Role of Platelets. Tohoku J. exp. Med., 1983, 141(4), 423-431-Zymosan-induced chemiluminescence (ZI-CL) of whole blood which is mainly the response of granulocytes can be used as a rapid, simple and reliable diagnostic tool for hematological and allergic disorders. ZI-CL of whole blood remained unchanged when stored at 0°C for 4hr, whereas it increased by incubation at 37°C. This phenomenon points to platelet-granulocyte interaction during the incubation. ZI-CL of freshly prepared suspension of leukocytes and erythrocytes was enhanced by adding platelet rich plasma (PRP) obtained from incubated blood. Enhanced CL response was observed when erythrocytes or factors derived thereof were present in incubated blood. Platelet stimulating factor (PSF) was prepared from incubated erythrocyte suspension. This factor also increased ZI-CL of granulocytes when incubated with fresh PRP. The consistent inhibition of CL of incubated blood by apyrase (0.5U/ml) and the increased response of fresh blood by the addition of ADP (10-5M) suggested that this factor might be ADP itself. Platelets stimulated by this factor may respond more markedly to added zymosan for still unexplored reason with enhanced CL.
KATO, T., TERUI, T., KURAMOTO, Y. and FUJIYAMA, T. Suppression ofZymosan-Induced Chemiluminescence of Whole Blood by Conjugates Composed of Drug, Guinea Pig Skin Extracts and Sera from Patients with Suspicious Dru Eruptions. Tohoku J. exp. Med., 1983, 141(4), 433-441-Conjugates composed of drug, guinea pig skin soluble fraction, and sera from 50 patients with various types of drug eruptions were prepared by the incubation of these mixtures for 60min at 37°C. And the effects of conjugates on zymosan-induced chemiluminescence (ZI-CL) in whole blood were examined. The conjugates obtained from 32 cases significantly suppressed ZI-CL of whole blood. The mean value of peak intensities of CL in the presence of their conjugates showed 62% of those after the pretreatment of mixtures consisting of drug, soluble fraction and sera from healthy donors. In the systems of non-opsonized and opsonized zymosan-induced CL of leukocyte-erythrocyte sediment, similar inhibitory effects were obtained in both systems in the presence of conjugates, but the time course of CL response was slower in the system with non-opsonized zymosan. In other experiments with the use of immune complexes, which were formed by human albumin and antihuman albumin goat serum in vitro, soluble immune complexes suppressed ZI-Cl of whole blood. These results suggest that immune complexes may be formed during incubation of conjugates and block the receptors on the surfaces of granulocytes, resulting in the suppression of ZI-CL.
TASAKA, Y., INOUE, S., MARUMO, K. and HIRATA, Y. Pancreatic Polypeptideand Insulin Contents in Diabetic and Nondiabetic Human Pancreas and TheirRelationship to the Stability of the Fasting Serum Glucose. Tohoku J. exp. Med., 1983, 141 (4), 443-450-The amounts of insulin and pancreatic polypeptide (PP) in twenty-four autopsied diabetic and nineteen nondiabetic human pancreases were determined and their relationship to the stability of the fasting serum glucose level was investigated. The PP content of the tail of the pancreas in diabetic and nondiabetic subjects was 9.55±2.41 and 7.71±1.52μg/g pancreas, and that of the head of the pancreas was 16.86±5.51 and 15.82±5.38μg/g, respectively. No significant differences in content were found between diabetic and nondiabetic pancreases. The PP content of the head pancreas of some diabetics and nondiabetics was higher than that of the tail. The insulin content of the tail of the diabetic pancreas was lower than that of the nondiabetic pancreas. In those diabetics where there was less than 0.5U/g of insulin in the tail pancreas, the stability of the fasting serum glucose was very poor, indicating an unstable type of diabetes. There was a significant inverse correlation between standard deviation of FBS and the amount of insulin, but the PP content of the pancreas had no relation to the stability of the fasting serum glucose.
YAJIMA, A., SATO, S., HIGASHIIWAI, H., MORI, T., WADA, Y., YAMAUCHI, R., UEHARA, S. and SUZUKI, M. Therapy for Cervical Cancer Detected by MassScreening. Tohoku J. exp. Med., 1983, 141(4), 451-456-Over a 19 year period since 1962, 972 cases of cervical cancer have been detected by mass screening in Miyagi Prefecture, a detection rate of 0.11%. Among these cases, 551 (56.7%) were cases of carcinoma in situ. In contrast, cervical cancers detected by means of private screening gave a detection rate of 0.39% (889 cases), among which there were 611 cases of invasive carcinoma (68.7%). Among the 421 cases of invasive carcinoma detected by mass screening, 352 were Stage I, 52 were Stage II, 14 were Stage III and 1 was Stage IV. Moreover, 178 of the 352 Stage I cases were Stage Ia. The 5 year survival rate for the cervical cancer patients detected by mass screening was 97.8% for Stage 0, 92.9% for Stage I, 75% for Stage II, 45.5% for Stage III and 0% for Stage IV. The 5-year survival rate for invasive carcinoma was 88.7%. Twenty-five deaths due to recurrence of the cancer were found, but all such cases were invasive carcinomas. There were no mortalities due to recurrence of carcinoma in situ among such cases detected by mass screening.
TOYOTA, T., UMEZU, M., OIKAWA, N., SANOYAMA, R., SUZUKI, S., SUZUKI, H., NAKAJIMA, Y. and GOTO, Y. Diabetic Scleredema. Tohoku J. exp. Med., 1983, 141 (4) 457-461-Many skin lesions are specific for diabetes mellitus. Necro-biosis lipoidica, lipoatrophy and idiopathic bullae (bullosis diabeticorum) are usually associated with diabetes. However, diabetic scleredema has not been noticed by internists, although dermatologists have paid attention to such a cutaneous manifestation. We reported a clinical case of a female diabetic patient aged 15 who had been afflicted with diabetic scleredema. She had been treated with insulin since 5 years of age. She noticed stiffness of the skin in April 1980. Skin biopsy showed thickness of the dermis and accumulation of acid mucopolysaccharide. After control of blood glucose with continuous subcutaneous insulin infusion (CSII) and administration of tocopherol acetate and hyaluronidase, the skin lesion improved. Etiology of diabetic scleredema is unknown. Such skin lesion which is observed frequently in insulin dependent obese patients is different from a category of scleredema of Buschke.
TAKAHASHI, Y. and HIRATA, Y. A Follow- Up Study of Painful DiabeticNeuropathy: Physical and Psychological Aspects. Tohoku J. exp. Med., 1983, 141(4), 463-471 Twenty-one patients with painful diabetic neuropathy were followed up for about 18 months by means of physical and psychological tests. Patients with painful diabetic neuropathy had significantly more neurotic, anxious and depressive traits than those with non-painful diabetic neuropathy. During the course of the study, 17 patients out of 21 were found to be relieved of their neuropathic symptoms with improved blood glucose control and medications. However, despite this improvement, diabetic retinopathy and nephropathy of the patients deteriorated. Patients with improved neuropathy had gained body weight, with a concomitant relief of depression, nervous tendency and anxiety. However, lack of extroversion was not changed at all. Patients with painful diabetic neuropathy were significantly less extroversive than those with non-painful diabetic neuropathy, even when their neuropathic symptoms might have improved. This study shows that although nervousness, anxiety and depressive tendencies may be secondary to the symptoms of painful diabetic neuropathy, lack of extroversion can be a primary characteristic trait which may easily induce painful diabetic neuropathy.
ARAI, H., IKEDA, H., ICHIKI, M., IINO, M., KUMAI, M., and IKEDA, M. A Caseof Poisoning by a Mixture of Methanol and Ethylene Glycol. Tohoku J. exp. Med., 1983, 141 (4), 473-480-A fatal case of poisoning by a mixture of methanol and ethylene glycol is described. A 72-year-old man was hospitalized when he was found stuporous to semicomatose, and despite massive bicarbonate therapy, died 36 hr after the admission. While the presence of numerous oxalate crystals in urine strongly suggested ethylene glycol intoxication, the GC analysis of the liquid the patient ingested revealed that he presumably drunk about 150 to 200ml of a mixture of methanol (80%) and ethylene glycol (20%), the amount well over the lowest lethal dose when the additiveness of toxicity was considered. Retrospective evaluation of the signs suggested that while some of them such as oxalate crystalluria, elevated CPK, hypocalcemia, renal failure are attributable to the toxicity of ethylene glycol, others including elevated serum amylase and cyanosis are indicative of methanol poisoning. Disturbed consciousness was considered to be of metabolic origin; the high anion gap observed (38.2mEq/liter) may be due not only to lactic acidosis but also to acidogenicity of the two chemicals ingested. The importance of gas chromatographic analysis for identification of the causative chemical(s) is stressed.
KOBAYASHI, T., NIHEI, J. and OHNEDA, A. Response of ExtrapancreaticGlucagon to Glycemic Changes under Chronic Insulin Deficiency in Dogs. Tohoku J. exp. Med., 1983, 141 (4), 481-488-Since the secretion of pancreatic glu cagonis largely influenced by the changes in the blood glucose level, the response of extrapancreatic glucagon was investigated in totally pancreatectomized dogs under chronic insulin deficiency. Insulin-induced hypoglycemia did not alter plasma glucagon in the portal vein in a group of 5 pancreatectomized dogs, but the decrease of the blood glucose was small, by 70mg/100ml, in spite of a large amount of insulin. The administration of 2-deoxyglucose did not cause any changes in plasma glucagon in the portal vein in a group of 6 pancreatectomized dogs. Glucose-induced hyperglycemia, both transient and continuous, did not cause any changes in plasma glucagon in the portal vein, although blood glucose was significantly elevated. It is concluded that regulation of extrapancreatic glucagon differs from that of pancreatic glucagon.
MORITA, T., SUZUKI, T., KONDO, S. and TSUCHIDA, S. Effects of Noradrenalineand Acetylcholine on Ureteral Peristalsis. Tohoku J. exp. Med., 1983, 141 (4), 489-490-Experiments in vitro were performed to compare effects of noradrenaline and acetylcholine on the pyeloureter, both of which activate ureteral peristalsis. Noradrenaline elevated the baseline renal pressure to accelerate the ureteral peristalic pace in a ratio of 1:1 with the pacemaker discharge at the pelvicalyceal border (PC-border). Acetylcholine also accelerated the ureteral pace for a short time, as compared with the effect of noradrenaline. The baseline renal pelvic pressure dropped after administration of acetylcholine. Noradrenaline a little quickened the rhythm of the pacemaker contraction at the PC-border, and acetylcholine also quickened the pacemaker rhythm. These data suggest that noradrenaline and acetylcholine, which both activate pelviureteral peristalsis, exert different effects on pelvic pressure.
IGARASHI, M. N-Actetyl-β-Glucosaminidase Activity in Serum of Patientswith Epidermolysis Bullosa. Tohoku J. exp. Med., 1983, 141 (4), 491-492-A spectrophotometric study for serum N-acetyl-β-glucosaminidase activity in patients with different types of epidermolysis bullosa and other bullous diseases was carried out. The activity in recessive type of epidermolysis bullosa dystrophica was higher than in dominant type of epidermolysis bullosa dystrophica and other bullous diseases. High levels of this enzymatic activity may be related to the metabolism of glycosaminoglycans, especially hyaluronic acid in recessive type of epidermolysis bullosa dystrophica.