SUZUKI, H., NARA, T., MINATO, S. and KAMIISHI, H. Experience of SurgicalTreatment for Craniofrontonasal .Dysplasia. Tohoku J. Exp. Med., 1991, 164 (4), 251-257 - We present a case of a 5-year-old girl diagnosed as having craniofrontonasal dysplasia (CFND), which was first reported by Cohen in 1979. CFND is very rare and reports concerning this syndrome have never been found in Japan. In our case, frontal plagiocephaly, third degree orbital hypertelorism and clefting nasal tip coexisted. At 10 months after birth when she visited our hospital, signs of craniostenosis were not recognized and cosmetic improvement was considered the main purpose of the treatment. We performed supraorbital bar reshaping, ethmoidectomy and orbitotomy for reconstruction in one-stage at the age of five. The operation produced marked improvement in her exotropia before entering a primary school. Past reports dealing with abnormalities of the central nervous system in this syndrome are few, but agenesis of the splenium was noted in our case. This paper is a report of our findings together with some discussions in reference to the literature.
FUNAUCHI, M., SUGISHIMA, H., MINODA, M. and HORIUCHI, A. Serum Levelof Interferon-γ in Autoimmune Diseases. Tohoku J. Exp. Med., 1991, 164 (4), 259-267 - Interferon-γ is one of the cytokines which have various immuno-regulatory functions. In the present study, the serum interferon-γ level was determined in autoimmune diseases. It was increased in the active cases of systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD). Since there was a positive correlation between the serum interferon-γ level and the rate of peripheral mononuclear cells positive for HLA-DR antigen in systemic lupus erythematosus, circulating interferon-γ might have a biological functions as suggested by many in vitro studies. In rheumatoid arthritis and Sjögren's syndrome, there was no correlation between the serum interferon-γ level and the clinical findings. These data suggest that interferon-γ might be associated with the pathogenesis of autoimmune diseases such as SLE and MCTD, and it can be one of the indices for their disease activity.
TSUJI, I., FUKAO, A., SHOJI, T., KUWAJIMA, I., SUGAWARA, N. and HISAMICHI, S. Cost-Effectiveness Analysis of Screening for Colorectal Cancer in Japan. Tohoku J. Exp. Med., 1991, 164 (4), 269-278 - To clarify the best cost-effective screening strategy for colorectal cancer in Japan, the cost-effectiveness ratio was compared among six currently performed procedures. The analysis was made using a simulation model to estimate long-term cost and effectiveness of the screening programs. In the screening by the immunological fecal occult blood test (FOBT), a comparison between the one- and two-day fecal collection methods indicated that the latter was more cost-effective than the former. A comparison was also made on the four workup methods: barium enema (BE) alone, a combination of BE and sigmoidoscopy (BE+SIG), total colonoscopy (TCF) alone, and a combination of BE and TCF (BE+TCF). The cost-effectiveness ratio was the lowest in the method using TCF alone, followed by those based on BE alone and BE+TCF, and the highest in the BE+SIG method. The superiority of TCF alone strategy was stable over a range of estimates such as the sensitivity of diagnostic tests, the probability of complications due to TCF, etc. It is concluded that a combination of the two-day FOBT and TCF yields the best cost-effectiveness.
TSUJI, I., FUKAO, A., SUGAWARA, N., SHOJI, T., KUWAJIMA, I. and HISAMICHI, S. Cost-Effectiveness Analysis of Screening for Gastric Cancer in Japan. Tohoku J. Exp. Med., 1991, 164 (4), 279-284 - Cost-effectiveness analysis of gastric cancer screening in Japan was performed, and the cost-effectiveness ratio was compared with that of colorectal cancer screening. The analytical model was the same as that adopted in our previous study on colorectal cancer screening (Tsuji et al. 1991). The results indicated that the cost per case-fatality prevented by colorectal cancer screening was 5.5 and 2.7 times more expensive for males and females, respectively, than that by gastric cancer screening. The age of the population influenced the cost-effectiveness of screening programs. The cost-effectiveness ratio in gastric cancer screening became negative among males older than the age of 65 years, suggesting that the total cost for prevention and control of deaths by gastric cancer in these age populations is saved by the screening program.
WAKAYAMA, Y., OHBU, S. and MACHIDA, H. Myasthenia Gravis, MuscleTwitch, Hyperhidrosis and Limb Pain Associated with Thymoma: Proposal ofPossible New Myasthenic Syndrome. Tohoku J. Exp. Med., 1991, 164 (4), 285-291-We describe a 54-year-old man with myasthenia gravis, thymoma, systemic muscle twitch particularly of both lower limbs, hyperhidrosis and lower limb pain. The muscle twitch resembled to fasciculation rather than to myokymia and was persistent after discontinuation of anti-acetylcholinesterase drug. No attenuation nor disappearance of the muscle twitch was educed by spinal anesthesia. However, it disappeared when a nondepolarizing type muscle relaxant (pancuronium bromide) was used. The muscle twitch was thus considered to originate from peripheral axons. Thymoma was considered to be involved in the pathogenesis of these unusual clinical manifestations which may constitute a new myasthenic syndrome.
SHIMIZU, T., NAKAMURA, M. and IMAI, M. Effect of S-8666 on Cl- Transportin the Rabbit Connecting Tubule Perfused in Vitro. Tohoku J. Exp. Med., 1991, 164 (4), 293-298-S-8666, [6, 7-dichloro-5-(N, N-dimethylsulfamoyl)-2, 3-dihydrobenzofurancarboxylic acid] is a potent diuretic with uricosuric action. Although the major site of action of S-8666 has been proven by the in vitro microperfusion study to be the thick ascending limb of Henle's loop, clearance studies in the rat suggested that this drug has an additional thiazide-like action. To provide direct evidence that S-8666 acts also on distal nephron segments, we examined effect of S-8666 on Cl- flux across the rabbit connecting tubule perfused in vitro. The drug suppressed the lumen-to-bath Cl- flux by 96±41 (S.E.)pmol• mm-1•min-1 (n=9) without affecting transmural voltage. To demonstrate that S-8666 acts on the connecting tubule cell, the target of thiazide diuretics, we compared effects of S-8666 and trichlormethiazide on the basolateral membrane voltage of the connecting tubule cell. Both drugs added to the lumen caused a small but significant hyperpolarization of the basolateral membrane without affecting transmural voltage. We conclude that S-8666 is a unique uricosuric diuretic having actions on both thick ascending limb of Henle's loop and connecting tubule.
KIMURA, H. and MATSUZAWA, S. A Continuously Rotating Passive AgglutinationMethod Using Rapidly Precipitable Latex Particles and Its Application. Tohoku J. Exp. Med., 1991, 164 (4), 299-307-A new passive agglutination method is reported. Large, very heavy, uniform latex particles coated with antigens or antibodies were mixed with corresponding antibodies or antigens in reacting wells of an appropriate shape and size. Agglutination results were read after 30min of continuous rotation at a suitable speed. With this simple and rapid continuously rotating passive agglutination method, we could detect anti-dinitrophenol monoclonal antibodies, natural anti-dinitrophenol antibodies, rheumatoid factor, allergic antibody to tick, human chorionic gonadotrophin and human IgE. This method is suitable to detect weak and small quantities of antibodies in a brief time.
KASHIMURA, J., SHIMOSEGAWA, T., KIKUCHI, Y., KOIZUMI, M. and TOYOTA, T. The Stimuratory Effect of PACAP 38 on Amylase Release in Dispersed RatPancreatic Acini. Tohoku J. Exp. Med., 1991, 164 (4), 309-318-Pituitary adenylate cyclase activating polypeptide 38 (PACAP 38), a novel peptide of the vasoactive intestinal polypeptide (VIP) family, was shown to stimulate enzyme secretion in the dispersed rat pancreatic acini. The dose-response of pancreatic enzyme secretion to PACAP 38 was nearly identical with that to VIP. In the presence of a submaximal dose of PACAP 38 (1nM), amylase release stimulated by an agonist working via the elevation of intracellular cyclic AMP (VIP, dibutyryl cAMP) was additionally responded, but the amylase release stimulated by an agonist via the elevation of cytosolic free calcium (carbachol, cholecystokinin) was potentiated synergistically. The present data suggest that PACAP 38 is a new candidate for the cAMP-mediated stimulant of pancreatic exocrine secretion.
IWATA, K., SAITO, H. and NAKANO, A. Association between Cadmium-InducedRenal Dysfunction and Mortality: Further Evidence. Tohoku J. Exp. Med., 1991, 164 (4), 319-330-Our previous follow-up study, carried out from 1979 to 1989, on 256 residents of Sasu, a cadmium (Cd)-polluted area located on Tsushima Island, Nagasaki Prefecture, Japan, showed a significant relationship between urinary β2-microglobulin (β2-m) excretion and mortality in men. To investigate the association between Cd-induced renal dysfunction and mortality more precisely, 275 residents in the same area aged 40-92 years, who had participated in a health survey conducted in May 1982, were followed to February 1989. The expected number of deaths was calculated on the basis of the sex- and 5-year-age-specific mortality rates for Tsushima Island in 1985. In both men and women with urinary β2-m concentrations greater than 1, 000μg/g creatinine, observed deaths were greater than the expected. However, the P value of the difference was less than 0.05 only in women. Analysis by the Cox proportional hazards model showed that, in both men and women, serum β2-m and creatinine, as well as urinary total protein and β2-m were significantly or marginally significantly related to mortality independent of age. In men, serum β2-m was more strongly related to mortality than urinary β2-m. The results provide further evidence for the causal association between Cd-induced renal dysfunction and mortality. The present report also discusses the role played by decreased glomerular filtration rate in the excess mortality of subjects with Cd-induced renal dysfunction.
SUZUKI, H., KAWAKAMI, Y. and FUJITA, M. Electroencephalographic PatternsRelated to Hemodynamic Changes at the Onset of Cardio-Pulmonary BypassCirculation. Tohoku J. Exp. Med., 1991, 164(4), 331-337-Electroencephalographic (EEG) changes in relation to hemodynamic changes at the onset of cardio-pulmonary (C-P) bypass circulation in 31 cases undergoing open heart surgeries were studied. Rapid and extensive changes in systemic circulation, which were followed by abnormal EEGs, appeared within the first five minutes of C-P bypass. Abnormal EEG patterns including disappearance of fast waves, slowing under 6Hz in frequency with high voltage and flattening were observed in 64% of the cases. The relations between the appearance of these abnormal EEGs and hemodynamic factors such as mean arterial pressure (mAP), central venous pressure (CVP), rate of decrease in mAP and rate of change in CVP, were analyzed in order to elucidate causes of development of the abnormal EEGs. Only the rate of decrease in mAP at the onset of C-P bypass had a high correlation (p<0.01) with the appearance of abnormal EEGs. The findings suggest that rapid circulatory changes in the first five minutes of C-P bypass may induce disruption of cerebral autoregulation.