The epidemiology of gout and hyperuricemia in a rural population of Java. The prevalence of gout and hyperuricemia was investigated by a survey of a total population of 4683 rural adults. The successful response rate was 95.2%. Of the respondents 85.3% of the individuals were examined. The prevalence of gout and hyperuricemia in men was 1.7 and 24.3%, respectively. The male to female ratio was 34:1 for gout and 2:1 for hyperuricemia. The observed higher prevalence of gout and hyperuricemia in this male Malayo-Polynesian population compared with Caucasian data, in spite of a lower life expectancy and subsistence economy, suggests that genetic and racial predisposition are key causative factors.


31P magnetic resonance spectroscopy of skeletal muscle in patients with fibromyalgia. 31Phosphorous nuclear magnetic resonance (31P NMR) spectroscopy of painful calf muscle was performed in 12 patients with fibromyalgia (FS) and 7 healthy subjects during rest, aerobic and anaerobic exercising conditions, and postexercise recovery. Ratios of inorganic phosphate and creatinine phosphate (Pi/PCr) and pH were calculated from the collected 31P NMR spectra. Resting values of Pi/PCr were normal in the patients. Patients delivered only 49% of the muscle power of the controls (p = 0.005). Patients and controls had similar rates of Pi/PCr and pH changes during work and recovery. The controls were able to change their Pi/PCr and pH more than the patients, due to the greater workload reached. However, statistical significance was reached only for the anaerobic static exercise (p = 0.003). It was concluded that patients with FS have a reduced voluntary capacity for work, but normal biochemical response to work and recovery.


Preliminary report of higher dose methotrexate treatment in juvenile rheumatoid arthritis. Methotrexate (MTX) is widely used to treat juvenile rheumatoid arthritis (JRA). Although most patients respond to lower doses (0.15-0.5 mg/kg/wk), some patients have required higher doses of MTX to control their arthritis. Thirteen children were treated with MTX 0.82-1.1 mg/kg/wk for 2-26 months. Although all children initially responded (> 50% improvement in joint index, erythrocyte sedimentation rate, morning stiffness and global evaluation), 4 patients discontinued treatment because of side effects or lack of prolonged efficacy. Five patients have continued taking higher dose MTX for 4-26 months, while 4 other patients have been able to decrease their MTX dose and maintain improvement. Twenty-four hour MTX levels were done on all patients at initiation of higher dose MTX and all cleared MTX well. Our report suggests that MTX in doses of 0.82-1.1 mg/kg/wk can successfully treat active synovitis in some children with severe JRA with few short term toxicities. Longterm use at these doses has not been studied and thus its safety is not known.


Longterm followup of hip and knee soft tissue release in juvenile chronic arthritis. Longterm results of soft tissue release for hip and knee flexion deformity in 27 patients with juvenile chronic arthritis (JCA) were evaluated. A total of 53 tenotomies were reviewed: 22 hips and 31 knees. Mean age at surgery was 12.1 years, with a mean underlying disease duration of 6.3 years and a postoperative followup of 5 years. Patients were evaluated at 3-6 months, then at one, 3 and 5 years. Results showed a marked drop in flexion contracture and an improvement in joint range up to the first 3 years postsurgery, but beyond this period benefits achieved were gradually partially lost. Only 37% of patients were able to walk before surgery. At one year followup, 81% were able to do so. Soft tissue release thus seems a beneficial therapeutic alternative to preserve both alignment and function in hip and knee flexion deformity affecting patients with JCA.


Cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. Seven girls between 8.6 and 17.7 years of age were treated for symptoms of juvenile primary fibromyalgia syndrome (JPFS) using cognitive-behavioral techniques (progressive muscle relaxation, guided imagery) aimed at reducing pain and facilitating sleep, as well as strategies aimed at increasing mastery over the pain and improving mood. Patients satisfying diagnostic criteria for JPFS based on the presence of chronic diffuse musculoskeletal pain lasting at least 3 months (mean = 9.4, SD = 8.28) and a minimum of 5 characteristic soft tissue trigger and/or tender points with absence of synovitis, were referred for intervention. Results indicated that in the majority of patients, such techniques were effective in reducing pain and facilitating improved functioning.


Seroprevalence survey of borreliosis in children with chronic arthritis in British Columbia, Canada. A seroprevalence survey using an indirect immunofluorescence assay (IFA) for IgG antibodies to Borrelia hermsii and Borrelia burgdorferi was conducted for varied pediatric chronic arthritis patients and a nonrheumatic control group in the province of British Columbia, Canada. Overall, a higher rate of sera with IFA titers > or = 1/256 was found for B. hermsii (36.6%) compared to B. burgdorferi (12.5%). There were no significant differences among the arthritis subgroups and controls for the distribution of IFA titers for either organism. IgG immunoblotting of selected high titered sera to either borrelia species confirmed the lack of specificity of the IFA assay. Serological tests for borreliosis should be cautiously interpreted in children with chronic arthritis.


Acute nonlymphocytic leukemia after treatment of systemic lupus erythematosus with immunosuppressive agents. We describe a case of acute nonlymphocytic leukemia with inversion of chromosome 16 in a patient with systemic lupus erythematosus treated with immunosuppressive agents including azathioprine and cyclophosphamide. Although the leukemia may have been caused by other factors, it is worth noting the potential association of this malignancy with immunosuppressive therapy.


Jaccoud's arthropathy and inflammatory bowel disease. A patient with longstanding ulcerative colitis developed an arthropathy of the hands and feet characterized by subluxations at the metacarpophalangeal and metatarsophalangeal joints without apparent osseous erosions. This could be a case of Jaccoud's arthropathy associated with inflammatory bowel disease.


Massive soft tissue calcification causing complete loss of extensor tendon function in renal failure. Extraskeletal soft tissue calcifications occur commonly in patients with uremia receiving dialysis. Rarely, a large tumoral calcinosis-like mass may develop. A patient receiving chronic ambulatory peritoneal dialysis for only 7 months developed a tumoral calcinosis-like mass that encased the extensor tendons of his wrist with loss of extensor tendon function, initially suggesting extensor tendon rupture. Surgical debridement restored tendon function. Tumoral calcinosis-like lesions are uncommon, but may cause limitation of joint movement, pain or ulceration through the skin. Measures aimed at controlling factors contributing to soft tissue calcification should be undertaken in any event whether surgery is required or not.


Severe progressive erosive arthritis in multicentric reticulohistiocytosis: possible involvement of cytokines in synovial proliferation. A case of multicentric reticulohistiocytosis complicated by severe progressive erosive arthritis in a 40-year-old man is described. The diagnosis was confirmed by biopsies of the cutaneous nodule and the synovial tissue of the right knee joint. Destructive changes in the multiple joints rapidly progressed and resulted in severe progressive erosive arthritis. Immunohistochemical staining revealed that the histiocytes reacted positively to interleukin 1 beta and platelet derived growth factor B, leading to the speculation that these cytokines may play a role in the synovial proliferation seen in patients with multicentric reticulohistiocytosis.


Association between insulin and blood pressure in a community population with normal glucose tolerance. The purpose of this study was to examine the relationship between insulin and BP in patients with normal glucose tolerance. The associations between systolic and diastolic BP, age, body mass index, waist/hip ratio, fasting glucose, insulin, fructosamine, glycosylated haemoglobin, lipid profile, and glucose and insulin two hours after 75 g oral glucose were examined in 1,520 employees of a public utility company and non-medical staff of a district hospital. Patients with impaired glucose tolerance or diabetes mellitus (using WHO criteria) were excluded. In men (mean age 35.6 +/- 8.7 years, n = 769), both systolic and diastolic BP were positively associated with age, body mass index, waist/hip ratio, fasting and 2h glucose and insulin, triglycerides and apolipoprotein B, and were negatively associated with glucose/insulin ration, and high density lipoprotein and cholesterol and its subfractions. However, in multivariate analysis only body mass index, age, fasting glucose and insulin were independent predictors of systolic BP, while only body mass index and age predicted diastolic BP. In women, age, glycosylated haemoglobin, 2h glucose/insulin ratio, 2h glucose, fructosamine and triglycerides were predictors of systolic BP. Fasting or 2h insulin, and glucose/insulin ratios did not predict diastolic BP. The results are compatible with the hypothesis that systolic hypertension may reflect a hyper-insulinaemic state even in those with normal glucose tolerance, independent of age and obesity. The association between plasma lipids and blood pressure is probably mediated by insulin and obesity.


Overdiagnosis of hypertension in the elderly. Seventeen untreated and 36 treated hypertensives aged 65 years or more were referred to our clinic because of repeated values of systolic blood pressure > or = 160 mmHg and diastolic blood pressure > or = 95 mmHg. All 53 patients underwent 24h blood pressure monitoring during their customary daily activities. Eleven (65%) untreated and 23 (64%) treated patients were normotensive during their daily activities. Thus, ambulatory BP monitoring appears to be useful in the elderly hypertensive patients in detecting those whose BP is elevated only in the clinic. Ambulatory BP obtained outside the clinic may be useful in diagnostic and therapeutic decision-making in the elderly population.


Terminal aortic response to sodium intake is the major determinant of total peripheral resistance in elderly hypertensives. Thirty-four elderly patients were studied using a Doppler flowmeter during different sodium intakes. Salt increased mean blood pressure and cardiac output (CO), while total peripheral resistance (TPR) remained unchanged. Neither carotid nor terminal aortic resistance changed, while coeliac, superior mesenteric or renal resistance increased. There was a significant and direct correlation (r = 0.82) between the change in TPR and that in terminal aortic resistance. Salt-sensitive patients were divided into two subgroups; the SST group in which sodium loading increased TPR more than CO, and the SSC group in which salt loading increased CO more than TPR. Terminal aortic resistance increased in the SST, decreased in the SSC, and remained unchanged in the non-salt-sensitive group with salt loading. The terminal aortic vascular bed received much of the increase of CO in the SSC patients. In the SST group, the contribution of the individual vascular area to increased TPR was assessed, which revealed that terminal aortic response to sodium loading was the major determinant of increased TPR. We concluded that the responses of terminal aortic vascular bed to sodium loading contributed to the changes in TPR.


Effect of cigarette smoking on the J-shaped relationship between treated blood pressure and cardiovascular disease. Hypertension Follow-up Group of the Japan Federation of Democratic Medical Institutions. It is known that a J-shaped relationship exists between treated blood pressure and the incidence of cardiovascular disease. To determine the relationship, an assessment was made of 6,825 patients aged 50-75 years who were receiving antihypertensive drugs. Blood pressures were averaged from five readings that were measured at the time of entry and during the preceding year. Current smoking status was ascertained by interview. During the mean follow-up period of 2.7 years (18,562 patient-years), the 241 incidences of cardiovascular disease (CVD), which occurred including cerebrovascular disease, were classified into 156 strokes, 59 myocardial infarctions, 18 congestive heart failures, 2 aortic aneurysmal ruptures, and 6 sudden deaths. In smokers, the sex, and age-adjusted incidence of CVD per 1,000 patient-years was 24*, 13, 24*, 40**, according to the treated systolic blood pressure (SBP) subgroups, i.e., < 140, 140-149, 150-159, and > or = 160 mmHg, respectively (*P < 0.05, **P < 0.005 compared with 140-149 mmHg). A J-shaped relationship with a dip at the middle SBP (140-149 mmHg) was recognized between treated SBP and CVD. Similar J-shaped curves were also present in each male age bracket, 50-59, 60-69, 70 yrs and older, and in women. However, in nonsmokers, the incidence in relation to SBP was 7, 9, 10, 17, respectively, (P < 0.01 compared with 140-149 mmHg), showing a positive linear relationship between SBP and CVD. These findings suggest that cigarette smoking leads to the J-shaped relationship between treated SBP and the incidence of CVD.


Blood pressure and body composition in children: importance of allowing for cuff size. A cross-sectional study of blood pressure (BP) was conducted in a sample of 1312 Australian school children aged 11-12 yrs. In line with current recommendations for the measurement of BP, a cuff of appropriate size was chosen for each subject based on his or her arm circumference. Analyses revealed statistically significant independent relationships between measured BP and cuff size. Observed relationships in the sample between measured BP and body composition variables were substantially affected when BP measurements were adjusted to remove the effect of cuff size. Cuff-associated biases in estimates of relationships between BP and body composition variables may still exist even though cuffs are carefully chosen to suit arms of different circumferences. It would appear that this potential problem is largely unrecognised. Some previous studies of relationships between BP and body composition may have been affected.


Usefulness of self-measured blood pressure when diagnosing mild hypertension. Blood pressure (BP) measured by the patients themselves at home and at their workplaces (self BP) and office blood pressure (office BP) were compared with ambulatory BP (amb BP) in 41 middle-aged borderline hypertensive men when diagnosing hypertension. Ambulatory BP was used as the 'gold standard'. The mean (standard deviation) value for office BP was 142/89 (14/7), self BP 143/92 (14/8), and amb BP 134/88 (12/6) mmHg. There was no difference between diastolic office BP and self BP as instruments for diagnosing hypertension. Furthermore, combining the two added little to the diagnostic value obtained from only one of them.


Converting enzyme inhibition: dissociation between antihypertensive and arterial effects. In this study the dose-response curves reflecting the arterial and the antihypertensive effects of converting enzyme inhibition were analysed. The BP measurement (using a random zero sphygmomanometer) and its decrease following converting enzyme inhibition were used as a marker of the arteriolar effect of the drug. The effect on conduit arteries was evaluated through determination of carotid-femoral pulse wave velocity used as an index of arterial distensibility. We compared the dose-response curves of these two parameters in a double-blind study carried out in 24 patients with essential hypertension, who were randomised between placebo and 2, 4 and 8 mg of the converting enzyme inhibitor trandolapril given for 8 days. The antihypertensive effect was observed from 2 mg, at which dose the plateau of BP reduction was already achieved. No significant correlation was found between dose and BP reduction (r = -0.34), whereas the dose was significantly related to the change in pulse wave velocity (r = -0.56, P < 0.01). No significant correlation was found between changes in BP and change of pulse wave velocity. The study provides evidence that the effect on the conduit artery was obtained for higher doses than the BP effect in patients treated for hypertension by the converting enzyme inhibitor trandolapril.


Airway responsiveness and cough induced by angiotensin converting enzyme inhibition. Dry cough is one of the most common side-effects of angiotensin converting enzyme inhibitors. The mechanism of cough induced by ACE inhibitors is not completely understood and may be related to bronchial hyperreactivity and/or an accumulation of kinins. In a placebo-controlled, double-blind randomised study, the effect of captopril on lung function and bronchial reactivity to histamine and bradykinin was investigated in eight asthmatic and 12 hypertensive patients (six with and six without cough during previous ACE inhibition). Lung function did not change in any patient after a single (25 mg) or short-term (2 x 25 mg for two weeks) administration of captopril. Bronchial reactivity to histamine and bradykinin remained unaltered in all groups. In hypertensive patients with cough, reactivity to histamine tended to be more pronounced and bronchial hyperreactivity to be more frequent than in those without cough. In conclusion, the present results do not support a major role for kinins in cough induced by ACE inhibition. On the other hand, bronchial hyperreactivity may be important in some patients. Additionally, these results demonstrate that treatment with ACE inhibitors is safe in most patients with bronchial asthma.


Effects of Chinese herbal drugs on serum lipids, lipoproteins and apolipoproteins in mild to moderate essential hypertensive patients. We investigated the effects of the traditional Chinese herbal drugs, Dai-saiko-to (D) and Saiko-ka-ryukotsuboreito (S) on blood pressure, pulse rates, serum lipids, lipoproteins and apolipoproteins in 30 patients with mild to moderate hypertension in an open, randomised trial. After the drug treatment, BP remained unchanged, but pulse rates declined significantly after 3 months in the S treated group. Serum total cholesterol and triglyceride values did not change, but high density lipoprotein-cholesterol increased significantly (P < 0.05) in both groups. Apo-AI (P < 0.1 in S group) and apo-AII (P < 0.05 in D group, P < 0.1 in S group) tended to increase 3 months after treatment. These data indicate that both of these traditional Chinese medicines have a preferential effect on lipid metabolism with little antihypertensive action.


Combined actions of isradipine and captopril on renal function in hypertension. The object of this study was to test the hypothesis that the natriuretic and uricosuric effect of calcium-entry blockers could be mediated through antagonism of angiotensin II dependent intrarenal mechanisms. The antihypertensive efficacy, haemodynamic and excretional effects of superimposed calcium blockade with isradipine were investigated in seven hypertensives with unsatisfactorally controlled blood pressure with captopril 50 mg twice daily. Glomerular filtration rate (GFR) and renal plasma flow (RPF), clearances (C) of sodium (Na), potassium (K), uric acid (UA) and lithium (Li), were measured before and after a low-dose bolus of isradipine, i.v. Subsequently, measurements were repeated during constant i.v. infusion of a higher dose with definite systemic haemodynamic effects. After 4 months of combined treatment with isradipine and captopril renal investigations were carried out again. The low isradipine dose induced a slight but statistically significant increment in CNa (22% +/- 28) and heart rate (4% +/- 4), whereas no other variables changed significantly. Infusion of the high isradipine dose caused a pronounced fall in renal vascular resistance (27% +/- 14), systolic (8% +/- 2) and diastolic blood pressure (17% +/- 5). RPF increased significantly (15% +/- 18) whereas no changes were noted in GFR, filtration fraction and urinary albumin excretion rate. In spite of the pronounced fall in BP during the high dose infusion, significant increments in natriuresis (91% +/- 63) and diuresis (41% +/- 27) were induced. The natriuresis was caused by a proximal tubular action as indicated by increased CLi and CLi/GFR.(ABSTRACT TRUNCATED AT 250 WORDS)


Stereo pairs of bright-field micrographs via Wiener-type inverse filtering. In a three-dimensional (3-D) image data set obtained through optical sectioning, each two-dimensional (2-D) segment is blurred by out-of-focus information from neighbouring focal planes superimposed on the in-focus segments from that plane. Instead of attempting to remove this redundant information over the full 3-D data set, we have developed a technique for restoring stereoscopic views. In this paper we describe the implementation of a Wiener-type inverse filtering method for generating stereo pairs of bright-field micrographs. A theoretical optical transfer function valid under certain simplifying approximations has been used in implementing this filtering technique. In developing this method the slice theorem of computed tomography is used. In this way the image reconstruction problem is reduced to one of processing 2-D arrays rather than 3-D arrays and the problem of restoring missing Fourier components within the missing-cone region is circumvented. Limited experimentation with real micrographs shows that the approach provides images that display an effective increased depth of field and 3-D attributes of the specimen, even though some of the underlying assumptions on which this method is based are difficult to verify explicitly. The method can be implemented with a relatively fast execution time on 386-SX computers.


High-resolution scanning electron microscopy of frozen-hydrated cells. Cryo-fixed yeast Paramecia and sea urchin embryos were investigated with an in-lens type field-emission SEM using a cold stage. The goal was to further develop and investigate the processing of frozen samples for the low-temperature scanning electron microscope (LTSEM). Uncoated frozen-hydrated samples were imaged with the low-voltage backscattered electron signal (BSE). Resolution and contrast were sufficient to visualize cross-fractured membranes, nuclear pores and small vesicles in the cytoplasm. It is assumed that the resolution of this approach is limited by the extraction depth of the BSE which depends upon the accelerating voltage of the primary beam (V0). In this study, the lowest possible V0 was 2.6 kV because below this value the sensitivity of the BSE detector is insufficient. It is concluded that the resolution of the uncoated specimen could be improved if equipment were available for high-resolution BSE imaging at 0.5-2 kV. Higher resolution was obtained with platinum cryo-coated samples, on which intramembranous particles were easily imaged. These images even show the ring-like appearance of the hexagonally arranged intramembranous particles known from high-resolution replica studies. On fully hydrated samples at high magnification, the observation time for a particular area is limited by mass loss caused by electron irradiation. Other potential sources of artefacts are the deposition of water vapour contamination and shrinkage caused by the sublimation of ice. Imaging of partially dehydrated (partially freeze-dried) samples, e.g. high-pressure frozen Paramecium and sea urchin embryos, will probably become the main application in cell biology. In spite of possible shrinkage problems, this approach has a number of advantages compared with any other electron microscopy preparation method: no chemical fixation is necessary, eliminating this source of artefacts; due to partial removal of the water additional structures in the cytoplasm can be investigated; and finally, the mass loss due to electron beam irradiation is greatly reduced compared to fully frozen-hydrated specimens.


Artefacts and morphological changes during chemical fixation. The normally 'condensed' (darkly stained) chromosomes of dinoflagellates decondense by swelling. This occurs in an increasing number of cells when the concentration of added OsO4 is decreased. With different fixatives other types of disintegration can be observed, which vary with the concentration. With cryofixation and freeze-substitution the chromosomes are most 'condensed'. Escherichia coli infected with bacteriophage T4, with or without active lysozyme production, were studied by optical densitometry for partial lysis and by light and electron microscopy for observing swelling. When active lysozyme is present some of the acrolein (2.5%)-glutaraldehyde (2%)-fixed cells swell at 0 degrees C, but do not in the absence of lysozyme nor when fixed at room temperature. If OsO4 is added at concentrations < or = 0.5%, partial lysis occurs when lysozyme is present. The optical density decreases, the cells lose some matter and swell slightly. The corresponding electron micrographs show gap formation by curdling and/or a decreased concentration of the cytoplasm which reveals certain phage-related particles.


Mutagens in urine sampled repetitively from municipal refuse incinerator workers and water treatment workers. Municipal refuse incinerator workers may be exposed to mutagenic compounds from combustion gases and particulates during plant operation, maintenance, and ash removal procedures. The frequency of mutagens was measured by the Ames assay in 3 urine samples collected from each of 37 workers in 4 refuse incinerators and 35 (control) workers from 8 water treatment plants during June-August 1990. When comparing the first urine samples contributed by workers in each cohort, incinerator workers had a significantly (p < .05) increased risk of both direct-acting mutagens and promutagens (8/37 or 22% for each mutagen type) compared with water treatment workers (2/35 or 6% for each mutagen type). Smoking within 24 h before urine sampling was not a confounder of these results. Interestingly, there was no significant (p > .05) difference for risk of urinary mutagens or promutagens between the two cohorts when comparing, respectively, the second and third urine samples from each cohort. The repeatability of demonstrating urinary mutagens in individual incinerator workers was poor, suggesting that their exposure was highly variable and/or that these workers modified their exposure (e.g., wore masks) as a consequence of being studied. Factors that influence production of mutagenic compounds during refuse incineration and subsequent worker exposure are discussed.


Correlation between cataract and retinopathy due to lighting in F344 rats used in a long-term carcinogenicity study. Correlations between light intensity of animal room lighting and both cataract and retinopathy of rats were examined, and relationships between the cataract and the retinopathy were further investigated. Seventy-nine male rats and 106 female rats surviving to the end of a 2-yr carcinogenicity study of monosodium succinate were used in this investigation. Animals were housed in polycarbonate cages, each containing 4 rats, with wire lids and hardwood chips for bedding and with a 12-h light/dark cycle. Individual groups comprising 13 cages were inserted into 3 by 5 cage hanging type racks. Light intensity was measured at the bottom (on the bedding) of individual cages. Statistically, both the incidence of cataracts and the severity of retinopathy were closely related to light intensity. The incidence of cataracts in males was significantly higher than that in females, while no sex difference was observed for the severity of retinopathy. Meanwhile, no differences in either the incidence of cataracts or the severity of retinopathy were observed between the monosodium succinate-treated and control groups and between the right and left eyes. While the occurrences of retinopathy and cataract were strongly associated, our results indicated that retinopathy occurs more frequently than cataracts, and thus the retina appeared to be more sensitive to the effects of lighting.


Structure-activity relationship of a series of sensory irritants. The relative potencies for a series of sensory irritants, with structures based on toluene, were determined by measuring the airborne concentrations that caused a 50% decrease in respiratory rate in Swiss-Webster mice. This concentration is referred to as the RD50. Toluene, a relatively nonirritating compound, and compounds with chlorine, two chlorines, bromine, and iodine atoms substituted on the alpha carbon of toluene were tested. The RD50s for these compound types were determined to be 4900, 27, 27, 5.2, and 4.3 ppm, respectively. In addition, compounds with chlorine substituted at the ortho, meta, and para positions on the toluene ring were also tested. The RD50s were determined to be 4.9, 13, and 14 ppm, respectively. The structure-activity relationships of the compounds studied are explained by a model (Abraham et al., 1990; Nielsen and Alarie, 1982) that relates the interaction of sensory irritants with a receptor protein in a lipid bilayer. The trends in the RD50s, and thus sensory irritation, for the compounds studies are related to the development of a partial positive charge on the toluene alpha carbon by the positioning of a ring chlorine and the bond dissociation energies of the alpha carbon-halogen bond for the iodo, bromo, and chloro isomers of benzyl halide.


Impairment of vitamin D metabolism due to environmental cadmium exposure, and possible relevance to sex-related differences in vulnerability to the bone damage. To determine whether depleted serum 1 alpha,25-dihydroxyvitamin D (VD) concentrations are associated with cadmium (Cd)-induced renal damage, the relationships between four indices of renal function and two indicators of bone metabolism, that is, serum VD and parathyroid hormone (PTH) concentrations, were analyzed in 30 male and 44 female subjects exposed to environmental Cd. Also, these associations were compared in male and female subjects to evaluate sex-related differences in vulnerability to the bone damage observed in Cd-exposed persons. Serum VD decreased significantly with declines in creatinine clearance and percentage tubular reabsorption of phosphate, and with increases in serum creatinine and serum beta 2-microglobulin (beta 2m) concentrations in the female subjects exposed to Cd, but not in the male subjects. The correlation between serum VD and PTH levels was also significant only in the females. Correlation coefficients between serum beta 2m and VD and those between serum PTH and VD in both sexes were significantly different. These results suggest that renal damage due to Cd exposure leads to the decreases in the serum VD level and increases in serum PTH level, and that the more marked changes in serum VD and PTH in the women may play a role in the development of sex-related differences in Cd-induced bone injury.


Evidence of thyroxine formation following iodine administration in Sprague-Dawley rats. Iodine (I2) has been proposed to be used as a water disinfectant on the manned space station. Previous work has shown that subchronic administration of I2 to Sprague-Dawley rats in drinking water significantly increases plasma thyroxine/triiodothyronine (T4/T3) levels. This is not observed with iodide (I-) treatment. The present study addresses the possibility that I2 reacts with deiodinated T4 metabolites in the gastrointestinal tract to resynthesize T4. Incubation of diiodothyronine (T2), T3, or reverse T3 with I2 in phosphate-buffered saline resulted in the formation of T4 as measured by radioimmunoassay. Washes from the initial segments of the small intestine of the rat show that substrates are present that react with I2 to produce T4. Single oral doses of I2 to rats produced significant dose-related increases in serum T4 and decreases in T3 concentrations after 2 h. Administration of an equivalent dose of I- did not alter significantly plasma T4 concentrations. Higher concentrations of a radioactive substance that bound a T4-specific antibody are present in plasma of animals treated with 125I2 compared to 125I-. These data support the hypothesis that I2 reacts with metabolites of thyroid hormone in the gastrointestinal tract to resynthesize T4 and elevate its levels in blood.


Intestinal bacterial translocation in experimentally burned mice with wounds colonized by Pseudomonas aeruginosa. Translocation of micro-organisms from the gastrointestinal tract may play a role in the pathogenesis of septic complications in severely burned patients. We therefore investigated the influence of burn wound infection with Pseudomonas aeruginosa on translocation in experimentally burned mice. The P. aeruginosa disseminated in 15% of the animals on the second day and in 20% of the animals on the third day postburn in the Pseudomonas-seeded group. Wound colonization with P. aeruginosa, compared with a control group, led to an increased incidence of translocation of Escherichia coli from the GI tract to the spleen (p < 0.005), liver (p < 0.03), lungs (p < 0.005), and peritoneal cavity (p < 0.03) on the second day postburn but not on the third day postburn. On both the second and third days, the number of viable E. coli in the organs in the Pseudomonas-seeded group exceeded that in the organs in the control group. In this model translocation of E. coli from the GI tract played a more important role than did hematogeneous dissemination of P. aeruginosa from the burn wound.


Association between blood transfusion and infection in injured patients. The association between red blood cell transfusions and infectious complications in 484 patients with acute injuries was studied in 1989. The median age was 62 years (0.5-97) and the median stay 7 days (3-141). Infectious complications developed in 46 (9.5%) patients. A number of potential risk factors, except blood transfusion, were analyzed in a logistic regression model to determine significant predictors of infectious complications. Blood transfusion as a cofactor was then added to this model. The final logistic regression analysis showed a relationship between blood transfusions and infectious morbidity that was independent of the other significant factors; Injury Severity Score, age, and surgical procedure. The corrected odds ratios for infection were 1.6 (95% confidence interval: 0.7-3.7) when 1-4 units of blood were given and 6.4 (95% CI: 2.3-18.3) when more than 4 units were used.


Identifying body fluid distribution by measuring electrical impedance. The effects of critical illness on extracellular water (ECW) and total body water (TBW) were measured using (1) a multiple dilutional technique, and (2) whole body and regional bioelectrical impedance analysis (BIA) in a group of stable patients. Total body water and body resistance (R) were similar in patients when compared with normal healthy subjects (TBW: 45.1 +/- 4.5 vs. 46.2 +/- 3.4 L, p = 0.85; R: 518 +/- 42 vs. 500 +/- 22 omega, p = 0.70), and a significant relationship was present between these measurements (r = -0.87, p < 0.001). However, patients demonstrated an increase in ECW compared with controls (ECW: 18.6 +/- 1.3 vs. 14.7 +/- 1.1 L, p < 0.05). Expanded ECW values were associated with diminished electrical reactance (Xc) values (38 +/- 6 vs. 70 +/- 4 omega, p < 0.001) and these values were correlated (r = -0.67, p < 0.005). The ratio of Xc to R determined across the body and each of the segments was significantly lower in patients compared with controls (at least p < 0.005) and this ratio measured across a leg was the most sensitive predictor of health (Xc/R > or = 0.137) and disease (Xc/R < or = 0.101). Bioelectrical impedance analysis is a noninvasive and simple bedside technique that can be used to predict TBW and identify altered fluid distribution following critical illness.


Effects of hypothermia on hemodynamic responses to dopamine and dobutamine. Hemodynamic characteristics, arrhythmogenicity, and dose-related hemodynamic responses to intravenous dopamine (group I) and dobutamine (group II) were examined in 16 swine at three different core body temperatures (38.5 degrees C, 35 degrees C, and 30 degrees C). The animals were anesthetized with isoflurane and mechanically ventilated. Cooling and re-warming were accomplished by a femoral-jugular A-V shunt. The animals were cooled down to 30 degrees C and stabilized for 1 hour before intravenous infusion of dopamine (group I, n = 8) or dobutamine (group II, n = 8) was started at 2, 5, 10, 15, 20, and 30 micrograms/kg/min. Hemodynamic responses to the two inotropes were continuously monitored with a bedside monitor equipped with a PC mode for customized data collection and analysis. Computerized arrhythmia detection was performed. Our findings were: (1) profound hypothermia (30 degrees C) causes significant depression of hemodynamic functions; (2) IV infusion of dopamine and dobutamine can be used safely and effectively for inotropic support during profound hypothermia, and the optimal dosage for improving cardiac output is 10-20 micrograms/kg/min; (3) no risk of inducing arrhythmia was noted with IV infusion of both inotropes up to a maximum dosage of 30 micrograms/kg/min, even though significant sinus tachycardia was consistently seen at 30 micrograms/kg/min.


Isolated fracture-dislocations of the first tarsometatarsal joint. Eight cases of isolated fracture-dislocation of the first tarsometatarsal joint are presented. This is an uncommon injury and a distinct entity from other tarsometatarsal joint injuries. Reduction of both the fracture and the dislocation is easy but is unstable. Kirschner wire and screw fixation adequately stabilizes the reduction and gives good results. Results of conservatively treated cases are usually poor, since redisplacement in plaster is quite common.


Mechanical failures of internal fixation in T and Y fractures of the distal humerus. To evaluate the factors resulting in mechanical failures of internal fixation of distal T-type and Y-type humeral fractures, we reviewed the clinical course and final results in 61 consecutive cases treated with AO-ASIF internal fixation devices. The patients were followed for at least 2 years (range, 2-11 years). Mechanical failure occurred in 18 cases (29.5%). In 12 patients this resulted from an unstable fixation. Severe osteoporosis was present in four patients. In two patients no specific causative factor could be detected. A second osteosynthesis was undertaken in five patients, and four additional patients were later operated on for nonunion. The functional outcome after these mechanical failures was, unexpectedly, poor in only 6 of the 18 patients. In spite of this comforting finding, the conclusion is that to minimize the failure rate in the management of these demanding fractures strict adherence to the correct technical fixation principles is mandatory, and when the bone is very osteoporotic a nonsurgical approach seems advisable.


External fixation of lower limb fractures in children. Thirty-four tibial and femoral shaft fractures in 32 children between the ages of 3 and 15 years were treated by external fixation over a 5-year period. The indications were fractures occurring in association with other major injuries and failure of conservative treatment to maintain satisfactory reduction. There was one case of delayed union and one early refracture. The overall pin track infection rate was 6%, but the rate for the tibial pins (2.1%) was much lower than for the femoral pins (10.3%). Union was achieved at an average of 11.7 weeks in the femoral fractures and 10.0 weeks in the tibial fractures. The use of external fixation is recommended for childhood femoral and tibial fractures, particularly in children with multiple injuries.


Balloon tamponade for bilobar transfixing hepatic gunshot wounds. The nonresectional approach to major liver trauma is clearly preferred. Unfortunately, trachotomy with vessel ligation, selective hepatic arterial ligation, perihepatic pack, and fibrin glue are not viable options with high-energy bilobar liver injuries. We have fashioned a balloon tamponade device that has proved very effective for these transfixing hepatic gunshot wounds.


The role and limitations of computed tomographic scanning in the evaluation of cervical trauma. We retrospectively reviewed the medical records, plain films, CT scans and complex-motion tomographic studies (TOMOS) of 216 consecutive patients with cervical injuries to determine the uses and limitations of CT in the evaluation of cervical trauma and the indications, if any, for the continued use of TOMOS in evaluating cervical trauma. There were 453 fractures and 104 subluxations or dislocations of the cervical spine in the 216 patients. Plain films detected 58% (262 of 453) of the fractures and 93% (97 of 104) of the subluxations and dislocations; and 94% (202 of 216) of the patients with abnormalities were identified. Computed tomographic scans detected 90% (406 of 453) of the fractures and 54% (56 of 104) of the subluxations and dislocations; 92% (198 of 216) of the patients with abnormalities were identified. Most of the abnormalities missed on the CT scans involved the dens, C-6, and C-7, and were oriented in the axial plane. Although CT scanning was better than plain films in detecting most types of cervical fractures, plain films were better than CT for detecting fractures of the vertebral body, dens, and spinous processes, and significantly better than CT in detecting subluxation and dislocation. When plain films and CT scans were combined they identified 98% (443 of 453) of the fractures and 99% (103 of 104) of the subluxations and dislocations; 100% (216 of 216) of the patients with abnormalities were identified. In the 20 patients who underwent both CT scanning and TOMOS, TOMOS detected more fractures, subluxations, and dislocations than CT scanning. Complex-motion tomographic studies detected atlanto-occipital dislocation and subluxation of the vertebral bodies and fractures of the spinous processes, lateral masses, articular processes, vertebral bodies, and dens better than CT scanning. Although the more routine use of CT scanning in evaluating cervical trauma should increase the detection of cervical abnormalities to near 100%, TOMOS remain the gold standard of diagnosis for atlanto-occipital dislocation, subluxation of the vertebral bodies, and fractures of the lateral masses, articular processes, vertebral bodies, and dens.


The effects of alcohol intoxication on the initial treatment and hospital course of patients with acute brain injury. The effect of alcohol intoxication at the time of injury on hospital outcome was evaluated in 520 adult patients diagnosed with brain injury who were admitted to the emergency department of Harborview Medical Center. Data were collected for each subject's status from field intervention through hospitalization. Serum alcohol levels were measured from blood drawn in the emergency room, and the subjects were stratified into two groups: intoxicated (> or = 100 mg/dL, n = 191) and nonintoxicated (< 100 mg/dL, n = 329). Compared with subjects who were not intoxicated, intoxicated patients were more likely to be intubated in the field or emergency department (relative risk [RR] = 1.3, 95% confidence interval [CI] = 1.1-1.5), require placement of an intracranial pressure bolt (RR = 1.4, 95% CI = 1.1-1.8), develop respiratory distress requiring ventilatory assistance during hospitalization (RR = 1.8, 95% CI = 1.0-3.3), or develop pneumonia (RR = 1.4, 95% CI = 0.9-2.2). The similarities in the clinical presentation of patients with acute brain injury and those who are intoxicated appear to influence prehospital care and also suggest that a more objective assessment of cerebral injury than provided by clinical diagnostic measures alone is required, thus accounting for the elevated likelihood of intracranial pressure monitoring in intoxicated trauma patients.


Emergency room resuscitative thoracotomy: when is it indicated? This study was designed to examine the results of emergency room resuscitative thoracotomy (ERRT) and to formulate cost-effective indications for this procedure. A retrospective study was performed of 28 patients who had ERRT at St. Elizabeth Hospital Medical Center, Youngstown, Ohio, during the 4 years from July 1985 through June 1989. The prognostic factors analyzed included mechanism and site of injury, signs of life (SOL), vital signs (VS), age, gender, and prehospital care. The overall survival rate of ERRT was 7% (2 of 28 patients). The survival rate was 18% (2 of 11 patients) with penetrating trauma, and 0% (none of 17 patients) with blunt trauma. The best survival rate was 66% in the subgroup of patients with penetrating trauma and SOL present at the scene and in the emergency room (ER), (two of three patients). Our observations were combined with those of 23 studies from the literature involving 2294 trauma patients who had ERRT. Using meta-analysis, the survival rate was 11% overall. Improved survival was noted for patients with penetrating trauma compared with patients with blunt trauma (14% vs. 2%, p < 0.01). There were no survivors in the group of patients with no SOL at the scene, and there were no neurologically intact survivors among blunt trauma patients with no SOL upon arrival at the ER. An algorithm based on mechanism of injury and presence or absence of SOL at the scene and in the ER is proposed. This algorithm would decrease the number of ERRTs performed by 41% without decreasing the number of neurologically intact survivors.(ABSTRACT TRUNCATED AT 250 WORDS)


Computed tomography in the initial evaluation of patients with blunt trauma. Two hundred sixty-six of 374 consecutive blunt trauma patients underwent emergency computed tomographic (CT) scanning during evaluation at a level I trauma center. The purpose of this study was to develop guidelines for use of CT scanning in the initial evaluation of blunt trauma patients. Of the 131 CT scans of the head obtained, 20 (15%) had positive results. Seven patients whose initial neurologic examinations were normal had abnormal results on head CT scans; none required emergent treatment of their head injury. This suggests that, in the presence of a normal neurologic examination, head CT scans can safely be delayed until other more serious injuries are addressed. Twenty-six CT scans of the chest were performed and ten (38%) were interpreted as abnormal. Chest CT scans provided information about the extent of the injury but did not alter the initial management of any patient and therefore are rarely indicated in the acute evaluation of trauma patients. A total of 110 abdominopelvic CT scans were performed and 20 (19%) were interpreted as positive. Seventy-five percent of those patients with positive CT scans were treated successfully in a nonsurgical fashion.


Posttraumatic disablement: a prospective study of impairment, disability, and handicap. This study was designed to evaluate both the frequency and the course of impairments, disabilities, and handicaps resulting from trauma. It was conducted in Aquitaine, France, on a sample of 1005 trauma patients (mean ISS, 10.5 +/- 0.3) in which severe trauma (ISS > 25) was rather overrepresented (169 of 1005). A prospective follow-up of disablement according to the WHO classification was based on medical examinations performed 6 and 12 months after the trauma. Of 664 survivors reviewed at 6 months, the findings were cross tabulated with Injury Severity Score (ISS) and age. There was a good relationship between ISS and the mean length of stay in the hospital (r = 0.46; p < 0.001), the duration of rehabilitation, and the time away from work or school. Out of this sample of 1005 patients with rather major injuries, 73% of the survivors suffered from at least one impairment, with a consistently lower frequency in children whatever the severity. At least one disability was encountered in 52.3% of these patients depending on both ISS and age. Handicap was noted in at least 26% of the cases. Between the sixth month and the end of the first year, the minimal handicap regression was 35.8%, whereas the minimal regression of the disability rate was 19.5%. The best improvement was observed essentially in the low ISS categories. Whereas for minor trauma the course of disablement seems to be fixed 1 year after the injury, such is not the case for severe trauma.


The association of trauma death and alcohol use in a rural state. This study documents the strong association of alcohol in trauma-related deaths. In a previous study alcohol was present in 62.8% of homicide victims, 48.6% of unintentional injury fatality victims, 35.3% of persons who committed suicide, and 14.4% of persons who died of natural causes. The present study uses the legal limit of 100 mg/100 mL to include patients as having an alcohol-associated trauma death. In addition the study includes patients who die up to 20 hours after injury. These features of our study result in the lower reported frequency rates. Our study confirms that alcohol is strongly associated with trauma deaths resulting from motor vehicle crashes. It also demonstrates a strong association between alcohol use and victims of all types of trauma mortality; specifically those victims of gunshot wounds, burns, stabbings, and falls all are frequently using alcohol. This information is of importance for those who treat such injured patients, since such tests as neurologic examination frequently will be compromised by the use of alcohol in the victims of major trauma. Perhaps most importantly this information can be of help in designing appropriate strategies in attacking this problem the best possible way--by prevention.


TRISS unexpected survivors--a statistical phenomenon or a clinical reality? Data from patients treated in Pennsylvania-accredited trauma centers during 1989 were analyzed. TRISS expected and unexpected survivors (1.6% of all survivors) differed in many ways. Unexpected survivors were more than twice as likely to have been transferred from a nondesignated trauma center (45.8% vs. 22.8%, p < 0.001). Unexpected survivors had significantly higher frequencies of motor vehicle injuries (56.2% vs. 38.3%, p < 0.001), pedestrian injuries (9.6% vs. 5.4%, p < 0.01), and gunshot wounds (7.3% vs. 4.7%, p < 0.01). Expected survivors were injured more frequently in falls (26.1% vs. 10.8%, p < 0.001) and were less frequently male (64.5% vs. 75%, p < 0.001). Unexpected survivors had significantly longer average hospital stay (29.6 s vs. 9.3 days, p < 0.001) and more frequent (98.8% vs. 36.8%, p < 0.001) and longer average stays in the ICU (13.3 s vs. 4.1 days, p < 0.001). The percentage of unexpected survivors discharged to rehabilitation centers (61.9%) was significantly greater than that for expected survivors (8.7%), (p < 0.001). Unexpected survivors were more frequently judged "completely dependent" in five measures of functional disability than expected survivors. We conclude that unexpected survivors are a seriously injured and clinically relevant patient set, not just a statistical phenomenon.


Difficult aeromedical rescue situations: experience of a Swiss pre-alpine helicopter base. Swiss Air Rescue (REGA) teams execute more than 3000 aeromedical missions annually, of which some require the use of a winch. To evaluate the need for early medical intervention at sites where landing is impossible, we analyzed retrospectively 100 consecutive operations (10.8% of all primary missions, 110 patients) accomplished by the REGA base at Lausanne with an emergency physician of the Centre Hospitalier Universitaire Vaudois (CHUV) on board. In such difficult rescue conditions, time to call, response times, and scene times were particularly long (mean delay to admission: 114 minutes). Fourteen patients were dead on arrival, 22 were uninjured, 50 had NACA Index 1-3 injuries (moderate), 22 had NACA Index 4-6 injuries (severe). Seventeen required major intervention at the site or during rescue. We conclude that in our European pre-alpine region 22% of patients rescued by winch are severely injured. Since rescue actions are particularly long and difficult, the performance of advanced procedures at the scene and during transportation is of great value.


Intrahepatic arterioportal fistula following conservative treatment of a traumatic liver rupture: case report. A 16-year-old girl with severe liver injury complicated by the development of an intrahepatic arterial aneurysm and arteriovenous fistula is presented. Nonsurgical treatment combining close observation and repeat hepatic arterial embolization was successful.


Appendiceal transection in a child associated with a lap belt restraint: case report. The seatbelt syndrome refers to the spectrum of injuries associated with lap belt restraints and includes intestinal tears, perforations, and transections; mesenteric disruptions; and lumbar distractions, dislocations, and fractures. We report a case of appendiceal transection associated with a lap belt restraint in a small child.


Massive craniofacial injuries from recreational fireworks: a report of three cases. Recreational rocket injuries can result in massive destruction of facial soft tissues and bone and can produce long-term sequelae. This study reviews the cases of three patients who arrived at our medical center within a 3-week period in July 1990 who sustained severe craniofacial injuries from fireworks. A timely multidisciplinary approach is important in the care of these injuries, since there are usually associated serious ophthalmologic and cranial injuries that require immediate attention. We present the management dilemmas confronting the personnel who treat such injuries as well as tips on avoiding long-term complications.


Case report: the management of penetrating cardiac trauma with major coronary artery injury--is cardiopulmonary bypass essential? Major coronary artery injury in penetrating cardiac trauma is relatively uncommon and is associated with a poor prognosis. However, for a variety of reasons, the outcome for such patients has been improving during the last two decades. The main factor responsible for this change is, according to some authors, the use of emergency cardiopulmonary bypass (CPB). We present a case of complete transection of the LAD coronary artery managed by primary ligation of the vessel, but because of progressive signs of extensive myocardial infarction, the patient underwent emergency CPB and an aortocoronary bypass graft. The patient experienced a good cardiac recovery but died 5 days later of irreversible anoxic brain damage. In reviewing the literature concerning the absolute need for emergency CPB in the management of penetrating coronary artery injury (PCAI), we found that the overall outcome for patients treated with emergency CPB was not significantly better than for those treated with ligation alone. We believe that CPB is not always essential in the management of PCAI and should be instituted only when the injury to a main coronary artery is very proximal, whenever associated intracardiac injuries exist, or when the patient develops extensive myocardial infarction or uncontrolled arrhythmias following ligation of the injured coronary vessel.


Penetrating stab wound of the gluteus--a potentially life-threatening injury: case reports. Presented are two cases of stab wounds through the gluteus in which serious damage was incurred by internal organs: in one case there was penetration of the rectum with the appearance of signs of acute abdomen; in the other there was tearing of retroperitoneal muscles and the internal iliac vessels with resultant hypovolemic shock. These observations suggest that there should be greater awareness of the life-threatening nature of stab wounds of the gluteus under similar circumstances.


Fracture-dislocation of the lumbosacral spine: case report and review of the literature. This report describes an extensively comminuted fracture of the sacrum and the L-5 vertebral body with complete anterior dislocation of the lumbar spine on the sacrum that occurred in a 19-year-old man ejected from a motor vehicle. Lumbosacral dissociation was characterized by computed tomography with three-dimensional and multiplanar reconstruction, and definitively managed by posterior instrumentation using locking hook spinal rods attached to the pelvis with hockey stick attachments by the Galveston technique. Implications of this case and a review of the literature are presented.


Avulsion fractures of the scapula: report of eight cases. Fractures of the scapula from indirect trauma represent 0.01% of all skeletal fractures treated in our Institute. They are avulsion fractures that result from the violent pulling of the muscles, the ligaments, or both on their bony insertion. In our series of eight cases any possible direct trauma to the scapula was carefully excluded. In all patients treatment did not represent a particular problem and it was always conservative. Clinical results were always good, with excellent recovery of shoulder function except in one case with a circumflex nerve lesion leaving a deltoid muscle deficit.


Bilateral patellar tendon rupture: case report and literature review. Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases. We report the case of a 67-year-old man with bilateral ruptures of the patellar tendons caused by minor trauma and with a good functional end result.


Bilateral sacroiliac joint fracture-dislocation requiring late coccygectomy: a case report. Associated injuries often prevent aggressive management of bilateral sacroiliac fracture-dislocations, although excellent results have been reported with nonsurgical treatment. We report a case of bilateral sacroiliac joint fracture-dislocation in a patient with multiple injuries which was managed with the placement of an external fixation frame. This patient developed a prominent and painful coccyx and ultimately required a coccygectomy. The excellent final result demonstrates the therapeutic role of coccygectomy as a late treatment for this injury.


Oblique sliding metatarsal osteotomy for pressure metatarsalgia. The transverse arch of the foot is formed by metatarsals which heads lie in a straight line to endure most of the loading of the forefoot. Malalignment of one or more metatarsal heads will result in increased loading and produce local tender plantar callosity. The treatment of pressure metatarsalgia must aim for it's pathomechanic cause, that is, hyper-extension of metatarsophalangeal joint. We have modified the distal metatarsal osteotomy to treat 40 toes in 22 cases. Follow up for an average of 21.3 months (ranging from 18 months to 31 months) indicated 19 cases (86.4%) with satisfactory results. The 3 cases with unsatisfied results were all due to early removal of the pin. Maximum oblige sloping of the osteotomy makes the osteotomy slide more easily and ensures union. Intramedullary pinning and early weight bearing maintain the osteotomic alignment, prevent foot stiffness and allow the distal fragment telescopes to be adequately positioned to prevent over correction which leads to transfer lesion. Compared to other methods, modified metatarsal osteotomy is less invasive, preserves natural structure, is easily performed and easy cared for which leads to effective and stable results.


[The effect of monosodium L-glutamate (MSG) treatment during neonatal period on the pineal function in young female rats]. The purpose of this study is to examine whether monosodium L-glutamate (MSG) influences the function of pinealocytes in female rats. MSG was administered at a does of 4 mg/g body weight to rat pups on days 1 and 3 postnatally. As the rats matured, sexual receptivity as well as proceptivity were observed by testing the lordosis quotient (LQ), rejection quotient (RQ) and solicitation. Pineal function was estimated by measuring the serum level of melatonin and the activity of protein kinase A (PKA) in the pineal gland. Blood samples were withdrawn at light and dark phases for four consecutive days, respectively. The serum concentration of melatonin was determined by radioimmunoassay and the data of each phase were pooled together. The results showed that both the receptivity and proceptivity of MSG-treated female rats were significantly lower than that of the control ones. Melatonin levels during the dark phase were significantly higher than those during the light phase in both control and MSG-treated groups, but whenever in the light or dark phase, the levels of melatonin were the same in both groups. There was no significant difference in PKA activity in the pineal gland between the control and MSG-treated group. These results indicate that MSG used as a neurotoxin to induce hypogonadal status affected neither the PKA activity of pineal gland nor the serum level of melatonin in young female rats. Thus, the decrease in receptivity and proceptivity of MSG-treated female rats was not caused by the alteration of pineal function.


[A study on sexual differences of postero-anterior cephalometrics among Chinese in Taiwan with different occlusions]. The main purpose of this study is to investigate the characteristics of cranio-dento-facial morphology among Chinese in Taiwan with different occlusions by the postero-anterior cephalograms and to examine the differences between sexes in the cranio-dento-facial width as well as morphology. Our study comprised three hundred and seventy three patients with preorthodontic treatment records. They were divided into 12 groups with respect to the Angle's classification, sex, and age. Summarizing the differences of the various cephalometric analyses, 31 kinds of measurement, including 20 values of width dimension and 11 values of the width ratio, were employed. The results of using the Student t-test to study the sex differences of cranio-dento-facial width and morphology are summarized as follows: (1) The sexual dimorphism of the cranio-dento-facial width occurs as early as the age of 9-12. The deviation is augmented continuously with growth and, hence, it is more pronounced in adults. (2) Regardless of the class of occlusion or the stage of maturity, the cranio-dento-facial size of the male is significantly larger than that of the female. However, their cranio-dento-facial morphology is similar. (3) The sexual dimorphism of the cranio-dento-facial width dimensions is most pronounced in the zygoma, the mandibular angle and the condyles.


[Surgical management of blunt splenic trauma]. From 1986 to 1990, 94 patients with blunt splenic trauma were hospitalized and operated on in the Kuang Tien General Hospital. Included were 74 males and 20 females with a mean age of 33 years (range: 5 to 78). The mean duration of the follow-up was 40 months. We classified the severity of the injury according to the splenic injury scale which was published in 1989 by the Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.). Based on the operative findings, the splenic injuries of the 94 cases were classified as follows: grade I--4 cases, grade II--14 cases, grade III--24 cases, grade IV--41 cases, and grade V--11 cases. Twelve of the patients were treated with splenorrhaphy, and 82 cases underwent splenectomy. The mortality rate was 5.3%, and the morbidity rate, 12.8%. The most frequent postoperative complications in the patients who survived the initial operation were wound infections (4.2%), small bowel obstruction (3.2%), pulmonary infection (3.2%), intra-abdominal abscesses (1.1%), and pancreatitis (1.1%).


Pituitary oncocytoma: three cases report. Three out of 102 pituitary adenoma patients, including 2 males and one female, had their pituitary tumors diagnosed as "oncocytomas" and underwent transsphenoidal adenomectomy. The tumors were confirmed as "pituitary oncocytomas" by both immunohistochemical staining and electron microscopy. They had poorly developed subcellular organelles and were markedly hyperplastic and pleomorphic, with swollen mitochondria in the cytoplasm and scattered secretory granules along the cell membranes. Postoperative follow-up revealed that visual acuity gradually improved in all the patients, and no tumor recurrence was found. The accurate preoperative diagnosis of pituitary oncocytomas relies on endocrinological, neuroradiological clinical evaluation, and the management of this disease must be surgery with postoperative radiotherapy.


[Schizophrenia and factitious cheilitis: a case report]. Factitious Cheilitis is a rare skin disorder which has been seen in patients with emotional disturbances, particularly in cases with neurotic and personality disorders. However, there have been no reports of factitious cheilitis seen in cases of schizophrenia. This study reports on a case of schizophrenic disorder, where the patient was observed to develop factitious cheilitis whilst subject to unstable psychiatric conditions. The case reported here is of a 59 year-old female widow, who has experienced the delusion of being controlled, the delusion of being possessed. Been subject to auditory hallucination and vague somatic pain for eight years and had a very poor psychotropic drug compliance. Observation revealed frequent licking of the lips unrelated to drug-induced dyskinesia, but as a possibly linked response to hallucination whilst subject to an intense unstable emotional and painful state. Factitious cheilitis was proved with biopsy of the lips and pathological findings of acanthosis, hyperkeratosis and parakeratosis. After psychiatric and dermatologic care, her cheilitic condition improved. This study demonstrates that factitious cheilitis can be seen in a schizophrenic patient, specifically where hallucination and emotional instability coupled with long-term licking of the lips can result in factitious cheilitis. The relationship of skin disorder and psychiatric illness is discussed.


[Human ecological and epidemiological studies of Japanese immigrants and their descendants in South America]. Over a million people of Japanese origin reside in South America. However, only a limited number of studies on their health status and lifestyle factors affecting it have been carried out. The author and his co-workers have been conducting a series of field surveys on the health situation and lifestyle factors in Japanese immigrants and their descendants in various areas of South America. The subjects of the first-phase study were residents in four agricultural settlements (colonies) in the suburbs of Brazil, Paraguay and Bolivia. The levels of minerals and heavy metals in the hair were measured, and significant variations were found in several elements. These different levels were found to be regulated by the environmental level of their living place and by the dietary pattern. In the second-phase study, several health-related indicators such as blood pressure, anthropometric features, viral infection markers in sera, and dietary pattern were investigated in two group of immigrants, one from Okinawa and the other from the mainland of Japan, both living in Bolivia. Differences in health situation and lifestyle were identified between them. Traditional habits seen in their original places of residence in Japan still existed in their life in Bolivia, while the introduction of Bolivian lifestyle was prevalent among them. Although the number of Japanese residents in Brazil is largest in the world outside of Japan, little has been known about their health situation. The subjects of the third-phase study were Japanese Brazilians. A descriptive epidemiologic study was carried out, and the mortality and incidence of cancer were determined. Some changes in disease pattern were noted when compared with Japanese in Japan, but these changes were not as marked as in the case of Japanese in the U.S.. A cross-section study on the lifestyle factors of Japanese residents in São Paulo showed some differences in health-related indicators and dietary habits in comparison with Japanese living in five areas of Japan. Such differences were also found among Japanese in São Paulo according to the place of origin in Japan. These series of studies in Japanese immigrants in South America showed the importance of lifestyle factors, especially dietary habits, for the health situation.


[Statistical study of the optimal conditions of the spiral plating method for counting bacterial numbers in river water]. The application of the spiral plating method, a rapid and labor-saving technique for enumerating bacteria in food, to evaluate bacteria in river water, was examined. Standard plate counts and the numbers of heterotrophic bacteria, coliforms and Flavobacterium spp. in the water were tested by the spiral plating method, the results were compared with those of the conventional method and the optimal conditions for using the spiral plating method were considered and selected to fit the conventional methods. The optimal conditions selected were as follows: by laser colony counter after incubation at 35 degrees C for 38h. for standard plate counts; by laser colony counter after incubation at 25 degrees C for 48h. for the numbers of heterotrophic bacteria and Flavobacterium spp.; by colony viewer counting reddish colonies > or = 0.25mm in diameter after incubation at 35 degrees C for 22h. for the number of coliforms. The numbers of bacteria, except for coliforms, determined by this spiral plating method were found to be closely related to those from conventional methods (r > or = 0.91), and the replicating variances of both methods were not significant. The counts of bacteria by laser colony counter gave results similar to those by colony viewer counting by visual inspection. This spiral plating method saved time, money and labor in the evaluation of bacteria in river water as comparable to that in food. These results indicate that the spiral plating method can be used in place of conventional methods in evaluating the number of bacteria in river water.


[Concentration of trace elements in hair from children living in a Keshan disease district in China]. The hair from 9 children living in a Keshan disease prevalent district and from 10 children living in a Keshan disease non-prevalent district in China was analyzed. At the same time, the hair from 35 children of the same age residing in Tsukuba district in Japan was analyzed for comparison of the concentration of essential trace elements with that of children living in the Keshan disease prevalent district. Se concentration was determined by a fluorophotometric method and 16 other elements were analyzed by ICP emission spectrometry. Hg was analyzed by the heating evaporation method and by neutron activation analysis. The Se concentration in the hair of children living in the prevalent district was very low, being one-tenth that of the Japanese. The Ni concentration was particularly low in the prevalent district, and it determined to study more about the effects of Ni deficiency on health. In the prevalent district, Mg and Ca levels were low and those of Pb, Fe, Al, Ti were relatively high. Mn concentrations of both districts in China were very high when compared to the Japanese. The results of this study showed that the low Se concentration in Keshan disease is in agreement with previously reported data. Ecological factors, including nutrition were considered to be important in the etiology of this disease.


Metabolic fate of cis- and trans-chlordane in mice. A single dose of a cis-chlordane and trans-chlordane mixture (1:1) was orally administered to mice (total dose: 40 mg/kg), and the metabolic fate of the two congeners administered and their major metabolite, oxychlordane, in various tissues, was studied from day 1 after dosing to week 52. Cis-chlordane and trans-chlordane showed the highest concentrations on day 1 after dosing, and disappeared on day 14 except in the liver. The half life in the tissues was approximately one day for both congeners. On the other hand, oxychlordane was observed in various tissues from day 1 after dosing, reaching the maximum concentration on day 1 or 2 showing considerably higher concentrations than those of the congeners. The rate of decrease of oxychlordane in the tissues was extremely slow compared to the congeners. It was found that oxychlordane remained in the tissues even in week 52 (year 1) after dosing. The regression curve for the tissue oxychlordane concentration was diphasic after or at around week 8 after dosing; the half life was approximately 20 days in the first phase and was prolonged to over 100 days in the second phase. These results suggest that the cis-chlordane and trans-chlordane taken into the human body via foods disappear rapidly from the tissues but that oxychlordane, their metabolite, remains in the body over a prolonged period of time.


Effect of the continuity and sampling rate of polygraphy data on sleep stage by a computerized scoring system--a reliability study. The percentage of each sleep stage determined by visual judgment was compared with computerized judgment using continuous and three intermittent sampling data. Comparison of stage agreements of four types of computerized judgments with visual judgment were also conducted. Hypnograms of six healthy young male students were recorded on each of five nights. Data of each subject were compiled individually, and the six data were analyzed. Agreement rate of the sleep stage by computerized judgment using continuous (method A), one-third (method B), one-ninth (method C), and one-fifteenth (method D) data with that of visual judgment were compared. The agreement rate of visual and computerized judgment using method A showed no difference from that between visual and computerized judgment using method B. There was a significant loss of agreement between visual and computerized judgment using method C or D compared with that between visual and computerized judgment using method A. Paired t-tests were conducted for each stage percentage against total sleep time of visual judgment and those of computerized judgments using method A, B, C, or D. There were no significant changes in any sleep stage percentages between visual judgment and computerized judgments using method A, B, C, or D. From sleep stage agreement and the degree of difference from visual judgment, the acceptable limitation of the sampling period was concluded to be one-third of continuous data.


[Characteristics of medical institutions visited by 30 intractable disease patients receiving financial aid for treatment]. In order to determine the characteristics of medical institutions which patients with 30 intractable diseases visited, we analyzed data of a nationwide survey conducted by the Epidemiology of Intractable Diseases Research Committee in 1989. Each of 47 prefectural governments in Japan reported information of all patients with 30 intractable diseases who received financial aid for the diseases between April 1988 and March 1989. Information collected about each patient consisted of identification numbers, which included the disease code, sex, age, the code of the municipality where the patient lived, the medical institution which treated the patient, etc. Out of 173,637 patients whose information was reported by prefectural governments, we used data of 159,910 patients whose medical institutions were reported completely. The results can be summarized as follow: 1) Of the 159,910 patients, 8.6 percent visited medical institutions outside of the prefectures where the patients lived. Many patients living in prefectures located close to large cities, such as Tokyo, visited medical institutions in large cities. 2) The proportion of patients who visited hospitals of medical schools was 27.9 percent. 3) Patients who were affected by diseases causing physical disabilities such as SMON and malignant rheumatoid arthritis tended to visit medical institutions located in their neighborhoods and were treated in small hospitals or clinics. Old patients had the same tendency as patients with such diseases. 4) Although the number of patients receiving aid in 1988, whose data we analyzed in the current study, was larger than that in 1984, the proportion of patients visiting medical institutions outside of the prefecture where the patients lived, and the proportion of patients visiting hospitals of medical schools were nearly equal to those in 1984.


[Factors influencing prolonged hospital stays by elderly patients: problems in medical management including use of urethral catheters]. Fifty-nine elderly patients who had been hospitalized more than six months in five hospitals in the city of Mino in Osaka Prefecture, were studied to clarify the factors influencing prolonged hospital stays by the elderly. Their mean age was 82.2 years, and women accounted for 86% of the patients. One-third had suffered a stroke. As for ADL, 44% were completely dependent when walking, eating, bathing and dressing. Moreover, 36% had severe dementia, 19% suffered from decubitus ulcers, 66% were undergoing rehabilitation, 58% were receiving venous infusion therapy, 36% used a urethral catheter, and 10% were receiving tube feeding. The subjects were divided into two groups according to the likelihood of discharge assessed by the doctors in charge: one group consisted of 27 patients who might be discharged and the other of 32 patients with an ongoing need for inpatient care. Multivariate analyses using Hayashi's quantification method II indicated that use of a urethral catheter and not undergoing rehabilitation were the main factors associated with the need for inpatient care, while being a woman, being of advanced age and not having one's own room at home were the non-medical factors which made it difficult for the patients to be discharged from the hospital. As use of a urethral catheter was the factor most strongly related to prolonged hospital stay, multivariate analyses were applied to the 45 patients with urinary incontinence, who were divided into one group of 21 patients with, and one of 24 without a urethral catheter. The factors associated with use of a urethral catheter were then investigated.(ABSTRACT TRUNCATED AT 250 WORDS)


[Concentration and form of asbestos fibers in tap drinking water contaminated from a water supply pipe with asbestos-cement]. The identification and concentration of asbestos fibers in tap drinking water supplied in a central area of Akita Prefecture, Japan, were determined by phase-contrast microscopy and a scanning electron microscope equipped with an energy-dispersive X-ray microanalyzer. The following results were obtained. 1. Asbestos fibers were found in the tap water from two areas in which an asbestos-cement pipe was used for public water supply. The concentrations of asbestos fibers in the tap water were 2.7 x 10(4) to 27.0 x 10(4) fibers per liter of water in area A and 10.0 x 10(4) to 21.0 x 10(4) in area B. On the other hand, no asbestos fiber contamination was observed in tap water of area C, which shared a common water source with area A. A vinyl chloride pipe was used over the entire length of the water supply in route C. 2. Crocidolite was the predominant type of asbestos fiber detected in the tap water. Chrysotile and a mixture of chrysotile and amosite were also observed. 3. Almost all asbestos fibers detected in the tap water possessed the form of thick or sheaved fibers with lengths ranging from ca. 5 to 10 microns. Their shapes were very different from those of asbestos fibers found in the atmosphere. The typical form of the latter is short (ca. 1 micron in length) and needle-like. 4. It was suggested that the contamination of asbestos fibers in the tap water was caused by erosion and peeling off of the inner wall of the asbestos-cement pipe used as a conduit. In order to evaluate the safety of drinking water in Japan, an extensive survey on asbestos-fiber contamination in tap water is necessary.


Age-related differences in the inhibition of neuropathy target esterase and susceptibility to triphenyl phosphite-induced delayed neurotoxicity in chickens. Triphenyl phosphite (TPP)-induced delayed neurotoxicity, which is thought to resemble but somewhat differ from classical organophosphate-induced delayed neurotoxicity (OPIDN), is known to be age-dependent. The relationship between clinical appearance and histopathological lesions, and the inhibition of neurotoxicity target esterase (NTE) in nervous tissues were compared in young and adult chickens after i.v. administration of TPP. NTE inhibition by TPP in vitro was also compared between the two age groups. Fourteen days after i.v. administration of TPP (50 mg/kg), adult chickens (24 months old) showed obvious histopathological lesions as well as obvious clinical neurological signs. On the other hand, young chickens (65 days old) showed few histopathological lesions and only marginal neurological signs. NTE activity in brain, spinal cord, and sciatic nerves was inhibited in a dose-dependent manner in both age groups. While inhibition tended to be mild in the younger chickens, the level of activity was less than 30% of the normal value in all three tissues at 24 hours after administration of 50mg/kg of TPP (14% vs. 8% in brain, 15% vs. 9% in spinal cord and 13% vs. 14% in sciatic nerves). Recovery of NTE activity in the sciatic nerves was faster in the younger chickens. The IC50 of TPP on brain (6.67 vs. 6.76 x 10(-8)M) and spinal cord NTE (1.05 vs. 1.53 x 10(-7)M) was almost the same in the two age groups. These results confirmed age-specific susceptibility to TPP, not only clinically but also histopathologically, and, suggested that the differences in both TPP metabolism and NTE recovery are related to and/or contribute to this age specificity. Judging from the age specificity and the figure of NTE inhibition, the delayed neurotoxicity produced by an i.v. administration of TPP is virtually identical to classical organophosphate-induced delayed neurotoxicity. Hydrolytic products may produce additional effects characteristic of TPP-induced neurotoxicity observed after an s.c. dose.


[Phase I clinical trial of a new myocardial imaging agent, 99mTc-PPN1011]. A new myocardial imaging agent, 99mTc-1,2-bis[bis(2-ethoxyethyl) phosphino]ethane (99mTc-PPN1011) was administered to healthy male volunteers to evaluate its safety and kinetics. No significant drug-related events were observed. After intravenous injection, blood clearance was rapid. Prompt heart uptake (1.8% of the injected dose after 5 minutes) was followed by relatively slow wash-out (1.0% remained after 3 hours). Liver and lung uptake was observed but the clearance was more rapid than in the heart. 4.7-24.0% of the injected 99mTc-PPN1011 was excreted into urine until 4 hours after injection. 99mTc-PPN1011 also seemed to be excreted through hepato-biliary system. Excellent and low-background myocardial images were obtained using either SPECT or planar imaging. We conclude that 99mTc-PPN1011 could be useful for myocardial perfusion imaging.


[Dual nuclides SPECT for ventilation and perfusion study]. Dual nuclides SPECT using 81mKr and 99mTc-MAA for ventilation and perfusion study was performed in 24 subjects. Crosstalk of 81mKr to 99mTc-energy window was about 7.5% when ventilation and perfusion study were performed by 370 MBq of 81mKr gas and 185 MBq of 99mTc-MAA. Areas of low V/Q was significantly larger in SPECT study than in planar study, in 11 cases with various pulmonary diseases. High V/Q mismatches were also more clearly delineated in SPECT than in planar study. Dual nuclides SPECT study has advantages of obtaining V/Q distribution without movement artifacts and of simultaneous acquisition of ventilation and perfusion image. Area of high V/Q became larger in SPECT with crosstalk than in SPECT without crosstalk, but in the low V/Q area no significant difference was noted between SPECT with crosstalk and without crosstalk.


[Right ventricular volume determination by continuous 81mKr infusion and 99mTc blood pool imaging]. Our newly developed radionuclide method for the calculation of right ventricular (RV) volume was examined in this study. Using a semi-geometric count-based method, volume can be measured by the following equation: Cv = Cm/(L/d). V = (Ct/Cv) x d3 = (Ct/Cm) x L x d2. (V = volume, Cv = voxel count, Cm = the maximum count of a container, Ct = the total count of the container, L = maximum length of the image of the container obtained from a direction perpendicular to the direction where the count data were collected, and d = pixel size.) A phantom study was performed by setting a cylindrical container in a system which circulated 5 liters of water per minute. 81mKr solution was infused continuously into the container, and images of the container were collected for one minute. Cm and Ct were obtained and, because the container was cylindrical, the maximum width of the image of the container was measured as L. The volume of the container was calculated using the above equation. The container's true volume and the volume measured by this method showed a good correlation with r = 0.997 (n = 13, p < 0.001). This theorem was applied to RV images obtained in the 30 degree right anterior oblique position by continuous infusion of the 81mKr solution. Multiple gated acquisition was performed and RV end-diastolic maximum counts and total counts were obtained. The RV maximum width was measured as L on the end-diastolic cardiac pool image with 99mTc-D-HSA collected in the 40 degree left anterior oblique position.(ABSTRACT TRUNCATED AT 250 WORDS)


[A method for measurement of regional cerebral blood flow using N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) SPECT; two scans with one point blood sampling technique]. We have developed a new method to quantitate regional cerebral blood flow (CBF) using 123I-IMP and SPECT. This technique requires two SPECT scans and one blood sampling. Based on the 2 compartment model (influx; k1 and outflux; k2), a table between k2 and ratio of 1st scan counts/2nd scan counts was calculated, and a table look up procedure yielded a unique pair of k1 (CBF) and distribution volume (Vd = k1/k2) for each region of interest (ROI). The arterial input function was obtained by one point blood sampling to calibrate the standard input function, which has been obtained from the previous study on 12 subjects. This method was applied to 5 subjects including 1 healthy volunteer and 4 patients with cerebral infarction, and the regional CBF results were compared with those measured by H2(15)O PET technique. Optimized scan time combination was 40, 180 min which provided the best correlation with H2(15)O-CBF. The Vd values obtained in infarcted regions were significantly smaller than those in normal regions, suggesting the importance of measuring Vd for each ROI.


[Visualization of the female breast in bone scintigraphy]. Breast cancer incidence rates in Japan have more than doubled in the decade between 1975 and 1985 due to a well-established and affluent Western life-style. One hundred patients having breast cancer, 107 patients having mastectomies, and 243 patients having no breast cancer were reviewed for whole body and spot views of bone scintigraphy with 99mTc-MDP. The frequency of positive breast uptake in patients with no breast cancer showed a maximum in those patients between the ages of 30 and 40, with a progressive rise and fall before and after the peak, respectively. Patients between the ages of 50 and 60 with breast cancer showed a maximum uptake of 83%, while those patients between the ages of 70 and 80 with breast cancer showed an uptake higher than 50%. There was a markedly higher breast uptake ratio in the breast cancer group compared to the breast cancer free group. Although this scanning agent was of no value in recognition of tumor localization from breast uptake, we have to suspect a high incidence of cancer existence whenever there was unilateral increased breast activity. Even though the mechanism of 99mTc-MDP uptake by breast tissue is unknown, breast concentration of 99mTc-MDP appears to be influenced by hormones, especially estrogen.


[Dipyridamole-thallium myocardial imaging in patients unable to exercise adequately: comparison with arm and bicycle ergometer]. We assessed the usefulness of dipyridamole-thallium myocardial imaging in patients unable to exercise adequately, compared with arm-ergometer and standard (bicycle) ergometer. Fifty-six patients with arteriosclerosis obliterans, aortic aneurysm, aortic dissection and so on, who were revealed normal imaging, were studied. Only one of 13 cases with arm-ergometer and two of 14 with bicycle ergometer reached target heart rate. Lung thallium uptake in the cases with arm-ergometer (37 +/- 9%) is higher than that with dipyridamole (29 +/- 5%). This elevation may be confused with pectoralis muscle uptake. Washout rate is 45 +/- 9% with dipyridamole and 46 +/- 12% with bicycle ergometer, respectively, though there was no significant differences. Myocardial/background counts ratio with dipyridamole (4.6 +/- 0.8%) is significantly higher than that with arm and bicycle ergometer (arm-ergometer; 3.5 +/- 0.7, bicycle ergometer; 4.2 +/- 0.9). Then, myocardial image with dipyridamole have superior quality. We concluded that dipyridamole-thallium myocardial imaging is very useful in the patients who have suboptimal exercise efforts.


[Autoradiographic demonstration of 18F-FDG distribution within mouse FM3A tumor tissue in vivo]. To demonstrate the distribution of 2-deoxy-2-18F-fluoro-D-glucose (FDG) within the tumor in vivo, C3H/He mice transplanted with FM3A tumors were studied one hour after intravenous injection of FDG using whole-body, macro- and micro-autoradiography. The whole-body autoradiograph showed that the tumor mass as well as the brain, heart, bone marrows, and the diaphragm and crus diaphragm were clearly visualized. The macro-autoradiograph showed the heterogeneous distribution of FDG in the tumor mass. Markedly dense areas surrounding the tumor and the necrotic area were observed. Micro-autoradiograph showed the high grain densities in the macrophages between the necrosis and viable tumor cells, and in the young granulation tissues demarcating between the tumor and surrounding intact host tissues. Our results showed that the FDG uptake in the tumors may reflect not only the uptake by the tumor cells but also that by the inflammatory reaction elements.


[Cerebral hemodynamic difference between early- and late-onset Alzheimer's disease by circumferential profile analysis with 123I-IMP brain SPECT]. We conducted investigation to determine whether early- and late-onset Alzheimer's disease differ pathophysiologically. Five patients with the early-onset (65 years and under) of the disease and 11 with the late-onset (65 years and over) of the disease were studied by single photon emission CT (SPECT) with N-isopropyl-p-[123I]iodoamphetamine (IMP). Circumferential profile analysis (CPA) was performed to examine differences in the predominant hypoperfusion in the temporoparietal lobe, which is considered to be functionally damaged the most in Alzheimer's disease. The Xm values, calculated from gradients between the motor sensory or occipital cortices and temporoparietal cortex in the circumferential profile curve, were compared in both groups. The Xm values for the patients with early- and late-onset Alzheimer's disease were 6.81 +/- 2.10 (count/degree) and 3.28 +/- 1.58, respectively, the difference being significant. Our results suggest that functional abnormalities in the temporoparietal area severer in early- than late-onset Alzheimer's disease and that the application of CPA to IMP SPECT is useful to elucidate the pathophysiological difference between each of the disease.


[A fundamental study of 99mTc-ethyl cysteinate dimer (99mTc-ECD)]. In vitro fundamental studies of 99mTc-ethyl cysteinate dimer (99mTc-ECD), a newly developed radiopharmaceutical for cerebral perfusion scintigraphy, were performed, and were compared with those of 99mTc-HM-PAO, which has been widely applied to clinical use. 99mTc-HM-PAO should not only be injected soon after reconstitution, but also be avoided mixture with saline or drugs such as Diamox, because of its radiochemical purity decreases with the passage of time and the addition of saline and Diamox. On the other hand, the radiochemical purity of 99mTc-ECD reached a constant level of 94-96% at 30 to 180 min after reconstitution, and it remained stable against the addition of saline and Diamox. Therefore, it was suggested that 99mTc-ECD could be injected from an already saline-infused venous-line or mixed with Diamox. However, early injection after reconstitution should be avoided, because 99mTc-ECD did not become stable enough to maintain sufficient radiochemical purity until 30 min after reconstitution. The present studies are suggested that the red blood cell component is largely related to the metabolism of 99mTc-ECD in blood. Furthermore, from study of the metabolic rate using rabbit blood, it was suggested that a species difference existed in esterase activity in blood.


Anesthetically blocked optic nerve conduction in congenital stationary night blindness. It has been hypothesized that the negative configuration of the electroretinogram (ERG) in congenital stationary night blindness (CSNB) may change to a positive configuration following loss of the inhibitory function of the optic nerve centrifugal fibers. In order to study this hypothesis, the ERGs before and after blocking optic nerve conduction by retrobulbar anesthesia were recorded in a patient with CSNB, who had retinal breaks and was being treated with cryopexy under retrobulbar anesthesia. After complete blockade of the optic nerve conduction induced by retrobulbar anesthesia, the ERG showed little change in comparison with that recorded before anesthesia. The above finding indicates that the temporary blockade of optic nerve conduction does not modify the ERG configuration in CSNB.


Photopic electroretinogram B-wave implicit time in monkey eye. Photopic electroretinograms were elicited in anesthetized monkey eyes with stimulus light of various intensities under background light of different luminances. The b-wave implicit time was prolonged with increasing stimulus light intensity and shortened with brighter background luminance. While the change of anesthetic conditions produced by the addition of halothane (0.5% or 1.0%) mildly prolonged the implicit time, it affected neither the waveforms nor the relationship between the b-wave implicit time and background luminance.


Fundus flavimaculatus with severely reduced cone electroretinogram. An 11-year-old girl complaining of progressive visual loss in both eyes showed atrophic macular degeneration with yellowish white flecks around the fovea in both eyegrounds. Decreased vision, central scotoma with normal peripheral visual field, and angiographic dark choroid except for transmitted hyperfluorescence in the macula and at the flecks confirmed the diagnosis of fundus flavimaculatus with atrophic macula. Electroretinograms, however, revealed severely reduced cone responses associated with almost normal rod response, which led to the diagnosis of cone dystrophy. The rare combination of angiographic evidence of fundus flavimaculatus and electroretinographically diagnosed cone dystrophy was discussed.


Glycolytic oscillation and effect of metabolic inhibitor on rat lens. Abnormalities in glucose metabolism are thought to be among the main causes of cataract formation. We have taken noninvasive biochemical measurements of the lens which provides us with information concerning glucose metabolism in the lens epithelium. The autofluorescence of reduced pyridine nucleotides (PN) and oxidized flavoproteins (Fp) in the rat lens epithelium was measured noninvasively as a function of time using redox fluorometry. The oscillations of the metabolic ratio, PN/Fp, were measured in vivo, in situ, and in the organ-cultured lens. The PN/Fp ratio in the organ-cultured lens ranged from 1.05 to 2.57 within a period of 60-90 minutes (mean +/- SD = 1.52 +/- 0.36). This PN/Fp ratio increased by 23% when a respiratory inhibitor (8 mM KCN) was applied to the lens. However, it decreased by 10% in the presence of a complete metabolic inhibitor (8 mM iodoacetamide). The presence of metabolic oscillations in the in vivo, in situ and cultured lens indicates that this oscillation is a local phenomenon. In cell-free extract systems, oscillations of several intermediates in the glycolytic pathway have been previously demonstrated and this PN/Fp oscillation is thought to be a reflection of glycolytic oscillation.


Q-switched Nd:YAG laser treatment for corneal neovascularization. Q-switched Nd:YAG laser treatment to occlude newly formed corneal vessels was performed in patients with herpetic keratitis to reduce corneal opacity and the risk of graft rejection. Nine neovascularized corneas of 9 patients were treated. In 8 of the 9 patients, corneal neovascularization was markedly reduced with a resulting decrease in corneal opacity. Penetrating keratoplasty was performed in 3 patients after the treatment. Two patients in whom YAG laser treatment was effective had uneventful postoperative courses for 13 and 17 months, respectively. In one patient with ineffective YAG laser treatment, rejection occurred 3 months after keratoplasty, and systemic steroid and ciclosporin therapy was needed. Ultrastructural examination of the corneal button removed during keratoplasty from a patient with successful laser treatment showed destruction of vascular endothelial cells and occlusion of the vascular lumen.


Two cases of acquired syphilis with acute central chorioretinitis as initial manifestation. Acquired syphilis has become an overlooked cause of posterior uveitis including chorioretinitis. Two male cases of bilateral acute acquired syphilitic chorioretinitis were observed, one of whom demonstrated an early delay of choroidal circulation during fluorescein angiography, possibly indicating the choroidal or subretinal neovascular proliferation which occurred later. Although both patients had been treated with oral prednisone for approximately one month before their initial visit to our clinic, good visual recovery had not been achieved. Diagnosis was first confirmed by the positive results of serologic Treponema pallidum hemagglutination and Venereal Disease Research Laboratory tests. The patients were successfully treated with orally administered bacampicillin, which resulted in the complete recovery of visual acuity and normal fundus appearance except for slight pigmentary changes of the retina in the macular area.