Shorter stay urology: the way forward

A large part of the total cost of the treatment of surgical patients in hospitals is from the duration of hospitalization. Urology is well suited for short-stay surgery, and a large proportion of our work is elective in nature. We audited our in-patients over a 6-month period and found that 77% of our patients stayed for 3 days or fewer. The advantages of having elective 5-day beds in maintaining our throughput without requiring an increase in the total number of beds is discussed.

Dementia in elderly patients: can the 3R mental stimulation programme improve mental status?

The aim of this study was to determine whether the 3R mental stimulation programme can improve the mental status score (MSS) of a group of patients with dementia attending a day care centre. Fifteen patients with dementia attending a day care centre were exposed to the 3R stimulation programme over eight weeks while 15 controls were not. All patients from both groups were subjected to pre- and post-exposure questionnaires modified from the Mental Status Questionnaire of Kahn et al. A mental status score (MSS) was thus calculated on both occasions. All patients in the exposed group showed an improved mental status score, with the mean 'pre-exposure' and 'post-exposure' scores of 4.4 and 7.3, respectively (p < 0.001; paired t test). In contrast, the mental status scores of 12 control patients had deteriorated and mean 'pre-exposure' and 'post-exposure' scores were 4.1 and 3.4, respectively (p < 0.05; paired t test). Using multiple covariance analysis, the adjusted 'post-exposure' mean mental status score was 7.1 for the exposed and 3.6 for the controlled group (p < 0.001). The 3R programme appears to be effective for short-term mental stimulation of demented elderly people.

[Extramedullary blastic crisis of chronic myelogenous leukemia--a case with various additional chromosomal appearance]

We describe a characteristic case of chromosomal abnormalities in a 47-year-old man with chronic myelogenous leukemia (CML). He had been diagnosed with the chronic phase of CML on May 1990, but he refused treatment. He was readmitted in October 1991 because of peripheral lymphadenopathy. Hematologic studies showed that he remained in the chronic phase of CML. There were no additional chromosomal findings in the bone marrow, but cervical lymph node biopsy revealed complete replacement with blastoid cells. The blasts were positive for CD13 and CD33. DNA analysis for the breakpoint cluster region gene showed rearrangement pattern, but immunoglobulin heavy chain joining region genes and T-cell antigen receptor gene rearrangement were not observed. The karyotype of lymph node cells showed various additional chromosomal abnormalities. Therefore, we concluded that the patient had an extramedullary blastic crisis in his peripheral lymph nodes. Abnormal clones were composed of one main clone and three subclones, with the latter occupying more than 10% of the volume each other. Considering the types of the additional chromosomal abnormalities, all four types of clones were thought to have evolved through independent pathways.

Outpatient adult bronchial asthma in Singapore

OBJECTIVES

To describe the clinical pattern and drug use in adult bronchial asthma seen in Government polyclinics (primary health care centres).

DESIGN

A cross-sectional study using a structured questionnaire.

SETTING

The five largest Government polyclinics in Singapore.

SUBJECTS

Eight hundred and two subjects aged between 21-58 years drawn from the register of outpatient attendances. The response rate was 63%.

RESULTS

The mean age of the study subjects was 37.4 years and the mean age of onset was 19.2 years. Thirty-three percent had onset of asthma under 10 years old. The most commonly reported trigger factors were cold drinks (67%), a change of temperature or humidity (65%), influenza or colds (65%), house dust (58%) and cigarette smoke (37%). In 27%, the work environment was a provoking factor. One-fifth had attacks every night or every day. About half of the patients had FEV1 under 80% of predicted. In the past year, 10% had 4 or more acute attacks requiring emergency attendance, 18% had one or more hospital admissions and 21% had sickness absence from asthma for one week or more. Of the 186 subjects who needed bronchodilators/inhalers 3 times or more a day, only 19.3% were on inhaled steroids.

CONCLUSIONS

Considerable morbidity existed amongst outpatient asthmatics. Inhaled steroids appeared to be under-used.

Inhibitory effect of penicillin on caecal urease activity in chickens fed on a low protein diet plus urea

1. The effects of dietary penicillin on the urease activities of small intestine, large intestine, caecum and their contents, liver and kidney in chickens fed a diet containing 5 g/kg protein plus urea were examined. 2. About 0.88 of the total urease activity determined was observed in intestinal contents, of which 0.95 of the activity was accounted for by caecal contents, 0.05 by colo-rectal contents and none by small intestinal contents. Intestinal tissues (caecum included), liver and kidney accounted for 0.03, 0.06 and 0.02, respectively, of the total urease activity. 3. Dietary penicillin decreased urease activity to 0.17 in caecal contents and to 0.05 in colo-rectal contents of the corresponding control values (P < 0.01). The urease activity of caecal tissue was lowered by penicillin to half that of control activity (P < 0.05) but none of the activities of other tissues were affected. 4. It is concluded that, even when the urease activity is stimulated by dietary urea, 20 mg/kg dietary penicillin can strikingly lower it in the caecum, where most of the urease activity in the chicken body is to be found.

Relationship of decreased caecal urease activity by dietary penicillin to nitrogen utilisation in chickens fed on a low protein diet plus urea

1. The relationship of the decreased caecal urease activity by dietary penicillin to nitrogen utilisation was assessed in chickens fed a low protein diet plus urea. 2. Dietary penicillin at 20 and 100 mg/kg decreased anaerobic bacteria counts, urease activity and ammonia concentration in caecal contents (P < 0.05, except for ammonia in the case of the 100 mg/kg penicillin diet). 3. The 20 mg/kg penicillin diets significantly increased the excretion of urea and total nitrogen (P < 0.05) and decreased ammonia excretion, and significantly reduced nitrogen retention (P < 0.05). The 100 mg/kg penicillin diet also resulted in similar but not significant changes, which tended to be less than those by the 20 mg/kg penicillin diet. 4. Ammonia, urea, glutamine and uric acid concentrations in blood, liver and kidney were unchanged by dietary penicillin. 5. It is concluded that caecal ammonia production from urea was closely correlated with nitrogen utilisation in chickens fed a low protein diet plus urea.

[Adaptation and effects of ileal reservoir on ileo-proctostomy following total colectomy in dogs]

We examined postoperative adaptation and effects of J-pouch reservoir on ileo-proctostomy following total colectomy in dogs. End to end (E-E; n = 5) or J-pouch (J-P; n = 5) anastomosis was performed after resection of total colon and the rectum 3 cm above the peritoneal reflexion. Gastrointestinal motility with strain gauge force transducers (SG) and transit time with barium meal under the fluoroscopy were recorded 6 months after total colectomy. Then, histological changes of seven specimens from totally resected ileum in J-P and E-E vs control (normal ileum; n = 5) were measured with hematoxylin-eosin and PYY immunohistochemical stains. Propagation rate of interdigestive migrating complex (IMC) from jejunum to ileum was significantly lower in J-P (64.8 +/- 13.2%) than in E-E (98.6 +/- 1.2%) (p < 0.001). Oro-neorectal transit time (ONTT) in E-E (138 +/- 10 min) was shorter (p < 0.05), but ONTT in J-P (189 +/- 26 min) was significantly longer (p < 0.01) than oro-caecal transit time (OCTT) in preoperative control (165 +/- 19 min; n = 10). There was no difference about length of villi among control, E-E and J-P, but length of crypts in J-P (0.59 +/- 0.08 mm) was longer than that in E-E (0.27 +/- 0.02 mm) and normal ileum (0.34 +/- 0.07 mm) (p < 0.01). PYY positive cells in J-P were more than in E-E and control at any site of ileum and total number of PYY positive cells in J-P (168 +/- 18) significantly increased than that in E-E (111 +/- 16) and control (103 +/- 14) (p < 0.05). Thus, increase of PYY positive cells in J-P inhibits gastrointestinal motility and transit. Delayed transit time and crypts elongation were intestinal adaptation that assists the absorption of luminal contents. Therefore, it suggested that J-pouch reservoir had advantage to ileo-proctostomy following total colectomy in dogs.

Complete remission of liver metastases from colorectal cancer by treatment with a hepatic artery infusion (HAI) of interleukin-2-based immunochemotherapy: reports of three cases

In an attempt to improve the therapeutic efficacy against liver metastases, a hepatic arterial infusion (HAI) of interleukin-2 (IL-2)-based immunochemotherapy for anticipating the regional potentiation of hepatic lymphokine-activated killer (LAK)/tumor-infiltrating lymphocytes (TIL) was initiated. We present herein the cases of three patients with multiple liver metastases from colorectal cancer in whom complete remission was achieved by treatment with an HAI of IL-2 in combination with mitomycin C (MMC) and 5-fluorouracil (5-FU). These patients received an HAI of IL-2 at 8 x 10(5) JRU, 5-FU at 250 mg daily, and MMC at 4 mg once weekly for 3 weeks, being the induction regimen, after which they were discharged on maintenance therapy consisting of IL-2 at 2 x 10(6) JRU, 5-FU at 250 mg twice weekly, and MMC at 4 mg once weekly. It was evident from the liver CT scan taken after 2-3 months that the metastatic foci seen before therapy had clearly disappeared, while the serum carcinoembryonic antigen (CEA) had decreased to normal levels in all three patients. Pancytopenia was seen in one patient, but other laboratory studies of the hepatic and renal parameters were normal. The total lymphocyte count in the peripheral blood showed a mild decrease, while the lymphocyte phenotype study showed a notable increase in CD4+ cells and a decrease in CD8+ cells, with an elevation of a 4/8 ratio, in all cases during therapy. One patient relapsed with pelvic recurrence 14 months after the initiation of therapy, but the other two patients are still in remission 25 and 22 months after the initiation of therapy.

Detection of Mycobacterium leprae DNA in formalin-fixed, paraffin-embedded samples from multibacillary and paucibacillary leprosy patients by polymerase chain reaction

BACKGROUND

Diagnosis of paucibacillary leprosy is often difficult. A method that could confirm the diagnosis is the polymerase chain reaction (PCR) of M. leprae DNA. This reaction was applied to biopsied tissues of leprotic patients to determine the suitability and sensitivity of the reaction.

METHODS

Biopsy samples were taken from previously untreated patients with multibacillary (5 patients) and paucibacillary (3 patients) leprosy, fixed in formalin, and embedded in paraffin. DNA was extracted from paraffin blocks and PCR applied. The sensitivity of the PCR method was tested by using the serially diluted DNA sample as the template.

RESULTS

All eight patients showed a positive PCR for M. leprae DNA. The sensitivity was such that a single organism of M. leprae, as counted by staining of the acid-fast bacilli was identified by the PCR.

CONCLUSIONS

The PCR method is simple, sensitive, specific, and does not require the use of radioisotopes. It can be applied to the unequivocal diagnosis of paucibacillary leprosy which is difficult by other means. The diagnosis can be obtained within 10 hours.

Induction of combination rules in two-dimensional function learning

Previous studies have typically found that when people learn to combine two dimensions of a stimulus to select a response, they learn additive combination rules more easily than nonadditive (e.g., multiplicative) ones. The present experiments demonstrate that in some situations people can learn multiplicative rules more easily than other (e.g., additive) rules. Subjects learned to produce specified response durations when presented with stimulus lines varying in length and angle of orientation. When stimuli and correct responses were related by a multiplicative combination of power functions, learning was relatively easy (Experiment 1). In contrast, systematic response biases occurred during the early phases of learning an additive combination of linear functions (Experiment 2) and a more complex (nonadditive and nonmultiplicative) combination of linear functions (Experiment 3), suggesting that people have a tendency to induce a multiplicative combination of power functions. However, the initial biases decreased with practice. These results are explained in terms of a revised adaptive regression model of function learning originally proposed by Koh and Meyer (1991). Differences between the present results and previous results in the literature are discussed.

Effect of dietary protein and urea on in vitro caecal ammonia production from urea and uric acid in cockerels

1. Single Comb White Leghorn adult cockerels were fed on 50 g/kg protein diet, 200 g/kg protein diet or 50 g/kg protein diet plus urea and in vitro ammoniagenesis from urea and uric acid in the caeca was determined. 2. Four-fold protein intake caused about 4.6-fold increase in caecal ammonia production from urea (P < 0.05), and tended to increase it from uric acid as compared with 50 g/kg protein-fed birds. 3. Dietary urea significantly increased caecal ammonia production from urea and uric acid by about 2 and 3 times as much as those of control birds, respectively (P < 0.05). 4. It is concluded that increased protein intake and the feeding of urea are able to induce ammoniagenesis from urea and uric acid in the caeca of fowls.

Hepatic arterial infusions of interleukin-2-based immunochemotherapy in the treatment of unresectable liver metastases from colorectal cancer

In preclinical studies, hepatic arterial infusion of interleukin-2 (IL-2) in dogs significantly induced lymphocyte proliferation and augmented antitumor killing activity in the liver. Based on these findings, a pilot study of hepatic arterial infusions of IL-2-based immunochemotherapy was conducted in 21 patients (15 men, 6 women) with unresectable liver metastases from colorectal cancer, to determine whether the addition of IL-2 improved the therapeutic efficacy of chemotherapy alone. Interleukin-2 was given to all patients as 7 to 8 x 10(5) Japanese reference units (JRU) in addition to 5-fluorouracil (5-FU) 250 mg daily and mitomycin C (MMC) 4 mg once weekly, through a subcutaneous port for 3 weeks. After completion of the initial course, patients were discharged from the hospital and continued on a modified regimen for outpatient therapy: IL-2, 2.0 to 2.1 x 10(6) JRU and 5-FU 250 mg twice weekly; MMC 4 mg once weekly. Patient response rate was 76%, and the median survival from initiation of treatment was 24 months. Toxicity of the combined regimen was minimal. Peripheral lymphocyte phenotype study showed notable decreases in CD8+, CD16+, and CD57+ cells and an increase in CD4+ cells (ie, elevation of 4:8 ratio) during therapy. Electron microscopic analysis of the resected liver of a patient receiving the IL-2-mitomycin-C/5-fluorouracil (IL-2.MF) infusion showed a pronounced accumulation of lymphocytes, penetrating from the space of Disse, around the cancer cells. The present study explores hepatic arterial infusion of IL-2-based immunochemotherapy as a new strategy, based on the activation of liver-associated immune response; this technique may provide improved response and survival for unresectable liver metastases.

Parental body mass index: a predictor of childhood obesity?

Cross-sectional data of 210 Chinese children aged three to 16 years, of whom 29 (13.8%) were obese, and their biological parents were statistically assessed whether the body mass index (BMI = weight/height2) of the parents were predictive of childhood obesity. Using the logistic regression and proportional hazards models to predict the probability of obesity and to control for potential confounding due to the age and sex of the children, families with one parent having a BMI score of 25 or higher were 3.7 times, and families with two such parents were five times more likely to have an obese child than families with no such parent. Childhood obesity was more markedly correlated with the mother's BMI than with the father's BMI. These findings were all stochastically significant (p < 0.05) inspite of the modest sample size. One in two parents with an obese child did not perceive their child to be overweight and 62% of the parents with an obese child did not want their child to lose weight.

Clinical trials of intrasplenic arterial infusion of interleukin-2 (IS-IL-2) to patients with advanced cancer

We tried a infusion of interleukin-2 (IL-2) of a relatively low dose via an intrasplenic arterial catheter connected to a chronometric infusion (IS-IL-2). Eighteen patients of colorectal cancer with metastases to the liver or lung or of unresectable hepatoma received a 24 hour continuous infusion with low dose recombinant of IL-2 (mainly 8 x 10(5) JRU/day) for 25-40 days. All patients tolerated this protocol of the therapy and the main toxic effects were fever and general fatigue. Such serious toxicity as previously reported by high dose IL-2 therapy was not observed. Data of hepatic and renal functions were normal. IS-IL-2 therapy induced a high incidence of eosinophilia (12/18) and thrombocythemia (12/18). Peripheral natural killer (NK) and LAK activities were augmented in all patients and total white blood cell counts were increased during IS-IL-2 therapy. An increase in IL-2 receptor expression of peripheral blood mononuclear cells and significant rises in numbers of Leu11 (CD16)+, OKM1(CD11)+ and OKIa1(HLA-DR)+ were observed. Of 18 patients 12 were evaluable for their response to therapy. Partial response (PR) was observed in one unresectable hepatoma and 11 demonstrated no change (NC) or progressive disease (PD). Six patients were not evaluable because of additional therapy (3 cases) or decreasing tumor cell markers having no measurable lesions (3 cases). Three patients of colorectal cancer from an unresectable group were presumed to have micrometastases to the liver as suggested by an elevated serum CEA level. After receiving IS-IL-2 therapy they demonstrated a decrease in the serum CEA level for more than 3 years after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Sudden unexplained death syndrome. A review and update

Sudden unexplained death syndrome (SUDS) among young healthy Thai construction workers in Singapore has been given much publicity recently. From May 1982 to July 1990, 226 SUDS were reported among them. In this article we review and compare studies on SUDS in the United States and South-east Asia. So far, studies to identify the causal factors have been inconclusive and they cannot explain the male preponderance and occurrence of death during sleep. Current hypotheses about the cause of SUDS have included stress, genetic factors, dietary deficiency (particularly thiamine), potassium deficiency, melioidosis and sleep disorders. The following areas are suggested for further research: epidemiological investigations on SUDS at its source; in-depth case studies of families with and without SUDS; role of dietary factors, biochemical studies with respect to thiamine, pyruvate and potassium metabolism in the victims and susceptibles; and histopathological studies of cases and controls.

[An experimental study of gastrointestinal motility during chronic large bowel obstruction]

Gastrointestinal motility and plasma PYY levels were investigated under chronic progressive large bowel obstruction in dogs. The obstruction device was applied around the descending colon at a laparotomy and gastrointestinal motility was recorded with strain gauge force transducers in the conscious state. Complete obstruction occurred at 26 days (21-33 days). The duration of postprandial interruption of motor complex (DIMC) in the antrum and duodenum were prolonged progressively, at partial obstruction (17.7 +/- 2.7 hr; p less than 0.05) and complete obstruction (23.0 +/- 4.0 hr; p less than 0.01) vs in control (13.7 +/- 1.9 hr), while DIMC in the small bowel showed no significant changes. Progressive obstruction caused hypermotility in the proximal colon to the obstruction and hypomotility in the distal colon. These dysmotility were improved after resection of the obstructed segment and anastomosis. Plasma PYY levels in the fasting state showed no significant increase at complete obstruction (42.6 +/- 14.5 pmol/l) vs in control (32.9 +/- 10.2 pmol/l).

Clinical aspects of health screening for senior citizens

Out of a total of 1,224 subjects aged 55 years and above who attended the Senior Citizens' Health Care Centres for health screening, new medical conditions were picked up for the first time in 472 subjects, giving an overall pick-up rate of 38.6%. This rate increased with age rising from 29.4% among those aged 55-64, to 45.8% among those aged 65-74 and to 51.4% in the 75 years and above. This trend was found to be of statistical significance (p greater than 0.001). The objective of the health screening programme in the Senior Citizens' Health Care Centres is to detect geriatric problems early in order to take adequate steps to prevent disability and dependency states, so that the elderly may continue to live at home. In this paper, we studied the 472 subjects with abnormal medical conditions. The pick-up rates (per 100) of medical conditions were as follows: cataract 13.8, other eye conditions 6.5, deafness 4.5, other ear conditions 2.7, diabetes mellitus 2.5, hypertension 2.2 and osteoarthritis 1.6. The socio demographic profile and the medical conditions of the 472 subjects were also studied, with implications on their quality of life in future. We recommend that physicians specifically screen for diabetes mellitus, hypertension, eye and ear abnormalities in all asymptomatic elderly, during periodic health check ups.

Function learning: induction of continuous stimulus-response relations

This research investigates how people learn to select particular response magnitudes along one physical dimension (duration) when given stimulus magnitudes from another dimension (spatial extent). Stimuli and correct responses were related by either a power function, a logarithmic function, or a linear function with a positive intercept. The power function was learned quickly and accurately. In contrast, systematic response biases occurred during the early phases of learning the logarithmic and linear functions. As practice progressed, however, the biases gradually disappeared. These results support an adaptive regression model. According to it, people learn functions through a subjective process analogous to statistical regression. There is assumed to be an initial constraint that treats stimulus-response pairs as if a power function characterizes them.

Health screening for the elderly--the Singapore Senior Citizens' Health Care Centres' experience 1986-1989: an overview

A systematic health screening programme for the elderly aged 55 years and above was implemented in the first Senior Citizens' Health Care Centre (SCHCC) in 1986. This programme was expanded to two more SCHCCs by 1989. The first 1,224 clients aged 55 years and above, who attended this programme in the first three SCHCCs were studied in this paper. The characteristics of the elderly who voluntarily attended the SCHCCs for health screening were studied with respect to their referrals, socio demographic status, whether they had regular physician care, the existing medical problems and the new medical problems picked up at health screening. Of those screened, 49.6% were referred for the programme by relatives and self, and 28.2% by community centres, thus, showing that community and family supported the programme. Only 7.2% of referrals to the screening programme came from general practitioners and 4% from polyclinic doctors. It is interesting to note that 40% of clients had no regular physician care. About two thirds (57.2%) had one or more existing chronic medical conditions or disability at the time of screening. The majority with existing conditions had hypertension (24.8%) and diabetes (15.5%). Other existing conditions were ischaemic heart disease (6.2%), cataract (3.9%) and asthma (3.6%). The pick-up rate of medical conditions among the clients at the time of health screening was 38.6% for the whole group. This showed a rising trend from the younger to the older age groups being 29.4% in the age group 55 to 64, to 45.8% in the age group 65 to 74, and 51.4% in the age group 75 years and above (p less than 0.001). Some of the topical issues related to a health screening programme for the elderly have been discussed.

[Clinical and experimental studies on gastrointestinal motility following total colectomy: direct measurement (strain gauge force transducer method, barium method) and indirect measurement (hydrogen breath test, acetaminophen method)]

In a clinical study, we examined the clinical assessment of bowel function and lactulose hydrogen breath test in 14 patients after total colectomy. All patients within one year after ileostomy closure had 'poor' function and showed no increase of hydrogen breath gas concentration. 10 of 12 patients more than one year showed increase of hydrogen breath gas concentration, and 8 of them had 'fair' function. The oro-neorectal transit time (ONTT) in 'poor' group was shorter than in 'fair' group and control (p less than 0.05). The increase of hydrogen breath gas suggests changes of bacterial flora and colonization of the remained ileum. In an experimental study, we performed subtotal colectomy with the J-pouch reservoir in 11 dogs. We examined ONTT with barium method, gastric emptying with acetaminophen method, and gastrointestinal motility with strain gauge force transducers. Although ONTT at one month after operation had been shorter than control, ONTT at 3 and 6 months became longer than at one month. The gastric emptying after subtotal colectomy was significantly slower than control. Although the propagation velocity of interdigestive migrating complex (IMC) in the jejunum and ileum at 2 weeks had been faster than control, the velocity at 4 weeks and 3 months became slower than at 2 weeks. The frequency of IMC and prolonged propagated contraction in the J-pouch reservoir decreased. The specimen of J-pouch reservoir resected at 6 months showed villous atrophy, crypt elongation, decrease of muscle layers thickness and disappearance of solitary follicles. Therefore, the suppressed motility in each sites of the gastrointestinal tract, increase of anaerobic and colonization of the ileum implied 'adaptation' after total colectomy.

Ultrastructural changes of the midgut epithelial cells in feeding and moulting nymphs of the tick Haemaphysalis longicornis

The midgut epithelial cells in nymphs fed on laboratory rabbits were examined during feeding and after detachment. The midgut epithelium at the unfed stage consisted of digestive cells of lower activity, containing such nutritive substances as protein, lipid and glycogen. As feeding proceeded, the cells became active in intracellular digestion. At the middle of the feeding stage, the spent digestive cells derived from the active digestive cells began to be replaced by the new digestive cells of lower activity. After detachment, the pinocytotic activity of the above cells increased greatly, and the digestive activity increased to some extent. As a result, many large endosomes were formed by fusion of numerous pinosomes. Thereafter, endosomes decreased in size as digestion proceeded and there was an increase of haematin granules. On day 7 after detachment, the new digestive cells of lower activity, belonging to the 'nutritional reserve' type, appeared adjacent to the spent digestive cells which had almost exhausted all endosomes, and these new cells had completely replaced the spent cells by day 3 after moulting.

Function learning: Induction of continuous stimulus-response relations

This research investigates how people learn to select particular response magnitudes along one physical dimension (duration) when given stimulus magnitudes from another dimension (spatial extent). Stimuli and correct responses were related by either a power function, a logarithmic function, or a linear function with a positive intercept. The power function was learned quickly and accurately. In contrast, systematic response biases occurred during the early phases of learning the logarithmic and linear functions. As practice progressed, however, the biases gradually disappeared. These results support an adaptive regression model. According to it, people learn functions through a subjective process analogous to statistical regression. There is assumed to be an initial constraint that treats stimulus-response pairs as if a power function characterizes them.

Asymmetric synthesis of podophyllotoxin analogs

Two analogs of podophyllotoxin, with the same absolute stereochemistry as the natural product, have been synthesized from the cycloadduct between α-hydroxy-α′-phenyl-o-quinodimefhane and the fumarate of S-methyl lactate. After initial attempts to produce the cycloadduct from photochemically generated α-hydroxy-α′-phenyl-o-quinodimethane failed, a study of the thermal generation and reaction of α-hydroxy-o-quinodimethane with the fumarate and acrylate of S-methyl lactate was made. A comparison was made of the diastereoselectivity of these cycloaddition reactions to those previously reported, in which the o-quinodimethane was generated photochemically. The α-hydroxy-o-quinodimethane was produced both by the known thermolysis of benzocyclobutenol and by thermolysis of 1-hydroxy-1,3-dihydrobenzo[c]thiophene-2,2-dioxide. The diastereomeric excess for the cycloaddition reactions was found to be greater than 95% with modest (ca. 55%) isolated yields of the major cycloadducts. Following these model studies, it was found that α-hydroxy-α′-phenyl-o-quinodimethane produced thermally from 1-hydroxy-3-phenyl-1,3-dihydrobenzo[c]thiophene-2,2-dioxide could be added to the fumarate of S-methyl lactate with high diastereoselectivity and good yield. The product of this reaction was converted to the podophyllotoxin analogs 7 and 17. Keywords: o-quinodimethanes, asymmetric, Diels–Alder, lactate, podophyllotoxin, lignan.

[An experimental study of the gastrointestinal motility in conscious dogs with strain gauge force transducers]

Interdigestive motor complex (IMC) from the stomach to the ileum and colonic migrating motor complex (CMMC), and the effects of motilin and PYY to them were studied in conscious dogs with strain gauge force transducers (SG). In fasted dogs, IMC cycle times were 100.5 +/- 7.5 min in from the antrum to the ileum and propagation velocity of the small intestine was fastest in the proximal jejunum (4.85 +/- 0.81 cm/min), slowest in the distal ileum (0.81 +/- 0.08 cm/min). The duration of postprandial interruption of motor complex (DIMC) was longer in the antrum and duodenum in 8 dogs of the twelves than the middle and lower intestines. Ileo-colonic propagation rates of IMC that reached to the terminal ileum were 95/116 (81.9%), but the frequency of CMMCs was about 4 times higher than that of IMCs. Each colonic motor complex were classified into four patterns, such as aboral migrating complex (A), oral migrating complex (O), discrete complex (D) and giant migrating contractions (G), and the starting point of migrating complex was marked with -, like A, O or G. Thus, independency index (I I) in each site was defined as: I I = (sum of number of A, O, G and D)/(total number of colonic motor complex). I I was highest in colon 1 (70-80%) and next in colon 4. Motilin (0.5 microgram/kg.hr) elicited IMC like activities in the antrum, duodenum and proximal jejunum, but no effects in the middle and lower small intestine, and the colon. PYY infusion caused dose dependent inhibitions of IMC in the antrum and duodenum, but no effects in the below intestines as same as motilin. These findings suggest that IMCs are basal rhythms of gastrointestinal motility and IMCs occurring from the antrum to the proximal jejunum are more sensitive to the factors as eating or gut peptides.

Retinal folds in the shaken baby syndrome

We examined two children with presumed shaken baby syndrome. Both children suffered severe, indirect closed head trauma with intracranial hemorrhage, sharply increased intracranial pressure, and extensive neurologic damage. In addition to extensive retinal and preretinal hemorrhages, bilateral symmetric white ring-shaped retinal folds were seen encircling the macula outside the vascular arcades. These retinal folds may be a hallmark of shaking injuries in child abuse victims.

[A case of advanced gallbladder carcinoma of a 77-year-old female successfully resected with extended right hepatic lobectomy with caudate lobectomy and pancreatoduodenectomy]

A 77-year-old woman was admitted with obstructive jaundice. US and CT demonstrated a solid mass 2.5cm in diameter in the hepatic hilum. Cholangiography revealed not only severe stenosis of the hilar hepatic duct but also involvement of the right-posterior-inferior-ventral branch and right caudal branch. Angiography showed almost normal appearance except cystic artery. Duodenal invasion was also detected by per oral duodenography. These findings forced to plan extended right hepatic lobectomy with caudate lobectomy and pancreatoduodenectomy for radicality. In spite of the aged and her complications such as DM, hypertension, scoliosis and bradyacusia, liver function was good and she was mentally very active for life. Therefore, planned operation was performed and the suitability of this operation was proved by histological examination. She underwent resection of the abdominal wall for recurrence 8 months after and now alive without the disease 27 months after the first operation. It is stressed that the most suitable operation should be selected conceiving the mode and severity of cancer extension which is revealed by precise preoperative examinations and extended operation may be indicated in even the elderly if various conditions are good.

Expression of the gene for main intrinsic polypeptide (MIP): separate spatial distributions of MIP and beta-crystallin gene transcripts in rat lens development

The main intrinsic polypeptide (MIP) is the major protein present in the lens fiber cell membrane and is the product of a gene which, as far as is known, is expressed only in the lens. We have used in situ hybridization and immunofluorescence microscopy to characterize the expression of this gene during the course of development in the rat. At progressive stages of lens morphogenesis, we find that synthesis of the protein is closely tied to the accumulation of MIP mRNA in cells that are committed to terminal differentiation, first in the elongating presumptive primary lens fibers and later in the secondary fibers as they differentiate from the anterior epithelial cells. The transcripts accumulate in the basal cytoplasm of the primary fibers and in the cytoplasm which surrounds the cell nucleus in the secondary fibers. We have compared this pattern of expression with that of a gene for a cytoplasmic protein, beta-crystallin beta-A1/A3. In sharp contrast to the localized concentrations seen for the MIP mRNA, beta-A1/A3 transcripts are relatively uniformly distributed throughout the cytoplasm. Neither MIP nor crystallin gene appears to be transcriptionally active in the undifferentiated epithelial cell, but transcripts from the beta-A1/A3 gene appear earlier in fiber cell differentiation than do those from the gene for MIP.

Incorporation of intraportal ammonia-N into blood and tissue nitrogenous compounds in chickens fed low and high protein diets

1. 15N-Percentage of the amide of glutamine in total blood non-protein-15N was 42 and 48% in chickens fed 5 and 20% protein diets, respectively, when 15N-ammonia was intraportally-infused for 6 hr. 2. The infused ammonia-15N also appeared in the amide of free glutamine in the liver and kidney in large amounts at both levels of protein intake. 3. The 15N incorporated into glutamine-amide in the blood, liver and kidney and non-protein-15N in plasma were greater in chickens fed the low protein diet than in those fed the high protein diet (P less than 0.05 except kidney of P less than 0.01). 4. About 60% of the amide-N of the glutamine which was increased during 6 hr infusion of ammonia was derived from infused ammonia-N and the remainder from endogenous nitrogen, irrespective of protein intake. 5. These results suggest that glutamine is the most important intermediate in detoxication of intraportal ammonia in chickens.

Effect of insulin on excretion and retention of infused glutamine amide-N in chickens (Gallus domesticus)

1. The purpose of this study was to examine the effects of insulin on urinary excretion and retention of the intravenously infused glutamine amide-15N in chickens. 2. Insulin pretreatment reduced urinary total 15N excretion (P less than 0.05) and enhanced 15N retention in chicken body (P less than 0.05), but it did not affect non protein-15N retained in the liver and blood. 3. Insulin decreased the incorporation of the infused glutamine amide-15N into urinary uric acid as well as the excretion of other N-derived urinary uric acid (P less than 0.05), which resulted in a significant decrease in total urinary uric acid (P less than 0.05). 4. There was no effect of insulin on urinary appearance of the infused glutamine amide-15N in the form of ammonia.

[Function-preserving operation in rectal cancer]

Function preservation in rectal cancer surgery consists of preservation of the anal function, the urinary function and the male sexual function. Low anterior resection (manual or instrumental), invagination technique and pull-through are selected as the sphincter saving operation for cancer of the upper and middle rectum. It is reported that more than 60% of rectal cancers are treated by these operations and that a favorable function are obtained. Autonomic nerves such as hypogastric, pelvic and pudendal nerves are anatomically preserved in Dukes A cancer to prevent the urinary and male sexual dysfunction. The post-operative disturbances of urination and male sexual potency decreased to 10% or less by the autonomic nerves preservation.

An update of the indications for penetrating keratoplasty. 1979 through 1983

We performed a retrospective analysis of the clinical and pathologic diagnoses of 497 corneal buttons that had been submitted to the Estelle Doheny Eye Pathology Laboratory, Los Angeles, during the five-year period 1979 through 1983. The leading indications, in order of decreasing frequency, were pseudophakic bullous keratopathy (17.5%), regrafts (15.1%), aphakic bullous keratopathy (10.9%), corneal trauma (9.3%), and Fuchs' endothelial dystrophy (9.1%). The emergence of pseudophakic bullous keratopathy as the most common cause for penetrating keratoplasty correlates well with the dramatic increase in the number of cataract extractions with intraocular lens implantations performed since the mid-1970s. Less frequent indications for penetrating keratoplasty included the following: corneal scars (6%); active ulcerative keratitis (7%); keratoconus (6%); keratitis secondary to virus (5%); non-Fuchs' corneal dystrophies (3%); congenital corneal opacities (3%); interstitial keratitis (2%); and chemical burns (1%).

Anaerobic bacterial endophthalmitis in the rabbit

Anaerobic bacterial endophthalmitis was studied in rabbits following intravitreal injection of live Fusobacterium necrophorum. Clinical response, bacterial recovery, and histopathology were studied. An inoculum of approximately 50 organisms produced endophthalmitis in 59% of injected eyes, while 1000 or more organisms produced endophthalmitis in 100% of injected eyes. The course and severity of disease seemed to be independent of the concentration of bacteria above a minimal inoculum size. Affected eyes showed progressive endophthalmitis. Histopathologic changes corresponded to the clinical gradation of endophthalmitis, including progressive retinal necrosis.

Depression of glutamine-stimulated uric acid production and blood glutamine accumulation by insulin in chickens

This experiment was conducted to examine effects of insulin on glutamine accumulation in blood and uric acid production in the chicken infused with glutamine. Insulin pretreatment eliminated the stimulatory effect of glutamine infusion on urinary uric acid excretion in the chicken fed a 5% protein diet, which resulted in no increase in urinary total nitrogen excretion by the infusion. In the chicken fed a 20% protein diet the pretreatment with insulin did not have such clear depressive effects on the increases in urinary uric acid and total nitrogen excretion caused by the glutamine infusion. Insulin tended to depress the increases in plasma glutamine concentration caused by the infusion of glutamine at both levels of dietary protein intake.

The autonomy of prolactin secretion in patients with prolactin producing tumor

To examine the responsiveness of prolactin (PRL) secretion in patients with PRL-producing tumor (PRL-noma), TRH (500 micrograms), arginine (0.5 g/kg, b. wt.), and sulpiride (100 mg) were administered to 13 patients with PRL-noma. Seven of these patients responded to TRH or other agents with an increase in their plasma PRL levels of 50% or more above the basal values (categorized as Group I). The remaining six patients, however, showed no response to any of these agents (categorized as Group II). After the administration of L-dopa (500 mg, p.o.), Group I patients showed significantly greater decreases in plasma PRL (-68.9 +/- 6.6%) from the basal value than did Group II (-37.4 +/- 8.6%; p less than 0.02). The mean basal PRL levels were higher in Group II than in Group I, although these differences failed to reach statistical significance. Moreover, there were no differences in age, sellar volume, or the presence of bitemporal hemianopsia between the two groups of patients. It is concluded that there are two patterns of PRL-secretory responses to pharmacological stimuli in patients with PRL-noma. The differences between the two patterns might be characterized by the properties of the lactotroph cells themselves rather than by the relation of these cells to the hypothalamus.

[A study on the significance of bromocriptine (CB-154) administration in normoprolactinemic anovulatory women (author's transl)]

The ovulation-inducing effect of bromocriptine (CB-154) and the underlying mechanism in the management of anovulatory infertility with normoprolactinemia were investigated. Thirty-seven normoprolactinemic women (anovulatory cycle, 11 cases; 1st grade amenorrhea, 18; and 2nd grade amenorrhea 8) with anovulia showing plasma prolactin levels of less than 25 ng/ml were give CB-154 daily in doses of 2.5 mh from the second day of menstruation or withdrawal bleeding (1) to assess the ovulatory induction rate, (2) to determine the serum PRL, LH, FSH and E2 levels before and during the drug administration, (3) to measure the serum PRL concentration by TRH test prior to CB-154 medication and (4) to assess size heterogeneity of serum PRL with the use of lyophilization.

RESULTS

(1) Ovulation occurred in 21 of the 37 patients, of a total of 42 menstrual cycles studied, 33 were ovulatory, indicating a high rate of repeated success. (2) There was a significant decrease of serum PRL following administration of CB-154, and the finding was the same in the group of women with successful ovulatory induction. Serum LH, FSH and E2 levels did not show any significant change following CB-154 therapy. (3) Prl concentrations were suppressed more in cases of unsuccessful induction than those in successful induction. (4) PRL responses to TRH tended to be lower in cases of successful induction than those in unsuccessful cases. (5) The Little PRL content ratio decreased after administration of CB-154, and this data have suggested that not only the problem of immunologically measured serum PRL levels but the qualitative problems also bear relations to the effect of this hormone on the endocrinological environment.