[A clinicopathological study on carcinoma of the gastric stump, with special reference to mucosal change]

Ten carcinomas of the gastric stump reconstructed by Billroth I (one case) and Billroth II (9 cases) methods were treated an average of 20 (range: 7-46) years after partial gastrectomy. Because of highly advanced carcinoma, total gastrectomy with resection of invaded organs was performed. The 5-year survival rate was 33%, and was not different from that in patients with carcinoma of the cardia. Thus, the prognosis of gastric stump carcinoma was not poor if extended radical operation was carried out. The mucosa showed severe atrophic gastritis with intestinal metaplasia or atrophic and hypertrophic gastritis in patients with carcinoma. However, the mucosa was hyperplasia of the glands in almost all patients with stomal ulcer. Thus, our findings suggest that atrophic change with intestinalization plays a role in gastric carcinogenesis.

[Combination chemotherapy with adriamycin, carboquone and 5-Fu for bladder cancer]

We treated 25 bladder cancer patients with combined cytotoxic chemotherapy of adriamycin (10--20 mg/day administration on days 1, 2 and 3), carboquone (4 mg/day administration on day 1 of weeks 3, 4 and 5 and 5-Fu (200 mg/day for 5 weeks) or futraful suppositories (750 mg/day for 5 weeks) as one course. According to the Koyama - Saitoh criteria, CR + PR was observed in 4 (17.4%) of 23 patients excluding the 2 dropout patients. According to Karnofsky's criteria, an effect with chemotherapy was observed in 9 (39.1%) of the 23 patients. There was a relatively good response rate in a group of 12 patients with the superficial tumors as compared with a group of 11 patients with the deep tumors. There were no severe adverse reactions.

Intestinal absorption and metabolism of clioquinol in the rat

Plasma concentrations of clioquinol and its metabolites after single or repeated oral administration of clioquinol, absorption region of clioquinol in gastrointestinal tract, and intestinal metabolism were studied in rats. Plasma concentrations of clioquinol after oral administration of four different doses (20, 100, 200 and 400 mg/kg) were lower than those of the two metabolites, clioquinol glucuronide and sulfate. Mean maximal plasma concentration of unchanged drug was in the range of 1-8 nmol/ml. Clioquinol was absorbed poorly from the stomach and fairly from the small intestine. Bile was an important route for excretion of clioquinol in rats. The mesenteric venous plasma from the closed intestinal loops of both jejunal and ileal regions was analyzed for clioquinol and the metabolites and it was found that clioquinol glucuronide was formed predominantly in both regions. From the results of the present studies, intestinal metabolism of clioquinol can be pointed out as a major factor for difficulty to cause clioquinol intoxication.

Appearance of intoxication in rats by intraperitoneal administration of clioquinol

The investigation was undertaken to study the neurological symptoms in rats caused by maintaining high plasma concentration of about 30 nmol/ml or more, of clioquinol. Clioquinol suspension which was prepared using polysorbate 80 was administered intraperitoneally to rats and plasma and tissue concentrations were determined. On administration of clioquinol of 100 and 200 mg/kg, the mean plasma concentrations of clioquinol reached maximum values of 30 and 58 nmol/ml, respectively, after 0.5-1 h and thereafter decreased rapidly. With 400 mg/kg, however, plasma concentration reached maximum value of about 75 nmol/ml and fell slowly. By single and repeated administration of the suspension, clioquinol was distributed in the liver and kidney at a high concentration, and also in the nervous system. In experiments on appearance of neurotoxicity in rats by repeated administration of the suspension, all of 10 rats administered intraperitoneally with 100 mg/kg/d did not develop any neurological symptoms for about 30 d. On the other hand, one of 10 and 7 of 13 rats administered with 200 and 400 mg/kg/d, respectively, developed ataxia in the hind legs or all legs on the 3rd to the 12th day after starting administration. Pathologically, a slight change of the peripheral nerve, central chromatolysis of the anterior horn neuron and severe neuronal degeneration of the Ammon's horn were observed in the rats with ataxia.

Comparison of bioavailability for phenytoin products prepared by wet granulation in normal subjects and epileptic patients

A 20% phenytoin (PHT) plain mixture with excipients (20%PM) and three PHT products prepared by wet granulation, which are 20% fine granule (20%FG), 99% air-dried fine granule (99%FG-A) and 99% freeze-dried fine granule (99%FG-F), were prepared. The extents of PHT absorption from these products and the Aleviatin Fine Granules (97%FG) prepared with microcrystalline PHT powder were compared with those from commercially available PHT powder (Aleviatin) and tablet (Hydantol Tablet 25 mg), which are of the Pharmacopoeia of Japan grade, in healthy adult volunteers. In single dose study, the extents of PHT absorption from the powder, 20%PM, 20FG, 99%FG-A, 99%FG-F, 97%FG and tablet were 89.7, 92.2, 99.0, 96.7, 99.1, 99.1 and 99.3%, respectively. The property of almost complete absorption of PHT from the product was shown in the 20%FG, 99%FG-F and 97%FG similar to the tablet. In multiple dose study, the minimum and the average estimated free concentrations of PHT at steady-state for 99%FG-F and 97%FG were nearly equal to those for the tablet, and were higher than those for the powder. In epileptic patients, the plasma PHT concentrations were increased when dosage form was changed from the powder to 99%FG-F. However, the plasma PHT concentrations were scarcely altered when dosage form was changed from the tablet to 99%FG-F. The change in dosage forms from the tablet to 99%FG-F and 97%FG or opposite direction can be done without causing toxicity in epileptic patients, so long as these products are used at the same amounts as PHT.

Clinical pharmacokinetics and diuretic effect of furosemide in plain tablet and retard capsule with normal subjects and cirrhotic patients

The dissolution profiles of furosemide in various solutions were studied with plain tablet and retard capsule of furosemide. The rate constant and percent dissolution in retard capsule were lower than that in plain tablet. Clinical pharmacokinetics and diuretic effect of furosemide after oral administration of two dosage forms were also studied with 3 normal subjects and 3 cirrhotic patients. In normal subjects, the extent of furosemide absorption from retard capsule was 45% of plain tablet. The daily urine volume after oral administration of two dosage forms was comparable, however, quite different profiles were observed between these dosage forms. In patients, the extent of furosemide absorption in retard capsule was one half that of plain tablet. The dose of retard capsule was increased without adverse reactions, thus decreasing of ascites, which was not observed with plain tablet, was achieved with increasing urine volume.

[Germ cell tumor in the basal ganglia with elevated serum and CSF alpha-fetoprotein levels]

Intracranial germ cell tumors usually locate either in the pineal region or in the suprasellar region or both. Primary occurrence of germ cell tumor in the basal ganglia is rare. To our knowledge, only 17 cases have been reported in the literatures, and all the patients were Japanese. None of these patients presented elevated serum and CSF AFP levels in the literatures. We are reporting a patient with a germ cell tumor which developed in the left basal ganglia and showed high serum and CSF alpha-fetoprotein (AFP) levels. The patient was a 12-year-old boy who had been completely well until five months prior to the first admission when he developed weakness of right extremities. On admission he showed a right hemiparesis of mild degree and right hypesthesia. CT-scans demonstrated a homogeneous high density area over the caudate head and the putamen on the left side. The anterior limb of the left internal capsule and a part of the posterior limb were also involved. The lesion was moderately enhanced by the contrast medium. Stereotaxic biopsy of the lesion was uncontributory and he was discharged for follow up. Five months later, CT-scans demonstrated the enlargement of the high density area with perifocal edema. Then we performed a craniotomy, and the tumor which was soft and dark red in colour was biopsied at the wall of the anterior horn of the left lateral ventricle. Histopathology of the specimen showed germinoma of two-cell pattern.(ABSTRACT TRUNCATED AT 250 WORDS)

Bioavailability of phenytoin on single and multiple oral doses of two dosage forms in normal subjects

The extent and rate of absorption of phenytoin (PHT) from tablet and powder were studied in four healthy adult volunteers. It was demonstrated by urinary and fecal excretion that the almost all quantity of PHT in tablet was absorbed through the gastrointestinal tract, and the observed values of the estimated free concentration (Cest.f) estimated from mixed saliva concentration of PHT in the multiple dose were in fair agreement with the calculated values of that by using computer simulation in case of tablet. On the contrary, the variations were observed in Cest.f using therapeutic dose of PHT powder. The values of Cest.f at steady-state in tablet administration were higher than those in powder administration. The absorption ratio of PHT powder was low and variable, and decreased upon increase of dose. The ratio calculated from the Cest.f values of both dosage forms at steady-state were in good correspondence to the observed values of PHT excreted in feces.

Annulate lamellae in prolactin-secreting pituitary adenomas

Electron-microscopic examination revealed the presence of annulate lamellae in four of five prolactinomas. All the patients examined were 24--30-year-old women who had suffered from amenorrhea and galactorrhea for 3-5 years. Serum levels of prolactin were 114--4,700 ng/ml. The tumors removed by a transsphenoidal approach were 4-23 mm in diameter and showed the ultrastructural features of sparsely granulated prolactinoma. Analysis in correlation with clinical and laboratory data revealed that the annulate lamellae were found in rapidly growing prolactinomas. This is the fifth report on pituitary adenomas with annulate lamellae.

Evidence for "response to injury" hypothesis

Role of platelet-derived growth factor (PDGF) in myointimal thickening described in "response to injury" hypothesis was investigated with artery of rats in culture and with air-injured artery of rats. PDGF promoted cell growth in ring preparation of carotid artery in culture denuded with citrate. It did not promote any cell growth in preparations without denudation. Trapidil, a PDGF antagonist, inhibited the cell growth promoted by PDGF in the denuded arterial ring. Systemic injection of PDGF was performed for 8 days to rats with thrombocytopenia induced by injections of anti-platelet serum. This treatment caused myointimal thickening of carotid artery 10 days after denudation by means of air injury. Trapidil at oral intake levels of 1, 3 and 30 mg/kg/day inhibited this change observed in denuded site of artery. Trapidil at oral intake of 6 mg/kg/day also inhibited myointimal thickening observed 15 days after denudation of carotid artery by air injury in normotensive and spontaneous hypertensive rats both with normal platelet counts. These results evidenced the role of PDGF in myointimal thickening described in "response to injury" hypothesis and clinical use of trapidil may be a new approach to the treatment of atherosclerosis.

Isolation and characterization of mucoid and non-mucoid Salmonella oranienburg isolated from pleural effusion of a patient with hemolytic anemia

Salmonella oranienburg, mucoid and non-mucoid strains, were simultaneously isolated as causative agents from the pleural effusion of a patient with hereditary spherocytosis. The mucoid-typed Salmonella oranienburg was characterized by serological examination, taking advantage of the high frequency of mucoid (M) to non-mucoid (N) variation.

Atypical biogroups of Escherichia coli found in clinical specimens and description of Escherichia hermannii sp. nov

DNA relatedness was used to define the biochemical boundaries of Escherichia coli. A large number of biochemically atypical strains were shown to belong to biogroups of E. coli. These included strains negative in reactions for indole, all three decarboxylases, D-mannitol, lactose, or methyl red and strains positive in reactions for H2S, urea, citrate, KCN, adonitol, myo-inositol, or phenylalanine deaminase. Frequency and source data are presented for these atypical E. coli biogroups. One group of KCN-positive, cellobiose-positive, yellow-pigmented strains was 84 to 91% interrelated but only 35 to 45% related to E. coli. The name Escherichia hermannii sp. nov. is proposed for this group of organisms that was formerly called Enteric Group 11 by the Enteric Section, Centers for Disease Control, Atlanta, GA. Twenty-nine strains of E. hermannii have been isolated in the United States from a variety of clinical sources, principally wounds, sputum, and stools. Three additional strains were isolated from food. E. hermannii strains are gram-negative, oxidase-negative, fermentative, motile rods. In addition to yellow pigment and positive KCN and cellobiose tests, the biochemical reactions characteristic of 32 strains of E. hermannii were as follows: gas from D-glucose, acid from D-glucose, maltose, D-xylose, L-arabinose, L-rhamnose, and D-mannitol; no acid from adonitol or inositol; variable acid production from lactose and sucrose; positive tests for indole, methyl red, and mucate; negative tests for Voges-Proskauer. Simmons citrate, H2S, urea, phenylalanine deaminase, and gelatin hydrolysis; negative or delayed test for L-lysine decarboxylase and negative test for L-arginine dihydrolase; and positive test for ornithine decarboxylase. E. hermannii strains were resistant to penicillin, ampicillin, and carbenicillin and sensitive to other commonly used antibiotics. Wounds account for almost 50% of human isolates of E. hermannii, followed by sputum or lung isolates (ca. 25%) and stool isolates (20%).

Anti-spasmodic effect of prifinium bromide on the proximal and distal colon in patients with diverticular disease

In 5 patients with diverticular disease, colonic motilities of the proximal and distal colon were recorded using the ERBI method. The motilities were studied during resting, after prostigmin 0.5 mg i.m. injection and after prifinium bromide 7.5 mg i.m. injection, with the following results: After prostigmin colonic motility of the proximal colon became significantly greater than that of the distal colon. Prifinium bromide inhibited the prostigmin-induced hypermotility markedly. It was demonstrated that this drug has an antispasmodic action not only on the distal colon but also on the proximal colon. Prifinium bromide was an antispasmodic drug which brought about a rapid effect which appears within 3 minutes after injection. The effect persisted for about 1 hour.

The isolation of Vibrio alginolyticus from a patient with acute entero-colitis

Vibrio alginolyticus was isolated from the "rice water" diarrheal stool of a female patient with acute entero-colitis, and from the trout roe which she ate. Subsequently, it was clearly demonstrated that, besides of Vibrio cholerae and Vibrio parahaemolyticus, Vibrio alginolyticus was also enteropathogenic for humans. Additionally, we described the difference in the colony formation on some commercial thiosulfate citrate bile salts sucrose (TCBS) agars when Vibrio alginolyticus and Vibrio cholerae were tested.

Ascending and descending components of the medial forebrain bundle in the rat as demonstrated by the horseradish peroxidase-blue reaction. I. Forebrain and upper brain stem

The ascending and descending components of the medial forebrain bundle (MFB) were investigated by means of horseradish peroxidase (HRP) with a sensitive substrate. The HRP was injected iontophoretically into the MFB at various levels from the anterior commissure to the posterior hypothalamus. In order to prevent the diffusion of HRP to other brain areas, a double micropipette system was used. The descending components of the MFB are derived from (1) the anterior cingulate area, infra- or prelimbic area, and sulcal cortex, (2) the lateral septal nucleus and diagonal band, (3) the bed nucleus of the stria terminalis, (4) the paraventricular nucleus (5) the substantia innominata, (6) the amygdaloid complex (AM), (7) the ventromedial (VM) and dorsomedial (DM) hypothalamic nuclei, (8) the entopeduncular nucleus and (9) nucleus periventricularis stellatocellularis. The ascending components of the MFB originate in: (1) the medial preoptic nucleus, (2) the nucleus periventricularis stellatocellularis and rotundocellularis, (3) the posterior hypothalamic nucleus, (4) the parafascicular nucleus, (5) the ventral premammillary nucleus, (6) the substantia grisea periventricularis, (7) the lateral habenular nucleus, (8) the VM and DM, (9) the paratenial nucleus, (10) the AM and (11) the arcuate nucleus.

Studies on porcine pancreatic elastase activity. II. Immunoreactive elastase level during acute hemorrhagic pancreatitis in pigs

Acute hemorrhagic pancreatitis was produced in pig to study serum concentration of elastase and its physiological role. Pancreatitis was induced in two groups of young pigs by the injection of autologous bile. One group was injected with autologous bile (0.5 ml/kg) at high pressure, and the second group was injected as low pressure (100 cm H2O). Then femoral blood, portal blood and thoracic lymph were sampled at scheduled time intervals. The control level of immunoreactive elastase was around 90 ng/ml in each site, which significantly increased beginning 15 min after bile injection; the level of immunoreactive elastase was higher in the thoracic lymph duct than in the femoral and portal vein. The total and free elastase of both groups in pancreatic tissue were significantly decreased in pancreatitis, and an abundance of immunoreactive elastase was found in the ascites. The increasing pattern of immunoreactive elastase and amylase after bile injection was very similar. Therefore, the level of immunoreactive elastase was considered to be inadequate to determine the grade of severity of pancreatitis as well as the level of amylase which is already known.

Studies on porcine pancreatic elastase activity. I. Radioimmunoassay of porcine pancreatic elastase

An improved method of radioimmunoassay was devised to offer a successful formula for determining blood concentration of elastase. With porcine pancreatic elastase as the antigen, rabbits were immunized to obtain antiserum. Iodinated elastase labeled by the chloramine-T procedure using 131I (or 125I) had a specific activity of 200-300 mCi/mg. The double antibody method was used for BF separation. While the usual method of radioimmunoassay was not always successful in obtaining accurate serum concentration of elastase, the use of diisopropyl fluorophosphate (DFP) was able to eliminate the disturbing influence of intra-serious inhibitors, alpha 1-AT and alpha 2-M, eventually producing satisfactory results. With the use of DFP, the elastase standard curve and the porcine serum dilution curve had a statistically significant correlation; precision and recovery were both satisfactory; cross-reactivity of the antiserum with trypsin and chymotrypsin was less than 0.001%. The minimal detectable concentration of elastase was 5 ng/ml, and the range of normal fasting porcine serum level was 70-100 ng/ml.

The tissue content of cyclic AMP in rats after microwave irradiation in vivo

When anesthetized rats were exposed to microwave (power output 1.3 kw, frequency 2,450 MHz), the cyclic AMP phosphodiesterase activity showed a rapid decline in the skeletal muscle, heart, trachea and lung; no activity essentially could be detected after a 30 sec irradiation. Cyclic AMP levels in these tissues also decreased rapidly to constant values within 30 sec. Concentrations of cyclic AMP in the heart, skeletal muscle, trachea and lung measured by the tissue fixation with liquid nitrogen were approximately 3, 3, 4 and 4 times higher than those after microwave irradiation, respectively. The intravenous injection of procaterol (1 mu mol/kg), a beta 2-adrenoceptor agonist, caused a 6-fold increase in the trachea cyclic AMP level when measured after microwave fixation but only a 2-fold increase when measured after liquid nitrogen fixation. It is concluded that rapid tissue fixation by microwave irradiation may provide a useful means for obtaining reliable values of the tissue cyclic AMP content.

Effects of eight amino acids on the exocrine and endocrine pancreatic function

Eight amino acids were intravenously administered in a dose of 2 mmoles/kg/hr to dogs with chronic pancreatic fistula, and the effect of each amino acid on endocrine and exocrine pancreatic secretions was investigated. Asparagine, arginine, isoleucine and phenylalanine administered under the stimulation of secretin-pancreozymin significantly inhibited the secretion of pancreatic juice by 23%, 15%, 13% and 13%, and the output of amylase by 53%, 37%, 27% and 18%, respectively. Threonine, glycine or methionine brought about no significant changes in pancreatic secretion, but valine significantly increased pancreatic juice secretion by 13% and amylase output by 15%. Any of the eight amino acids caused no noticeable change in the concentration of bicarbonate.

Significance of Erwinia in the vagina as causative agents of urinary tract infections

The isolation of Erwiniae from the vagina became positive just before the occurrence of erwiniuria. It is proposed that the appearance of Erwiniae in the vagina is an important indicator in the prediction of urinary tract infection by Erwiniae.

Alterations in blood levels of carbohydrate and lipid metabolites and of cyclic AMP mediated by beta1- and beta2-adrenoceptors in beagle dogs: effects of procaterol, a new selective beta2-adrenoceptor agonist

The intravenous injection of isoprenaline (10 nmole/kg) into conscious beagle dogs caused significant increases in the blood level of lactate, glucose, FFA, insulin and cyclic AMP. These metabolic alterations induced by isoprenaline were blocked completely by pretreatment of the dog with propranolol (1 mg/kg). Butoxamine (10 mg/kg) antagonized isoprenaline-induced increases in glucose, lactate and insulin, but not the increases in FFA. Practolol (10 mg/kg) diminished the increase in blood FFA very strongly. Salbutamol, which is known to be an agonist of the beta 2-subtype in its bronchomotor and cardiovascular actions, produced marked increases in the blood concentrations of lactate, glucose and insulin but were without effect on the FFA level. Thus metabolic responses of conscious beagle dogs to beta-adrenoceptor agonists appeared to depend differentially on two types of beta-adrenoceptors: beta1-adrenoceptors are largely involved in lipolysis while beta2-adrenoceptors are involved in the regulation of blood glucose metabolism and insulin secretion. A new beta-adrenoceptor agonist, 5-(1-hydroxy-2-isopropylaminobutyl)-8-hydroxycarbostyril hydrochloride hemihydrate (Procaterol), was classified as a beta 2-agonist, because it markedly increased plasma concentrations of glucose, lactate and insulin but increased the plasma level of FFA to a lesser degree. The order of potency of beta2-agonists was procaterol greater than salbutamol greater than trimetoquinol. Metabolic responses of beagle dogs would be useful for appreciating the selectivity and potency of beta-adrenoceptor agonists and antagonists.

Estimation of plasma unbound phenobarbital concentration by using mixed saliva

Relationships among plasma total (Ct), plasma protein unbound (Cf) and mixed salivary (Cs) concentrations of phenobarbital (PB) were studied in 29 epileptic patients. A highly significant correlation was observed between Ct and Cf. Although a significant correlation was observed between Cf and Cs, Cs/Cf ratio was only 0.63. When Cs was corrected by using pKa (7.41) and pH of saliva to estimate free PB concentration (Cest f), a highly significant correlation was obtained between Cf and Cest f, and Cest f/Cr ratio was 0.96. The temporal course of Cest f obtained from Cs after an oral single dose of 50 mg PB in a healthy adult male volunteer was approximated as a triexponential equation. The peak time was 2 hr after ingestion and apparent half life was 66 hr. The prediction of minimum concentrations at steady state on the basis of these parameters corresponded well with actually obtained Cest f following repetitive administration of PB.

Factors influencing the late results of operation for carcinoma of the pancreas

In 151 patients with carcinoma of the pancreas presenting at the surgical clinic of Tohoku University Hospital, predominant factors affecting postoperative prognosis were studied with relation to the stages of the disease. The presence of lymph node metastasis and of cancer invasion to the pancreatic capsule, particularly the latter, was apparently a significant factor most crucially affecting the survival of the patients who underwent pancreatoduodenectomy. The mean survival periods of resected patients were 16.4 months for those with carcinoma of the head of the pancreas and 11.0 months for those with carcinoma of the body and tail of the pancreas, distinctly longer than after palliative operations. However, in patients with stage III disease, pancreatoduodenectomy tended to lead to a shorter period of survival, suggesting that surgery at that stage is generally unpromising for cure.

Septicemia caused by Klebsiella oxytoca

Klebsiella oxytoca was isolated from the blood of a leukemic patient. The typical pathogenicity of Klebsiella oxytoca was observed in the patient. The pathogenicity of several Klebsiella oxytoca strains isolated from blood, urine and sputum of different patients was examined in mice, and it was found that Klebsiella oxytoca isolated from the blood had a higher toxicity than the others.