Estimated weight of the residual parathyroid gland after parathyroidectomy using plasma levels of the parathyroid hormone

The possibility of estimating the total weight of the parathyroid glands based on the plasma concentration of the parathyroid hormone (PTH) would be of great help when searching for the parathyroid glands during surgery on patients with secondary hyperparathyroidism. Thus, we studied the relationship between the levels of carboxyl-terminal PTH (C-PTH), midportion PTH (M-PTH) and intact PTH, and the weight of the parathyroid glands resected for secondary hyperparathyroidism. The subjects studied were 11 patients with secondary hyperparathyroidism caused by chronic renal failure. The pre- and post-operative differences in the plasma C-PTH levels and plasma M-PTH levels were significantly correlated with the weight of the resected parathyroid glands (p less than 0.001 for both), but there was no correlation between the differences in the levels of intact PTH and the weight of the resected parathyroid glands. From these relationships we estimated the weight of the residual parathyroid gland after parathyroidectomy using the levels of each PTH. All patients in whom the residual parathyroid gland was estimated to be heavy based on the levels of M-PTH showed recurrence of hyperparathyroidism after the parathyroidectomy. We therefore found that estimation of the weight of the parathyroid glands from the levels of M-PTH is both possible and useful.

Characterization of AL amyloid protein identified by immunoelectron microscopy: a simple method using the protein A-gold technique

The classification of amyloidosis depends on the chemical nature of the specific amyloid protein involved. Because AL amyloid protein consists mainly of variable regions of light chain (LC), immunohistochemical staining with conventional anti-LC antisera cannot identify its protein. We were able to classify three cases of AL amyloidosis, including one case of AL-kappa LC and two cases of AL-lambda LC, using post-embedding protein A-gold immunoelectron microscopy on autopsy-derived tissues. We describe here our procedure in which a protein A-gold staining apparatus was used. The main advantage of this method is that many sections can be stained and washed simultaneously under the same conditions. These results suggest that the post-embedding protein A-gold technique using conventional kappa or lambda LC may be useful in diagnosing AL amyloidosis.

Clinical application of electric resistance welding and soldering methods to removable partial dentures

The joining procedure for uniting metal structures is very important in the construction of removable partial dentures. However, it has several restricted problems in joining wrought wire clasps to rests or major connectors. For example, the base metal wires made of chromium-cobalt alloy are subject to changes in their mechanical properties caused by heating, and damage to acrylic resin materials (denture base and artificial teeth) occurs in the repair of removable partial dentures by using the torch soldering method. In this paper, in order to resolve these problems, an electric resistance welding machine was applied to attach wrought wire components to a removable partial denture framework. This welding machine was used to attach metal structures temporarily to each other, and to solder the welded joint with hard solder. Consequently, some problems of the conventional torch soldering method were improved by using the electric resistance welding and soldering methods. It was suggested that the clinical application of the electric welding and soldering methods was very useful in the construction of removable partial dentures.

[A case of mediastinal immature teratoma with elevated levels of CA19-9]

A 15-year-old woman was found to have a large anterior mediastinal mass on chest roentgenogram. Preoperatively, serum levels of CA19-9 were found to be elevated. From the result of pathological study on the resected lesion, it was diagnosed as immature teratoma. The fluid levels of CA19-9 extracted from the tumor were found to be elevated. Part of the tumor, the pancreas, the bronchial epithelium and the intestinal epithelium, were shown positive staining in immunoperoxidase assay using anti CA19-9 antibody. The postoperative course was satisfactory and the serum levels of CA19-9 returned to normal. In mediastinal germ cells tumors, there are no cases reported in which CA19-9 was detected in serum and in the tumors. In order to define the relation between mediastinal germ cell tumors and CA19-9, further more cases should be investigated.

An autopsy case of diffuse myelomatosis associated with systemic kappa light chain deposition disease (LCDD). A patho-anatomical, immunohistochemical and immunobiochemical study

A case of systemic light chain deposition disease in a 48-year-old man is presented. Clinically, the patient showed the signs of multiple organ (liver, heart and kidney) failure, but multiple myeloma was not diagnosed. Autopsy revealed generalized deposition of hyaline, a Congo red-negative substance, especially in the arterial walls of various organs. In the bone marrow, myelomatous proliferations of plasma cells positive for kappa light chain were recognized. The deposited substance was ultrastructurally different from amyloid fibrils, and was identified as kappa light chain by immunohistochemistry. A liver tissue extract was immunobiochemically examined and the deposited substance was confirmed to consist of kappa light chain, its molecular weight being approximately 14,000 to 17,000 Da.

[Development of tetany in siblings suffered from Bartter's syndrome]

The present authors observed and treated a siblings case of normocalcemic tetany, which is considered as belonging to Bartter's syndrome. As far as we know, there are a number of familial cases of tetany in literature, but none of them spreads over more than two generations, so that the tetany appears to be recessive in hereditary characters including our patients. Both of them presented tetanic seizures in the course of Bartter's syndrome and they were regarded as one of various manifestations of the syndrome. In other words, the Bartter's syndrome or the hypopotassemia should be one of the fundamental disorders for developing tetanic symptom. The tetanic symptoms became extinct during the treatment with spironolactone against hypopotassemia. Of the two patients, younger sister had shown an agitated depression developed on her childish and over-sensitive personality, but the depression was improved in parallel to the recovery from tetany and hypopotassemia. Therefore, it appears to be certain that the patients would have some premorbid deviation of personality traits, where symptomatic psychoses could be attributed, in the case of Bartter's syndrome. Generally speaking the psychic disorders, such as personality deviation and psychotic episode, seem to by very important symptoms in patient with Bartter's syndrome as well as in patient with hypocalcemia or hypoparathyroidism.

Effects of 1-(4-nitrophenyl)-2-isopropylaminoethanol (INPEA) and propranolol and their dextro-isomers on hemodynamic and metabolic responses to isoproterenol in dogs

The effects of dl-propranolol, D-(-)-(4-nitrophenyl)-2-isopropylaminoethanol (INPEA) and L-(+)-INPEA on the hemodynamic and metabolic responses to isoproterenol were investigated in dogs anesthetized with pentobarbital. Isoproterenol (200 micrograms/kg i.p.) was injected 15 min after an i.v. injection of propranolol or INPEA, or their dextro-isomers. Isoproterenol increased heart rate, myocardial contractile force (determined by a strain gauge arch), blood glucose, blood lactate and plasma free fatty acids, and decreased diastolic blood pressure. dl-Propranolol (1 or 3 mg/kg) or D-(-)-INPEA (5 or 15 mg/kg) inhibited all the responses to isoproterenol. d-Propranolol (1 or 3 mg/kg) did not inhibit the isoproterenol-induced responses of heart rate, myocardial contractile force and plasma free fatty acids, but it inhibited the isoproterenol-induced responses of diastolic blood pressure, blood glucose and blood lactate, although the inhibition was small. Similar results were obtained by L-(+)-INPEA; L-(+)-INPEA (5 or 15 mg/kg) did not inhibit the isoproterenol-induced responses of heart rate, myocardial contractile force and plasma free fatty acids, but it inhibited the isoproterenol-induced responses of diastolic blood pressure, blood glucose and blood lactate, although the degree of inhibition was small. These results indicate that dextro-isomers of propranolol and INPEA may have a weak beta-2 adrenoceptor antagonistic action.

Studies on duodenal cyclic AMP content content in pancreatic disease after administration of pancreozymin and secretin

Cyclic AMP (cAMP) output in the duodenal contents of 11 normal subjects, 18 patients with chronic pancreatitis, six convalescing from acute pancreatitis and five with pancreatic carcinoma was measured after a single dose of pancreozymin and secretin. The technic was indirect, utilizing recovery of duodenal contents by the Dreiling tube rather than direct measurements of fluid that was not contaminated by bile. In all patients groups, cAMP output reached a peak after this stimulation with a concomitant increase of bicarbonate and amylase outputs. A significantly decreased cAMP output was observed in all pancreatic disease groups compared to the normal group. Patients with chronic pancreatitis showed a slightly decreased cAMP output, considerably decreased bicarbonate output and normal amylase output. In acute pancreatitis cAMP output was reduced with normal bicarbonate and amylase outputs. In pancreatic carcinoma cAMP decreased significantly, bicarbonate output was moderately reduced and amylase output was normal. cAMP output in all groups studied did not correlate with either bicarbonate output or amylase output.

Serum secretory component level in myeloma patients with disorders of the secretory surface

Secretory component (SC) in myeloma serum was measured by a double antibody radioimmunoassay. It was elevated in patients with IgA myeloma and the highest level was observed in a patient with macroglobulinemia. The presence of disorders of secretory surface in myeloma patients slightly but not significantly elevated the serum SC concentration. A significant correlation between serum SC and IgG is demonstrated, but not between serum SC and IgA. Over the whole patient groups, serum SC is significantly related to serum IgM but not when patients with macroglobulinemia are excluded from the calculation. Serum SC is present as SC-IgM in macroglobulinemia and SC-IgM and SC-IgA in IgA myeloma.

Studies on acid protease fractions and gastric mucosal atrophy. 3. Special reference to peptic ulcers

In combination with routine gastric secretion test and endoscopic congo red test, alkali labile pepsin (ALP) and alkali stable pepsin (ASP) were separately determined in total of 41 patients with peptic ulcer including 20 gastric (GU), 12 duodenal (DU) and 9 gastroduodenal ulcers (GDU), and in 10 normal controls. In both of basal and tetragastrin stimulated states, percent of ASP in total acid protease (%ASP) was increased in order of GU, GDU, normal control and DU with a close relation to the dimension of acid secreting area determined by endoscopic congo red test. Percent ASP was decreased after tetragastrin provocation in all disease groups. GU had high % ASP and low maximal acid output (MAO), GDU had high %ASP and high MAO, and DU showed low %ASP and high MAO.

Microcirculation of the rat small intestine as studied by the injection replica scanning electron microscope method

Mucosal blood supply in the rat small intestine was studied by the injection replica scanning electron microscope method. The blood vascular plexus in the villus is originated at the tip of the villus and confluenced near the base of the villus. This supports the classical "fountain pattern" of MALL in the villous microcirculation. The capillary plexus in the crypt is derived at the base of the crypt and converged near the base of the crypt. The capillary plexuses in the villus and the crypt communicate with each other. It is considered that the basal segment of the villus, where the arterial termination is lacking, is supplied by the cryptal capillaries via this communication.

A case of alcaptonuria with fatal cardiovascular disturbance

A case of alcaptonuria combined with aortic insufficiency was found in a 28-year-old male. The patient was palpitating at admission. The daily excretion of homogentisic acid was 2.0-6.0 g. Electrocardiography indicated atrial fibrillation and left ventricular hypertrophy with a ST-T change and right axis deviation. Cartilage tissues in the knee-joints showed no pigmentation. Vertebral X-ray revealed no calcification. The patient's history disclosed a family intermarriage in his grandparents. The patient's mother noticed the presence of black stains on diapers in his infancy and brown pigmentation on the skin and sclera in childhood. No kin had similar symptoms.

Methemoglobinemia induced by chlorphenamidine

A 76-year old farmer ingested 100 g of chlorphenamidine (Galectron), a plant acaricle, for the purpose of suicide. Gastric lavage was performed and the patient survived. Methemoglobinemia was noted after emergency treatment and was still present at 20 hours after ingestion of the compound. The patient was lethargic for at least 50 hours. Moderate neutrophilic leukocytosis and kidney injury were observed.