Shear-induced platelet aggregation in cerebral ischemia

BACKGROUND AND PURPOSE

Recent evidence has suggested that shear-induced platelet aggregation is an important mechanism of thrombosis at arterial bifurcations or stenoses. We measured shear-induced platelet aggregation with a new apparatus in patients with cerebral ischemia and also studied correlations with other hemostatic parameters as well as the effect of antiplatelet agents.

METHODS

The subjects were 75 patients with cerebral ischemia and 26 control subjects. Platelet aggregation was induced in citrated platelet-rich plasma by a high shear stress (108 dynes/cm2) that was applied by means of a cone-plate streaming chamber based on turbidimetry. We studied the correlation of test results with hemostatic parameters and also the effects of antiplatelet agents.

RESULTS

Compared with the control subjects, an increase of shear-induced platelet aggregation was observed in 21 patients with atherothrombotic stroke and 12 with transient ischemic attacks, but not in 11 with cardioembolic stroke or 31 with lacunar stroke. There was no significant correlation of shear-induced platelet aggregation with platelet count, agonist-induced platelet aggregation, fibrinogen level, or beta-thromboglobulin level. The extent of shear-induced aggregation was not correlated with von Willebrand factor antigen levels but was significantly correlated with the amounts of larger von Willebrand factor multimers. Oral aspirin (81 mg/d) did not inhibit shear-induced platelet aggregation, whereas oral ticlopidine (200 mg/d) significantly inhibited it.

CONCLUSIONS

These results indicate that shear-induced platelet aggregation is increased in patients with atherothrombotic stroke and transient ischemic attacks, is correlated with the increase of larger von Willebrand factor multimers, and is corrected by ticlopidine but not by low-dose aspirin.

Anatomical and radiological evaluation of the triangular fibrocartilage complex of the wrist

109 wrists from 69 cadavers (mean age 74 years) have been studied to clarify the pathology and morphology of the triangular fibrocartilage complex (TFCC) and to correlate pathological and radiological findings. Perforation of the TFCC was observed in 65% of the specimens and was considered to be secondary to a degenerative process, because it was often accompanied by degenerative changes in the ulnar carpal bones and perforation of the lunotriquetral ligament. To detect TFCC perforations on plain postero-anterior radiographs, it is important to evaluate ulnar plus variance and degenerative changes in the ulnar carpus. Existence of ulnar plus variance alone is more sensitive but less specific in detection of TFCC perforation than the existence of degenerative changes in the ulnar carpus.

Fluorescence in the migrating pseudoplasmodium of the cellular slime mold Dictyostelium mucoroides

Fluorescence was observed under light microscope in living cells and cell mass of Dictyostelium mucoroides. The fluorescence was localized in the vacuoles of live vegetative cells. While the cell mass of D. discoideum does not have a stalk during migration period, the cell mass of D. mucoroides has a stalk that forms at the beginning of the migration period. We were able to observe a preferential loss of the fluorescent vacuoles from the cells of the stalk and from the stalk-forming cells at the tip region of the slug. Although the fluorescence was also present in the mature spore mass of D. mucoroides, the fluorescence was not observed in the spores, but rather in the spaces between the spores within the spore mass. The fluorescent vacuoles in the cells of vegetative stage and of migrating slug stage may be related to the interspore fluorescence in the spore mass. Possible roles of the fluorescent substance(s) in amoebae, slugs and spore masses were discussed.

[A case of cortical blindness confirmed by single photon emission computerized tomography and visual evoked potential]

We reported a rare case of cortical blindness in cerebral ischemia following post-anoxic state confirmed by single photon emission computerized tomography (SPECT) and visual evoked potential. A 45-year-old woman who had been suffering from bronchial asthma was admitted to our hospital because of sudden progressive dyspnea and depressed consciousness. When she arrived at the hospital by ambulance, she was in hypoxic state and fell into cardiac arrest. Her respiratory condition gradually improved with respirator assistance, and she recovered consciousness, but complained of bilateral visual loss. She had no history of any neurological or psychiatric illness, nor of drug abuse. On neurological examination, she was alert and oriented. Light reflex, optic fundi, extraocular movement and other neurological findings were all normal, with the exception of bilateral blindness. EEG showed generalized slow background activity, but cranial CT scan and MRI showed no abnormalities. 99mTc-HMPAO SPECT indicated hypoperfusion in prominent bilateral occipital and parietal lobes. Simultaneous recordings of pattern reversal visual evoked potential (VEP) and electroretinograms (ERG) using transient checkerboard pattern reversal in 15 min and 30 min checks were recorded. The results showed normal b waves but absent P100 in the bilateral eyes. From the patient's neurological symptoms and the results of SPECT and VEP, she was diagnosed as cortical blindness in post-anoxic state. On the 30th hospital day, her visual acuity and visual fields improved, but she was suspected of having visual agnosia. Eighty-five days after the onset of the neurological abnormalities, no traces of visual disturbances were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Long thoracic nerve paralysis associated with thoracic outlet syndrome

Two cases of long thoracic nerve palsy associated with thoracic outlet syndrome are reported. Both patients had abnormal posture, with low-set shoulders and winged scapulae. Clinically there was weakness of the serratus anterior muscle with partial denervotion on electromyography. The diagnosis of thoracic outlet syndrome was based on positive vascular tests and brachial plexus nerve compression symptoms induced by the vascular testing positions. An orthosis that held the shoulder in an elevated position was used in both cases. Complete recovery of shoulder function and relief of the symptoms was achieved in both cases at 8 and 13 months, respectively, after application of the orthosis.

Three-dimensional cytoarchitecture of complex branched fibers in soleus muscle from mdx mutant mice

Three-dimensional cytoarchitecture and types and features of muscle fibers were examined in soleus muscles from mdx mutant mice at different stages of development. In the 2-week-old mice, no abnormal muscle fibers were observed light microscopically, whereas in the 4-week-old animals, disrupted fibers were frequent in light microscopy and scanning electron microscopy. Muscle fibers fused with several short fiber branches appeared at the sixth week after birth and increased in number until the tenth week. In the 1-year-old mice, approximately ten or more muscle fibers were seen fused together. They had many complex branches forming an "anastomosing syncytial reticulum." Muscle fibers with irregular diameters and aggregations of the same type fibers were also observed. Our results demonstrated that these complex branched fibers might be formed by long term repetition of the degeneration and regeneration cycle during the development of soleus muscles, indicating that the characteristic features of muscle fibers with irregular diameters and aggregations of the same type fibers are certainly dependent on the existence of the complex branched fibers.

Capsular infarcts: location, size and etiology of pure motor hemiparesis, sensorimotor stroke and ataxic hemiparesis

We investigated the types of syndrome, location, size and presumed causes of 72 patients with acute capsular lacunar infarction. Clinical syndromes were classified into pure motor hemiparesis (PM), sensorimotor stroke (SM) and ataxic hemiparesis (AH). Lesion sizes of AH were significantly smaller than those of PM (p < 0.01) or SM (p < 0.01). When the lesion volume was classified into two groups, > or = 1 ml and < 1 ml, the large volume group had more frequent cardioembolic sources than the small volume group (41% and 18% respectively, p < 0.05). In AH patients no cardioembolic sources could be detected. Significant carotid stenosis was found in only 4% of patients. Patients with anterior choroidal artery territory infarction had infrequent cardioembolic sources (7%). The results suggest that the lesion size varies with clinical syndrome and some etiological trends are seen in the volume and the location of lesions.

Alterations of haemostatic markers in various subtypes and phases of stroke

The purpose of this study was to clarify differences in coagulation and fibrinolytic activation between the various subtypes and phases of ischaemic stroke. Haemostatic activation markers were measured in 52 patients with cardioembolic stroke, 32 with atherothrombotic stroke and 54 with lacunar stroke and compared with 23 age-matched controls. Data were obtained in the acute (< or = 7 days after onset), subacute (8-28 days) and chronic (> or = 29 days) phases of stroke. In patients with cardioembolic stroke, D-dimer and alpha 2-antiplasmin-plasmin complex levels were higher during the acute and subacute phases, while thrombin-antithrombin III complex levels were higher during the acute phase than in patients with lacunar stroke and controls. In cardioembolic stroke, fibrinopeptide A was increased during the acute and subacute phases, thrombin-antithrombin III complexes were higher during the subacute phase and D-dimer levels were higher during the chronic phase. Protein C activity was lower during the acute phase than in atherothrombotic stroke, lacunar stroke and controls. Protein C antigen was lower during the acute phase than in lacunar stroke and controls and during the chronic phase than in lacunar stroke. In contrast, only D-dimer levels were higher in atherothrombotic stroke patients than controls during the acute and chronic phases and no significant alterations in these markers were observed in the patients with lacunar stroke. These findings suggest that measurement of molecular markers of coagulation and fibrinolysis may be useful for detecting intracardiac thrombin and plasmin generation in patients with cardioembolic stroke.

[The significance of cervical collaterals in the subclavian steal phenomenon]

The subclavian steal syndrome (SSS) is often associated with occlusive disease involving the subclavian or innominate arteries, but an asymptomatic subclavian steal, called the "subclavian steal phenomenon" (SSP), is not uncommon. Though intracranial collaterals had been postulated as one of the etiologies for the SSP's being asymptomatic, little has been accomplished in the investigation of extracranial channels. To study the hemodynamic role of cervical collateral channels, an angiographical study was done in three cases with SSP. The three cases were admitted to the hospital because of carotid ischemic symptoms, such as right hemiplegia or sensory aphasia. Each case had a blood pressure difference between the two arms, but in all of them the past history or the exercise test was negative for vertebrobasilar or arm ischemia. On angiography, occlusions of the unilateral proximal subclavian artery, the left in case 1 and the right in case 2, or a tight stenosis of the innominate artery was found in case 3. In each case, the vertebral artery flow in the affected side was inverted, siphoning off from the opposite vertebral artery into the affected subclavian artery. In addition to the vertebral siphoning; muscular branches of ipsilateral external carotid origin in cases 1 and 2, or the thyrocervical trunk via the inferior thyroid artery in case 3 was also found to function as a collateral channel to the vertebral artery on the affected side.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of diagnostic dyspraxia without ideomotor apraxia by callosal lesion]

A case of diagnostic dyspraxia was reported. A 57-year-old right handed male had been suffering from the lack of cooperation between his right and left hands for six months. Except for decreased deep tendon reflexes in all extremities, there were no abnormal findings on neurological examination. On neuropsychological examination, he was attentive, well orientated and his spontaneous speech, comprehension, naming, repetition and reading were intact. There was peculiar dissociative behavior between his right and left hands. For instance, he put a cigarette or coin in the pocket with his right hand then his left hand took out and replaced them, and he buttoned his shirts with his right hand but then unbuttoned with his left hand. These left hand oppositional behavior to his right hand were triggered by voluntary activities of his right hand. Left unilateral agraphia was also revealed but ideomotor apraxia, compulsive manipulation of tools and grasp reflex were not demonstrated. T1-weighted MRI demonstrated irregular low signal intensity areas extending from the genu to the body of the corpus callosum. No definite lesion was detected in the medial aspect of the frontal lobe. Only small numbers of diagnostic dyspraxia have been reported and such cases without ideomotor apraxia or medial frontal lesion are even rare. MRI is very useful for detecting the lesion of the corpus callosum.

Allele frequency distribution of the D1S80 (pMCT118) locus polymorphism in the Japanese population by the polymerase chain reaction

Population studies among Japanese were carried out at the D1S80 locus by the polymerase chain reaction and subsequent analysis in agarose gel electrophoresis. A total of 58 genotypes and 25 alleles ranging from 16 to 45 repeat units were observed in a population group of 121 unrelated individuals. The alleles with 18, 24 and 30 repeat units were found to be most common. Some large alleles with more than 42 repeat units were first observed in this study. Statistical tests for Hardy-Weinberg equilibrium showed that no significant deviations could be found in this Japanese population sample. The values of the mean exclusion chance and the discriminating power (DP) were calculated to be 0.76 and 0.91, respectively. The observed heterozygosity was 0.91.

[Clinical assessment of serum intestine type alkaline phosphatase using Japan Society of Clinical Chemistry (JSCC) recommended method--assessment of JSCC recommended method followed by indoxylphosphate staining]

We assessed a clinical usefulness of JSCC (Japan Society of Clinical Chemistry) recommended method for the measurement of serum alkaline phosphatase. The recommended method is completely correlated both in the liver-bone and intestine isoenzymes with Kind-King method recommended by the expert panel of liver function tests in Japanese Society of Gastroenterology. On the other hand, mixed tests of liver-bone and intestine isoenzyme completely show the full recovery at any combinations of both enzymes using indoxylphosphate isoenzyme staining method. These results indicated that the quantitative analysis of blood alkaline phosphatase is possible employing the combination of JSCC recommended and indoxylphosphate staining methods. Employing these combinations, we could effectively assess the pathophysiological significance of intestine alkaline phosphatase appeared in liver cirrhosis and portal hypertension.

[Clinical investigation of striatocapsular infarction]

We investigated the clinical profile, etiological factors, neuropsychological features and radiological characteristics of 17 cases of striatocapsular infarction (SCI). SCI was defined as the following CT criteria: the area of infarction included the internal capsule and striatum, the maximum diameter of the lesion exceeded 2.0 cm without cortical involvement. There were 9 men and 8 women with mean age of 58 years. Five patients had lesions mainly involving the caudate head (anterior type) and the other 12 had lesions mainly involving the putamen (lateral type), 6 with left side lesion and 6 with right side lesion. Motor weakness was observed in all patients, and the upper extremities were preferentially involved, while in 9 patients face, upper and lower extremities were simultaneously involved. Etiological investigation revealed that 8 patients were cardioembolic stroke, 2 were artery-to-artery embolism and 2 were MCA stem occlusive disease, while the remaining 5 were undetermined. When compared with patients with lacunar infarction (LI), patients with SCI had significantly more frequent cardioembolic sources (47% vs 17%, p < 0.05) and less frequent hypertension (41% vs 80%, p < 0.01). In acute phase, neuropsychological abnormalities were found in 15 patients. Anterior type patients had psychiatric symptoms such as abulia, depression and agitation, while left lateral type patients had aphasia and right lateral type patients had hemispatial neglect or anosognosia. These symptoms gradually improved, although in most patients subtle abnormalities lasted over chronic phase. In 11 out of 13 patients who underwent SPECT using 99mTc-HMPAO, blood flow was decreased in overlying cerebral cortex besides the infarcted area.(ABSTRACT TRUNCATED AT 250 WORDS)

Problems related to dorsal root entry zone lesions

Several clinical problems related to the dorsal root entry zone lesions (DREZLs) in 15 patients with chronic pain are presented and discussed in terms of ratings of pain relief following surgery, development of sensory or motor weakness and postmortem histologies. Subjective pain relief exceeding 70% was achieved at around 2 weeks after the operations in most patients (13/15), and then decreased in some to 30 from 70% in the follow-up observations. Our new "objective" pain relief score was tested in these patients. A significant positive correlation between subjective pain relief and our objective pain relief scale was found, but some discrepancies between them were also found during the follow-up. Sensory loss, motor weakness, paraesthesia and a new pain were found as complications in 12, 7, 4 and 6 patients, respectively. Postmortem histological findings of the spinal cord in two patients with systemic lupus erythematosus and uterine cancer, who received bilateral DREZLs twice and bilateral DREZLs plus commissural myelotomy, respectively, indicate that care should be taken to avoid extension of the coagulation beyond the dorsal horn.

A weight-lifting exercise model for inducing hypertrophy in the hindlimb muscles of rats

A new method for strength-training of rat hindlimb muscles, comparable to human weight lifting, is compared with sprint training by a treadmill. The new training apparatus that can induce rats to perform human squats was designed. Squat training was composed of isotonic high-intensity, short-duration, and graded overload exercises. After 60 min of one bout of all-out squat and sprint training, serum creatine kinase activities were markedly increased in the squat group (P less than 0.001), but no significant changes were observed in the sprint group. These responses were reflected in the histological sections of the muscles. Some splitting and small fibers were observed only in the squat group, suggesting that different stimulations were applied to the muscles of both the squat and sprint groups. At the end of 12 wk of both types of training, performed 4-5 d.wk-1, the number of fibers in the plantaris muscles of the squat group was greater by 14% than that in the control and sprint groups (P less than 0.001), suggesting hyperplasia following hypertrophy. These results indicated that the muscle strength-training model presented here may provide a new insight into the muscle hypertrophy associated with hyperplasia induced by heavy resistance training.

Anatomic study of the glenoid labrum

Thirty-one shoulder joints from the cadavers of 13 men and four women and from two cadavers of unspecified sex were dissected to investigate the anatomic characteristics of the glenoid labrum. The ages at death ranged from 63 to 90 years with a mean age of 78.5 years. The glenoids were divided with a bone saw along both their long and short axes. The size of the glenoid and the labrum of each specimen was then measured with calipers. No significant correlation existed between the size of the labrum and that of the glenoid. This indicated that even if the glenoid was large, the labrum was not always correspondingly large. If one aspect of the labrum was large, other portions of the labrum tended to be large also. The anterior and inferior portions of the labrum were the largest, and this may have contributed to stability in the anterior and inferior directions.

[Risk factors of cerebro-cardiovascular events in treated hypertensive male workers in the fifth decade]

The relationship between cerebro-cardiovascular events (CCE) and work-related factors was examined in a cohort of 899 treated hypertensive men who were aged 50-59 yr and working more than 7 portal to portal hours (PPH). During the follow-up of 2.8 yr (2,513 person-years), 27 cases of CCEs occurred, which were classified into 18 cases of stroke, 7 cases of acute myocardial infarction, and 2 cases of others. Using univariate analysis, it was found that managerial position and long PPH (more than 11 h) were significantly related to CCE (relative risk of 3.0 and 2.2, respectively) as well as risk factors such as emaciation, left ventricular hypertrophy, excessive sleeping hours, obesity, cigarette smoking, and inadequate control of systolic blood pressure. Using Cox proportional hazards general model, both managerial position and long PPH remained independently related to the risk of CCE (hazards ratio and 95% confidence interval, 4.1; 1.7-10.0 and 2.7; 1.1-6.2, respectively), after adjustment for other risk factors. These findings suggested that work-related factors, such as managerial position and long PPH, are independent risk factors of CCE among treated hypertensive male workers in the fifth decade.

Determination of the molecular weights of ribonuclease isozymes in a cell-free crude extract of Dictyostelium discoideum, by activity-staining of gels after SDS-PAGE

1. In a previous report we described three isozymes of intracellular ribonuclease in Dictyostelium discoideum, which were found in vegetative cells. Here we report that the molecular weights of the three isozymes from vegetative cells. 2. They are 14.3 kDa, 60 kDa and 80 kDa, as determined by activity-staining of gels after SDS-PAGE. 3. For renaturation of ribonucleolytic activity from D. discoideum cells after SDS-PAGE, fibrinogen-containing gels were used and gels were washed in aqueous isopropanol to remove detergent. Results of studies by this method suggest that each of these isozymes is composed of only a single polypeptide. 4. The effect of the buffer system on this technique is discussed.

Three distinctive activities of human triceps surae muscle during the stance phase in treadmill walking and running

Activity of human triceps surae muscle (TS) during locomotion was investigated in relation to the muscle shortening and lengthening contractions. Length changes in the TS were presumed from its girth recorded using a mercury-in-silastic gauge wrapped around the muscle belly. The muscle girth during the stance phase resulted in three peaks corresponding to the actions of heel contact, weight support and toe kick. These peak heights were apparently larger than the girth level in the perpendicular standing posture. Three girth increases in running appeared in the process of ankle dorsiflexion. During walking, girth increases on weight support and toe kick were seen in the same phase. The TS through the stance phase is considered to always contract into a shortening state less than the muscle length in the perpendicular standing posture. These muscle activities are probably imposed to resist the muscle stretching. Therefore, it was suggested that the TS contracts eccentrically, with no lengthening contraction.

Generation of active oxygen species in vitro by the interaction of potassium bromate with rat kidney cell

Active oxygen species derived from the interaction of potassium bromate (KBrO3), a rat renal carcinogen, with cells from rat kidney and other organs were examined by electron spin resonance spectrometry using the spin trapping agents 5,5-dimethyl-1-pyrroline-N-oxide (DMPO) and 2,2,6,6-tetramethylpiperidine (TEMP). DMPO-OH, an indicator of hydroxyl radical production, was generated from KBrO3 by kidney cells or homogenate, but not by liver preparations and to only a limited extent by heart and brain homogenates, suggesting relative kidney specificity. To assess what chemical components are responsible for production of DMPO-OH, several physiologically related materials were examined. Glucose, saccharose, albumin and methyl linolate were found not to be involved in the KBrO3 reaction, but reduced glutathione and also ferric ions participated to produce DMPO-OH. In addition, DMPO-OH production derived from the reaction of KBrO3 with kidney homogenate was not affected by superoxide dismutase, catalase or hydroxyl radical scavengers such as DMSO or ethanol, but was effectively inhibited by singlet oxygen scavengers such as histidine and NaN3, implying singlet oxygen production. To assess this possibility, TEMP was used as a trapping agent, and TEMPO, derived from singlet oxygen, was found to be produced by the reaction of KBrO3 with homogenates of kidney, but not of liver. Furthermore, singlet oxygen production was confirmed by studies of chemiluminescence using 2-methyl-6-phenyl-3,7-dihydroimidazo[1,2a]pyrazine-3-one. As a control, DMPO-OH was also demonstrated to be produced by a known singlet oxygen source, toluidine blue plus light. The results thus indicate that singlet oxygen is a very probably candidate for the active oxygen species generated in the specific interaction of KBrO3 with rat kidney cells in vitro. This raises the question of its concern with renal carcinogenicity in vivo.

[Antiplatelet effect of clopidogrel]

Clopidogrel is a new thieno-pyridine derivative and has a more potent inhibitory effect on platelet aggregation, dependent on ADP rather than ticlopidine. In a phase I study performed in Japan, significant inhibition of ADP-induced platelet aggregation and prolongation of bleeding time was observed in the dose range of 25, 50 and 75 mg. These effects were comparable to 200 or 300 mg of ticlopidine. Antithrombotic effects have also been shown in experimental animal models. Clopidogrel is expected to reduce the incidence of neutropenia since smaller doses are sufficient to suppress platelet aggregation compared to ticlopidine. Clopidogrel has been proven to be a potent and well-tolerated antiplatelet agent for atherosclerosis patients at risk of thrombosis, in Europe.

[Determination of nicarbazin in imported chicken]

The confirmation and quantitative analysis of nicarbazin (NCZ) in imported chickens were made by high performance liquid chromatography equipped with a photodiode array detector. The results showed that 1 out of 7 chicken samples contained over 30 ng/g of NCZ. The concentrations of NCZ varied from 10 to 120 ng/g according to the parts of the NCZ positive chicken samples.

Role of platelet-activating factor in aggregation of leukocytes and platelets in cerebral ischemia

Leukocyte and platelet aggregation stimulated with formyl-methionyl-leucyl-phenylalanine (FMLP) was measured in 32 patients with cerebral ischemia and in 15 controls, using a whole blood aggregometer. The increases in impedance and the reductions in leukocyte and platelet counts were significantly greater in stroke patients than in controls. Aggregation was inhibited by oral ticlopidine, but not by oral aspirin. The effects were clearly counteracted by platelet-activating factor (PAF) antagonists, and counteracted in part by a 5-lipoxygenase inhibitor. The results suggest that platelets tend to be activated by PAF and leukotrienes liberated from hyperaggregable leukocytes in patients with ischemic stroke.

[Periosteal osteosarcoma of the femur: a pathological and ultrastructural study]

A femoral, diaphyseal tumor was found in a 17-year old male, and the diagnosis of periosteal osteosarcoma was made, based on the typical radiological and pathological findings. Microscopic observation on a resected specimen revealed that the tumor was covered with the intact periosteal fibrous layer and did not extend beyond the periosteum. The adjacent cortex was free of tumor. These findings indicated that the tumor originated from the periosteal cambium layer, which lies between the periosteal fibrous layer and the cortex. For transmission electron microscopic examination, the tissue was obtained at open biopsy. Ultrastructurally, no specific cell of periosteal osteosarcoma was found. Although most types of osteosarcoma cells were identified in the tumor (osteoblast-like, chondroblast-like, fibroblast-like, primitive mesenchymal-like, osteoclast-like and so on), the ultrastructural characteristics were of wide variety and of low malignancy.

Statistical observation of osteosarcoma of the maxillofacial region in Japan. Analysis of 114 Japanese cases reported between 1930 and 1989

In Japan 114 cases of osteosarcoma of the maxillofacial region have been reported during the past 60 years. The average age at the onset of the disease in this region was about one or two decades later than that of osteosarcoma of other regions. Females were affected more frequently (59.6%) than males (40.4%). The mandible was more frequently affected (58.8%) than the maxilla (41.2%). Swelling was the conspicuous symptom for osteosarcoma of the maxillofacial region. Most patients received surgical treatment with or without radiation and chemotherapy; however, the prognosis is poor, regardless of the type of treatment.

[Central visual fields in pure alexia "without hemianopsia"--visual dysfunction in the right hemifield, and alexia for "kana" words in the left]

Following a left occipito-temporal subcortical hematoma, a 57-year-old, right-handed man developed pure alexia that was more prominent in kana words, especially in kana nonwords, than in kanji letters. Although a kinetic perimetry with a Goldmann perimeter showed his visual fields to be full, a static perimetry with a Humphrey visual field analyzer disclosed decreased visual sensitivity in the right visual field in its central 30 degrees. In addition, a tachnistoscopic examination with Landolt rings revealed his visual acuity (the ability of two points discrimination) to have decreased in the right half of his central visual filed in its 3 degrees. In the right central vision, he was unable to recognize the letters, pictures or colors presented by the tachistoscope. Concerning the reading, the more letters in kana words or the higher the number of strokes in kanji letters, the more difficulty he experienced in orally reading both kana and kanji. On the contrary, in the left central vision, kanji reading was not so affected by an increased number of strokes as the kana-word reading which became difficult when the number of the letters increased. CT scan showed subcortical hematoma in the left occipitotemporal region. Magnetic resonance imaging 3 months after onset revealed a localized injury in the region between the left postero-inferior temporal lobe and the infero-lateral occipital lobe, including the fusiform gyrus. None of the splenium, the lingual gyrus or the optic area were affected. The spared structures also included the angular gyrus, the Wernicke area and their subcortical white matter.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmogenic right ventricular dysplasia with massive involvement of the left ventricle

A 30-year-old male died suddenly after two years of clinically progressive episodes of recurrent ventricular tachycardia. In spite of recurrent episodes of palpitation, the patient had never shown signs or symptoms of heart failure before death. Post mortem examination revealed massive left ventricular involvement in addition to complete absence of myocardial tissue in the right ventricle, replaced by adipose tissue. This case illustrates that patients with arrhythmogenic right ventricular dysplasia may die of arrhythmia before failure of the left ventricle.

Prognosis of unresectable hepatocellular carcinoma: an evaluation based on multivariate analysis of 90 cases

A multivariate analysis of data from 90 patients with unresectable hepatocellular carcinoma was performed using Cox's regression model to identify factors possibly affecting their prognoses. Thirty-one patients underwent arterial anticancer chemotherapy, and the remaining 59 patients received transcatheter arterial embolization with anticancer agents. Four of 27 variables tested for all the patients (i.e., encapsulation [p less than 0.05], gross appearance of hepatocellular carcinoma [p less than 0.01], clinical stage [p less than 0.01] and therapy [p less than 0.01]) were found to be prognostically significant. Five of 27 variables tested were prognostically significant for the transcatheter arterial embolization group; they were an extension rate of hepatocellular carcinoma (p less than 0.01), encapsulation (p less than 0.01), alpha-fetoprotein (p less than 0.01), prothrombin time (p less than 0.01) and serum sodium (p less than 0.01). Regression equations were used to describe a prognostic index. A prognostic index was defined as the regression equation derived from the results of a total of 90 patients; PI-1 = eY, where PI-1 = prognostic index 1 Y = 1.549 (gross appearance of hepatocellular carcinoma - 1.344) + 0.778 (encapsulation - 1.622) + 0.818 (clinical stage - 1.800) + 1.760 (therapy - 1.344) and prognostic index 2, the regression equation derived from the results of the transcatheter arterial embolization group of patients; PI-2 = eY, where PI-2 = prognostic index 2 Y = 1.210 (extension rate of hepatocellular carcinoma - 1.576) + 1.179 (encapsulation - 1.475) + 0.0001277 (alpha-fetoprotein - 1420.792) -0.039 (prothrombin time - 72.237) - 0.214 (serum sodium - 138.427).(ABSTRACT TRUNCATED AT 250 WORDS)

Opposite effects of metoclopramide and propantheline on intestinal absorption of imipramine in rats

Intraperitoneally administered metoclopramide (MCP) markedly increased the serum concentration of imipramine (IPM) soon after oral administration. In contrast, intraperitoneally administered propantheline (PPT) slightly decreased the serum concentration. The administration of these two drugs had no significant effect on the serum concentration of IPM after intravenous bolus administration. It was concluded from pharmacokinetic analyses and gastric emptying experiments that the administration of MCP markedly increased the rate of IPM absorption by counteracting the gastric emptying delayed by IPM, but that the administration of PPT slightly decreased the rate of IPM absorption by strengthening the gastric emptying also delayed by IPM.

[Survey of radiocesium in domestic mushrooms on the market]

Domestic mushrooms on the market were tested for concentration of radiocesium; cesium-134 and 137 by gamma-ray spectrometer. Cesium-137 was detected in most samples of dried and raw shiitake (Lentinus edodes (Berk.) Sing.). The concentrations were from 6.7 to 73.9 Bq/kg in dried ones and from 1.3 to 6.4 Bq/kg in raw ones. It was not detected in enokitake (Flammulina veltipes (Fr.) Sing.) and shimeji (Lyophyllum aggregatum (Secr.) Kühner and Pleurotus ostreatus (Fr.) Quél.). Cesium-134 was not found in all samples.

Isozymes of ribonuclease and the changes in their relative levels during development in the cellular slime mould Dictyostelium discoideum

The isozymes of ribonuclease were analyzed in cell-free, crude extracts of Dictyostelium discoideum by activity staining of polyacrylamide gels after electrophoresis. The relative levels of three isozymes were then examined during the growth and during the first stages of multicellular development. We observed the replacement of two of these three isozymes by two other isozymes at the pseudoplasmodial stage. These isozymes were different from ribonuclease T1 in terms of their mobility in polyacrylamide gels during electrophoresis. The mobilities of two of the isozymes, DdI and DdII, were 59 and 42% of that of ribonuclease T1. The changes in the relative levels of the isozymes during development are discussed.

Radiographic changes in wrists with ulnar plus variance observed over a ten-year period

This study provides additional radiographic information concerning the long-term effect of ulnar impingement. Films of 198 wrists of 102 patients with vibration disease observed over ten or more years were reviewed. All the wrists showed ulnar plus variance of more than 0 mm except seven. Degenerative changes were found in 58 wrists and were seen only on the ulnar side of the wrist, especially in the ulnoproximal area of the lunate. Most of the degenerative changes in the wrists with ulnar plus variance had progressed or changed during the ten or more years. Ulnar plus variance may play an important role in inducing or causing progression of degenerative change in the wrist.

[A case of inorganic germanium poisoning with peripheral and cranial neuropathy, myopathy and autonomic dysfunction]

A 51-year-old man, taking beverage containing inorganic germanium (Ge), (90-100 mg/day, total 70 g) for two years, developed body weight loss, anemia, renal dysfunction, peripheral neuropathy, myopathy, autonomic dysfunctions and multiple cranial nerve palsies. Serum CK, GOT, LDH, BUN, and creatinine levels were elevated. The cerebrospinal fluid showed albumino-cytologic dissociation. Sural nerve biopsy showed axonal degeneration, and peroneal muscle biopsy showed neurogenic changes including type 2 fiber atrophy and ragged red fibers. High level of Ge content was detected from the hair and nail by inductively coupled plasma atomic emission spectrometry. Despite discontinuation of Ge taking, the peripheral neuropathy and autonomic dysfunction progressed. The symptoms remained unchanged even in the treatment with prednisolone. These findings suggest that inorganic Ge has a serious irreversible multiple system toxicity.

[A clinical evaluation of distant metastases from a hepatocellular carcinoma with reference to location, frequency, symptoms, treatment & prognosis]

A clinical analysis of patients with hepatocellular carcinoma (HCC) associated with a distant metastases has been undertaken by the authors. Studied were eight patients (Group A) whose distant metastases were detected at the time of their initial examination, and 24 patients (Group B) whose distant metastases had been diagnosed during the course of treatment of their primary lesions. Complications arising from liver cirrhosis in Group A was less than in Group B. The location of the metastases were the bone in 16, the lung and the adrenal gland in four, the brain and the skin in two and the kidney in one. The mean survival times were 4.6 months (Group A), and 6.3 months (Group B). The cause of death was chiefly a progression of the primary lesion, except for one brain metastases. This analysis had shown that treatment of a bone metastasis is necessary for the relief of pain, and that care should be taken for the prevention of a fracture or paralysis, and that control of the primary lesion is necessary for improving the chances of survival.

Effects of calcitonin gene-related peptide and vasoactive intestinal peptide on nicotine-induced sweating in man

The effects of two neuropeptides, calcitonin gene-related peptide and vasoactive intestinal peptide on nicotine-induced sweating in human skin were investigated. Intradermal injection of nicotine induced local sweating and each peptide, administered together with nicotine, inhibited these responses in a concentration-dependent manner. The concentration of calcitonin gene-related peptide for threshold and half-maximum inhibition were about 10(-10) M and 10(-8) M, respectively, while those of vasoactive intestinal peptide were approximately 10(-9) M and 10(-7) M, respectively. The results suggest that calcitonin gene-related peptide and vasoactive intestinal peptide have inhibitory effects on the nicotinic action, and release of endogenous calcitonin gene-related peptide and/or vasoactive intestinal peptide may influence sweating in human skin under physiological conditions in vivo.

[A case of delayed radiation lumbo-sacral plexopathy]

We report a 47-year-old woman who developed a slowly progressive lumbosacral plexopathy with mixed sensorimotor losses in the lower extremities. The symptoms were apparent 8 years after x-ray irradiation for an ovarian carcinoma. Neurological examination showed mild weakness and absent deep tendon reflexes of bilateral lower extremities, and hypesthesia to all modalities in anterior aspects of bilateral lower thighs, in dorsum pedis and soles. Extensive investigations regarding the possibility of tumor recurrence were negative. Computed tomography of pelvis showed abnormal soft tissue densities around the lumbosacral plexus. Intravenous pyelography showed bilateral hydronephrosis and narrowed ureters at the first sacral vertebra level. These findings are consistent with radiation-induced fibrosis rather than tumor infiltration. The results suggest the entrapment lumbosacral plexopathy due to surrounding fibrosis after irradiation. We speculated the sensorimotor losses caused by entrapment of the lumbosacral plexus.

Combination therapy with low-dose aspirin and ticlopidine in cerebral ischemia

We compared combination therapy with low-dose aspirin plus ticlopidine to therapy with aspirin alone or ticlopidine alone in patients suffering transient ischemic attack or cerebral infarction. In 17, 24, and 23 patients, respectively, 300 mg/day aspirin, 200 mg/day ticlopidine, and 81 mg/day aspirin plus 100 mg/day ticlopidine were administered orally. Aspirin alone markedly inhibited platelet aggregation induced by arachidonic acid, partially inhibited platelet aggregation induced by adenosine diphosphate, and did not inhibit platelet aggregation induced by platelet activating factor. Ticlopidine alone inhibited platelet aggregation induced by adenosine diphosphate and platelet activating factor, but did not inhibit platelet aggregation induced by arachidonic acid. Combination therapy with aspirin plus ticlopidine markedly inhibited platelet aggregation induced by all three agonists. Plasma concentrations of beta-thromboglobulin and platelet factor 4 remained unchanged by aspirin alone, were slightly reduced by ticlopidine alone, and were markedly reduced by aspirin plus ticlopidine. Plasma concentration of thromboxane B2 was reduced by aspirin alone or with ticlopidine, but not by ticlopidine alone. The level of 6-ketoprostaglandin F1 alpha was reduced only by aspirin alone. Bleeding time was significantly prolonged by aspirin alone and by ticlopidine alone, although the greatest prolongation was produced by aspirin plus ticlopidine. Our results indicate that the combination of aspirin plus ticlopidine is a potent antiplatelet strategy, although the clinical importance of the changes observed need to be determined by a properly designed and controlled prospective study.

An experimental study of spinal cord evoked potentials and histologic changes following spinal cord heating

To study the safety of hyperthermia cancer treatment, canine spinal cords were heated with radio waves to between 43 C and 47 C for 30 minutes. Spinal cord evoked potentials (SCEP) studied by epidural recording after epidural stimulation showed shortened latency and unchanged amplitude at 44 C or below. At 45 C or above, reduction of amplitude combined with shortened latency was observed, a phenomenon that has not hitherto been reported. After heating to 45 C, SCEP recovered with the reduction of temperature, but histologic examinations showed pigment exudation, vacuolation, and hemorrhage. These results suggest that tolerable spinal cord temperature should not exceed about 44 C.