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We investigated the postoperative clinical results of ankle fracture-dislocation with distal tibiofibular joint separation being fixed using only a temporal screw in 31 American football and 13 Rugby players between 1986 and 2004. Two cases were Weber type B and 42 cases were Weber type C. The mean age was 23.6±7.5(16-30) years old. All cases were male. The temporal screw was removed after 4 weeks temporal fixation of the distal tibiofibular joint. The mean follow-up period was 17.5±10.5(12-60) months. There were no incidences of re-separation of the tibiofibular joint after removing the temporal screw. It is considered that lower soft tissue damage does not lead to tibiofibular joint re-separation, because the injury energy of these sporting activities is lower than those of a traffic accident Only one case with residual shortening of the fibula after surgery had pain, narrowing of the ankle joint space and ROM limitation. The mean fusion of the fibula was 15.0±7.8(4-48) weeks. The mean period of return to jogging after surgery was 12.3±6.8(4-47) weeks. That of return to competition was 16.8±8.3(6-60) weeks. The period of return to sporting activity was affected by that of bony fusion on X-ray. The results indicate that only temporal fixation of distal tibiofibular syndesmosis can attain stability when performing both strict anatomical reduction of the fibula and suture of the deltoid ligament, if it is necessary, in the case of ankle fracture-dislocation that occurs through sporting activities such as AF and RB. [ABSTRACT FROM AUTHOR]

Lacking experience of laparoscopic surgery against gynecologic malignancies, we started performing robot-assisted surgery for uterine cancer in September 2017. Here we compared the safety and efficacy of robot-assisted surgery with those of open surgery in early-stage uterine cancer patients. The surgical time was significantly longer and the blood loss and hospital stay were significantly shorter for robot-assisted versus open surgery. No recurrence was observed after robot-assisted surgery. Robot-assisted surgery can be safely performed even in general hospitals and is an effective treatment option for early-stage uterine cancer patients.

Taste disorders are caused by several factors, and there have been few reports concerning the clinical course of taste disorders. In this study, patients with taste disorders were classified into 10 groups according to causes, and they were retrospectively studied in terms of therapeutic effects. In total, 1059 patients (412 men and 647 women, mean age: 60.0 years) who complained of taste disorders were reviewed in our clinic. The patients were asked detailed questions about their history of symptoms, and their emotional status was assessed using a self-rating depression scale. In all subjects, taste functions were measured by electrogustometry (EGM) and filter paper disks (FPD). The grades of their symptoms were assessed with a visual analogue scale (VAS). In addition, the levels of serum iron, copper, and zinc were examined. The patients were treated with zinc sulfate, polaprezinc, iron preparation, herbal medicine, and minor tranquilizers according to the factors causing the taste disorders. The most frequent cause was idiopathic taste disorder (192 cases, 18.2%), the second was psychogenic (186 cases, 17.6%), and the third was drug-induced (179 cases, 16.9%). The recovery rate of the symptoms was 64/92 (70.2%) in post-common cold, 31/35 (88.6%) in iron deficiency, and 85/116 (73.3%) in zinc deficiency. In these groups, the rates of recoveries were better than in the other groups. The recovery period in drug-induced taste disorders was approximately twice as long as the recovery period in the other groups. In the patients who were able to start treatment within 6 months from the onset of taste disorder, the recovery rate was significantly higher and the therapeutic period was significantly shorter than in those who had the disorders for more than 6 months (p<0.05, respectively).

In Japan, endoscopic surgeries are covered by health insurance only when they are performed for benign diseases. Actually, endoscopic surgery is performed for the treatment of benign diseases in most cases. However, it is difficult to precisely know what types of cases are currently treated with laparoscopic procedures in Japan. The Japan Society of Gynecological and Obstetrical Surgery performed a survey to examine the frequency of the use of endoscopic surgery for the first time in Japan, and reported the results. In this article, we described the present situation and problem of gynecologic laparoscopic surgery in Japan from the results.

In recent years, the number of patients with psychologenesis taste disorders has increased. In this study, related psychological factors were examined in 258 patients (85 men, 173 women) using a self-rating depression scale (SDS). The results were as follows: 1) 189 patients reported normal psychological factors, 2) 173 patients reported neurotic sates, and 3) 40 patients reported positive correlations with a depressive sates, Most of the patients, self-reported results were not correlated with taste function tests. On the other hand, the patients with depression had reduced salivary secretion tests results. Only 50% of the patients with depression recovered their taste functions. These results suggest that the SDS test may be useful for diagnosing taste disorders and monitoring effects of treatment.

The importance of taste has been recently evaluated from the standpoint of quality of life, but few reports exist on the clinical status of taste disturbance. We classified taste disturbance by cause and studied the effect of treatment and recovery duration. Subjects were 321 patients with taste disturbance, i.e., 131 men and 190 women (mean age: 59.9 years). Electrogustometry (EGM) and filter paper disks (FPD) were used to assess taste function in all subjects. We also asked them all about the degree of symptoms using visual analog scale (VAS). Statistical analysis was done using the unpaired t-test, with p<0.05 considered significant. Patients were treated with zinc sulfate, ferrotherapy, herbal medicine, and minor tranquilizers. Causes of taste disturbance were classified into idiopathic, post-common-cold, drug-induced, psychogenic, constitutional, and iron deficiency. Idiopathic taste disturbance was the commonest cause (125 cases, 38.9%), followed by drug-induced (62 cases, 19.3%), and post common cold (38 cases, 11.8%). Drug induced and psychogenic taste disturbance have increased. Recovery from symptoms was 79/103 (76.7%) in idiopathic taste disturbance, 24/33 (72.7%) in post-common-cold, and 14/17 (82.4%) in iron deficiency. Recovery took 22.2 weeks. Recovery was 32/50 cases (62.4%) in drug induced, taking 48 weeks. For all causes, EGM and FPD results were not associated with the degree of symptoms. Both tests tended to show delayed improvement compared to symptoms. Cases taking more than 6 months from symptom onset to medical examination showed significantly lower improvement and longer recovery time than those taking 6 months on less (p = 0.04).

Objective and Methods: To assess the clinical significance of CA19-9 in patients with interstitial pneumonia showing pathological nonspecific interstitial pneumonia (NSIP) pattern (IP/NSIP groups), we measured the levels of serum (n = 14) and bronchoalveolar lavage fluid (BALF, n = 10) CA19-9 in IP/NSIP groups., Result: The serum levels of CA19-9 did not correlate with the serum levels of LDH, of KL-6, or of SP-D or with the intensity of chest Ga-67 scintigraphy. There were no significant differences between the serum CA19-9 levels before therapy and those after therapy in improving patients. The levels of CA19-9 in fibrotic NSIP groups (serum:n = 7, 138.3 + /- 79.6 U/ml BALF: n = 5, 845.8 + /- 334.2 U/ml) were significantly higher than those in cellular NSIP groups (serum: n = 7, 12.8 +/-2.1 U/ml, BALF: n = 5, 40.8 +/- 16.2 U/ml). Immunohistochemical stains of CA19-9 showed the strong positivity in the bronchiolar epitheliums located in severe fibrotic lesions and the mucus within the lumens of microscopic honeycomb. The serum levels of CA19-9 were increased in both worsening patients., Conclusion: We speculated that the serum levels of CA19-9 may reflect the progression of lung fibrosis but not the disease activity in IP-NSIP groups.

Serum zinc deficiency is known to be a major cause of taste disturbances, but the effects of serum iron deficiency on taste disturbances are not widely known. In the present study, we clinically investigated the relationship between taste disturbances and serum iron deficiency as well as the results of pharmacological therapy. The clinical and serological test results of 25 patients with serum iron deficiency (3 men and 22 women; mean age +/- SD, 56.1 +/- 16.5 years) were reviewed at the Department of Otolaryngology, Hospital of Hyogo College of Medicine. All of the patients had been seen at the hospital between January 1999 and February 2003. Electrogustometry (EGM) and the filter paper disc method (FPD) were used to measure taste function. The patients were treated with iron and zinc supplements. The age distribution of the patients peaked at the ages of 40 and 70 years. The ratio of males to females was 1:7. Based on the EGM results, 70% of the patients exhibited taste disturbances. The FPD results showed that the recognition threshold of sour tastes was slightly higher than that of the other tastes. No significant difference in the results of treatment was seen, regardless of the duration of the deficiency. These results suggest that treatment with iron and zinc medicine is useful for correcting taste disturbances caused by serum deficiencies of trace elements.

We treated a 74-years-old male who had recurrence with pericardial effusion and a tumor between the pulmonary artery and left atrium 15 years after operation for invasive thymoma complicated by myasthenia gravis. Despite pericardial drainage, CDDP infusion, and radiation therapy for the tumor, the patient died due to pneumonia after 1 and half years. Long-term observation is considered to be needed after surgical resection of thymoma for recurrence or multiple oncogenesis in ectopic thymus.

There are few reports on the postoperative recurrence of bronchogenic cysts. We conducted a re-operation on a 57-year-old man with a bronchogenic cyst 15 years after an initial operation. His history showed an earlier operation for a bronchogenic cyst at the age of 42 at another hospital. 15 years after this initial operation, he suffered from common cold like symptoms, and was referred to our hospital, because of an abnormal shadow on his chest X-ray. A chest CT and MRI revealed an oval tumor just under the right intermediate bronchus. We suspected it was a recurrence of the bronchogenic cyst, and an operation was performed. The cyst was firmly adhered to the lung, and at the upper site of the cyst, a region adjacent to the intermediate bronchus was adhered to the bronchial wall. The histological findings were similar to those of 15 years previously. The cyst wall lined with pseudostratified columnar ciliary epithelium with muscular layer, which led to a diagnosis of a bronchogenic cyst. Congenital cysts, including bronchogenic cysts, are considered to originate in abnormal primordia. If there are remaining abnormal primordia, a recurrence of the disease can occur.

A 44-year-old man was admitted to out hospital complaining of chest pain and increasing dyspnea. Chest X-ray on admission revealed a collapsed lung and an air fluid line in the left hemothorax. Following blood transfusion because of 2,000 ml hemorrhagic pleural fluid, emergent surgery was carried out. At operation, a bleeding artery originating from the apex of the thoracic cavity and a bulla on the upper lobe were noticed. After extubation of endotracheal tube, he offered severe dyspnea with hypoxia. The chest X-ray showed figure of pulmonary edema in the left lower lobe. Patient was managed by oxygen, steroid, and urinastatin. On the 3rd operative day, pulmonary edema was disappeared. It should be kept in the mind that the re-expansion pulmonary edema occurred in patients with spontaneous hemopneumothorax of less than 3 days of duration.

Postoperative relapse was noted in 8 (14.8%) of 54 patients who underwent video-assisted thoracoscopic surgery for spontaneous pneumothorax followed for more than one year. Five of the eight patients with relapse were among the 15 initial-stage cases. Concerning treatment, only drainage was performed in 1 patient, and thoracotomy was performed in 5 patients. Findings on additional surgery consisted of missed cystic lesions, in 2 patients, a small opening adjacent to a suture caused by an autosuture device in 1 patient, and a cyst around a suture in patients. There was no missed cystic lesion after the 15th case. In subsequent cases, there were changes at the periphery of a suture. In patients with other diseases, there were no changes observed when an autosuture device was used under thoracoscopic guidance. Therefore, the changes may be associated with hypertonus of the emphysematous lung at the periphery of the site where an autosuture device was used. Thoracoscopic surgery for spontaneous pneumothorax using an autosuture device has limitations such as the presence of a dead angle, insufficient evaluation of emphysematous changes in the collapse lung, a large volume of resected tissue, and hypertonus of the peripheral lung. These limitations may contribute to a high recurrence rate of spontaneous pneumothorax. To reduce the recurrence rate, conditions and problems in cases showing relapse should be clarified before selecting treatment including pleurodesis in individual cases.

In the patients with invasion to the aortic window, we performed operation via median sternotomy combined with anteroaxillar thoracotomy. In such patients with T4 invasion, conventional pneumonectomy could not be performed because of the extensive invasion near the main pulmonary artery trunk. In these patients in this study, complete resection of the involved pulmonary artery could be performed using a vascular clamp without CP bypass. Operative technique was as follows: first, the pericardium was opened and taping of the aorta was applied. When the uninvolved part of the intrapericardial pulmonary artery was long enough to cut, we could use a stapling device, but the stapling device could not be used in many cases because the length of the uninvolved segment was too short to cut the left pulmonary artery. In order to carry out complete resection, it was necessary to clamp the central part of the main pulmonary artery diagonally from the left lower side to the right upper side. The pulmonary arterial stump was closed with continuous 4-0 monofilament mattress and over and over suture. We recommend an aggressive surgical approach for the tumor with invasion to the aortic window, because the prognosis is dismal in nonresected locally advanced lung cancer.

A 37-year-old male whose chief complaint was fever and back pain was admitted to our hospital because of a mass shadow in the left lower P3ng field found in X-ray examination. The level of serum SLX on admission increased to 1,338 U/ml. He was diagnosed intralobar pulmonary sequestration by angiography. The left lower lobe was resected 2 months after second admission. His general condition was steady, and he was discharged 18 days after the operation because the level of serum SLX decreased to 49.9 U/ml.

A case of right postpneumonectomy empyema treated by open window thoracostomy, thoracoplasty, pedicled omental flap and musculocutaneous flaps is reported. After open window thoracostomy, pedicled omental flap and musculocutaneous flaps transplantation utilizing techniques used in plastic surgery were performed, and right postneumonctomy empyema was successfully treated. In this study, open window thoracostomy was effective against depuration of the empyema cavity and omental and musculocutaneous flaps against the infection control and plombage of the cavity. Furthermore, to maximize the effect of musculocutaneous flaps and to use them effectively, it is thought that techniques utilized in plastic surgery are effective and necessary.

The therapeutic approach to a patient with obstructive sleep apnea syndrome (OSAS) must be individualized because of the heterogeneity in the pathogenesis of the disorder. Although nasal continuous positive airway pressure (CPAP) is effective no matter what the pathogenesis, risk factors for this disorder should be identified in each patient. Nasal CPAP will be discussed by others. Weight loss is one of the best nonsurgical treatments of OSAS and it should be strongly recommended to obese patients with the disorder, even though only a few achieve satisfactory weight reduction. Sleeping in the lateral position or upright may be effective in some patients with OSAS. Acetazolamide, medroxyprogesterone, or protriptyline may also have a role in some patients, although the efficacy must be weighed against the considerable side effects. The cross-sectional area of the oropharynx measured by computed tomography in patients with OSAS was significantly lower than that in control subjects. Lateral cephalograms revealed a retarded mandible in many patients. A dental device designed to advance the mandible 2 to 7 mm and to eliminate the airway obstruction at the base of tongue was used in 20 consecutive patients (17 men and 3 women, average age 53.8 years) to treat the obstructive sleep apnea. The body mass index of the patients was 27.6 +/- 4.2 kg/m2 (mean +/- SD). The device moved the mandible forward (p = 0.038) and increased the airway space in the lower part of the oropharynx (p = 0.031) as assessed with lateral cephalograms. After nightly use of the device for 24 to 211 days, overnight polysomnography was performed for two nights: without the device for the first night and with it for the second night. The apnea index was reduced from an average of 30.7 to 18.5 events/hour (60.4% of the pretreatment value, p = 0.004). The number of desaturations (more than 5% decrease from the base line SaO2) decreased and the lowest level of SaO2 increased: from 26.5 to 14.4 events/hour (p = 0.009) and from 63.6 to 70.1% (p = 0.005), respectively. Not every patient improved sufficiently. Eleven of 20 patients were classified as good responders, because of a reduction in apnea index of at least 50% of the pretreatment value, and the remaining nine patients were classified as poor responders. Use of the device reduced the severity ratings of snoring and excessive daytime sleepiness not only in the good responders but also in the poor responders. No serious complications were observed. The mandibular positioning device is an effective treatment for some patients with OSAS. The effectiveness of the device should be predicted from polysomnographic and cephalometric data, and from CT measurements of the upper airway and other characteristics of the patients.

The autopsy of a 28-year-old Japanese male patient, which revealed immature teratoma combined with choriocarcinoma in the mediastinum, is presented. The tumor, which was removed after chemotherapy, was localized in the superior-anterior mediastinum. Chemotherapy was performed several times after operation. However, HCG increased again, and a roentgenogram revealed metastatic shadows in both lungs. The metastatic tumors in the lungs showed only the choriocarcinoma.

The occurrence of pneumothorax in patients with compromised lung function or severe pulmonary disease may be fatal. We describe a 77-year-old patient with MRSA pneumonia complicated by pneumothorax and reduced pulmonary function. Although the patient was treated with drainage of the pleural cavity and nonsurgical pleurodesis, the pneumothorax could not be managed successfully. The patient underwent successful surgical treatment of the pneumothorax on 105 days after onset. The following factors must be considered in the surgical treatment of pneumothrax with reduced pulmonary function in patients with MRSA pneumonia: 1) When there is massive air leakage, adequate doses of VCM should be administered to prevent pyothorax, 2) when conservative treatment fails and surgical treatment becomes necessary, the operation should be instituted only when MRSA has been completely or almost completely eradicated so as to prevent the occurrence of postsurgical pyothorax, and 3) surgical intervention should be limited to what is necessary to repair the site of ruptured bulla; care should be exercised to preserve as much lung parenchyma as possible and to shorten the operation time.

We performed lung resection together with esophagectomy in 2 patients with advanced thoracic esophageal cancer. Both patients survived more than 2 years with no evidence of disease. The first case was a 60-year-old man who had a cancer lesion in middle of the intra-thoracic esophagus (Im) and the right lower lobe of the lung was involved. In March 1989, right lower lobectomy of the lung was performed with esophagectomy. Pathologic examination showed well differentiated squamous cell carcinoma invading the lung parenchyma and intrapulmonary lymph node. Postoperatively, 44 Gy of radiation and Peplomycin cancer chemotherapy was performed. The patient survived 51 months after surgery and died of chronic myelogenous leukemia. The second case was a 60-year-old man who underwent thoracic esophagectomy with resection of the involved pericardium and right lung in February 1992. Pathologic examination showed N3 lymph node metastasis. Postoperatively, the patient received 48 Gy of radiation and was free from cancer after 30 months. In conclusion, better surgical results are expected in cases of advanced thoracic esophageal cancer with lung involvement which can be completely resected en bloc with the primary tumor even in a3 cases than in those with aortic or tracheobronchial involvement.

Primary malignant germ cell tumors of the mediastinum are rare neoplasm, almost always occurring in young adult males. This report described embryonal carcinoma in a 13-year-old girl. The patient was checked up at chest X-ray examination of middle-school pupils on June 1989, and was referred to us because of rapid enlargement of the shadow on October 1989. Chest rentogenograms on admission showed a large mass at the anterior mediastinum, and MRI also revealed a multicystic one extending to the right hemithorax and pressing the superior vena cava and the right atrium. Her serum AFP level was high at 211.1 ng/ml. At operation, on November 6, 1989, a large tumor (110 x 95 x 75 mm) was removed completely through median sternotomy. Histological study of the lesion revealed a wide spread of cystic mature teratoma containing some foci of embryonal carcinoma. Positive immunochemical reaction indicated the presence of AFP in these carcinoma cells. She was treated with 13 courses of anti-cancer chemotherapy by various combinations of CDDP, THP-ADR, VP-16, VCR, ACD, CPM, CBDCA, for one postoperative year. She showed clinical improvement and has continued to be free from recurrence now at 52 months after surgery.

The number of official inspection of coal-tar dyes and their lakes from April in 1994 till March in 1995 were 635 in total. The quantity which passed inspection amounted to 186 ton in Japan. The production of color in each month was summarised in Table 1, and by each producing company in Table 2. The food coal-tar dye produced in the largest quantity was Food Yellow No.4, occupying 40.7% in this period.

We reported a metachronous primary triple cancer of lung, rectum and trachea. Patient was a 64-year-old male, who was admitted with a episode of bloody sputum. A chest X-ray and rentogen tomogram showed a irregularity and narrowing of the upper trachea. Transbronchoscopic biopsy specimen showed squamous cell carcinoma. December '92, trachea was resected in the length of five cartilages and end-to-end anastomosis was performed. Microscopic examination demonstrated a moderately differentiated squamous cell carcinoma with mediastinal lymph node metastasis. Therefore, he received a course of 30 Gy of radiation to the upper mediastinum after surgery. Three years before the tracheal resection, he had undergone left pneumonectomy for moderately differentiated squamous cell carcinoma of the lung. Nineteen months after the pulmonary resection, he had undergone low anterior resection of the colon for the rectum carcinoma.

Osteopontin (OPN) is considered to be a non-collagenous bone matrix protein which is involved in the ossification process. However, OPN has recently been observed in ectopic sites such as the kidney and nervous tissues. In the present study, expression of OPN mRNA was examined in the rat inner ear by non-radioisotopic in situ hybridization. Signals of OPN mRNA were observed in the marginal cells of the stria vascularis, spiral ganglions, vestibular sensory hair cells and vestibular dark cells. OPN protein was detected only in otoliths by immunohistochemistry. The reasons for the presence of OPN mRNA in the cochlea and dark cells of the vestibulum were unclear. On the other hand, findings of the sacculus and utriculus suggest that OPN is one of the protein components of rat otoliths and that vestibular sensory hair cells are involved in the production of otoliths.

The number of official inspections of coal-tar dyes and their aluminum lakes from April 1993 till March 1994 were 734 in total, with the quantity which passed inspection amounting to 213 tons in Japan. Data for production by color for each month are summarised in Table 1, and by each producing company in Table 2. The food coal-tar dye produced in the largest quantity was Food Yellow No. 4, occupying a 42.9% proportion of the total during this period.

A 67-year-old man, who was nephrectomized due to renal cell cancer 4 years ago, was admitted to examine a mass shadow in the right middle lung field. He was diagnosed as small cell lung cancer with TBLB. Because of impaired renal function, he was treated with CBDCA (300 mg/m2, day 1), THP (30 mg/m2, day 1) and oral etoposide (25 mg/body, for 21 days) without any renal complications. After 3 courses of chemotherapy, the lung CT showed scar lesion despite the disappearance on the chest X-ray, and a right lower lobectomy was performed. Malignant cells remained in the scar lesion, but not in the lymph nodes. These findings suggested the effectiveness of neoadjuvant chemotherapy. This newly-designed chemotherapy procedure is necessary for patients with renal complications.

The "Sunset Yellow FCF Standard (C.I. 15985)" for the Dye Standard of the National Institute of Health Sciences was prepared. The content of this Dye Standard determined by the titanium trichloride titration method was 96.9% on the average. The ultraviolet-visible absorption and infrared spectra of the Dye Standard were also measured.

The number of official inspection of coal-tar dyes and their lakes from April in 1992 till March in 1993 were 711 in total. The quantity which passed inspection amounted to 201 ton in Japan. The production of color in each month was summarised in Table 1, and by each producing company in Table 2. The food coal-tar dye produced in the largest quantity was Food Yellow No. 4, occupying 40.7% during this period.

The patient, a 55-year-old male, suffered from malignant lung tumor with complaints of bloody sputum and anterior chest pain. Angina pectoris was detected during neoadjuvant chemotherapy, because of total obstruction at #7 and 99% stenosis at #12, as disclosed by CAG. As he complained frequently anginal chest pain in the course of time, the concomitant cardiac and pulmonary operation was decided via median sternotomy and fourth intercostal thoracotomy. The operating procedure was as follows: 1) mediastinal lymph nodes dissection before extracorporeal circulation, 2) aorto-coronary bypass (#8, #12), 3) final left lower lobectomy. He was histopathologically diagnosed as a rare case of endobronchial type of leiomyosarcoma. He has achieved a remarkable recovery, without tumor recurrence or angina pectoris for ten months postoperatively, and has been allowed to resume a normal life.

A 41-year-old male visited with chief complaints of chest pain and cough. The patient was operated on under a diagnosis of invasive thymoma. The tumor was located in the left lobe of the thymus and measured 6 X 9 cm. Since the tumor invaded the left innominate vein, pericardium, and the upper lobe of the left lung, we resected it with adjacent structures. Postoperative pathological examination indicated squamous cell carcinoma of the thymus. Because the tumor metastasized also to the mediastinal lymph nodes, the patient was treated postoperatively by radiation therapy and adjuvant chemotherapy mainly with CDDP. The patient is well presently 2 years after operation without signs of recurrence.

Nitroblue tetrazolium (NBT) is reduced to a blue dye (blue formazan, gamma max 560 nm) by superoxide (O2-.) released from phagocytes upon phorbol myristate acetate-stimulation, resulting in the blue dye-deposition on the cell membrane. Thus, we tried to develop a semi-quantification method for determining the NBT-reducing activity in the peripheral leukocytes (NBT-staining intensity -SI- and its distribution in the cell) by flow cytometry. The SI (mean +/- SD) was 28.4 +/- 2.2 (n = 30) in normal subjects and 0.9 in a patient with chronic granulomatous disease, whereas it was 37.6 in a patient with malaria. In addition, patients with myelodysplastic syndrome showed values of 29.2 +/- 7.0 (n = 11), while a patient with partial monosomy of chromosome No. 7 had an SI of 10.8. The present assay of NBT-reducing activity in phagocytes may be useful for screening of peripheral leukocyte function.

Direct measurements under a microscope have been employed to evaluate experimental gastric ulcers, but the following problems have been left unsettled: it takes too much time, and much experience is required to perform accurate, objective measurements. The present study demonstrates the usefulness of image analysis technology for evaluating anti-ulcer drugs. With this newly developed method, the region of gastric mucosal injury can be automatically and/or mechanically chosen on the basis of three different factors: intensity, hue and purity. Consequently, this method can be used to rapidly obtain analytical data such as the number, area and length of gastric ulcers. Effect of NNP, a preparation containing aldioxa, on three different types of experimental ulcer formation (stress-induced, ethanol-induced, and pylorus-ligation) was studied by image analysis technology. In all cases, NNP (2,562 mg/kg, p.o.) almost completely inhibited the formation of rat gastric ulcer. From the finding that image analysis technology is very useful for evaluating anti-ulcer drugs, we conclude that this method will help further the development of anti-ulcer drugs.

We compared the effect of simple immersion and continuous perfusion on long-term cardiac preservation, and evaluated the effectiveness of perfusion with oxygenated fluorocarbon solution. The isolated rabbit hearts were preserved for 24 hours at 4 degrees C using the following five preservation techniques: (1) simple immersion with Collins M solution (Group I), (2) perfusion with oxygenated Collins M solution at a flow rate of 10 ml/hr (Group II), (3) perfusion with the same solution as in Group II at a flow rate of 20 ml/hr (Group III), (4) perfusion with oxygenated Collins M solution containing 10% fluorocarbon at a flow rate of 10 ml/hr (Group IV), (5) perfusion with the same solution as in Group IV at a flow rate of 20 ml/hr (Group V). The hearts of Group I showed a significant decrease of myocardial ATP and an increase of myocardial lactate during preservation compared to the hearts of perfusion groups. Assessment of isovolumic left ventricular function following 24-hour preservation using a support animal showed a significant decrease of Max dp/dt and increase of end-diastolic pressure in the hearts of Group I. Perfusion with fluorocarbon (Group IV and V) significantly increased oxygen consumption compared to Group II and III in association with minimum accumulation of myocardial lactate, indicating that aerobic metabolism during preservation is better maintained in the fluorocarbon-perfused hearts. Moreover, CPK release and myocardial water gain during preservation were significantly less, and left ventricular function following preservation was significantly better in these hearts. Increasing the flow rate from 10 ml/hr to 20 ml/hr resulted in sustained increase in perfusion pressure (1.80 +/- 0.53 to 3.70 +/- 0.34 mmHg) and myocardial water content (79.2 +/- 0.4 to 87.2 +/- 0.3%) during preservation in the hearts of Group III, but it did not further improve left ventricular function despite significant enhancement of myocardial oxygen uptake in both Group III and V. These results suggest that hypothermic low-flow continuous perfusion with oxygenated Collins M solution is superior to simple immersion with the same solution for long-term cardiac preservation, and that the addition of fluorocarbon to the perfusate enhances the efficacy of such a perfusion.

Mucopolysaccharidosis (MPS) has been shown to cause cardiac involvements. However, echocardiographic features of MPS were not well understood. We examined echocardiographic findings in three adult patients with MPS. The diagnosis was confirmed by measuring urinary acid mucopolysaccharide and alpha-L-iduronidase activity in the white blood cell and skin fibroblast. The age ranged from 29 to 54 years. Two patients were Scheie syndrome (MPS I-S) and one was suspected to be Maroteaux-Lamy syndrome (MPS VI). All patients had a systolic heart murmur suggestive of aortic stenosis, and one had an additional apical systolic murmur consistent with mitral regurgitation. The echocardiogram revealed the following findings; 1) an abnormal thickening of all aortic leaflets with reduced valve opening in all cases, 2) diffuse and marked thickening of the mitral leaflets, chordae and papillary muscles, no upward motion of the posterior mitral leaflet in spite of reduced E-F slope (13, 23 and 17 mm/sec, respectively), and slight narrowing of the mitral orifice, and 3) a slightly thickened and dilated left ventricle (IVS: 11, PW: 12, EDd: 58, and ESd 44 mm) in the case with Maroteaux-Lamy syndrome. The last finding was probably due to deposition of mucopolysaccharide in the myocardium, because the coronary arteriogram in this case did not demonstrate any significant lesions. The echocardiographic characteristics in our adult MPS cases were similar to those reported in infant or juvenile cases with Hurler syndrome (MPS 1-H) or Hunter syndrome (MPS II). However, our Maroteaux-Lamy patient may be the first case, in which myocardial involvement by mucopolysaccharide was suggested echocardiographically.

Recent advances in echocardiography have revealed that hypertension causes several types of cardiac hypertrophy. We classified hypertensive patients by type of cardiac hypertrophy, and evaluated left ventricular function and the severity of hypertension. The subjects consisted of 257 hypertensive patients, 13 patients with cardiac hypertrophy, and 95 normotensive controls. The hypertensives were classified in four groups: no hypertrophy, concentric hypertrophy, asymmetrical septal hypertrophy (ASH), and asymmetrical apical hypertrophy (AAH). The normotensive patients with cardiac hypertrophy included nine with ASH and four with AAH. Cardiac functions in these patients were determined by echocardiography, RI-angiocardiography and cardiac catheterization. The results were as follows: Among 257 hypertensive patients, the incidence of concentric hypertrophy, ASH, and AAH was 53%, 10%, and 4%, respectively. In patients with AAH and hypertension, the hypertensive blood pressure levels and hypertensive organ involvements were mild. The blood pressures of most of these patients fell to the normal range after admission. The cardiac index and left ventricular systolic function (FS, mVCF, and ejection fraction) were significantly higher in AAH with hypertension than in the other hypertensive groups or in the normotensive controls. The hypertensive patients showed lower E-F slopes and higher A/E ratios than the normotensive controls, as well as the normotensive patients with ASH or AAH. Cardiac function did not differ appreciably between normotensive AAH and hypertensive AAH. Left ventricular dimension and left ventricular end-diastolic volume index were larger in AAH with hypertension. The total peripheral resistance of the hypertensive AAH was significantly lower than that of the hypertensives with concentric hypertrophy (p less than 0.01), though it was higher than that of the normotensive AAH (p less than 0.01). It was, therefore, concluded that mild hypertension observed in patients with AAH may be the result of regulatory mechanisms in the hyperkinetic states.