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We investigated the potential of the wireless teleradiology system, using a Personal Handyphone System(PHS) and hand-held personal computer. To provide and interpret CT images, an internet web system was used. It took 5.5 seconds to transmit a single CT image of 28 KB. Therefore, about 2 minutes was required to brawse a series of brain examinations(20 CT images). Although transmission speed needs to be increased, our system makes it possible to perform imaging diagnosis anywhere and is especially useful in emergency situations.

A 72-year-old, female patient with severe hypothyroidism underwent tracheostomy using deltopectral flap. During the anesthetic management, we assessed the hypnotic level using the bispectral index and regulated the dose of general anesthetics to maintain the bispectral index at about 50. The general anesthetics caused a marked cardiovascular depression, but the condition was treatable with the intravenous administration of dopamine. Using these methods, we could anesthetize this patient safely without a prolonged awakening time from general anesthesia. Although the anesthetic requirement for patients with hypothyroidism is generally thought to be decreased, there is no practical index by which we can estimate the optimal dose of anesthetic agents for these patients. This case report shows that the assessment of the hypnotic level by the bispectral index can be utilized as an efficient index to determine the optimal dose of general anesthetics for patients with hypothyroidism.

Between 1983 and 1998 there were 23433 births at Kitasato University Hospital, including 359 births. A retrospective analysis was performed on 320 twin pairs analyzing survivability indexes with respect to fetal age, chorionicity and birth weight discordance. Furthermore, the paper illustrates an analysis of causes of neonatal deaths as well as the rate of various complications of twins delivered before 32 weeks gestation such as twin-twin transfusion syndrome and periventricular leukomalacia.

The aim of this study was to determine the sensitivity of 201Tl-chloride for small lung cancers. The study subjects consisted of 13 cases of surgically verified lung cancer smaller than 2 cm who had undergone 201Tl-SPECT prior to surgery, owing to the difficulty of establishing a diagnosis of lung cancer based on diagnostic CT. Among 13 cases, four showed positive accumulation in early and delayed SPECT, and nine negative, with a degree of accumulation of 31% (4/13).

The pharmacokinetics of panipenem/batamipron (Carbenin; PAPM/BP) was studied in 17 neonates of the postconceptional age (PCA) of 25.6 to 43.1 weeks. PAPM/BP was administered at 10 mg/kg to 20 mg/kg every 12 hours over 60 minutes by intravenous infusion. Blood samples were obtained just prior to the infusion, one or two hours and six hours after the infusion. All the data for the 85 serum PAPM concentrations were analyzed by one-compartment model using a nonlinear mixed-effect model (NONMEM). The pharmacokinetic parameters in these population are given below: CLPAPM; 0.239 +/- 0.206 (L/hr), VdPAPM; 0.97 +/- 0.80 (L), Half Life; 3.1 +/- 0.5 (hr). Half life in the patients with PCA34 (2.66 +/- 0.44 hr) were significantly lower (p0.001) than that with PCAor = 34 (3.39 +/- 0.23 hr). Our results suggest that postnatal alterations in the PAPM excretion are related to maturational changes in the renal function and that we should consider the values of PCA when determining the initial PAPM/BP dosing regimen in neonates. We conclude that the dosage of 10 mg/kg to 20 mg/kg every 12 hours are adequate treatment for neonatal infectious disease.

We investigated the effect of nitric oxide (NO) on iron-induced neuronal damage. Incubation of PC12 cells after the addition of FeCl2 induced rapid increases (within 1 hr) in lipid peroxidation and a concentration (0.1-2 mM)-dependent decrease in cell viability at 48 hr, both of which were blocked by deferoxamine and 2-methyl-6-(p-methoxyphenyl)-3,7-dihydroimidazo[1,2-a]pyrazine-3-o ne hydrochloride (MCLA) (a superoxide scavenger) but not by mannitol (a hydroxyl radical scavenger). Iron-induced cytotoxicity was also antagonized by superoxide dismutase with catalase. On the other hand, the NO donors S-nitroso-N-acetylpenicillamine (SNAP), 3-¿(+/-)-(E)-ethyl-2'-[(E)-hydroxylamino]-5-nitro-3-hexenecarbo moyl¿-pyridine (NOR-4), and 2,2'-(hydroxynitrosohydrazono)bis-ethanamine (NOC-18) decreased cell viability 48 hr after addition without increasing lipid peroxidation. However, when added with 1 mM FeCl2, NO donors including NOC-18, SNAP and NOR-4 (0.1-1 mM) inhibited lipid peroxidation in a concentration-dependent manner and suppressed cell death at lower concentrations. Addition of MCLA and NOC-18 also suppressed decreases in iron-induced [3H]thymidine incorporation. In rat brain homogenate, NOC-18 and SNAP both suppressed iron-induced lipid peroxidation. These findings suggest that NO has a dual effect on neuronal viability and can act as an antioxidant which protects neurons from iron-induced damage.

Ca(2+)-dependent regulation of [3H]noradrenaline ([3H]NA) uptake through the NA transporter was studied using PC12 cells. Preincubation for 10 min in the presence of 0.3-10 mM ca2+ in Krebs-Ringer (KR) buffer induced marked enhancement of the uptake (at 1 mM Ca2+, 6.6 times greater than that observed in the absence of Ca2+), which reflected both an increase in Vmax and a decrease in K(m) of the uptake process. Preincubation with 1 mM Ca2+ also induced a significant increase in the Bmax and Kd of [3H]desipramine binding. The uptake was still enhanced after washing cells with Ca(2+)-free buffer following preincubation with 1 mM Ca2+. 1-[N, O-bis(5-Isoquinolinesulfonyl)-N-methyl-L-tyrosyl]-4-phenylpiperazine (KN-62), 2-[N-(2-hydroxyethyl)-N-(4-methoxybenzenesulfonyl)]amino-N-(4-c hlo rocinnamyl) -N-methylbenzylamine (KN-93) (inhibitors of Ca2+/calmodulin-dependent kinase II), N-(6-aminohexyl)-5-chloro-1-naphthalenesulonamide (W-7) (a calmodulin antagonist), wortmannin (a myosin light chain kinase inhibitor) significantly reduced Ca(2+)-dependent enhancement of the uptake. Mycalolide B (an inhibitor of actin-myosin interaction) also inhibited the enhancement. Although calphostin C (a protein kinase C (PKC) inhibitor) did not affect the enhancement, 12-o-tetradecanoylphorbol 13-acetate (TPA) inhibited the uptake. A synthetic peptide with a sequence (KKVIYKFFS579 IRGSLW) contained in the intracellular COOH-terminal domain of a rat NA transporter was phosphorylated by purified brain Ca2+/calmodulin-dependent protein kinase II. These results suggest that Ca(2+)-dependent enhancement of the [3H]NA uptake in PC12 cells are mediated by activation of calmodulin-dependent protein kinases, probably through stimulation of translocation of the NA transporter to the plasma membrane and/or direct phosphorylation of the transporter itself.

We studied the involvement of coagulation and fibrinolysis system in the induction and development of atherosclerosis in rabbits with hyperlipidemia induced by a high-cholesterol diet (HCD). In HCD rabbits, plasma lipids and atherogenic indices were maintained at a high level throughout the experimental period compared with those in rabbits fed on a standard diet. In the early phase, a significant increase in fibrinogen level was followed by increases in the activities of plasminogen and tissue-type plasminogen activator with a decrease in alpha 2-plasmin inhibitor activity and platelet count. In the middle and late phases, significant increases in plasminogen activator inhibitor-1 and antithrombin-III were observed in HCD rabbits. These results suggest that the early enhancement of coagulation followed by high activity of fibrinolysis is involved in the induction and development of hyperlipidemic thromboembolism and atherosclerosis in HCD rabbits.

To evaluate the diagnostic performance of commercially available CRT monitors used in a teleradiology system by determining the rate of detection of simulated lung nodules.Three types of CRT monitors were tested in the observation study. They had matrix sizes of 1024 x 768(16 inches, color), 1024 x 768(20 inches, color) and 1600 x 1125(24 inches, black and white). Twenty chest radiographs were obtained by Fuji computed radiography(FCR) of an anthropomorphic chest phantom with ten simulated nodules on its surface. These FCR films were digitized by a film digitizer with 125 DPI(1024 x 1024 matrix sizes)and 12 bit gray scales, and the image data were transferred from Shinshu University Hospital to other hospitals where interpretation was carried out by the radiologists. Ten radiologists of three hospitals were asked to interpret independently both the original FCR films and the images shown on the CRT monitors and to indicate the presence or absence of simulated nodules on the images by using a five-category rating scale. Receiver operating characteristics(ROC)curves were generated, and the results of interpretation on the FCR films and CRT monitors were compared.Performance of the all readers was slightly better with the CRT monitors than on the FCR films, although the differences were not statistically significant. There were no statistically significant differences in performance depending on the type of CRT monitor.Performance of the CRT monitors was comparable to that of FCR radiography in terms of interpreting the simulated lung nodules.

The pharmacokinetics of norfloxacin (NFLX) and lomefloxacin (LFLX) in rabbit aqueous humour after instillation of 0.3% solution (20 microliters) and oral administration (20 mg/kg) were investigated by microdialysis. We also measured plasma concentration of fluoroquinolones after oral administration. After instillation, the maximum concentration (Cmax) of NFLX and LFLX in the aqueous humour was 0.80 and 1.20 micrograms/ml, and elimination half time (t1/2) was 130 and 96 min, respectively. After oral administration, the Cmax in plasma of NFLX and LFLX was 2.06 and 1.89 micrograms/ml, and the Cmax in aqueous humour was 0.16 and 0.62 microgram/ml, respectively. t1/2 of NFLX in aqueous humour and plasma was 225 and 295 min, and t1/2 of LFLX was 188 and 175 min, respectively. The ratio of aqueous humour/serum concentration of NFLX and LFLX was 7.8 and 35.3% 4 hrs after oral administration. These results suggest that, after instillation, LFLX penetrated better into the aqueous humour, and was eliminated faster, than NFLX, and that after oral administration, NFLX could not panetrate well into the aqueous humor from the blood.

We investigated the usefulness of nasal/oral discriminate sampling system (NODSS) that had been developed recently in order to obtain the accurate end-tidal carbon dioxide (PET(CO2)) from a spontaneously breathing patient through a nomal airway. Fifty patients were monitored using a capnograph with NODSS following extubation in the postanesthesia unit. PET(CO2) data were collected by means of nasal, oral or nasal/oral sampling. The levels of arterial carbon dioxide (PaCO2) were determined simultaneously. In addition to examining the correlation between PET(CO2) and PaCO2, we investigated the influence of method of anesthesia, age and respiratory rate on the (PaCO2 - PET(CO2)) gradient. In most patients without nasal obstruction breathing through the nostril, PET(CO2) determined by selective nasal sampling was closer to PaCO2 than those by oral or nasal/oral sampling. Furthermore, the mean (PaCO2 - PET(CO2)) gradient was 4.98 mmHg in patients aged over 60, while it was 2.02 mmHg in patients aged under 60, suggesting that PET(CO2) could not be a good index in elderly people. There was no significant difference in the mean (PaCO2 - PET(CO2)) gradient among different methods of anesthesia. In conclusion, NODSS was useful in determining PET(CO2) more accurately and estimating PaCO2 precisely when used in relatively young people by selective nasal or oral sampling.

We investigated a method of analyzing the hemodynamics of the lung mass by contrast enhanced dynamic computed tomography (dynamic CT) to determine the difference in vascular supply between the pulmonary artery and bronchial artery using an experimental model. Our experimental model consisted of two injectors connected to two tubes, representing the pulmonary artery and bronchial artery, which were further connected to a chamber representing the lung mass. Following infusion of contrast medium into each tube with some delay time, dynamic CT scans were performed to obtain time density curves of the two tubes and the chamber. Using the time-density curve of contrast passage, flow rates from the two tubes into the chamber were calculated by the curve fitting method. Calculated values correlated well with the adopted flow rates of fluid from the injectors (r = 0.893) in the experiment. The results indicate our method of individually measuring flow rates of dual-input blood flow, i.e., from the pulmonary artery and bronchial artery, into the lung mass is applicable clinically to determine blood flow by the two arteries supplying the lung mass.

We examined the usefulness of a new medical facsimile (MFAX) system in recording and transmitting various kinds of medical images, including X-ray images and colored histopathologic images. The system consists of an image scanner, a magnetic disk for image storage, a transmission circuit and a thermal image printer. Transmission time for a FCR (Fuji computed radiography) image by super-fine mode was 6 minutes. We used ROC (receiver operating characteristics) curves to evaluate the ability of eight radiologists to detect the small simulated nodules placed on an anthropomorphic chest phantom and shown on MFAX images. The radiologists observed both the FCR films and MFAX copies and determined the presence or absence of simulated nodules using five confidence levels. The results obtained for FCR films and MFAX images showed no statistically significant difference.

The detectability of simulated nodules placed on a chest phantom and shown on FCR images has been studied. Different tube voltages (130 kVp, 100 kVp), presence or absence of compensation filter, various sites and different sizes (5 mm/10 mm) and configurations (spherical or broad based) of the nodule were examined. 112 FCR chest phantom images were evaluated by ten radiology specialists utilizing ROC analysis. The detection rate for nodules was influenced in general by the site. The detection rate was as follows in decreasing order: intercostal, overlaid with one rib, two ribs, diaphragm and heart. Detection of nodules of 10 mm in height was mainly influenced by the density of the lung where the nodule was located, whereas that of nodules of 5 mm in height was more dependent on the site of the nodule, probably greatly influenced by the amount of structure mottle. Spherical nodules of 5 mm in height were more frequently recognized than the broad-based ones. High kVp (130 kVp) resulted in a higher detection rate for both sizes of nodules than low kVp (100 kVp). Detection of spherical nodules overlying the heart or diaphragm was improved with the use of a compensation filter.

We report our preliminary results of pulmonary imaging by digital tomosynthesis, and describe some advantages of these digitally processed longitudinal tomographic images. Digital tomosynthesis of the lung was performed in 60 subjects, including 56 patients with a localized lesion or diffuse disseminated lesions, with a fluororadiographic TV unit with linear tomographic capability, in conjunction with an image processing unit. Dual energy subtraction digital tomosynthesis was also available in our system. Multiple longitudinal tomographs of the lung, which were reconstructed from a single set of tomographic image data, facilitated easy evaluation of the morphology of pulmonary abnormalities together with related broncho-vascular structures located in the same longitudinal plane as the lesion, and were immune from any problem caused by inconsistent depth of respiration. The image quality of the reconstructed tomographs was greatly improved by digital image processing to reduce tomographic blur and enhance image clarity. Dual energy subtraction digital tomosynthesis was effective in clearly showing the size, configuration, and distribution of calcification in the lesion. Digital tomosynthesis provided useful information in making the roentgenologic diagnosis of pulmonary lesions.

201T1C1 SPECT and 123I-MIBG SPECT were performed in two patients with familial amyloid polyneuropathy (FAP). Both patients showed normal accumulation of 201T1C1 and no accumulation of 123I-MIBG in the myocardium at the early and delayed images. These results indicate that the patient with FAP-related myocardial change accompanies sympathetic nerve dysfunction. The dysfunction is supposed to be caused by disturbance of re-uptake of MIBG by the terminal ending of the sympathetic nerve (uptake-1) through the amyloid-deposited connective tissue.

We studied the effects of ATP depletion on neurotransmitter release in the rat brain using the microdialysis method. Ringer's solution containing 2 mM sodium cyanide (NaCN) was perfused into the hippocampus and striatum for 60 min via a microdialysis probe, and changes in serotonin (5-HT) and amino acids (glutamate, aspartate and taurine) levels in dialysates were investigated. NaCN perfusion induced a transient 3.9-fold increase in 5-HT levels in the hippocampal dialysate. Amino acid levels in dialysates also increased during NaCN perfusion, but differently in the striatum and hippocampus (glutamate: 1.3- and 2.4-fold, taurine: 2.3- and 1.3-fold, respectively). Perfusion of Ca(2+)-free Ringer's solution remarkably suppressed the NaCN-induced increase in 5-HT but not the increases in amino acid levels. Depolarization by 100 mM KCl perfusion could induce increases in 5-HT and amino acids in dialysates at 3 hr after NaCN perfusion similarly with that of control. These findings indicate that the sensitivity of nerve terminals to energy failure are different between neurons containing different neurotransmitters and also between brain regions, and suggest that this regionally different sensitivity of amino acid neurons might be involved in the underlying mechanism of the localized vulnerability to transient ischemia.

A microdialysis method has been developed in the past two decades to determine levels of drug and endogenous compounds in several organs under physiological conditions. In this study, we determined the pharmacokinetics of the model drug, trimethadione (TMO), and its only metabolite, dimethadione (DMO), in liver, blood and brain by the microdialysis method in freely-moving rats. Sampling times were extended up to 24 hours. The construction of a newly developed microdialysis probe for liver and blood is described. The elimination patterns of TMO in liver, blood and brain dialyzates were almost identical and the calculated t1/2 was approximately 3 hr in each sample. However, in brain, tmax was delayed compared with the others while the relative concentration of DMO (AUC0-24h) was lower in brain compared with liver and blood. These studies suggest that this concurrent and successive microdialysis sampling method will not only be a useful tool for pharmacokinetic and drug metabolism studies in the organs of small animals but will also decrease the number of experimental animals needed for a study.

We investigated the effects of topical and central administration of noradrenaline (NA) on the intraocular pressure (IOP) in pigmented rabbits. Unilateral instillation of NA (200 micrograms) produced no significant change in IOP. On the other hand, intracerebroventricular (ICV) administration of NA (0.01-1 micrograms) decreased IOP in both eyes in a dose-related fashion. The ocular hypotensive effect of NA was diminished by sympathectomy of the superior cervical sympathetic nerve or by ICV pretreatment with yohimbine hydrochloride 1-10 micrograms). These results suggest that the hypotensive effects of contrally administered NA might be mediated by alpha 2-adrenoceptor stimulation in the central nervous system.

We reported previously that electroacupuncture (Acu) applied to the acu-point equivalent to GV4 in the mouse just before the 2,4,6-trinitrochlorobenzene (TNCB) challenge suppressed the delayed type hypersensitivity (DTH) through endogenous opioidergic systems in the brain, and the pituitary was pivotal in this immunosuppression. The purpose of the present study was to compare the suppressive effects of Acu with those of single, acute doses of morphine on TNCB-DTH in intact and hypophysectomized (HPX) mice. Subcutaneous morphine 10 mg/kg in ddY mice, 30 mg/kg in BALB/c mice or intracisternal morphine 40 micrograms/mouse in BALB/c mice given just before TNCB challenge suppressed (40-53%) the maximal extent of ear swelling at 24 hrs after challenge in intact mice. In HPX mice, the suppressive effects of intracisternal morphine 10 and 100 micrograms/mouse were less pronounced than those observed in intact mice and there was no significant difference between intact and HPX groups. In addition, suppressive effects observed with Acu or subcutaneous morphine (30 mg/kg) were effectively antagonized by pretreatment with intracisternal naloxone at a dose of as low as 2 micrograms/mouse. Naloxone alone had no effect of its own. These results suggest that 1) the activation of opioid receptor-mediated pathways in the brain, which occurs when opioids are endogenously released (Acu) or exogenously given (morphine), is important in the suppression of TNCB-induced DTH, a cell-mediated immune response, and 2) the pituitary is less pivotal in the suppressive effects of acute morphine than in those of Acu.

This paper describes the construction of an image network system in Shinshu University Hospital, and some of its current issues and advantages. Our discussion is based on our experience with a PACS system. SAIPACS, which was installed in 1990 for use in clinical conferencing and pre- and post-graduate education, and with a new CT and MRI network, which was subsequently introduced in 1993. The SAIPACS interconnects eight digital imaging modalities, including CT, MRI, XTV-DR (including digital tomosynthesis), FCR, nuclear medicine (RI), DSA, US, and a film digitizer (FD), with a workstation. Transmission time from the magnetic disk of each imaging modality to the SAIPACS image disk is not rapid enough. Therefore, we need to select images for transfer that are pertinent to our specific purpose, to complete image transmission within a practically acceptable period of time. The new CT/MRI network is composed of two CT units, two MRI systems, an image processing unit and a Universal Gateway. It provides faster image transmission than the SAIPACS system, because there is no need to reform image data to send them in a reversible compressed form. A versatile network system connected to the SAIPACS and CT/MRI network enables digital image data to be processed and edited and images to be transferred back to SAIPACS for clinical or educational use.

A high-speed, high-resolution teleradiology system with full duplexing based on the Shinshu University Video and Communication Network System (SUNS) using Giga-Herz microwaves is described. The LAN at Nagano Red-Cross Hospital and The Radiology Department of Shinshu University Hospital are interfaced to a personal computer with a laser film digitizer, interactive display, and network interface. The throughput per digitized high-resolution radiographic image was 65 sec, and the mean transmission rate was 805 kilobit per sec. Teleradiology conferencing is also possible with this system. Radiologists at both hospitals interactively observe the same high-resolution images on the CRT screen using mouse cursor synchronization.

Effects of clinofibrate on the coagulative and fibrinolytic activity in an intrinsic hyperlipidemia induced by a cholesterol free-high fructose diet (HFD) for 14 days were studied using male Wistar rats. There were significant and positive correlations between plasma fibrinogen level and serum lipid content, and between fibrinogen level and VLDL-LDL-lipid content. Clinofibrate administration (50 and 100 mg/kg/day, p.o.) significantly inhibited the increase in plasma fibrinogen level as well as serum- and VLDL-LDL-lipids. It is concluded that clinofibrate, in addition to its beneficial effect on the serum lipid profile, can effectively reduce the plasma fibrinogen level.

The effect of single or daily oral administration of hot water extracts (HWE) from Byakushi or Ogon on rat hepatic drug-metabolizing enzymes were investigated in vivo. Enzymes were measured for 3 to 72 hr after single oral administration of HWE at the dose of 1.0 g/kg or 5.0 g/kg. Administration of 1.0 g/kg of Byakushi and 5.0 g/kg of Ogon inhibited aniline hydroxylase activity, while 5.0 g/kg of Byakushi inhibited it in the early phase, but increased it in the late phase. Byakushi inhibited aminopyrine N-demethylase activity, while 5.0 g/kg of Ogon increased it. Byakushi and Ogon decreased the amount of cytochrome P-450. Byakushi and Ogon increased the amount of cytochrome b5. Byakushi increased cytochrome c reductase activity 3 hr after administration and decreased it 6 and 12 hr after administration. In contrast, 1.0 g/kg of Ogon decreased cytochrome c reductase activity, and 5.0 g/kg increased it 6 hr after administration and decreased it 12 hr after administration. At 24 hr after the last administration to animals treated with a regimen of once a day administration of the HWE (0.1 or 1.0 g/kg) of Byakushi or Ogon for 14 days, the enzymes were measured. Byakushi decreased aminopyrine N-demethylase activity, the amount of cytochrome P-450, and cytochrome c reductase activity. Ogon decreased cytochrome c reductase activity. Byakushi altered the composition of cytochrome P-450 isozyme after daily administration.

Shinshu University consists of five campuses in different locations, a situation that presents some problems in communication. To solve this problem, the Shinshu University Video and Data Network System (SUNS), which includes a high-speed audio-visual transfer function, has been developed and utilized for pre- and postgraduate education, administrative teleconferences, and local telephone (PBX) and Fax services. In 1988, a cooperative group for the study of radiographic image processing was organized, consisting of staff members of Shinshu University Hospital in Matsumoto, the Faculty of Engineering in Nagano (75 km from Matsumoto) and the Faculty of Textile Science and Technology in Ueda (45 km from Matsumoto). The system has been developed with a pair of personal computer (PC)-based interactive image workstations and high-speed digital telecommunication interfaces to the SUNS. A transmission time of 878 kbps has been attained, including the time needed for read/write onto the PC hard disk. Image data thus transferred from the hospital have been utilized for the study of image processing by researchers in the Faculty of Engineering, and the processed images have been sent back to the hospital for evaluation of clinical efficacy of the processing by diagnostic radiologists. This kind of microwave network is a promising alternative for high-speed data transmission for radiological images and their processing.

To determine a suitable combination of X-ray filter and tube kilovoltage for Fuji Computed Radiography (FCR), to provide better detection of pulmonary nodules and reduce patient exposure, we compared observer performance with different X-ray filters and tube voltages. Radiographs were obtained with a copper filter backed by aluminium, with a tungsten filter backed by yttrium and aluminium, and with a lead filter backed by yttrium and aluminium, at both 100 kVp and 135 kVp. Observer performance in detecting simulated lung nodules, which were placed on the posterior aspect of a chest phantom, was compared using receiver operating characteristic (ROC) techniques for each combination of the X-ray filter and tube voltage. The results of the study indicated that 1) nodule detection was superior for the images obtained with 135 kVp as compared with 100 kVp; 2) approximately equal detection rates were obtained for the three X-ray filter sets, although results with the tungsten filter were slightly inferior to the other two filters; and 3) the absorbed dose may be reduced by 30% with the use of a lead filter backed by yttrium and aluminium compared with a copper filter backed by aluminium. We conclude that chest radiography with FCR should preferably be conducted with a higher kilovoltage, e.g., 135 kVp rather than 100 kVp, to ensure a higher detection rate of pulmonary nodules and in conjunction with a lead filter backed by yttrium and aluminium to reduce X-ray exposure to the patient.

We reported a case of progressive hemifacial atrophy associated with immunological abnormalities. This patient, a 35-year-old woman, had a history of high fever of unknown etiology associated with anemia and leukocytopenia at the age of 19. Eight months later, right hemifacial atrophy, alopecia and partial lipodystrophy of the right upper arm were developed. And the progression had stopped in the latter twenties. At the age of 35, she visited our hospital because of the hemifacial atrophy. Physical examination revealed right hemifacial atrophy, large alopecia at parietal and right temporal region, and partial lipodystrophy of the right upper arm. CT, MRI and ultrasound tomography of the head and the arm showed skin and scalp atrophy, temporal muscle atrophy and decrease of subcutaneous soft tissues. There was no autonomic dysfunction. Serum IgG was increased, and RA factor, anti-nuclear antibody, anti-DNA antibody and LE cell were positive. In this case, immunological abnormalities were considered to be related to the pathogenesis of hemifacial atrophy.

We used cerebral digital tomosynthetic angiography for planning the probe trajectory of stereotactic biopsy of brain tumors in four patients. The probe trajectory was basically planned by MRI examinations. However, cerebral digital tomosynthetic angiography demonstrated detailed three-dimensional vascular anatomy around the brain tumors, and therefore was very helpful in revising the planned trajectory when there was a fairly large vessel likely to cross with it.

DSWO was shown on bull's eye images of 98 of 1234 patients suspected of having coronary artery disease and examined with thallium-201 myocardial SPECT imaging. Fifty-eight of these 98 patients underwent coronary arteriography, and comparison studies were performed between the bull's eye SPECT images, the results of coronary arteriography and the laboratory data. DSWO was found in 11 of 58 cases (19.0%) of single vessel disease (1VD), 18 of 58 cases (31.0%) of double vessel disease (2VD) and 21 of 58 cases (36.2%) of triple vessel disease (3VD). Three of 58 cases (5.2%) of stenosis of a coronary artery less than 75% of its normal diameter (N group) also showed DSWO. DSWO was closely related with multiple vessel disease, as has been indicated by previous reports, but we also found another patient group that showed minor coronary arterial change (1VD and N group) and manifested DSWO. Based on the study of laboratory data, we clarified that this group of patients tended to show accompanying hypertension and hyperlipidemia as factors influencing the appearance of DSWO. DSWO was accompanied by hypertension and hyperlipidemia in 54.5% and 45.5% in 1VD. These values were higher than those in the 2VD and 3VD cases, which were 33.3% and 38.9% in 2VD, and 19.0% and 28.6% in 3VD, respectively. Hypertension and hyperlipidemia appeared to play an important role in causing DSWO by interfering with coronary circulation.

In Japan, fifteen drugs, including tricyclic and non-tricyclic antidepressants or an MAO inhibitor, are clinically available for treatment of depression. However, the pharmacological mechanism(s) of their antidepressive effect remain uncertain. "Receptor hypothesis" that functional changes of monoamine receptors after chronic treatment, such as down-regulation of beta-adrenoceptor or 5-HT2 receptor, bring about a therapeutic effect, seems to be unsatisfactory. Recent studies focus on interaction between antidepressants and intracellular signal transduction pathways. For effective and safe uses of antidepressants, especially in aged patients or those with hepatic and renal diseases, pharmacokinetics such as distribution, protein binding and metabolism must be well understood. In this paper, pharmacokinetic characteristics of antidepressants are also reviewed.

This paper proposes high-quality and low bit-rate (3.6 and 2.4 kbit/s) coders using a pitch synchronous innovation CELP (PSI-CELP) method or a phase adaptive PSI-CELP. PSI-CELP, which is used as the excitation structure of the half-rate codec for the standard of Japanese digital mobile telephony, is based on CELP but adds pitch synchronous innovation, which means that even random codevectors are adaptively converted to have pitch periodicity for voiced frames. Phase adaptive PSI-CELP makes not only the periodicity, like in PSI-CELP, but also the phase of random codevectors equal to those of an adaptive codevector. The subjective qualities of the 3.6- and 2.4-kbit/s coders exceed those of the 6.7-kbit/S VSELP coder, which is the full-rate codec for the standard of Japanese digital mobile telephony, and-the 4.8-kbit/s U.S. Federal Standard 1016 CELP coder, respectively, in the error-free condition.

We reported two cases of acute alcoholic myopathy associated with rhabdomyolysis. The first case was 62 year-old man, who had been drinking every day for 40 years. Following diarrhea, he had psychic symptoms, and was admitted to our hospital. He was in a state of delirium. Tremor in extremities, dysarthria and weakness of lower extremities were observed. Neither swelling nor grasping pain were seen in any muscles. Laboratory data showed severe hypokalemia and high levels of serum muscle enzymes and myoglobin. An increase of lactate and pyruvate was not seen in ischemic exercise test performed at the acute or the recovery phase. It was suggested that glycolysis in muscles was suppressed in this case. The second case was 43 year-old man, who had been drinking every day for 27 years. Rapidly progressive weakness of both lower extremities was seen, and he was admitted to our hospital. Grasping pain of both legs and proximal muscle weakness of extremities were observed. Laboratory date showed normokalemia and high levels of serum muscle enzymes and myoglobin. Muscle biopsy showed no abnormal findings in histology and electron microscopy. Although the pathogenesis of acute alcoholic myopathy is unknown, suppression of muscle glycolysis enzyme caused by ethanol may play an important role in the first case.

Extopic parathyroid glands and rudimentary glands which are not detected during initial parathyroidectomy may develop hyperplasia in the future, causing recurrence of hyperthyroidism. We have devised an improved surgical strategy to prevent the recurrence of hyperparathyroidism. The strategy is to dissect all central lymph nodes and fatty tissue according to the procedure of the dissection of thyroid cancer. The upper level of the dissection area is the upper edge of the thyroid cartilage and the lateral level of the dissection includes the lateral edge of the bilateral carotid sheath. Bilateral transcervical thymectomy is always included in this strategy. Upon confirming that more than 4 glands have been removed by intraoperative stamp cytology, total parathyroidectomy is terminated and 80 mg of glands is autotransplanted to the muscle of one forearm. We have performed this operation on 30 patients since 1987. More than 4 glands could be extirpated in every case, and supernumerary glands were detected in 6 cases (7 glands in 1 case and 5 glands in 4 cases). We have had no operative side effects in this series of 30 patients, and we have not experienced any persistent or recurrent hyperparathyroidism after any of these operations.

In order to perform a less invasive determination of regional cerebral blood flow (rCBF) using I-123-IMP, we used the lung clearance curve as a substitute for the arterial blood activity curve as an input function. We assumed that a major portion of the intravenously injected I-123-IMP initially accumulates in the lung and then is gradually cleared from the lung pool to enter the systemic circulation. In this case lung clearance could be considered nearly equal to the integral of arterial blood activity shown during the examination. We used a single probe detector to obtain the lung clearance curve as the difference between sequential lung activity and peak lung activity. The absolute value of the sequential change in arterial blood activity was estimated from the differentiated lung clearance curve compared with the arterial blood activity that was estimated by actual blood sampling once during the examination. The rCBF was calculated by the thus estimated arterial blood activity curve and brain activity by SPECT image using the microsphere model. The values of rCBF obtained by this method were similar to those obtained by the continuous arterial sampling method, and this lung monitoring method was thought to be applicable to clinical use.

A newly developed microdialysis probe for measurement of drugs in unrestrained, conscious animals was used for quantitation of antipyrine in liver and blood of rats. Microdialysis probe were implanted in the liver and right jugular vein of rats; antipyrine was then administered at a dose of 50 mg/kg i.p. The concentration of antipyrine was determined in the fluid from the two probes and compared with measurement made on blood drawn from the left jugular vein. The elimination half lives in serum, blood dialysate and hepatic dialysate were 2.24 +/- 0.09, 2.06 +/- 0.31 and 2.10 +/- 0.32 hrs, respectively; there were not significantly different statistically. The concentration of Na+, K+ and Cl- in the hepatic dialysate was stable at least for up to 12 hrs in anesthetized rats. In unrestrained, conscious animals these electrolytes were stable in hepatic dialysate for at least 48 hrs. Therefore, the microprobe should be useful for analysis of drugs in extra cellular fluids of rats liver for up to 48 hrs. These studies suggest that this microdialysis technique by employing the newly developed probe will be useful in many studies on pharmacokinetics and drug metabolism in the organ.

In the studies of stress 201Tl single photon emission computed tomography, we have developed a computer method to discriminate reversible from irreversible defect, then quantify each area and display the area on the polar map. Initial percent uptake (%Ui) and delayed percent uptake (%Ud) were expressed as percent of the maximum uptake area and were defined as regional myocardial 201Tl uptake in initial and delayed image, respectively. The %Ud/%Ui ratio was defined as redistribution ratio (RD-ratio). The values of %Ui obtained from each pixel of short axis slices were plotted against the values of RD-ratio on XY co-ordinates. In this graphic display, normal area, ischemic viable area and non viable area were separated by the following four lines. A; The straight line (Y = 2.0-0.012X) indicating the relationship between %Ui and RD-ratio for the group with ischemic viable myocardium. B; The parallel line to A and shifted to -1.5 SD from A. C; The vertical line at 67.0% level (ischemic upper level). D; The vertical line at 27.6% level (viable lower level). Each area was discriminated by color display and calculated relative area values were displayed on the polar map. Criteria for discriminating each area were derived from the results of ischemic pre-transluminal coronary angioplasty (PTCA) lesions (n = 21) in which viability was confirmed by successful PTCA and previous results of 66 cases with single vessel disease and 16 cases of control group. This new computerized technique was applied for evaluation of another group with successful PTCA (n = 15).(ABSTRACT TRUNCATED AT 250 WORDS)

The contribution of sympathetic cervical ganglion to the mechanism of action of clonidine for lowering intraocular pressure (IOP) was investigated. Pigmented rabbits were used. The animals were divided into 3 groups: normal control group (group 1), animals in which the bilateral cervical sympathetic trunks had been amputated presynaptically (group 2), animals in which the superior cervical ganglion (SCG) had been bilaterally dissected (group 3). Changes in IOP were measured after topical application of clonidine unilaterally. In group 1, IOP was significantly decreased in eye treated by clonidine and contralateral eyes compared to pretreatment values. Decrease of IOP in the contralateral eye was greater than that in the treated eye. In group 2, IOP was decreased in the contralateral eye but increased in the eye treated by clonidine. Pretreatment of yohimbine administered orally antagonized the ocular hypotensive effect of clonidine in a dose-related manner. In group 3, where SCGs were dissected, no changes in IOP were observed in both eyes by unilateral administration of clonidine. These results suggested that the bilateral ocular hypotensive effect of clonidine administered unilaterally is in part due to direct action on the SCG and that the alpha 2 receptor in the SCG plays some role in the regulation of IOP.

For the noninvasive quantitative measurement of cerebral blood flow (CBF) using N-isopropyl-[123I]p-iodoamphetamine (IMP), we studied the usefulness of the lung clearance curve obtained by a single probe detector as the input function for brain as an alternative to arterial blood activity. In four patients, we compared the time-activity curve of the lung and serial arterial blood activity for approximately 20 minutes following an IV bolus injection of IMP. Significant positive correlations were observed between lung clearance and the integral of arterial blood activity of IMP. In addition, a study to identify the best region for monitoring lung activity with the probe detector was performed in six patients using a gamma camera and region of interest (ROI) management. The central region of the right lung was found to be the best position for monitoring lung radioactivity. This study suggests that the lung clearance curve of IMP can be used as the input function for brain in the quantitative assessment of CBF.

Reverse tolerance to stereotyped behavior was induced after repeated administration of beta-phenylethylamine (PEA) (50 mg/kg, i.p., daily for 10 days) in rats. The reverse tolerance was maintained for at least 4 weeks after the last administration. We studied the effects of acoustic stimulation on locomotor activity 2 days and 4 weeks after withdrawal from PEA and measured the changes in brain monoamine levels 4 weeks after the withdrawal. Locomotor activity during acoustic stimulation was increased in the saline treated group, and this response was unaffected after repeated PEA treatment. Four weeks after withdrawal, significant increases in noradrenaline levels in the cerebral cortex and decreases in 5-hydroxytryptamine levels in the hypothalamus were found. The effects of acoustic stimulation on locomotor activity and the changes in brain monoamine levels were different from those of methamphetamine treatment obtained in our previous study. In conclusion, it may be suggested that the response to acoustic stimulation after repeated PEA administration in rats cannot be a model for abnormal responsiveness to environmental stimulation that is observed in chronic paranoid schizophrenics.

Interatrial shunt flow profiles in 36 normal term infants were examined serially by colour flow and pulsed Doppler echocardiographic techniques from within an hour of birth to four or five days after birth. Shunt flow across the foramen ovale was detected in 33 normal infants (92%) within an hour of birth (mean 40 minutes). The occurrence of interatrial shunting decreased with age, but a shunt signal was still detected in 17 infants (47%) on the fourth or fifth day of life, by then the ductus arteriosus had already closed in all the normal infants. The direction of interatrial shunt flow was predominantly left-to-right, but in 64% there was a coexistent small right-to-left shunt in diastole within an hour of birth; by four to five days it was found in 19%. In the six patients with persistent fetal circulation the direction of the interatrial shunt flow was predominantly right-to-left with biphasic peaks in diastole and systole at the early stage of the disease, and the period of right-to-left shunt flow during each cardiac cycle was significantly longer than that in normal infants examined within 1 hour of birth. In all patients the ductus closed before the foramen ovale. At the time of ductal closure in all patients with persistent fetal circulation right-to-left shunt flow was seen during diastole and its period was still prolonged. These findings suggest that interatrial shunting, predominantly left-to-right, is common in normal newborn infants. Evaluation of the characteristics of the interatrial shunt by Doppler echocardiography may be useful for predicting the progress of or improvement in neonates with persistent fetal circulation.

A case of myelolipoma of the right adrenal gland is reported. A 43-year-old female was admitted to our hospital, Department of 1st Internal Medicine, because of acute hepatitis. CT incidentally showed a well circumscribed mass, as an area of low density, arising from the right adrenal gland. Although sonography showed a markedly echogenic tumor, it was not visualized on the angiogram. Results, of hormonal examinations, were unremarkable except for low levels of ACTH. We confirmed a myelolipoma of the right adrenal gland, and performed right adrenalectomy. The tumor was 65 x 50 x 35 mm in size, 95 g in weight. Pathology disclosed an admixture of mature adipose tissue and hematopoietic elements resembling bone marrow.

The tumor can be more selectively heated by applying of high frequency inductive heating after administration of ferromagnetic particles into a tumor. In order to devise a technique used for the selective hyperthermia of a tumor with high frequency inductive heating, we continued fundamental studies using liposomal ferromagnetic particles (HP-LM), which were prepared as follows: triiron tetoraoxide (Fe3O4) particles were coated with liposomal membrane contained hematoporphyrin with neoplastic affinity. In Vivo Studies of Rabbits: We used high frequency inductive heater (NIHON KOSHUHA CO. LTD. YKN-10), frequency: 400 kHz, out put: 10 kW, coil diameter: 90 mm. VX-2 tumor cells at 1.5 X 10(7) were implanted to the lower thigh of rabbit. When the implanted tumor grew up 3 cm in diameter, A-D group were heated and studied. Group A: In a dose of 200 mg/kg of HP-LM was administered into the femoral artery, Group B: In a dose of 100 mg/kg of Fe3O4 was administered into the femoral artery, Group C: Ligation of femoral artery, Group D: Nonadministrated, and then was immediately heated. Group A: In a dose of 200 mg/kg of HP-LM, with heating for 10 minutes, temperature was elevated 14. 8 degrees C at center of tumor. Group B: In a dose of 100 mg/kg of Fe3O4, with heating for 10 minutes, temperature was elevated 10.6 degrees C at center of tumor. Group C: In a ligation of femoral artery, with heating for 10 minutes, temperature was elevated 6.5 degrees C at center of tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Pretreatment of mice with moxibustion (Mox) modulated lipopolysaccharide (LPS)-induced endogenous cytotoxic factor (CF) and interferon (IFN) production in serum. CF was measured by the L929 cytotoxicity test and IFN by the cytopathic effect microassay on L929 cells with vesicular stomatitis virus. Significant inhibition of CF activity was observed when Mox and LPS were applied simultaneously. Its potentiation was maximal, about 9 times the control level, when treatment intervals between Mox and LPS were 24-72 hours, and declined thereafter. Mox treatment modified LPS-induced IFN production with a similar biphasic pattern but the onset of modification was delayed. This is the first report of modulation of cytokine production by Mox treatment.

About 50% of the cases with Castleman disease firstly described by Castleman in 1956 occur in the thoracic cavity. The pelvic cavity is a rare location affected by the disease; there are only 7 reports. Herein, a case of Castleman disease of the pelvic cavity is reported. A 41-year-old man complaining of microscopic hematuria consulted us. Drip intravenous pyelography and computerized tomography showed a solitary mass at the pelvic retroperitoneum. Abnormal laboratory findings were as follows; glucose tolerance test (GTT), erythrocyte sedimentation rate, alpha 2-globulin level, CRP titer and hematuria. With the diagnosis of a pelvic retroperitoneal tumor, pelvic exploration was performed. The resected tumor was encapsulated, elastic hard and 4x3x2 cm in size. The cut surface was homogeneously granular and yellowish white in color. Histological diagnosis was the plasma cell type of Castleman disease. Within three weeks after the operation, laboratory abnormalities diminished except for GTT and microscopic hematuria. The patient is free from the disease with no signs of recurrence for 2 years postoperatively.