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Eighteen patients with angiographically proved intracranial arteriovenous malformation (AVM) were studied by computed tomography (CT) and their clinical features were reviewed at the same time. The pathophysiology of ruptured AVM in the acute stage was discussed. Seven of the 18 patients were performed CT scan within 7 days after the onset. Although all but one of the patients showed symptoms and signs suggestive of subarachnoid hemorrhage (SAH), intracerebral hematoma was demonstrated in all cases and two of them were accompanied by ventricular rupture. On the more, no high density lesion was demonstrated in cerebral cisterns by plain CT scan as seen in the acute stage of ruptured cerebral aneurysms. Six patients were performed contrast study within 7 days after the onset and showed no enhancement effect. On the contrary, nine of 10 patients performed contrast study more than 8 days after the onset showed enhancement effect. It has been commonly postulated that subarachnoid hemorrhage is the main pathophysiology of ruptured AVM. However, out study on CT scan of ruptured AVM demonstrated that intracerebral hematoma or ventricular hemorrhage is the chief underlying pathophysiology of ruptured AVM in the acute stage.

A three-year-old girl suffering from ecchymoses developed severe epistaxis. The diagnosis of thrombasthenia was made on the basis of platelet aggregation studies, flow cytometric analysis with monoclonal antibodies and gel electrophoretic analysis. In addition, coagulation studies at the time of epistaxis repeatedly showed a transient deficiency of factor XIII activity and antigen.

Carbamoyl-phosphate synthetase II [EC 6.3.5.5] of rat ascites hepatoma cells (AH 13), the first and regulatory enzyme of de novo pyrimidine nucleotide biosynthesis, exists as a multienzyme complex (molecular weight, 870,000) with aspartate carbamoyltransferase [EC 2.1.3.2] and dihydroorotase [EC 3.5.2.3] (Mori, M. & Tatibana, M. (1975) J. Biochem. 78, 239-242). The purified complex was phosphorylated by the catalytic subunit of cAMP-dependent protein kinase [EC 2.7.1.37] of rabbit skeletal muscle. The incorporation of 32Pi was 2.2 mol/mol of the complex. The phosphorylation was completely inhibited by the inhibitor protein of the cAMP-dependent protein kinase. Among the substrates and effectors of the enzyme complex tested, only MgUTP, an allosteric inhibitor of carbamoyl-phosphate synthetase II, strongly inhibited the phosphorylation; this inhibition was due probably to the competition of MgUTP with y inhibited by the inhibitor protein of the cAMP-dependent protein kinase. Among the substrates and effectors of the enzyme complex tested, only MgUTP, an allosteric inhibitor of carbamoyl-phosphate synthetase II, strongly inhibited the phosphorylation; this inhibition was due probably to the competition of MgUTP with y inhibited by the inhibitor protein of the cAMP-dependent protein kinase. Among the substrates and effectors of the enzyme complex tested, only MgUTP, an allosteric inhibitor of carbamoyl-phosphate synthetase II, strongly inhibited the phosphorylation; this inhibition was due probably to the competition of MgUTP with the substrate MgATP for the protein kinase. The complex that was phosphorylated by cAMP-dependent protein kinase was dephosphorylated by phosphoprotein phosphatase [EC 3.1.3.16] of rat skeletal muscle. The complex was also phosphorylated by cAMP-independent protein kinase activity present in the extract of AH 13 cells and dephosphorylated by phosphoprotein phosphatase activity of the same origin. These results suggest that the complex is subject to phosphorylation and dephosphorylation in the living cells. Phosphorylation of the complex by cAMP-dependent protein kinase was associated only with a slight change, albeit definite, in the activity of carbamoyl-phosphate synthetase II under the assay conditions. Thus, the physiological significance of phosphorylation-dephosphorylation remains to be further studied.

Factors which determine sodium chloride sensitivity, defined as the difference between the mean blood pressure after 1 week of a low sodium chloride diet (3 g/day) and that after 1 week of a high sodium chloride diet (20 g/day), were studied in 60 inpatients with essential hypertension using a multivariate analysis. The sodium chloride sensitivity was independently correlated with the change in erythrocyte sodium concentration (r = 0.47) and with the change in plasma renin activity (r = 0.29); but it was not related to basal blood pressure, the change in plasma volume of the change in plasma norepinephrine concentration. These data suggest that both intracellular sodium accumulation and inadequate suppression of the renin-angiotensin system may be independently involved in the elevation of blood pressure after sodium chloride loading. We could not find the independent importance of volume retention, hyperadrenergic activity or basal blood pressure in the sodium chloride sensitivity.

Normal human laryngeal epithelia and laryngeal squamous cell carcinoma were assayed by Feulgen DNA cytofluorometry using free cell nuclei isolated from carnoy-fixed, paraffin-embedded specimens. In all of the 12 normal specimens, the epithelium showed typical diploid cell clones with low proliferative activity. Polyploid cells were seen in only two specimens from subjects aged 61 and 69 years respectively, and the number of polyploid cells seen in these two specimens was only two. Fifteen cancer cases were divided into three groups: an untreated group (5 cases), a chemotherapy group (5 cases) and a group of cases with recurrence after radiation therapy (5 cases). Among these three groups the DNA ploidy patterns were compared. In the untreated group, all cases showed a two-peak diploid pattern and a high proliferative activity, and polyploid cells were present. In the chemotherapy group, a wide one-peak histogram extending from 2C to about 5C was noted in 4 cases, and an aneuploid pattern in one case. Thus, the DNA ploidy pattern in the chemotherapy group differed from that in the untreated group. Of the 5 cases with recurrence after radiation therapy, one had a tetraploid pattern, but the remaining 4, a two-peak diploid pattern similar to that seen in the untreated group. Polyploid cells were observed in all these cancer cases. However, because they were also seen in some normal subjects, the finding of polyploid cells is not considered to be conclusive of cancer diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

We report the use of CT-guided stereotaxic system to implant Ommaya reservoir in 26 patients with cystic brain tumors consisting of 16 gliomas, 3 craniopharyngiomas, 3 metastatic brain tumors and 5 other and unknown pathologies, on the way of their biopsy. The entire procedure was carried out in the CT room using Leksell's CT stereotaxic system. In 24 cases with supratentorial tumors, it was at the option of the operator to take any approach such as frontal, posterior temporal and parietal approaches. Especially in 3 cases of craniopharyngioma, we inserted the tube into their cyst directly so that the ventricle should not be open to the cyst. Also in cases of a pontine glioma and a C-P angle metastatic tumor, we used retromastoid approach to the posterior fossa by making patient's heads turned about 30 to 40 degrees to contralateral side of the approach, with slight flexion of the neck. Minimal bleeding occurred during operation in one case, however, it showed no clinical symptoms. Advantages of this method are as follows: Operative invasion is minimal; The surgeon can check the course of the cannula and position of the tip of Ommaya tube even at operation, and can modify it, if necessary.

We evaluated liver function and coagulation parameters in 117 patients with spontaneous intracerebral hemorrhage (68 men and 49 women) admitted to our clinic within 24 hours after onset. Liver dysfunction was more common among men than women due to differences in alcohol consumption. Number of thrombocytes and fibrinogen concentrations were lower, especially among men with elevated concentrations of glutamic oxaloacetic transaminase or glutamic pyruvic transaminase and/or elevated gamma-globulin fraction. Five of the 78 patients undergoing stereotactic hematoma aspiration and one of the 39 treated nonsurgically rebled. All six of the patients who rebled were men, heavy alcohol consumers with liver dysfunction. Fibrinogen concentration was abnormally low in four of the six and at the lower end of the normal range in one. Two showed thrombocytopenia and one case showed prolonged prothrombin time. These facts suggest that liver disorders produce a state in which hemorrhage occurs more readily and that this hemorrhagic tendency may be one of the causal factors of spontaneous intracerebral hemorrhage.

A 47-year-old man was admitted to our clinic because of the pain of left extremities for four years. The patient developed dysesthesia, hyperpathia and spontaneous pain 2 months after the onset of cerebrovascular accident with left hemiparesis. Using Toshiba TCT-20A CT scanner and Leksell's CT-stereotaxic system, stimulation electrode (by Medtronic Co.) was implanted in the posterior limb of the internal capsule which was 25 mm lateral to the posterior commissure. Ventriculography was not necessary because the target point was directly measured from the axial CT and midsagittal reformatted CT based on 18 axial CT images (2 mm thick slices). Anterior commissure, pineal calcification, posterior commissure and Sylvian aqueduct were demonstrated on the midsagittal reformatted CT by this method. The pain was relieved by the ramped square pulse stimulation (2 V, 0.6 msec, 50 Hz) and receivor system was internalized. The patient was free from pain by 30 minutes-long stimulation four to six times a day. Precise electrode placement was possible by CT images alone using high resolution CT and CT-stereotaxic system. CT-guided stereotaxic technique seemed to have an advantages especially for the implantation of electrode in the posterior limb of the internal capsule. The reason is as follows: The target is just lateral to the posterior commissure which could be recognized easily on the midsagittal reformatted CT. The internal capsule is advantageously demonstrated on the axial CT.

An animal model for tonic pain has been produced by means of injecting monosodium urate crystals into a knee joint of rat hind paws in order to evaluate the analgesic effects of various drugs and analgesic methods and to elucidate the physiology of tonic pain. This model allows for stable and long-term behavioural changes due to tonic pain followed by complete recovery without tissue damages. It is advantageous in allowing for objective and quantitative evaluation of the effects of analgesics and should prove useful in research on pain and the development of pain therapy techniques. Using this model, the analgesic effects of capsaicin was evaluated when administered to the neonatal rat or locally to peripheral nerves. In both cases, significant analgesic effects were obtained.

A 40 year-old male presented symptoms of angina pectoris for about nine years and expired with symptoms of unstable angina, changing pattern at the terminal stage. At autopsy, both right and left coronary arteries of the subepicardial region were grayish white and elastic hard. Histologically, inflammatory infiltration was localized in adventitia of coronary arteries located in the subepicardial region. Inflammatory cells infiltrated into the adventitia were mostly eosinophiles. The medial smooth muscle cells were well preserved and the intima showed irregular thickening with fibrosis. Vascular obstruction or recanalization could not be observed. As a result of these findings, it was considered that these inflammatory changes of the coronary arteries could be termed eosinophilic periarteritis. These inflammatory changes could not be found in the intramural coronary arteries. Rather extensive fibrosis could be seen in the muscle layer centering about the posterior wall of the left ventricle. No findings of angiitis could be detected in the blood vessels except subepicardial coronary arteries.

Cerebral vasospasm following subarachnoid hemorrhage (SAH) is one of the most important problems in the treatment of ruptured intracranial aneurysms. Several reports have recently emphasized that oxyHb from erythrocytes might be responsible for vasospasm. In this study, the hem-oxygenase which converts oxyHb to bilirubin was analyzed and the increase of hem-oxygenase in the CSF after SAH was reconfirmed. In 23 cases of ruptured intracranial aneurysms, combined ventriculo-cisternal drainage and cisternal drainage designed by us was performed after clipping of aneurysms in early stage after rupture. Through a Y-shaped tube the CSF accumulated in the cistern and was drained extracranially through cisternal drainage. As a result, 2 (9%) of the 23 patients treated with the drainage showed symptomatic vasospasm. On the other hand, 13 (33%) of 39 patients without the drainage showed symptomatic vasospasm. It may be concluded that the drainage may contribute to prevention of cerebral vasospasm after SAH.

Four forms of nephrocalcin have been routinely isolated from mammalian kidney tissues and urine using DEAE-cellulose column chromatography with a linear NaCl gradient. We have demonstrated that these four forms of nephrocalcin, isolated from bovine kidneys, contain different amounts of phosphate residues, and that alkaline phosphatase digestion converts these to only one form of nephrocalcin. The changes in the nephrocalcin before and after removal of phosphate residues were measured by 31P-NMR spectrometer. Loss of phosphate residues decreased the dissociation constant of nephrocalcin 10-fold toward calcium oxalate monohydrate crystals, suggesting the phosphate residues appear to be important in the inhibitory effects of calcium oxalate monohydrate crystal growth.

Primary cerebral neuroblastoma is rare. The case reported here was a 2-year-old girl who was comatose on admission to the Mito National Hospital. She had experienced headache and vomiting during the last two months. Neurological examination showed bilateral papilledema, left oculomotor palsy and bilateral Babinski's sign. A-P view of the left carotid angiogram showed square shift of the anterior cerebral artery to the right, and the lateral view showed upward and anterior displacement of the middle cerebral artery. CT revealed large mass lesion in the left parieto-temporal lobe, which was slightly enhanced on the contrast study. Subtotal removal of the tumor was performed on the day of admission. On the 15th postoperative day, she was started on radiation therapy to the brain and received 1900 rads. Vincristin and ACNU were administrated with radiation therapy. She improved progressively five weeks after the operation and CT demonstrated marked shrinkage of the tumor. However, signs of increased intracranial pressure were reappeared and she died six months after the operation. Autopsy showed well defined soft and grayish white tumor in the occipito-temporal lobe, which extended to the left thalamus and basal ganglia. No other tumor was present extracranially. Microscopic examination demonstrated Homer-Wright rosette and zonal filament. Pathological diagnosis was neuroblastoma.

In order to clarify the possible relationship between changes in blood pressure after salt loading, membrane sodium transport and renin profile, 19 patients with essential hypertension (8 patients with low renin hypertension and 11 patients with normal renin hypertension), admitted to our hospital, were studied. We also examined the correlation of changes in intracellular sodium concentration after salt loading between erythrocytes and lymphocytes. After a control period of one week, all subjects were placed on a low salt intake for one week followed by one week of a high salt intake. Percent increases in mean blood pressure and intracellular sodium concentration in erythrocytes and in lymphocytes after salt loading were greater in low renin hypertensive patients than in normal renin hypertensives. Percent changes in intracellular sodium concentration in erythrocytes inversely correlated with those in ouabain sensitive sodium efflux rate constant and positively correlated with those in intracellular sodium concentration in lymphocytes. These results suggest that an increase in sodium chloride sensitivity of blood pressure in patients with low renin hypertension may be due to the inhibition of Na+-K+ pump in vascular smooth muscle cell membrane.

CT-guided stereotactic aspiration was performed in the CT room on 97 patients with hypertensive intracerebral hematomas, using a standard ventricular cannula. Residual hematomas were liquefied by urokinase and aspirated through the drainage tube. Major and minor rebleeding were seen in 7 cases. Two out of the 4 major rebleeding cases were followed by craniotomy, while the other cases were treated conservatively. More than 80% of the hematomas were aspirated in 68 cases, 50-70% in 19 cases and 30-40% in 6 cases. Operation in the CT room and hematoma lysis with urokinase is very useful for the aspiration of intracerebral hematomas.

Lipoxygenase, a nonheme iron dioxygenase, catalyzes the oxygenation of 1,4-diene units in polyunsaturated fatty acids, forming conjugated diene hydroperoxides as the primary products. The naturally occurring all-Z geometry for the olefins in the polyunsaturated fatty acid has long been thought to be a substrate requirement for the enzyme. A rigorous test of this hypothesis using the two isomeric (9E,12Z)- and (9Z,12E)-9,12-octadecadienoic acids was carried out. Both isomeric substrates were found to be catalytically oxygenated by soybean lipoxygenase 1 at a significant fraction of the rate of the reaction of the natural substrate, linoleic acid. Product determinations revealed that a thermodynamically unfavorable E to Z isomerization at the 9,10-position occurred when (9E,12Z)-9,12-octadecadienoic acid was converted into the 13-hydroperoxide by lipoxygenase 1. Determination of the stereochemistry at the oxygenated position in the products indicated that a comparable isomerization at the 12,13-position did not occur when the 9Z,12E isomer was employed. The distribution of products obtained from oxygenation at the 9-position supported the hypothesis that the enzyme catalyzes the reaction in one of two substrate orientations, conventional and head to tail reversed. The observations can be understood on the basis of the steric demands on intermediates in the proposed mechanism of action as well as by catalysis by the active-site iron atom.