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Methods to quantitate changes in plasma volume based on changes in the hematocrit, which have been widely used in human subjects and large animals, were tested in small animals, such as rats. A modified equation was derived for application of the hematocrit method to small animals.

A case of stage IIB seminomatous tumor treated with the combination chemotherapy regimen of cis-platinum, vinblastin and bleomycin is presented. The patient was a 42-year-old man who was admitted to our hospital with the chief complaint of the right intrascrotal mass and edema in right lower extremity. Right radical orchiectomy was immediately performed under the diagnosis of testicular tumor. Histological diagnosis was pure seminoma. Paraaortic bulky metastasis and right hydronephrosis were found in the abdominal CT-scan. PVB therapy for initial treatment was started. After four courses of this therapy, retroperitoneal lymphadenectomy was performed. Because no live tumor cells were found histologically in any of the dissected material, complete response was considered to have been achieved by PVB therapy. Considering the poor survival and high relapse rate of advanced seminomatous tumor treated with radiotherapy, this PVB therapy should be the initial treatment for this disease.

This review offers a rational basis for the use of fundamental physiological controlling mechanisms in setting safe environmental limits for occupational situations where heat stress is encountered. There is no single index of heat stress that has been universally accepted. However, the use of wet bulb glove temperature (WBGT) has been adopted by various organizations on occupational health and safety in several industrial countries. Thermal limits suggested for everyday work continue to be subject to argument. The controversies arise from the fact that many factors such as individual variations, acclimatization, clothing, age, sex, physical fitness and work load lead to significant effects on tolerance of man to heat. Several measures for prevention of heat stress under industrial situations are summarized briefly. There is no agreement on a single measure to be used, rather a combination of these measures can be the most effective mean to alleviate or prevent severe heat stress. It is to be hoped that this review may help public health officials and medical doctors of various work occupations resolve some of the problems that arise in setting thermal limits and preventive measures, thus contributing to increase productivity and efficiency of work.

A comparison of fibres descending through the ventral column and segmental afferent fibres was carried out using an isolated frog spinal cord-nerve-muscle preparation with a pair of antagonistic muscles. The m. tibialis anterior (TIB) was contracted with stimulation of the ventral column much stronger than with that of the dorsal root (DR). Contraction of the m. gastrocnemius (GAS) was selectively induced with DR stimulation. These results suggest that the descending fibres and segmental afferent fibres preferentially regulate contractions of the flexor (the TIB) and the extensor (the GAS), respectively. Effects of alpha-aminoadipate, methysergide and LSD were also examined.

The role of renal sympathetic nerve activity (RSNA) in the natriuresis and diuresis induced by head-out water immersion (WI) was studied in eight conscious female dogs. The dog was instrumented chronically with a stainless steel electrode for the measurement of RSNA and two catheters for the measurements of systemic arterial (Pa) and central venous (Pv) pressures. The WI caused an immediate reduction of RSNA by 43 +/- 7% (P less than 0.05), and this low level was sustained throughout a 120-min WI under thermoneutral conditions (37 degrees C). Urine flow and sodium excretion increased by 211 +/- 54 (P less than 0.05) and 240 +/- 122% (P less than 0.05), respectively, but creatinine clearance did not change significantly during WI. A step increase in Pa (by 10 +/- 4 mmHg, P less than 0.05) and Pv (by 10.0 +/- 0.8 mmHg, P less than 0.05) was observed also during WI. In another series of studies, renal denervations were performed 2-4 wk before the experiment in six of the same dogs. Dogs with renal denervation showed no significant changes in urine flow and sodium excretion in response to WI, whereas Pa and Pv increased by 10 +/- 7 and 10.0 +/- 2.0 mmHg relative to the control level, respectively. It is concluded that the reduction of RSNA observed during WI plays a major role in the natriuresis in the dog.

The relation of membrane lipids and osmotic fragility of red cells of human and rat were studied in vitro by repletion and depletion of cell cholesterol. A decrease in the red cell cholesterol corresponded to an increase in osmotic fragility. Conversely, a repletion of red cell cholesterol decreased the osmotic fragility, but the procedure did not significantly change the phospholipid contents of red cells. Accordingly, osmotic fragility of the red cells correlated highly with the cholesterol content of the cell membrane (r = -0.922, p < 0.001) and with the molar ratio of cholesterol to phospholipid in the red cells (r = -0.887, p < 0.001). Red cells incubated with plasma had decreased membrane cholesterol and increased osmotic fragility, but the change was prevented by the inactivation of lecithin cholesterol acyltransferase (LCAT) in the plasma. The above results confirm that membrane cholesterol stabilizes human and rat red cells in vitro as well as in vivo, and the content of red cell cholesterol is regulated by the exchange of plasma free cholesterol in vitro. LCAT activity in the plasma is an influential factor in controlling the cholesterol content of red cells.

The present study was undertaken to investigate the diving pattern, buoyancy-mass relationship, and some respiratory functions in professional male breath-hold divers in Tsushima Island, Japan. These divers always wear neoprene wet suits and use fins and 4-kg counterweights. They usually dive to 3-10 m depths. The rate of descent was 1.12 m/s for deeper dives (greater than 10 m), which is nearly twofold greater than that of Korean female divers also wearing wet suits and fins. However, the rate of ascent (0.8 m/s) was comparable to that of Korean women divers. On a typical summer day, they spend nearly 4 h in the water and perform 175 dives. The average dive and surface time were 39 and 42 s, respectively. The total bottom time was estimated to be 67 min/d, nearly twice that of Korean women divers. These divers do not adjust the counterweight and all are using a 4-kg weight. Nevertheless, the buoyancy-mass relationship revealed that they maintain the same degree of positive buoyancy (approximately 10% above the neutral level) at surface as do Korean women divers who adjust counterweights. The vital capacity was significantly greater in the diver than in the control (P less than 0.05), which was largely due to the greater expiratory reserve volume in the diver. The end-tidal O2 and CO2 pressures of the diver resting in air were not different from those of the control. These results indicate that, while the basic diving pattern is similar in both male and female breath-hold divers, the overall efficiency of diving (in terms of the rate of descent and the bottom time) appears to be superior in male divers.

Human divers are now able to engage in a multi-day dive to a considerable depth using the mixed gas saturation diving technique, however their daily activities are somewhat limited in the depth. One of the major problems that has not been generally appreciated is the potential for body fluid disturbances at high pressure due to the development of a sustained diuresis. In addition, a marked nocturia has been observed in recent saturation dives at 26-31 atmospheres absolute (ATA), which disturbs divers' sleep during the night. In this review, we will briefly discuss the basic characteristics and mechanisms of these disturbances of renal functions observed during hyperbaric exposure.

Ceftizoxime (CZX) was given clinically to 80 patients with urogenital tract infections, in which 34 cases of complicated UTI satisfied the criteria of the UTI committee. CZX was administered for at least five days at a daily dose of 1 to 4 g in two divided doses by intravenous drip infusion. The overall clinical efficacy of CZX in 34 cases of complicated UTI was 59%, estimated by the criteria of the UTI committee. The overall clinical efficacy rate according to group of infection was: 64% for the 11 patients in the 1st group, 56% for the 9 patients in the 2nd group, 100% for the 5 patients in the 3rd group, 50% for the 4 patients in the 4th group and 20% for the 5 patients in the 5th group. No serious side effects were observed in the clinical or laboratory findings except for slight elevation in GOT & GPT values in two cases (2.5%), which returned to normal after CZX treatment. It is therefore suggested that CZX is a clinically useful and safe drug in the treatment of complicated UTI.

Hematologic changes, osmotic fragility of red cells, and lipid contents of plasma and red blood cells were determined during the course of a 14-day dry saturation dive at 31 ATA (SEADRAGON IV). Increases in hematocrit and red blood cell count were observed during the early period at 31 ATA, which was attributed to hemoconcentration resulting from a diuresis. The osmotic fragility of red blood cells decreased slightly during the course of the experiment, but the changes were not related to the atmospheric pressure. Cholesterol and phospholipid content of the red blood cell and the plasma showed slight, insignificant daily variations independent of pressure. However, the same overall correlation was observed between the osmotic fragility and the phosphatidylcholine content of red blood cells and between the osmotic fragility and the total cholesterol level in the plasma, at both 1 ATA and 31 ATA. These correlations revealed an intimate relationship between the cell fragility and lipid composition of the cell membrane and the plasma within intra- and interindividual variations during the course of the experiment, but did not indicate any significant alteration of red blood cell function by the prolonged exposure to 31 ATA helium-oxygen environment. These results indicate that the exposure of human divers to 31 ATA for 14 days does not seem to induce any irreversible chemical changes in the red blood cell.

The possibility that there is some common factor in protein deprivation and splenectomy affecting the properties of red cells was examined by measuring the lipid contents of the plasma and red cells, the surgace area and spherical index of red cells, and the lecithin cholesterol acyltransferase (LCAT) activity of the plasma in intact and splenectomized rats on diets with various levels of protein. Results showed that splenectomy markedly reduced the osmotic fragility and increased the lipid content and surface area of the red cells of all dietary groups, and that decrease in the protein content of the diet gradually reduced the osmotic fragility and increased the lipid content of the red cells. A significant linear correlation was observed between osmotic fragility and the lipid content of red cells. LCAT did not influence the cholesterol level in red cell membranes because its activity in the plasma was not affected by either splenectomy or the protein content of the diet. A protein-free diet induced normaocytic anemia, but increased the lipid content and reduced the osmotic fragility of red cells. Therefore, the effect of cholesterol in increasing the surface area of red cells was not proportional in the red cells of rats on a protein-free diet. The present studies suggest that the mechanism of accumulation of cholesterol in red cells is different in protein deprivation and splenectomy. That is, in protein deprivation, increase in red cell cholesterol may result from decreased esterification of cholesterol in the plasma because of the low concentration of the substrate of LCAT, high density lipoprotein; and in splenectomized rats, the cholesterol level of the cells may not be reduced because the red cells are not exposed to the red pulp of the spleen where the pH is very low. These possibilities are supported by the finding that the osmotic fragility of the red cells decreased most and the lipid content of the cells increased most in splenectomized rats on a protein-free diet.

Mizoribine (MIZ) suppressed the mitogen response and mixed lymphocyte reaction (MLR) significantly at doses of 100 micrograms/ml and 10 micrograms/ml in a dose-response analysis. The 50% inhibition dose (ID50) was between 10 micrograms/ml and 1.0 microgram/ml, both in the mitogen response and MLR. In a kinetic study of the MLR, the degree of suppression with MIZ at a given dosage was essentially the same as the degree of suppression observed in the dose-response analysis when MIZ was added to MLR cultures from day 0 to day 4. In addition, MLR was more susceptible to the suppressive activity of MIZ at 100 micrograms/ml when MIZ was added near the peak of lymphocyte proliferation. This experiment also showed that MLR suppression induced by MIZ at 10 micrograms/ml was reversible and MLR activity had completely recovered 6-8 hr after its removal. MIZ had no inhibitory action on MLR-derived cytotoxic cells or the effector phase of cell mediated lymphocytotoxicity. These results clearly demonstrate that MIZ suppresses lymphoproliferation, but has no effect on the recognition phase or effector phase of cytotoxic lymphocytes.

Five male volunteers were exposed for 4 days to a 4-ATA helium-oxygen saturation dive. Partitional calorimetry was performed during 2-h test periods at various ambient temperatures (Ta). Heat production during the period at 4 ATA in helium-oxygen was identical to that at 1 ATA in air. The nonevaporative heat loss (convective and radiant heat losses) was increased with a concomitant decrease in evaporative heat loss. The mean skin and mean body temperatures fell significantly at 4 ATA, and a slight reduction was observed in the rectal temperature. The conductive heat transfer coefficient from the core to skin (hk) was reduced, probably due to vasoconstriction at 4 ATA. Subjective thermal neutrality at rest at 4 ATA was obtained around Ta = 32 degrees C. A diuresis was observed at 4 ATA, but it disappeared with an increase in chamber temperature. An inverse relationship of urine flow to mean skin temperature was observed. An increase in urine flow at 4 ATA might be attributed to cold stress due to lower skin temperature that was caused by the increased nonevaporative heat loss.

The sequestration of erythrocytes in rats was studied using an isologous 51Cr-labeled population of either normal or N-ethyl-maleimide (NEM) treated red cells. The spleen sequestered the damaged red cells selectively, while the liver compensated and overshot the sequestration for spleen after splenectomy. The sequestering response in liver increased gradually reaching a maximum level around 8 weeks after splenectomy and then declining toward the control level. These compensatory responses in liver were not observed in rats fed a low-protein diet, which indicated that the proliferative response imposed on liver by an extra work after splenectomy was not stimulated in the rats fed a low-protein diet. Splenectomy prolonged erythrocyte survival and reduced the osmotic fragility of normal red cells, but the compensatory increase in sequestration of damaged red cells in liver did not alter the survival and osmotic fragility of normal red cells of the rat. This fact indicates that the increased sequestration of reticuloendothelial cells in liver is basically reparative, and it is impossible to compensate for the absence of the spleen because of an inability to duplicate certain anatomic features peculiary to the spleen.

A case of transitional cell carcinoma arising from a bladder which was left behind for more than 24 years without pyocystis syndrome is described. A search in the literature revealed 10 cases of defunctionalized bladder that developed tumors over a rather short latent period ranging from 3 months to 7 years, and mostly with evidence of severe bladder infection.

Using the ultrasonic Doppler technique, renal blood flow was measured in 67 patients who underwent living related renal transplantation from January, 1976 to December, 1979. In 58 of 67 cases, 81 acute and 9 chronic rejection episodes occurred. In the initial stage of acute rejection, there are no particular changes in the pattern of systolic blood flow and by contrast marked changes of diastolic flow. The disappearance of the diastolic phase is indicative of an advanced stage of rejection, the reappearance indicative of recovery from rejection, and persistent loss accompanied by changes of systolic flow indicative of an unfavorable prognosis of rejection. In chronic rejection, there are rapid changes of neither systolic nor diastolic flow though the acceleration time in the systolic phase lengthens gradually. The ultrasonic Doppler flow technique for blood flowmetry of a transplanted kidney is a useful means of knowing the prognosis of rejection and provides an index for corticosteroid bolus therapy.

A case of bilateral testicular germ cell tumor of different cell types was found to have a mature teratoma in the metastatic region. Histology of the right testis revealed seminoma and embryonal carcinoma while the left testis revealed seminoma and mature teratoma. A mature teratoma, containing cartilage components, was also found in the right para-aortic lymph node. The findings of the case are described and the literature on cases with maturation in the metastatic region are reviewed.

Cefixime (CFIX, Cefspan), a new oral cephem, was used in the treatment of urinary tract infections, and was evaluated for its therapeutic effectiveness and safety at the Department of Urology, Osaka University Hospital and 16 affiliated hospitals. A total of 238 patients were administered daily doses of 200 or 400 mg. Clinical efficacy was assessed on 92 female patients with acute uncomplicated cystitis and 42 patients with complicated UTI according to the Criteria for Clinical Evaluation of Antimicrobial Agents in UTI (3rd ed.) recommended by the Japan UTI Committee, to which we added our own minimum modification. Clinical efficacy was evaluated as excellent in 57 of the acute uncomplicated cystitis cases, moderate in 33 and poor in 2, with an overall clinical effectiveness rate of 98%. Clinical efficacy was evaluated as excellent in 12 of the complicated UTI cases moderate in 12 and poor in 18, with an overall clinical effectiveness rate of 57%. In one case of uncomplicated pyelonephritis, CFIX showed an excellent efficacy. Of the total of 102 bacterial strains isolated from uncomplicated UTIs, 95 (93%) were eradicated by CFIX, while 36 (72%) eradicated in 50 strains isolated from complicated UTIs. Subjective adverse reactions were seen in 4 cases (1.7%) of the 236 patients, as generalized pruritus and upper gastrointestinal discomforts. Abnormal laboratory findings were recorded in 6 out of 141 cases. They were increases in serum GPT, GOT, alkaline phosphatases, total bilirubin, as well as increases in peripheral leukocytes. These adverse symptoms and abnormal laboratory findings disappeared after the termination of CFIX administration. CFIX might therefore be considered as a clinically useful oral antibiotic in the treatment of UTI.

A case of bilateral testicular germ cell tumors of different cell types and maturation in the metastatic region is described. A 42-year-old man with bilateral testicular swelling visited our clinic. Bilateral high orchiectomy was performed. Subsequent histological examination revealed seminoma and embryonal carcinoma in the right testis and seminoma and mature teratoma in the left. Then bilateral retroperitoneal lymphadenectomy was performed and 7 metastatic regions were found in the para-aortic lymph nodes. One of these revealed histopathologically a mature teratoma containing cartilage constituents. After the operation, multiple drug treatment with Cis-DDP, vinblastine and pepleomycin was started. The patient has been in complete remission for about 1.5 year. In addition, we reviewed the literature about bilateral testicular germ cell tumors and maturation in the metastatic region.

Thirty-four cases of tumor of the renal pelvis or ureter or both have been treated in our department during the past decade. The primary tumor was in the renal pelvis in 11 cases, in the ureter in 21 cases and in the ureter and renal pelvis in 2 cases, a co-existent tumor in the bladder was found in 4 cases. Seventeen patients had a tumor on the right side and 17 on the left side. The most frequent symptom was gross hematuria (70.6%) and flank pain was the presenting symptom in 7 cases (20.6%). On the intravenous pyelography, a filling defect in the renal pelvis or ureter (41.2%) and nonvisualization (53.0%) were frequent findings. Twenty-nine cases had undergone total nephroureterectomy with resection of a bladder cuff, 3 had simple nephrectomy and 2 had open biopsy alone. Postoperative radiation therapy was done in 1 case, chemotherapy in 10 cases, and 6 cases of them were treated by CAP therapy (cis-dichlorodiamine platinum, doxorubicin and cyclophosphamide). Actual and relative 5-year survival rates were 53.8% and 63.5%, and no significant difference was found in survival rate between the patients with renal pelvic tumors and those with ureteral tumors.

Four male divers were exposed to a dry, 31 ATA, He-O2 environment for 7 d (Seadragon VI). Urine was collected diurnally (0700-2200 h) and nocturnally (2200-0700 h) before (predive 1 ATA air), during, and after (decompression and postdive 1 ATA air) exposure to 31 ATA. A typical hyperbaric diuresis associated with a reduction in urine osmolality was observed in the face of a constant creatinine clearance. A significant increase (P less than 0.05) in osmolal clearance (COSM) was observed with concomitant decrease (P less than 0.05) in negative free water clearance, indicating that the diuresis has both osmotic and free water components. Although urine flow increased at pressure during both day and night, its magnitude was twofold greater at night as compared to daytime. Moreover, the diurnal diuresis was entirely due to an increase in free water excretion, whereas the nocturnal diuresis was largely due to an increased COSM. These results indicate that hyperbaric diuresis is induced by inhibition of tubular reabsorption of free water during daytime and of certain solutes during the night. Approximately 80% of the nocturnal increase in the excretion of osmotic substances was accounted for by Na, K, Cl, and urea.