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Large capacity together with high reliability has been a major concern for international communication networks. In response to this requirement the transmission capacity of a 5 Gbit/s system corresponding to over 60,000 telephone circuits, has been adopted in the TAT-12/13 subsea cable network. As to the attainment of higher reliability of the communication network, a newly developed protection system has also been adopted. The TAT-12/13 cable network consists of four point to point links linked together by the network protection equipment (NPE) to form a ring. The network protection system (NPS) is composed of four NPE double rings and network management equipment (NME) which performs supervisory control of the entire network in four terminal stations. The NPE consists of two four fiber ring nodes. When a failure is detected in the network, a changeover of the communication signal from the failed route to a non-failed route is executed. (4 pages)

The relationship between serum PG I, PG II levels and extent of atrophic gastritis was examined. On 64 patients (male: 32, female: 32, 51.9 years old on average) with established diagnosis of either atrophic gastritis or normal. In the X-ray gastric examination, Fuji Computed Radiography (FCR) was used to obtain clear-cut images of the gastric area. Concerning the serum PG I level, patients in the group with atrophic gastritis showed lower levels than those of the people in the group with no atrophic change, but the variation was wide, and no definite tendency was seen in the relationship between the atrophic change and the serum PG I levels. Concerning the serum PG II level, as the atrophic change progresses, the serum PG II level tended to increase gradually. A significant reduction in the PG I/II ratio was seen in the group with atrophic changes (p0.01) in comparison with the group with no atrophic changes, and the PG I/II value tended to decrease. In conclusion, as a relationship between the atrophic change and the serum PG levels had a wide variation, we considered to be difficult by to measure the serum PG level to understand the presence and extent of the atrophic gastritis.

We examined arteriosclerotic carotid lesions in 76 patients using helical scanning CT (HES-CT), and evaluated the clinical usefulness of this method. A high speed slip-ring X-ray CT system was used. Scanning of the neck was performed for a 30 second period following intravenous bolus injection of non-ionic contrast medium, while couch top movement was 2.0 mm/sec. Multiplannar reconstruction images (MPR-image) and 3-dimensional surface images (3D-image) were reconstructed from the continuous raw data. MPR-images offered axial, coronal and sagittal images in which the lesion could be seen from any direction, and 3D-images that could be freely rotated were obtained by using a track ball and monitor. Eighteen cases were also evaluated by conventional angiography. Excellent HES-CT images were obtained in 73 cases, showing occlusion in 13, stenosis in 34, plaques without calcification in 15 and plaques with calcification in 74 vessels. A good correlation was obtained between HES-CT and angiogram in most cases, and in 6 cases, HES-CT was superior in the detection of stenosis, because it enabled us to observe the lesion from various directions. These results suggested that HES-CT was a minimally invasive, useful diagnostic method for the evaluation of arteriosclerotic carotid disease.

Twenty-one patients with malignant peritoneal or pleural effusions of gastric carcinomas were treated with intracavitary injection of lentinan (LNT). LNT was injected at a dosage of 4 mg/week for 4 weeks. In total, fifteen (71%) of twenty-one patients demonstrated clinical responses. Toxicity caused a high fever in only one case. LAK and ATK activities induced from peritoneal exudate cells (PEC) after culture with autologous tumor and interleukin-2 were examined before and after LNT injection. ATK activity was augmented, but LAK activity was reduced after LNT injection. These results indicate that intracavitary injection of LNT is a useful treatment for malignant effusions, and that LNT augments the induction of cytotoxic T-lymphocytes.

We have previously reported the efficacy of intraarterial combined immunochemotherapy for 24 patients with unresectable hepatocellular carcinoma. This therapy consists of recombinant interleukin-2, OK-432, adriamycin, cyclophosphamide, and famotidine. We observed a complete response (CR) in 4, partial response (PR) in 3, minor response (MR) in 7, no change (NC) in 7, and progressive disease (PD) in 3. The response rate (CR+PR+MR) was 58.3%. The overall 2-year survival rate was 52%. The present study was designed to analyze the phenotype of tumor infiltrating lymphocytes and apoptosis-related antigen (Ley and Fas antigen) expression in tumor cells.The analysis of phenotype of tumor infiltrating lymphocytes and apoptosis-related antigen (Ley and Fas antigen) expression in tumor cells were performed by immunohistochemical stain using resected specimens.Lymphocytes markedly infiltrated into the tumor lesions in treated patients compared with untreated patients. Phenotypes of tumor infiltrating lymphocytes were CD8+ and HLA-DR+. Ley-positive and Fas-positive tumor cells were observed as well. Furthermore, in the strong lymphocyte infiltrating area, the Fas antigen in tumor cells were strongly expressed.In conclusion, the antitumor effect of intraarterial combined immunochemotherapy may be related with the activation of tumor infiltrating lymphocytes. These lymphocytes may kill tumor cells in an apoptotic fashion. Fas ligand expression of TILs should be determined in future.

Usefulness of endoscopic imaging of cerebral aneurysms is presented. 3-D luminal images were obtained using a new processing technique which extracts CT numbers in the boundary region between the vessel wall and contrast media filled in the vascular lumen. Clinical application of this technique to complicated large cerebral aneurysms showed that, with this 3-D CT endoscopic imaging, anatomical details of cerebral aneurysms such as the orifice of the aneurysm, intraluminal thrombus, and calcification of the wall could be clearly demonstrated. Using a 3-D imaging method by Helical CT virtual views of various surgical approaches were compared preoperatively. With this technique, not only virtual surgical views of aneurysms and related vasculature, but also surgical views after virtual resection of skull base bone to a desirable extent are freely available. We operated on two large, complicated aneurysms and one broad-based aneurysm after obtaining 3-D CT endoscopic images of the aneurysms. Such information was found to be very useful for determining difficult and complicated cerebral aneurysms and broad-based aneurysms for coil embolization or direct open surgery.

Pars plana vitrectomy was performed on 19 eyes with idiopathic full-thickness macular holes (6 eyes at stage 2, 8 eyes at stage 3, and 5 eyes at stage 4). Factors affecting postoperative visual prognosis were evaluated. Preoperatively a potential acuity meter (PAM) and laser interferometry were used to predict postoperative visual acuity. Resolution of the surrounding fluid cuff and flattening of the macular holes were obtained in 9 eyes (47%). Eight eyes (42%) gained an improvement in visual acuity of 2 lines or more. Most eyes with anatomical success showed functional improvement. Eyes with short duration of macular holes were considered to have better visual postoperative prognosis. The stage of macular holes, however, had no relationship with postoperative visual acuity. Preoperative measurement with laser interferometry was relatively well correlated with postoperative visual acuity (r = 0.54, p = 0.07), but the results of PAM and preoperative visual acuity had poor correlation.

We used laser interferometry (LI) and a potential acuity meter (PAM) to predict visual acuity after surgery for patients with rhegmatogenous retinal detachment with macular involvement. Thirty one eyes of 31 patients with retinal detachment were treated with scleral buckling procedures. Postoperative visual acuity was correlated with preoperative measurements of the LI and PAM, preoperative visual acuity by Landort's ring, and the estimated duration of macular detachment. The correlation between the duration of macular detachment and the postoperative visual acuity was not good (r = 0.55, p0.01). Although the preoperative visual acuity showed a relatively good correlation with postoperative visual acuity (r = 0.62, p0.01), the results of the LI and PAM provided a better correlation (LI; r = 0.73, PAM; r = 0.71). Our results suggest that the LI and PAM are useful to predict the visual acuity after retinal reattachment in patients with preoperative macular detachment.

It has been reported that hyperbaric oxygen treatment improves visual function in patients with chronic macular edema associated with retinal vein occlusion. This study was designed to investigate relationship between visual prognosis and characteristics of macular edema. From fluorescein angiography performed prior to the therapy, areas of capillary closure and fluorescein leakages were quantitatively evaluated within 1 disc diameter from the fovea. In 27 eyes for which good angiograms were available, 19 eyes were classified as having mild ischemia 1 (area of capillary closure25%) and 8 eyes were classified as having severe ischemia (closure areaor = 25%). Of the 27 eyes, 14 showed visual improvement after the therapy. While only one eyes (13%) had visual improvement in the severe ischemic group, 11 eyes (58%) showed visual improvement in the mild ischemic group. The degree of fluorescein leakage before the therapy had no effect on visual outcome. The degree of macular ischemia was found to be a more significant factor influencing visual prognosis after the treatment than the degree of macular edema.

Leukocyte rheology may play a key role in microcirculation because leukocytes have unique properties, such as large cell volume, high cytoplasmic rigidity, and low deformability. However, only a few methods are available to study the dynamic behavior of leukocytes in retinal microcirculation. The authors developed a new method to analyze directly movements of leukocytes in the retinal vessels of primates.Acridine orange, which has been used as a nuclear stain in histochemistry and cytochemistry, was injected intravenously into cynomolgus monkeys for a vital staining of leukocytes. The fundus image was generated with the argon blue laser and a scanning laser ophthalmoscope. The images were recorded on a magnetic tape and evaluated with a personal computer-based image analysis system.Each leukocyte was recognized as a single fluorescent dot moving in the retinal vessels. It was possible to analyze the spatial and temporal dynamics of individual leukocytes in the capillaries. Some leukocytes passed through the capillaries, plugging transiently under the physiological condition. Leukocytes that stayed in the same position for a few minutes may have stuck to the endothelium as a result of leukocyte-endothelial interactions. In the postcapillary vessels, leukocytes tended to be displaced from the center stream toward the vessel walls. The mean flow velocity of leukocytes in the perifoveal capillary was 0.92 +/- 0.32 mm/sec.This study clearly demonstrated that rheologic behaviors of leukocytes in the retinal microcirculation can be studied through the vital staining with acridine orange in vivo. The authors' results suggest a potential role of leukocytes in retinal vascular flow disturbances. This study may open the door to the investigation of leukocyte hemodynamics in the retinal microcirculation in vivo.

Helical CT (HCT) was applied to the diagnosis of cerebral aneurysms. The diagnostic accuracy of HCT, including the detectability of aneurysms, was compared with that of conventional cerebral angiography in 62 aneurysms of 43 patients. The scanning parameters were 135 kV, 260 mA and 1 mm slice thickness. The couch top was moved at 1 to 1.2 mm/s during the scanning of 30 s. In a prospective study, the detection rates using HCT and angiography were 91.9% and 93.5%. Retrospectively, the detection rates with HCT and with angiography were 95.4% and 98.4%. HCT was also effective in illustrating the detailed contours of aneurysms and calcifications and thrombosed parts of aneurysms. Three-dimensional CT (3D-CT) images were helpful in diagnosing complicated vascular anomalies. Our results indicate that HCT was an effective diagnostic modality to supplement cerebral angiography.

A CT fluoroscopy system that permits real-time monitoring of CT images was developed. In phantom studies the images were displayed at a rate of 6 per s, with a delay time of 0.67 s. Early clinical trials in aspiration of intracranial haematoma and brain tumour biopsy indicated that CT fluoroscopy is useful for CT-guided intervention on the central nervous system.

An MRI technique permitting direct, noninvasive display of brain surface structures (surface anatomy scanning, SAS) was developed using T2-weighted images. In this study, synthesised SAS, which combines contrast-enhanced MR angiography and SAS, was used to 50 cases, and the detection rate of lesions and preoperative simulation was evaluated. Synthesised SAS enabled detection of more lesions (94%) than SAS alone (52%). Synthesised SAS has the following advantages: noninvasive visualisation of the brain surface structures (sulci, lesions and veins) and skin markers for surgical planning; practical data acquisition and postprocessing times; preoperative assessment of the suitability for a craniotomy; and minimisation of surgical damage to normal brain tissues and veins.

MRI is useful for detecting spinal lesions in multiple sclerosis (MS). We have performed MRI in 14 patients (26 attacks) with clinically definite MS and investigated correlations between neurological and MRI findings and their changes before and after high-dose steroid “pulse therapy”. The spinal level at which the lesion was suspected on the basis of neurological examinations was located as high-intensity areas on T2-weighted images. The lesions on Gd-DTPA enhanced T1-weighted images correlated better with clinically suspected lesions. Since the Gd-DTPA enhancing area disappeared after treatment in most cases, the enhancing lesions were useful for our understanding of the activity and the reaction to therapy in MS.

A new CT system that permits real-time monitoring of CT images was developed. Phantom and volunteer studies revealed that the images were displayed at a rate of six per second with a delay time of 0.83 second with clinically sufficient resolution (256 x 256) using the newly developed fast image processor and partial-reconstruction algorithm. The clinical trial of stereotactic aspiration of intracerebral hematoma was successful. The initial trial with CT fluoroscopy revealed potential usefulness of the system in biopsy and other CT-guided interventions.

Helical scanning CT (HES-CT) is a new technique to enable high-speed volumetric data acquisition. We have applied HES-CT to the diagnosis of cerebral vascular diseases. In our experience, the relationship between the scanning parameters of HES-CT and image quality was complex and reciprocal, so that optimization of the parameters according to the clinical demands was essential. We compared HES-CT with conventional cerebral angiography to determine the detectability of the aneurysm and surrounding vessels, and sought the optimal parameters to delineate small vessels. All aneurysms were detected in multiplanar reconstruction (MPR) images. The smallest one was 3 x 4 mm. MPR images were found to have some advantages over conventional cerebral angiography in delineation of intracranial aneurysms: 1) scanning was over in a short time (30s), 2) the relationship between the aneurysm and surrounding vessels was easily recognized, 3) the diameter of the neck could be measured, because the neck of the aneurysm and parent artery could be imaged on the same plane without overlapping another vessel, 4) calcified lesions on the aneurysmal wall were detected, and 5) HES-CT was done safety without arterial puncture. However, the detectability of unknown aneurysm was less than the detectability of known aneurysm in MPR images. The 180 degrees interpolation algorithm and 1 mm slice were effective in detecting small vessels. However, vessels with a diameter less than 1 mm could not be detected by HES-CT. HES-CT was considered to be useful as a supplementary examination to conventional angiography for the diagnosis of intracranial aneurysms.

The choroidal microvasculature and its circulation are inadequately assessed by presently available techniques. Laser-targeted delivery was applied to generate local, repetitive angiograms of the choriocapillaris in primates.Carboxyfluorescein was encapsulated in heat-sensitive liposomes and injected intravenously in monkeys. The liposome contents were then released locally in the choroid by application of a short heat pulse provided by an infrared laser. The bolus of dye spread rapidly downstream from the underlying arterioles into clusters of lobules. Video angiograms were generated with excitation illumination provided by an argon laser.Laser-targeted delivery choroidal angiography performed on three monkeys indicated that the fluorescence was emitted mainly from the choriocapillaris. Clusters of irregular shape with well-defined margins were observed. Adjacent arteries typically supplied separate clusters that fit together like a jigsaw puzzle. The dynamic filling and emptying patterns, recorded at video rate, revealed that macular lobules were filled by a central arteriole and drained by a venous annulus. The average dye transit time through a lobule (n = 10) was 118 +/- 26 msec (mean +/- SD), and the dye transit velocity was 2.53 +/- 0.55 mm/sec.This study clearly documents the segmental nature of the primate choroidal microvasculature. It also illustrates that choroidal angiography by laser-targeted dye delivery provides information useful for studying the response of the choriocapillaris to physiological and pathologic changes.

In fifteen cases of arteriovenous malformation (AVM), serial examinations of regional cerebral blood flow (rCBF) using single photon emission computed tomography (SPECT) and N-isopropyl-(123I)p-iodoamphetamine were performed. On SPECT images, the nidus was visualized as a focal rCBF defect in all cases preoperatively and seven of these cases had abnormal decreased perfusion areas in the tissues adjacent to the nidus. In five cases, the postoperative SPECT images on the day after surgery revealed an abnormal increased perfusion area adjacent to the nidus and in one case the increased perfusion was accompanied by a massive intracerebral haemorrhage detected by brain computed tomography (CT). In seven cases, postoperative SPECT images showed widespread abnormal decreased perfusion areas in the surrounding tissues and brain CT revealed either intracerebral haemorrhage or significant cerebral oedema. In the other three cases, no remarkable rCBF changes were found in comparison with the pre-operative study. There was a tendency for the preoperative abnormal decreased perfusion area adjacent to the nidus to correlate with the postoperative hyperperfusion and for the postoperative abnormal decreased perfusion area to reflect brain damage.

We investigated the clinical usefulness of the asymmetric film-screen system on postero-anterior chest roentgenograms for thoracic lesions. The asymmetric film-screen system, the so-called Kodak Insight thoracic imaging system, records a different image on each side of double-emulsion film. An image displaying the lung field is captured on the anterior side of the film, while one displaying the mediastinal, retrocardiac and retrodiaphragmatic structures is captured on the posterior side. The clinical usefulness of the asymmetric film was evaluated in 20 patients for visibility of the anatomical structures and abnormal lesions in comparison with conventional film. In the asymmetric film-screen system, the front and rear screens were HC (high contrast) and Regular, respectively. Chest radiography was performed at 200mA and 100kVp. As conventional film, we used SRC film (Konica, orthotype film), and chest radiography was performed at 100mA and 130kVp. The chest roentgenograms obtained with the asymmetric film-screen system provided better information on normal structures and abnormal lesions in the lung field, but slightly inferior information on mediastinal structures. In conclusion, it was considered that the asymmetric film-screen system was useful for thoracic lesions.

The authors evaluated the feasibility of using an implantable biodegradable polymeric device to deliver drugs into the vitreous humor.Two types of devices were prepared by compression-molding polymers of poly(DL-lactic acid) of two different molecular weights. The molecular weights of the poly(DL-lactic acid) used were 5,600 (device-1) and 9,100 (device-2). Sodium fluorescein (NaF) served as a hydrophilic drug marker. The release of the dye from the devices was studied in vitro. The intravitreal kinetics of NaF was evaluated in rabbits in vivo by fluorophotometry. The eyes were evaluated electrophysiologically and histologically to determine if there were toxic effects.Device-1 and device-2 released NaF for more than 25 and 45 days, respectively, in vitro. Detectable concentrations of NaF were present in the vitreous up to 17 days (device-1) and 28 days (device-2). Both types of devices were well tolerated, with no noted toxic effects.These results suggested that this device may be a potentially effective system to deliver drugs in the vitreous.

The newly developed 99mTc-labeled renal imaging agent, mercaptoacetyltriglycine (MAG3), is a tubular secreted compound. It is expected the most suitable agent to measure renal function and image urinary tract because of the excellent imaging properties and availability of 99mTc and preferred biological qualities of radiohippurates. We examined 15 patients (8 males, 7 females, mean age 55 years old) with renal and urinary tract disease. After drinking 400 ml of water, 185, 370 or 555 MBq of 99mTc-MAG3 was injected with the supine position. Dynamic scans were acquired for 20 minutes on a large field of view gamma camera (ZLC-7500 Siemens Medical Inc.) linked to a computer system (Scintipac-2400 Shimadzu Co.) in a 64 x 64 matrix. Regions of interest (ROI) were placed around each kidney. Curves of 12 seconds frame rate were generated from all two ROIs over the 20 minutes study. The time to peak count (Tmax) and time from peak count to a half count (T1/2) were calculated from the curve data. 99mTc-DTPA renal imaging was examined to the same patients with the same method like 99mTc-MAG3. The renogram of 131I-orthoiodohippurate (OIH) was performed with probe method. The excellent quality of the renal image was obtained with 185-555 MBq of 99mTc-MAG3 compared with the same dose of 99mTc-DTPA respectively. The diagnostic value of 99mTc-MAG3 renal imaging was as well as 99mTc-DMSA renal imaging. The Tmax of 99mTc-MAG3 renogram was same value of that of both 99mTc-DTPA and 131I-OIH renogram. The T1/2 of 99mTc-MAG3 renogram was significantly lower than that of 99mTc-DTPA renogram. The T1/2 of 99mTc-MAG3 renogram was slightly higher that of 131I-OIH renogram. We conclude that the renal imaging of 99mTc-MAG3 was able to acquire the most excellent image and the proper renogram pattern as same as 131I-OIH renogram.

To investigate the effectiveness of administering relatively high doses of r-HuEPO subcutaneously once a week or once every 2 weeks in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).Multicenter prospective analysis. The trial was divided into two phases: an initial 8-week phase (once a week dosing) followed by a 12-week maintenance phase (once every 2 weeks dosing). A response was defined as a change in hematocrit (Ht) of 3% or more. Results were analyzed using Sheffe's test, Mantel-Haenszel's test, and Dunnett's test.Eleven renal units in Japan providing a CAPD program.Forty-one CAPD patients with a Ht of 28% or less.After the initial 8 weeks, 13 (81.3%) of 16 patients showed a response to 6000 U (106.9 +/- 20.0 U/kg) subcutaneously (sc), once a week. Eleven (84.6%) of 13 in the 9000 U (166.5 +/- 27.7 U/kg) group and all 12 (100%) in the 12,000 U (210.7 +/- 42.1% U/kg) group also showed responses. At the end of both phases, that is, at 20 weeks, 7 (53.8%) of 13 patients in the 6000 U group with once every 2 weeks dosing, 7 (63.6%) of 11 in the 9000 U group, and 10 (90.9%) of 11 in the 12,000 U group maintained responses with the same dosing interval. There were no significant changes in mean blood pressure during the study period, and only 2 patients developed treatable hypertension with mild headache.Administration of relatively high doses of r-HuEPO to CAPD patients once a week or once every 2 weeks is safe and potentially an effective regimen for the correction of renal anemia.

We experienced a case of serious adverse reaction following the administration of Gd-DTPA (gadolinium with diethylenetriamine pentaacetic acid). The patient showed sneezing and hoarseness when Gd-DTPA was administered for the first time. At the second injection, when hydrocortisone was used in advance to prevent allergic reaction, she lapsed into a pre-shock state and anaphylactic reaction was strongly suggested by the laboratory data. The possibility that Gd-DTPA may cause the severe side effects must be noted.

The effect of ileectomy on the composition of biliary bile acids and the metabolism of 5 beta-cholestane-3 alpha,7 alpha-diol was studied in rats. In the ileectomized rats, there was an increase in the percentage of cholic acid group (cholic acid and deoxycholic acid) as compared with the normal rats. After rats with a bile fistula were given intravenously 5 beta-[7 beta-3H] cholestane-3 alpha,7 alpha-diol, there was a 3-fold increase in the percentage of [3H]cholic acid in the ileectomized rats compared to the normal rats. The findings have suggested that an increase in the percentage of cholic acid group in the ileectomized rats is due to the increased formation of cholic acid through an alternative pathway which involves 5 beta-cholestane-3 alpha,7 alpha-diol.

To evaluate the movements of retrobulbar structures radiologically, we have developed a new technique called "external ocular muscle movement CT" (EOM CT), in which dynamic CT scanning is performed while the patient performs controlled eye movements. This new technique was applied in one volunteer and 72 patients with external ophthalmoplegia due to orbital mass lesion, hyperthyroid ophthalmopathy, blowout fracture, and other retrobulbar lesions. EOM CT permits the assessment of extraocular muscle contraction in cases of blowout fracture, the evaluation of muscular contraction in hypertrophy of the extraocular muscles, and the diagnosis of adhesions between the extraocular muscles and intraorbital masses. Radiation dose to the lens from EOM CT was measured using a phantom and TLD, and was compared with that of conventional CT scanning with a 5 mm slice thickness. The dose to the lens from EOM CT was three times higher than that for conventional CT in axial scanning, but in the coronal section of the retrobulbar region, the dose to the lens from EOM CT decreases to one twelfth that of conventional CT. EOM CT promises to be a powerful modality for functional evaluation of the extraocular muscles and other retrobulbar structures.

Urinary excretion of albumin was measured after renal transplantation in 37 patients who received cyclosporine quadrotherapy (cyclosporine A, azathioprine, prednisolone and antilymphocytoglobulin). In 26 patients with a favorable clinical course, daily urinary albumin level increased significantly on the first operative day. Subsequently, it decreased gradually, and remained at about 40mg/day after 3 weeks. In these patients, the urinary albumin level did not correlate with blood pressure, whole blood cyclosporine level, serum creatinine level nor urinary enzyme level, i.e. beta 2-microglobulin, NAG, gamma-GTP. As for correlation between the urinary albumin level and biopsy findings in 21 patients who underwent renal graft biopsy, the urinary albumin level was significantly increased in 5 patients with high degree of lymphocyte infiltration in the renal graft as compared with 16 patients with low degree of infiltration. However, there was no significant correlation between the urinary albumin level and the degree of tubular damage. In 4 patients of allograft rejection, a clinical course was reflected better in the albumin level than in the urinary enzyme level, these results show that the measurement of urinary albumin is a useful clinical examination to evaluate the allograft rejection of renal transplantation in cyclosporine era.

We retrospectively evaluated the effect of hyperbaric oxygen treatment on seventy-nine eyes of seventy cases with cystoid macular edema secondary to retinal vein occlusion. Twenty-three eyes had central retinal vein occlusion (CRVO), and fifty-six eyes had branch retinal vein occlusion (BRVO). Visual acuity improved by two lines or more in 40 eyes (17%) with BRVO, and in 10 eyes (44%) with CRVO immediately after the therapy. Six months or more after treatment, visual improvement persisted in 14 of 30 BRVO eyes (47%), and in only one of 11 CRVO eyes (9%). CRVO showed poor prognosis in the long term compared with BRVO. We speculated that activation of aerobic metabolism might be more important than reduction of vascular hyperpermeability as the therapeutic effect of hyperbaric oxygen, and that hyperbaric oxygen might mainly affect the retinal cells in the marginal zone of the ischemic retina in the macular region.

Eighty-seven CAPD patients whose hematocrit (Ht) level was maintained by recombinant human erythropoietin (rHuEPO) were enrolled in this trial for a new formulation of rHuEPO suitable for subcutaneous injection. 6000IU rHuEPO was administered every 2 weeks for 12 weeks. Fortnightly doses were increased to 9000IU or 12000IU at 4 or 6 weeks if the Ht level decreased by 2% or more. During the study period, Ht values were maintained at the appropriate level in 88% of patients. 6000IU or lower was selected as a maintenance dose given every 2 weeks in 57 (76.0%) patients, 9000IU was selected in 8 patients and 12000IU was chosen in one patient. In 9 patients, the Ht could not be maintained during the study and the appropriate dose, therefore, remained unclear. Hypertension was observed in 2 patients as a side effect, and headache occurred in 2 other patients during the trial. Cutaneous abnormalities were not observed in the course of the subcutaneous injections. We conclude that anemia in most CAPD patients could be controlled with fortnightly injections in the dose range of 6000 to 12000IU rHuEPO given subcutaneously.

A case of mitral valve aneurysm associated with infective endocarditis is reported. The patient is a sixty-four year old male suffering from shortness of breath under slight exertion. He has been febrile since receiving dental treatment five months ago. The patient came to the hospital due to a continuous fever above 39 degrees C. Hematological studies suggested inflammation, and an echocardiogram revealed moderate dilatation of the left atrium, mild MR, and moderate AR. At the time of the operation, a protuberant lesion, shaped like a dome and having a size of 10 x 12 mm in diameter was found at the anterior mitral leaflet toward the left atrium. The resected specimen of the saccular lesion had a smooth surface, and the ceiling of the aneurysm was extremely thin. Microscopic study showed that the inner cavity of the lesion was covered by endothelial cells. In addition, there was granulomatous degeneration with neo-vascularization. The inferior surface of the resected valve tissue and chorda was characterized by active inflammation associated with the assembly of neutrophils and colony formation of gram-positive cocci. It was concluded that the mitral valve aneurysm was caused by weakened tissue of the anterior mitral leaflet due to sibilant inflammatory change, which resulted in protuberance of the leaflet toward the left atrium caused by left ventricular pressure.

To clarify the diagnostic value of the radioallergosorbent test (RAST), the relationship between RAST and the oral food challenge test was evaluated. 263 children with atopic dermatitis were challenged by egg, cow's milk or soy bean after their skin manifestations had been improved by elimination diet and environmental control. Of 200 cases with negative RAST results for egg white, 108 cases (54.0%) showed no reaction in egg challenge tests. However, 65 cases (31.5%) had non-immediate reactions, while 29 cases (14.5%) had immediate reactions (within 2 hours of challenge). Of 16 cases with RAST score of 1 for egg white, 11 cases (68.8%) had non-immediate reactions and 2 cases (12.5%) had immediate reactions in egg challenge tests. Of 19 cases with RAST scores of 2 for egg white, 2 cases (10.5%) had no reaction, 6 cases (31.6%) had non-immediate reactions and 11 cases (57.9%) had immediate reactions in egg challenge tests. Of 21 cases with RAST scores of 3 for egg white, 1 case (4.8%) had no reaction, 3 cases (14.3%) had non-immediate reactions and 17 cases (81.0%) had immediate reactions in egg challenge tests. All 7 cases with RAST scores of 4 for egg white had immediate reactions in egg challenge tests. Almost the same relationship between RAST and challenge tests were found in test using cow's milk or soy bean. In conclusion, false negative results were seen in 46.0% of RAST for egg white, 51.7% of RAST for cow's milk and 26.9% of RAST for soy bean.(ABSTRACT TRUNCATED AT 250 WORDS)

We prospectively evaluated lens changes after vitrectomy on 55 patients with vitreoretinal interface syndrome such as idiopathic epiretinal membrane, vitreomacular traction syndrome, and impending stages of idiopathic senile macular hole. Postoperative changes in crystalline lenses were assessed by fluorophotometric measurement of lens autofluorescence, measurement of refractive errors and biomicroscopic evaluation of progression of nuclear sclerosis. Examinations were repeated prior to surgery and at 1, 3, 6, and 12 months postoperatively. While autofluorescene and light transmittance of the lens were not affected by vitrectomy in patients less than 50 years old, older patients showed a significant increase of autofluorescence and decreased transmittance as early as 3 months after surgery. The refraction became myopic with time especially in the older patient group. Nuclear cataract was also found on biomicroscopic examination in the older patients as early as 1 month after surgery and progressed with time. The older the patients were, the more prominent those lens changes were.

99mTc-tetrofosmin is a lipophilic, cationic diphosphine which has been developed for myocardial imaging. We examined 9 patients with ischemic heart disease including 3 angina pectoris (AP), 4 old myocardial infarction (OMI), 1 AP with OMI and 1 syndrome X. One patient was examined before and after operation. 370 MBq of 99mTc-tetrofosmin was injected during exercise and 740 MBq at rest. And 74 MBq of 201Tl myocardial exercise and redistribution scintigraphy was also performed to compare with 99mTc-tetrofosmin myocardial scintigraphy. SPECT, multiple gated SPECT and anterior planar images were obtained in all cases. We calculated percent wall thickening (%WT) using multiple gated SPECT images. There was a decreased lung uptake in 99mTc-tetrofosmin planar images compared to 201Tl myocardial scintigraphy. Liver and Biliary system uptake in 99mTc-tetrofosmin images was decreased with intake of milk. Segmental comparison of SPECT images showed an agreement in 9/10 of the segment between 201Tl and 99mTc-tetrofosmin. We could obtain excellent quality of multiple gated SPECT images in all patients. We could calculate percent wall thickening (%WT) in all patients. We conclude that 99mTc-tetrofosmin myocardial scintigraphy should provide usefulness for detection of ischemic myocardium as same as 201Tl myocardial scintigraphy, although the biologic characteristics of two agents were different. These data and excellent quality of multiple gated SPECT images suggest that 99mTc-tetrofosmin is a new 99mTc agent for evaluation of patients with ischemic heart disease.

Helical scanning CT (HES-CT) was applied to multiplanar reconstruction (MPR) and 3-D imaging for the diagnosis of 65 patients with orbital lesions. We employed the the Toshiba TCT-900S, a fourth-generation high-speed CT scanner equipped with a slip-ring system. In HES-CT, scanning was performed with continuous rotation of the X-ray tube for 30 s, while the couch top was simultaneously moved at a constant speed of 1 to 2 mm/s. Images were reconstructed from continuous raw data to obtain a slice pitch of 1 mm in the longitudinal direction. HES-CT was found to have some advantages over conventional thin slice CT: 1) a wide area could be scanned in a short time (30 s) without motion artifact, 2) small lesions could be easily detected because slice images could be generated with a fine pitch at arbitrary positions from continuous raw data, 3) MPR images had good continuity in the longitudinal direction, and 4) high contrast of structures was obtained in the orbital region. HES-CT was considered to be useful for the detection of orbital lesions.

From the study on correlation between the depth of cancer invasion and the results of surgery, early cancer of the biliary tract may be defined as cancer cell invasion limited to the mucosal or muscularis propria in the case of carcinoma of the gallbladder, and to the mucosal or fibro-muscular layer in the case of carcinoma of the bile duct. With few exceptions, these tumors had no lymph node metastasis, venous invasion, perineural infiltration or involvement of the lymphatic vessels. Since the cumulative 5-year survival rate was 100% after resection of early cancer, the choice of surgical procedures was considered to be extended cholecystectomy for early cancer of the gallbladder, and the standard radical resective operation for early cancer of the bile duct. An accurate diagnosis was not made preoperatively in most cases of early cancer of the biliary tract. The diagnostic approach is discussed, including the recently developed imaging modalities, such as endoscopic ultrasonography and percutaneous transhepatic cholecystoscopy or cholangioscopy.

The authors evaluated the effects of biodegradable poly (lactic acid) microspheres that provided the controlled release of the antimetabolic agent adriamycin (ADR) to prevent post surgical fibrosis after glaucoma filtering surgery. Fifty six eyes of 28 rabbits underwent posterior lip sclerotomy and received a 0.2 ml subconjunctival injection that contained microspheres 90 degrees from the filtering site immediately after surgery. Microspheres containing ADR (100 or 200 micrograms) were randomly administered to one eye. The fellow eyes served as controls and received microspheres without the drug. Intraocular pressure in the eyes treated with the microspheres that contained the drug was significantly lower than that in the control eyes from days 7-12 in the 100 micrograms group and from days 6-16 in the 200 micrograms group (P.05). Eyes that received ADR had a significantly longer patent filtering bleb compared with the control eyes (P.05). No corneal complications were observed in the eyes treated with 100 micrograms of ADR and the control eyes. Peripheral corneal opacities (25%) and epithelial erosion (17%) were observed in the eyes that received the 200 micrograms dose, but the cornea returned to normal after 4 wk. These results suggest that controlled-drug-release microspheres with an antimetabolic agent may be promising for preventing fibrosis after surgery.

The use of biodegradable polymer microspheres containing adriamycin for the treatment of proliferative vitreoretinopathy (PVR) in an experimental rabbit model was investigated. A single injection of microspheres containing 10 micrograms of adriamycin effectively decreased traction retinal detachment to 10% (n = 10), whereas 50% of eyes injected with blank microspheres (n = 10) developed retinal detachment (P0.05). A single injection of microspheres, containing 3 micrograms of adriamycin, did not suppress retinal detachment. Electroretinographic and histologic studies confirmed that the 10 micrograms injection of adriamycin in microspheres was not toxic to the retina, although the injection of the same amount of free adriamycin caused retinal necrosis and detachment. Thus, microspheres containing adriamycin hold promise as a new treatment modality for PVR.

In the 235 patients with hepatectomy, 111 with pancreaticoduodenectomy (PD) and 547 with gastrectomy for the past 15 years and 5 months, we compared the incidence of postoperative complications between patients with diabetes mellitus (DM) and those without DM, and studied glucose metabolism and management of diabetic patients. DM was most frequently found at 27.7% in hepatectomy, especially 38.7% in cirrhotic patients, followed by 24.3% in PD and only 5.9% in gastrectomy. The incidence of postoperative complications was not different between DM and non-DM after gastrectomy and PD. It was significantly higher in DM than in non-DM after hepatectomy (38.5% vs. 11.8%), although there was no statistically significant difference in the cirrhotic patients with hepatectomy (34.9% vs. 23.5%). The studies on insulin metabolism preoperatively determined by oral glucose tolerance test and postoperative control of DM revealed that diabetic patients with hepatectomy, especially hepatogenous DM, had a significantly reduced insulin uptake in the liver and exogenous insulin resistance to glucose. After PD for diabetic patients, a long-term care of impaired pancreatic exocrine and endocrine functions was considered to be required, especially paying attention to lipid and zinc metabolism.

In a phase II clinical trial to test the ability of recombinant human erythropoietin (r-HuEPO) to reverse the anemia of patients undergoing hemodialysis, the changes of enzyme activity in red blood cells were evaluated in 5 hemodialysis anemic patients who were treated with r-HuEPO. Concerning the activity levels measured, the following conclusions are drawn. 1) HK, ALD, TPI, G6PD and 6PGD were statistically significantly increased at the time when the hematocrit has risen by 8% with the use of r-HuEPO. 2) The enzyme activity levels of PFK, GA3PD, MPGM, ENOL, PK, GR and ADA were higher than normal already before the r-HuEPO treatment. 3) The increases of HK and G6PD by r-HuEPO, as age dependent enzymes, may reflect the generation of young red blood cells. 4) In view of the fact that they are related to ATP production in the glycolysis cycle, we infer that increases of red blood cell enzymes by r-HuEPO may play at least some part in bringing a sensation of "well-being" to severely anemic patients undergoing hemodialysis.

Thirty-one autopsy cases of beta 2-microglobulin (beta 2M) amyloidosis were pathologically investigated in comparison with 17 autopsy cases of AA or AL amyloidosis. In 20 cases (65%, 20/31) of beta 2M amyloidosis, inflammatory cells, mainly macrophages were seen infiltrating around beta 2M amyloid in intervertebral disks. The more beta 2M amyloidosis advances, the more macrophage infiltration tends to be prominent. In cases of severe beta 2M amyloidosis, the cytoplasm of macrophages around amyloid deposition were swollen with engulfed amyloid substance and were often transforming to foreign body multinucleated giant cells. In addition, granulation tissue was formed with infiltrating macrophages, foreign body multinucleated giant cells, capillary proliferation and fibrosis around beta 2M amyloid deposition. On the other hand, inflammatory cell infiltration around amyloid deposition was scarcely seen in AA or AL amyloidosis. Ultrastructurally, macrophages were abundant in phagocytic vacuoles containing amyloid fibrils. These macrophages were immunohistochemically positive for CD68, IL-1 beta and TNF-alpha. Thus, macrophage infiltration around beta 2M amyloid is thought to be responsible for local pain and tissue destruction of dialysis patients.

We describe a patient who developed a systemic lupus erythematosus-like syndrome characterized by bilateral malar erythema, antinuclear antibody, and anti-double-stranded DNA antibody. He was started on hemodialysis (3 times/week) because of renal failure. He completely lacked total hemolytic complement (CH50) activity, which was subsequently determined to be due to the absence of the first component of complement (C1). The specificity was further defined, by Ouchterlony analysis using anti-C1s antiserum, and was found to be the C1 subcomponent C1s. There was no absence of C1r. We conclude that this is a case of selective deficiency of C1s.

Four cases of intraductal mucin-producing tumors of the pancreas are presented, with a literature review. These tumors have been reported with increasing frequency, especially in Japan, since it was advocated that they represented a new clinical entity in 1982. Despite the recent controversy, intraductal mucin-producing pancreatic tumor has been recognized as a distinct entity, i.e., mucinous ductal ectasia. In the present paper, clinical features of these tumors and their relation to our own classification of mucin-producing pancreatic tumors are discussed.