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Recently, pulsed Doppler echocardiography has been used for the quantitative evaluation of tricuspid regurgitation (TR). However, there are some problems about the clinical significance of TR diagnosed by Doppler examination probably because of the excellent sensitivity in detecting TR. In the present study, we used liver function tests as an indicator of the visceral damage caused by TR and compared them to the severity of TR estimated by Doppler examination. Forty Doppler examinations were performed in 33 cardiac patients including seven, in which the examinations were repeated because the severity of TR changed during the clinical course. The severity of TR was classified into four grades according to the maximal extent of the regurgitant signal. Abnormal liver function was defined by the abnormalities of at least one of the following six tests: cholinesterase (CHE), gamma-GTP, leucine aminopeptidase (LAP), total bilirubin, alkaline phosphatase and GPT. Abnormal liver function tests were present in one of eight patients without TR, two of 10 with 1 + TR, four of seven with 2 + TR, seven of eight with 3 + TR, and six of seven with 4 + TR. The incidence of abnormal liver function tests increased parallel to the grade of TR and was very frequent in patients with 3 + or 4 + TR. TR diagnosed as greater than 3 + by Doppler examination is considered to have an important clinical significance and an indication of the intensive therapy.

In order to test whether or not overeating of a nutritionally adequate diet with reasonable fat content could result in significant fat accumulation in the liver, male Sprague-Dawley rats were provided with free access to either a nutritionally adequate liquid diet with 35 per cent of calories as fat or a regular diet (controls) for 3 months. After the feeding period, body weight, Lee index, and epididymal adipose tissue weight, were significantly greater in rats fed with the liquid diet than in the controls. Liver weight, hepatic triglyceride levels were also greater in the liquid diet group. Histologically, remarkable fatty infiltration was observed predominantly in periportal areas in rats fed with the liquid diet ad libitum for 3 months. Compared to a large body of the literature concerning diet-induced obesity in experimental animals, information on animal models of fatty liver by dietary manipulations is insufficient. The results of this study clearly indicate that the overeating of a nutritionally adequate diet with reasonable fat content could result in remarkable fat accumulation in the liver in rats.

A 62-year-old man had an acute myocardial infarction with successful thrombolysis. Coronary spasm was documented in the following angiographic study. This case demonstrated that coronary spasm is implicated in the pathogenesis of coronary thrombosis and subsequent myocardial infarction.

Of 66 patients with hepatocellular carcinoma, 32 were treated by intraarterial injection of mitomycin C microcapsules (group A) and 34 patients by intraarterial injection of mitomycin C microcapsules followed by transcatheter hepatic artery embolization (group B). Measurable tumor regression greater than 50% in area on liver image occurred in 28% of group A and 57% of group B (p less than 0.05). A decrease of serum alpha-fetoprotein to less than half the initial level was demonstrated in 59% of group A and 91% of group B (p less than 0.05). The survival rate was better in group B compared with group A (p less than 0.05). These results indicate that arterial chemoembolization with mitomycin C microcapsules plus transcatheter hepatic artery embolization will be an improvement over arterial chemoembolization with mitomycin C microcapsules alone in the treatment of hepatocellular carcinoma.

The effects of recombinant human interferon (IFN) alpha-2b and gamma on the bone marrow megakaryocyte progenitors (CFU-Meg) were compared between eight patients in the chronic phase of Ph1-positive chronic myelocytic leukemia (CML) and five hematologically normal patients. CFU-Meg was assayed in plasma clot culture added with phytohemagglutinin-stimulated leukocyte-conditioned medium as a source of colony stimulating activity. The average count of CFU-Meg colonies formed from the bone marrow of CML patients was 5.5 times that of normal controls. Spontaneous CFU-Meg colonies were grown in seven of eight CML patients, but in none of five controls. Colony formation by CFU-Meg in CML as well as normal bone marrow was suppressed by the two preparations of IFN in a dose dependent fashion. Their suppressive influence on colonies from CFU-Meg was comparable between CML and normal bone marrow at lower concentrations, but was less marked for CML than normal bone marrow at higher concentrations. The formation of CFU-Meg colonies from CML bone marrow was more severely suppressed by IFN-gamma than IFN-alpha-2b. Depletion of either T lymphocytes or adherent cells from the CML bone marrow cells diminished the suppressive effects of IFN-gamma, but had no influence on the effects of IFN-alpha-2b.

The neutral beam injector for JAERI Fusion Torus-2(JFT-2) was developed and is now in successful operation. This is one of the largest injection systems in Japan and was designed, fabricated and tested in about one year.

A case of atrial septal defect associated with an abnormal chamber behind the right ventricle, which was heretofore undescribed, was reported. A 41-year-old woman was admitted to our hospital for the evaluation of a heart murmur. A Levine 3/6 ejection systolic murmur and a fixed splitting of the second heart sound were audible. Two-dimensional echocardiography disclosed an atrial septal defect and an abnormal chamber behind the right ventricle. This accessory chamber communicating with the right atrium was separated from the right ventricle by a membranous structure. The motion of this membrane showed a wide excursion just like that of the atrio-ventricular valve. On the M-mode echocardiogram, the anterior tricuspid leaflet and this membrane were recorded simultaneously without intervening septal echoes and this finding was very similar to that obtained in the single ventricle. Cardiac catheterization revealed that the pressure pattern in the abnormal chamber was that of the right atrium but its intracardiac electrocardiogram showed a right ventricular pattern. The complex morphological aspect of this case was confirmed by angiography and surgery. The developmental process of this very unusual anomaly is not clear, but it may be a kind of congenital anomaly related to Ebstein's anomaly.

Undifferentiated type 2C fibers and satellite cells were increased in number in younger patients with congenital myotonic dystrophy (CMD) indicating immaturity in muscle fiber growth. The changes found in a 38-year-old man with CMD were identical to those described in late onset myotonic dystrophy. Type 1 fibers were found to become predominant with age. This suggests that in this disorder fiber type transformation progresses with age, presumably due to abnormal neural influences or aberrant sarcolemmal responses.

Flow pattern within the main pulmonary artery was analysed by pulsed Doppler echocardiography in a case of coronary artery-pulmonary artery fistula. An asymptomatic 32-year-old female was referred to our hospital for evaluation of a continuous murmur in the second interspace at the left sternal border. Other physical findings, chest roentgenograms and electrocardiograms were normal. Two-dimensional echocardiography did not play an important role in the diagnosis. However, pulsed Doppler echocardiography revealed an antegrade turbulent flow along the antero-lateral wall of the main pulmonary artery from early diastole to early systole. The direction and distribution of this abnormal flow was judged to be different from that of patent ductus arteriosus. Coronary arteriography showed a fistula from the both coronary arteries to the proximal portion of the main pulmonary artery. However, its shunt was so small that it could not be detected by oxymetry or by hydrogen-platinum electrode method. This case suggests that Doppler method is very sensitive in shunt detection and possibly useful for non-invasive diagnosis of coronary artery-pulmonary artery fistula.

The value of glycosylated hemoglobin (HbA1) has been determined in diabetic patients with simple or proliferative retinopathy and in those without retinopathy. The mean value of HbA1 is significantly more highly elevated in patients with retinopathy than in those without retinopathy. Progressive augmentation of the value of HbA1 signifies a risk of deterioration of the retinopathy, whether it is a simple retinopathy or proliferative retinopathy.

The second harmonic generation in form of Cerenkov radiation has attracted considerable attention, especially since the experimental demonstrations was performed using proton-exchanged LiNbO3 waveguides with YAG and GaAs lasers1. They have proved its effectivity and applicability in wide range of wavelength.

Seventeen patients, aged 9 to 63 years (mean age 38.2 years), with 6 recurring malignant glioma, 5 malignant meningioma, 4 metastatic brain tumor, one endodermal sinus tumor and one embryonal carcinoma were postoperatively treated with adriamycin (ADM). As a rule, 20 mg of ADM (to 960 mg in a total dosis) were given by means of intra-carotid administration every two weeks (to 250 months in duration). According to Karnofsky's evaluation, 4 of 6 glioblastoma patients(66.7%), 4 of 5 malignant meningioma (80%), 2 of 4 metastatic brain tumor (50%) and one embryonal carcinoma had improvement of clinical condition, at least during two months after the beginning of the treatment, and/or remission of more than 50% of the enhanced area on CT scan. Consequently, allover response rate was 64.7%. Tumor tissue concentration of ADM administered intraoperatively by the same regimen, was estimated by fluorescence assay, twenty times in sixteen patients. The level of the concentration was higher in malignant tumor (3.6 to 6.2 micrograms/g) than in low grade astrocytoma (1.5 microgram/g in maximum) during sixty minutes after ADM administration. On the other hand, when ADM of same dosis was given intravenously, maximum serum level was 2.8 microgram/ml, which was less than half in comparison with tissue level of intracarotid administration. There was a serious myelosuppression in two cases in our series, but no cardiomuscular damage was observed in any cases. In conclusion, ADM concentration of brain tissue such as malignant meningioma, metastatic brain tumor and, even glioblastoma, was highly obtained. Further, intermittent intra-carotid administration of ADM was more effective than intravenous dripping in treating malignant intracranial tumor, although side effects should be carefully avoided.

A sulpyrin inhalation test was given to 13 patients with aspirin-induced asthma (AIA) and 8 patients with non-aspirin-induced asthma (non-AIA) to observe the changes in plasma histamine levels before and after challenges. The respiratory function (FEV1.0) was measured before and after sulpyrin inhalation. A decrease of more than 20% the initial value (basal value) was defined as a positive response. Plasma histamine was determined by high-performance liquid chromatography (HPLC). In 11 patients with AIA, a positive response was observed (SIT positive), with a fall of FEV1.0 to 63.70 +/- 4.87% of the basal value. In 2 patients with AIA and 8 patients with non-AIA, no positive response was observed (SIT negative). In patients with SIT positive, plasma histamine levels increased significantly from 0.61 +/- 0.06 ng/ml before challenges to 1.34 +/- 0.22 ng/ml after challenges (p less than 0.01). No significant changes of plasma histamine occurred in the SIT negative patients. These results suggest that mast cells play some role in the mechanism of the development of aspirin-induced asthma.

Unsymmetrical perylenebis(dicarboximide) derivatives—N-alkyl-N′-aryl-3,4:9,10-perylenebis (dicarboximide) (5a–e, 6a–e, 7a–e, 8a–e, and 9a–e)—were prepared by the condensation of N-alkyl-3,4:9,10-perylenetetracarboxylic monoanhydride monoimide(4a–e) with arylamines (aniline, p-toluidine, p-anisidine, and 3,5-xylidine etc.).

To evaluate the correlation of cardiothoracic ratios (CTR) on chest radiography with the sizes of the four cardiac chambers, we studied 41 normal persons and 77 cardiac patients using two-dimensional echocardiography (2DE). The transverse cardiac diameter and the CTR were ascertained from their chest radiographs. Using 2DE, each cardiac chamber was evaluated three-dimensionally, by measuring the short and long diameters of each left (LV) and right ventricle (RV), the diameter of the RV outflow, the anteroposterior, transverse, and long diameters of each left (LA) and right atrium (RA). These values were corrected using the square root of the body surface area. The correlation coefficient for the CTR was greatest in the long diameter of the LA (r = 0.84), and was greater in the atrial diameters (r greater than or equal to 0.71) than in the other diameters except for the transverse diameter of the RA (r less than or equal to 0.51). The contribution of each cardiac chamber to the transverse cardiac diameter was evaluated in 34 patients with cardiac enlargement by a method using the null hypothesis, which we originally designed. Consequently, the contribution of the LV to the CTR was definitely proven in two patients, that of RV in two, that of LA in 15 and that of RA in nine. These results indicated that the CTR is strongly influenced by enlargement of the LA.

This study reported that acute toxicity (expressed as the LD50 value) of rTNF-SAM1 and rTNF-SAM2 which we constructed was considerably lower than that of rTNF-alpha (1). Following this finding, the antitumor effects of systemic administration of these novel recombinant tumor necrosis factors (TNF-S) (named rTNF-SAM1 and rTNF-SAM2) were examined in vivo on murine tumors (Meth A fibrosarcoma, MH134 hepatoma, and B16 melanoma). Both rTNF-SAM1 and rTNF-SAM2 could be administered systemically to tumor-bearing mice at doses up to 3 X 10(4) to 10(5) U. Growth of all tumors was significantly inhibited by systemic administration of rTNF-SAM1 or rTNF-SAM2 at a dose of greater than 3 X 10(4) U; at this dosage conventional rTNF-alpha could not be administered systemically to any of the mice strains due to its toxicity. These results confirm our previous finding that the rTNF-SAM group can be administered with safety at higher doses than rTNF-alpha, and revealed that these novel rTNF-S could be more promising antitumor drugs than rTNF-alpha in view of their lower toxicity compared with antitumor effect.

Eight patients with ventricular extrasystoles are reported in whom coupling intervals of the extrasystoles to the proceding sinus beats were variable and in whom paired ventricular extrasystoles were occasionally seen. In all patients, paired ventricular extrasystoles were initiated only by comparatively late coupled ventricular extrasystoles. However, the interval between the first and the second of these paired extrasystoles was always much shorter than the coupling interval of this first extrasystole to the preceding sinus beat, so that the latter extrasystole often interrupted the T wave of the first one, indicating the R-on-T phenomenon. In two patients there was a gap between the ranges of coupling intervals for single extrasystoles and for the first ones of paired extrasystoles. These observations suggest the presence of longitudinal dissociation in the reentrant pathway as one of the causes of paired ventricular extrasystoles.

The diagnostic value of plasma abnormal prothrombin (PIVKA-II) measurements in detecting relatively small hepatocellular carcinomas (HCC), less than 5 cm in diameter, was compared with that of serum alpha-fetoprotein (AFP) determinations. Among 18 patients with relatively small hepatocellular carcinoma (HCC), abnormal PIVKA-II values were found in only three (16.6%). Highly elevated serum AFP levels (greater than 200 ng/ml) relatively specific for HCC were seen also in three patients. However, nonspecific elevation of PIVKA-II in patients with liver cirrhosis not accompanied by HCC was much less than that of AFP. Although complementary, both tests appear to be of limited value in early detection of HCC, indicating that searches for other markers are necessary, to allow early detection of small HCC.

The mechanism for the development of functional tricuspid regurgitation (TR) was studied by an ultrasonic method. Thirty-five examinations were performed in 31 patients who were expected to have functional TR, and the severity was classified into 4 grades according to the extension of the regurgitant signals by pulsed Doppler echocardiography. The satisfactory horizontal section of the tricuspid valve was obtained by two-dimensional echocardiography (2DE) to measure the tricuspid annular diameter and to observe systolic configuration of the tricuspid valve in 22 examinations. The tricuspid annular diameter was well correlated with the severity of TR, and "lack of coaptation" of the valve was recognized on 2DE in some cases of severe TR with the markedly dilated annulus, indicating that this dilatation was an important trigger of functional TR. Additionally, in the majority of patients with severe TR, "anterior displacement" of the tips of tricuspid leaflet(s) (6 mm or more from the tricuspid annulus towards the right ventricle) was observed, which was thought to be due to the chordal traction secondary to the right ventricular dilatation, and contributed to the development of functional TR by disturbing sufficient coaptation. In one particular case, severe TR was associated with " malaligned coaptation" caused by the anterior displacement confined to the septal leaflet, indicating that asymmetrical dilatation of the right ventricle and/or disorientation of chordae-valve system may contribute to TR.(ABSTRACT TRUNCATED AT 250 WORDS)