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We present a case of severe rhabdomyolysis developing after peripheral blood stem cell transplantation (PBSCT) in a 17-year-old woman with Ki-1 lymphoma. Severe muscle weakness, myoglobinemia and acute renal failure developed on day 23 following PBSCT associated with painful peripheral neuropathy. Cytomegalovirus infection may have been a contributory factor.

A 58-year-old male complaining of pollakisuria, miction pain and back pain visited us Dec. 26, 1979. Rectal examination revealed the prostate enlarged by 5 digital width, stony hard and irregular. Transrectal needle biopsy revealed moderately differentiated adenocarcinoma of the prostate. Bladder neck invasion, pelvic and mediastinal lymph node metastases and multiple bone metastases were found. The case was diagnosed with prostatic adenocarcinoma T3N2M1 (OSS, LYM) stage D2. Three courses of chemotherapy using ifosfamide applied from Feb. 2, 1980 showed no marked effect except for partial pain relief. Hormonal treatment with diethylstilbestrol diphosphate was started from May 28 and arterial infusion chemotherapy using CDDP and 5-FU was performed 2 months later, resulting in size reduction of the prostate and pelvic lymph node metastases and disappearance of mediastinal lymph node metastases. Needle biopsy of the prostate was negative for cancer cells. After 8 months, Tegafur was started, and 12 months later radiotherapy was added to the prostate and pelvic lymph nodes. The abnormal accumulation in bone scan began to decrease after 14 months and achieved complete remission 28 months after the initial therapy. We discontinued the hormonal therapy 31 months later because of his complaint of chest discomfort and palpitation. At the present time, 14 years after the initial therapy, the prostate was 35 x 29 x 19 mm in size on transrectal ultrasonography with undetectable serum PSA level and no tumor cells but only mass fibrosis has been seen by pathological examinations. We considered this patient to be with no evidence of disease.

Seventeen patients with refractory or relapsed, intermediate or high grade non-Hodgkin's lymphoma (NHL) were treated with the combination of dexamethasone (40 mg/body x 3d, iv) (DeVIC) between January and December 1992. The treatments were repeated every three weeks for a minimum of two courses unless the patient had PD. G-CSF (2 micrograms/kg, sc) was given during leukopenia in most cases. Of 16 evaluable patients 6 (38%) achieved a complete remission (CR) and 4 showed a partial remission. With median follow up of 15 (7-26) months (mos.) all CR patients were alive in CR, except for 1 patient who died of secondary AML. The actuarial 50% survival duration after DeVIC was 15+ mos. One patient died of sepsis but myelosuppression was generally moderate and no other serious toxicity was observed. Although this is a preliminary study, DeVIC regimen seems to be an effective salvage therapy for patients with refractory or relapsed NHL with acceptable toxicity.

A case of primary malignant lymphoma of the bladder is reported. A 70-year-old woman was admitted to our clinic with the chief complaint of intermittent gross hematuria on March 31, 1992. Examination of cystoscopy, IVP, ultrasonography and CT scan suggested a non-papillary invasive bladder tumor. Pathological examination of transurethral biopsy revealed malignant lymphoma, B cell type. After 5 courses of intraarterial COMPA (CDDP, VCR, MTX, PEP, ADR) chemotherapy, she have been in complete remission. Intraarterial COMPA chemotherapy might be effective and useful for primary malignant lymphoma of the urinary bladder.

In order to evaluate the effect of specific immune response on prognosis in acute leukemia, we investigated the correlation between the lysis of autologous tumor cells (ATC) by lymphocytes and prognosis. Peripheral mononuclear cells (PMC) from most patients with acute leukemia in complete remission (CR) do not exhibit cytotoxic activity against fresh-frozen ATC, although they have adequate cytotoxic activity against K562 cells. When the large granular lymphocyte (LGL) fraction was used in this study, we observed lysis of ATC in 17 (43.6%) of 39 patients with acute leukemia (12 (42.9%) of the 28 patients with acute myelogenous leukemia (AML) and 5 (45.5%) of the 11 patients with acute lymphocytic leukemia (ALL)). With regard to prognosis, the lytic activity of the LGL fraction did not reflect the duration of CR. The median CR duration in AML patients was 13 months for the lysis-positive group and 11 months for the lysis-negative group. No significant correlation was also found between lytic activity of the LGL fraction and overall survival in each patient. However, the lysis-positive group tended to have a longer survival, the median overall survival being 48 months for the lysis-positive group vs 12 months for the lysis-negative group. The prolonging of overall survival in the lysis-positive group was attributed to a high rate of induction of second remissions in this group. Long-term patient survival in the two groups did not differ.

A 43-year-old male developed acute myelogenous leukemia (AML, M5b) with an acquired Robertsonian 13;15 translocation. He did not achieve complete remission after sequential intensive induction chemotherapy and he died 13 months later. We reviewed 7 patients with this translocation reported in the literature. Acquired Robertsonian translocations are rare, but could represent an important event in the tumorigenesis of hematologic malignancies.

Alternating non-cross-resistant chemotherapy has been induced for the treatment of non-Hodgkin's lymphoma (NHL) with the aim of cure, even in advanced cases. We formulated a new high dose regimen, CAMBO-VIP, which was a weekly treatment. They were administered during alternate weeks for a total period of 12 weeks. We obtained high response rate and prolonged disease-free survival with this regimen. We noticed the elevation of serum LDH level in some patients at or shortly after the completion of CAMBO-VIP treatment. LDH elevation was not associated with liver function abnormality in terms of elevation of GOT or total bilirubin. All of these patients were in complete or partial response with no evidence of tumor progression. An LDH isozyme study which was done at the time of LDH elevation showed elevation of both LDH1 and LDH2. Interestingly serum haptoglobin was undetectable in all 6 patients measured at the time of LDH elevation. Reticulocytosis and leukoerythroblastosis in peripheral blood were also observed in all of these patients. These abnormalities including LDH elevation returned to normal within a rather short period, usually within 1 to 3 weeks. From these observations, it is most likely that these abnormalities were due to excessive blood cell destruction, which was observed in association with rapid recovery from myelosuppression.

Twenty-two patients with advanced diffuse large cell lymphoma (LSG classification) were treated with the combination chemotherapy of cyclophosphamide, doxorubicin, methotrexate with leucovorin rescue, bleomycin, vincristine, etoposide, ifosfamide and prednisolone (CAMBO-VIP) from Oct. 1987 to Sept. 1989. Eighteen (90%) of 20 evaluable patients achieved complete remission and 2 patients had partial remission. With a median follow-up of 52 mos, 3 patients relapsed (17%), and 2 patients died. The actuarial overall survival and relapse-free survival at 4 years were estimated to be 90% and 83%, respectively. Myelosuppression was severe, but transient. No serious infection was seen, and no platelet transfusion was required. Oral mucositis and liver damage (Grade 3 in WHO grading) was seen in one patient each, but no treatment-related fatalities were observed. CAMBO-VIP is a well tolerated, effective treatment regimen for advanced diffuse large cell lymphoma.

Thirty-nine patients with non-Hodgkin's lymphoma were treated with weekly alternating non-cross-resistant chemotherapy (CAMBO-VIP). We obtained a high response rate, and prolonged disease-free survival with side effects and complications of various severity were observed. Three patients were withdrawn from the study due to aggravation of liver cirrhosis, cerebral infarction, and poor tolerance. Thirty-six patients completed this 12-week intensive chemotherapy. The median treatment delay in all patients was 3 days (-4 to 29 days), and a delay of over 15 days was seen in 5 patients. The nadir of the neutrophil count was 0 to 2,100/microliters (median 140/microliters), and 15 patients were below 100/microliters. Two patients had pneumonia and 4 had herpes zoster infection. The platelet count nadir was 20,000 to 240,000/microliters (median 90,000/microliters). Ten patients were below 50,000/microliters, but none required platelet transfusion. Red cell transfusion was given in 6 patients. Elevation of transaminases was seen in 25 patients, but it was not serious except for a patient with liver cirrhosis. The elevation of serum LDH level and decrease of serum haptoglobin level seen shortly after completion of treatment seemed due to the increased blood cell destruction. Stomatitis was observed in 32 patients, 17 of whom showed more than grade 3 toxicity. Blister formation on palms and/or soles was noted in 6 patients. There was no treatment-related death observed.

We analyzed immunoglobulin (Ig) gene rearrangements in 69 patients with B-cell malignancies by Southern hybridization. We used 5 probes which covered JH 5'S mu and S gamma 3 loci of the Ig heavy (IgH) chain gene, and C kappa and kappa de loci of the Ig light (IgL) chain kappa gene, respectively. DNA rearrangements were observed in 68 out of the 69 patients using the JH probe. In 97% (33/34) of patients with non-Hodgkin's lymphoma (NHL), 100% (5/5) of chronic lymphocytic leukemia (CLL), 42% (10/24) of non-T cell acute lymphoblastic leukemia (non-T ALL), and in 0% (0/4) of chronic myelogenous leukemia lymphoid crisis (CML-LBC), the rearrangements were detected by C kappa and/or kappa de probes. Furthermore, the genotype of the light chain was defined by rearrangement patterns of these 2 probes. The by using the 5'S mu-probe, class switch recombinations were detected in 76% (25/33) of NHL, 20% (1/5) of CLL, 17% (4/24) of non-T ALL, and in 0% (0/4) of CML-LBC. Among them, 1 case of IgM NHL and 3 cases of double bearer NHL had rearranged on both IgH alleles by the constant region. The results of this study indicate that genotypes correspond well to phenotypes of B-cell malignancies and that the determination of genotype will be useful for making an exact diagnosis of B-cell malignancies.

Three patients with breast cancer with poor prognosis were treated with high-dose chemotherapy (HD-CT) and peripheral blood stem cell transplantation (PBSCT) as adjuvant treatment. After radical mastectomy, the consolidation chemotherapy with Adriamycin 50 mg/m2, Cyclophosphamide 1,000 mg/m2, Vincristine 1.0 mg/m2 and Methotrexate 200 mg/m2 with Leucovorin rescue was started. Recombinant human granulocyte colony stimulating factor (rhG-CSF) was also added for early recovery from myelosuppression. This combination chemotherapy was given every 3 weeks for 3 courses, and after the 2nd and 3rd courses, peripheral blood stem cells (PBSC) were collected and cryopreserved. HD-CT with Cyclophosphamide 2,000 mg/m2/day, Thio-TEPA 200 mg/m2/day, and Etoposide 300 mg/m2/day, were administered for 3 consecutive days, and after 48 hours of last doses, frozen-thawed PBSC (6.4-8.9 x 10(4)/kg of CFU-GM) were administered. rhG-CSF was also added. HD-CT and PBSCT were well tolerated, recovery from myelosuppression of the HD-CT was very quick and no serious side effects were observed.

We found that chondroitin 6-sulfotransferase and chondroitin 4-sulfotransferase were released into the culture medium from the cultured chick embryo chondrocytes. Since the release of the sulfotransferases was observed not only in serum-supplemented medium but also in serum-free medium, the released sulfotransferases were unlikely to be derived from serum. Addition of ascorbate to the serum-free medium supported the continuous release of the sulfotransferases. Monensin, which is known to cause dilatation of the Golgi apparatus and to inhibit sulfation of proteoglycan, was found to affect the release of the sulfotransferases. In the presence of 10(-6) M monensin, chondroitin 6-sulfotransferase activity in the cell layer was decreased to less than one tenth of the control, and the rate of the release of the activity became much smaller than the control after the initial rapid release. The activity of chondroitin 4-sulfotransferase was also affected by monensin, but the reduction of the chondroitin 4-sulfotransferase activity in the cell layer was not so great as the reduction of chondroitin 6-sulfotransferase activity. Unlike to the microsomal sulfotransferases, both chondroitin 6-sulfotransferase and chondroitin 4-sulfotransferase released into the culture medium were retained in the soluble fraction after centrifugation at 100,000 x g for 60 min, and were not activated by detergent. pH optimum and requirements for sulfhydryl compounds of the released sulfotransferases were similar to those observed previously in the chondroitin sulfotransferases from chick embryo cartilage and from cultured chick embryo chondrocytes. These results suggest that chondroitin sulfotransferases, which are localized in the Golgi apparatus, may be secreted to the extracellular space in a soluble form under the culture conditions.

Simulation of the needle puncture and volume estimation for the tumors in the liver were carried out with the three-dimensional image reconstruction system, which consists of a medical image acquisition system, a data processing system, and a graphic display. A set of sliced-image data from a computerized tomography and/or a magnetic resonance imaging was used to reconstruct the liver, the vessels, and the tumors of the patients with liver cancer. A good agreement of anatomic locations of both the intrahepatic vessels and the tumors between the reconstructed liver model and the echography done intraoperatively was observed. Surgical simulations with these graphic models clearly indicated safety areas for needle puncture in the laser coagulation therapy. In addition liver volumes were calculated within 3% of error in comparison to the measured values. These results indicate that the computer-aided surgery system is a highly promising method that avoids cumbersome stereoscopic recognition of the anatomical location of the diseased area and the vessels, before and after surgery.

The degree of unsaturation of fatty acids was higher in Chlorella vulgaris 11h cells grown with air (low-CO(2) cells) than in the cells grown with air enriched with 2% CO(2) (high-CO(2) cells). The change in the ratio of linoleic acid to alpha-linolenic acid was particularly significant. This change of the ratio was observed in four major lipids (monogalactosyldiacylglycerol, digalactosyldiacylglycerol, phosphatidylcholine, and phosphatidylethanolamine). The relative contents of lipid classes were essentially the same both in high-CO(2) and low-CO(2) cells. After high-CO(2) cells were transferred to low CO(2) condition, total amount of fatty acids remained constant but the relative content of alpha-linolenic acid increased during a 6-hour lag phase in growth with concomitant decreases in linoleic and oleic acids. When low-CO(2) cells were transferred to high CO(2) condition, total amount of fatty acids and relative content of oleic acid increased significantly. The amount of alpha-linolenic acid remained almost constant, while the amounts of palmitic, oleic, and linoleic acids increased. Similar, but smaller, changes in fatty acid compositions were observed in two species of green algae Chlamydomonas reinhardtii and Dunaliella tertiolecta. However, no difference was found in Euglena gracilis, Porphyridium cruentum, Anabaena variabilis, and Anacystis nidulans.

The sterilizing conditions of HBs Ag-contaminated materials were studied by means of the inactivation of the antigenicity (infectivity being thought to be lost when HBs Ag is inactivated). HBs Ag-coated beads and the serum from an HBs Ag-positive patient were used. After each sterilizing procedure, the antigenicity was studied by radioimmunoassay. HBs Ag-positive serum is easily inactivated by boiling and by steam under pressure; however, HBs Ag-coated beads require increased steam under pressure. For sterilizing HBs Ag-contaminated materials, 30 minutes at 132 degrees C is recommended.

The leaf anatomy and certain photosynthetic properties of nitrate- and ammonia-grown plants of Moricandia arvensis (L.) DC., a species previously reported to be a C(3)-C(4) intermediate, were investigated. Nitrate-grown plants had a high level of malate in the leaves while ammonia-grown plants had low levels of malate. In young leaves of nitrate-grown plants, there was a diurnal fluctuation of malate content, increasing during the day and decreasing during the night. Titratable acidity remained low in leaves of both nitrate- and ammonia-grown plants.In nitrate-grown plants, the activity of phosphoenolpyruvate (PEP) carboxylase was about 2-fold higher than in ammonia-grown plants, the latter having activity typical of C(3) species. Also, in nitrate-grown plants, the ratio of activities of ribulose 1,5-bisphosphate (RuBP) carboxylase/PEP carboxylase was lower than in ammonia-grown plants. Nitrate reductase activities were higher in nitrate- than in ammonia-grown plants and the greatest activity was found in younger leaves.With nitrate-grown plants, during a pulse-chase experiment the label in malate, as a percentage of the total labeled products, increased from about 7% after a 10-second pulse with (14)CO(2) up to 17% during a 5-minute chase with (12)CO(2). The pattern of (14)C labeling in various metabolites suggests the primary carboxylation is through RuBP carboxylase with a secondary carboxylation through PEP carboxylase. In similar experiments, with ammonia-grown plants, the percentage label in malate was only 0% to 4% with no increase in malate labeling during the chase period. The CO(2) compensation point was lower in nitrate-grown than ammonia-grown plants.There was no evidence of Kranz-like anatomy in either the nitrate or ammonia-grown plants. Mitochondria of bundle-sheath cells were strikingly positioned along the inner tangential wall. This might allow the chloroplasts of these cells to fix the mitochondrial photorespired CO(2) more effectively and contribute to the low CO(2) compensation point in the species. Chloroplasts of bundle-sheath cells and contiguous mesophyll cells were similar in size and structure in plants grown on different media, although chloroplast thylakoids and stromata of the ammonia-grown plants stained more intensely than those of nitrate-grown plants. In addition, irregular clusters of phytoferritin particles occurred in the chloroplasts of the ammonia-grown plants.The results indicate that the substantial activity of PEP carboxylase, incorporation of CO(2) into malate, the high malate content, and in part the relatively low CO(2) compensation point in Moricandia arvensis may be accounted for by metabolism of nitrate rather than by a state of C(3)-C(4) intermediacy.

Using direct chimpanzee inoculation as an assay method, we tested the abilities of the following chemical or physical treatments to inactivate hepatitis B virus in human plasma: 1% aqueous glutaraldehyde at 24 degrees C for 5 min, 0.1% aqueous glutaraldehyde at 24 degrees C for 5 min, 80% ethyl alcohol at 11 degrees C for 2 min, and heat at 98 degrees C for 2 min. All treatments were shown to be effective, indicating that the resistance level of the hepatitis B virus is not extreme.

The authors experienced thirty brain deaths including eighteen head injuries and seven cerebrovascular accidents during the period from Nov. 1980 to Dec. 1982 and encountered with some practical problems on clinical diagnosis of brain death. In sixteen patients subjected to barbiturate (pentobarbital) therapy, the attempt to meet the criteria of brain death made it necessary to confirm the total cerebrocirculatory arrest as well as to measure the serum concentration of pentobarbital and assure its level low enough. But as a result of the angiograms performed in twenty-four cases the cerebral angiography sometimes failed to give sufficient evidence to confirm it not merely because of the angiographical intracranial delayed opacification but also because of the dissociation of filling between supra- and infratentorial spaces or between right and left hemispheres. And besides the contrast enhancement of cerebral vessels was verified in computed tomograms of two cases among ten cases who had already met the criteria and demonstrated angiographical nonfilling phenomenon. The angiographical narrowing of C 1-2, A 1, M 1 portions or basilar artery observed on serial angiograms preceding the angiographical nonfilling phenomenon was regarded as direct vascular compression by cerebral swelling or vasospasm and considered to suggest that brain death might be impending. At present the continuous monitoring of intracranial pressure performed in twenty-six cases proved to be a convincing guide to suspicion of brain death or impending brain death according to decrease in cerebral perfusion pressure and appearance of so-called plateau waves recorded in four cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamic effects of nicorandil on exercise-induced impairment of left ventricular function were studied in nine patients with old myocardial infarction but without angina pectoris. Hemodynamic data were obtained by symptom-limited supine multistage bicycle ergometer exercise testing before and 1 h after single oral administration of 15 mg of nicorandil. Systolic and diastolic blood pressure at rest decreased significantly after nicorandil administration (p less than 0.01). A most remarkable change in the hemodynamic response to supine dynamic exercise after nicorandil was a decrease in pulmonary artery wedge pressure (both at rest and at peak exercise, p less than 0.001). An index cardiac function, obtained from the relation between pulmonary artery wedge pressure and left ventricular stroke work index, improved significantly after nicorandil. The ration of pressure-rate product to coronary sinus flow, which is an index of the ratio of myocardial oxygen consumption to myocardial oxygen supply, decreased significantly (p less than 0.05) after nicorandil administration. Reproducibility of the testings was also studied in six patients with old myocardial infarction. Invasive hemodynamic variables between two successive symptom-limited supine leg exercise testings, except pulmonary artery wedge pressure, were reproducible in patients with old myocardial infarction but without angina pectoris. Only pulmonary artery wedge pressure at rest in the second exercise testing showed a significantly lower value (p less than 0.05). It is concluded that nicorandil is a useful drug for improvement of exercise-induced impairment of left ventricular function with an increase in myocardial oxygen supply.

In a 26-year-old male with 17 alpha-hydroxylase deficiency, endocrinological examinations were performed not only after, but also before the onset of clinical signs and symptoms. In addition, the pathophysiological role of the renal kallikrein-kinin system was investigated in this patient. In spite of the fact that this disease is congenital, in the mechanism of its onset, this patient had a period of endocrinological normality before onset; that is, 9 months before onset, both ACTH and cortisol were within the normal range, although the former would be significantly higher and the latter significantly lower than normal values after the onset. In this case, both urinary kallikrein and kininase excretions abnormally increased and then returned to normal after dexamethasone treatment.

Malate dehydrogenase may interfere with the assay of NAD malic enzyme, as NADH is formed during the conversion of malate to oxaloacetate. During the present study, two additional effects of malate dehydrogenase were investigated; they are evident only if the malate dehydrogenase reaction is allowed to reach equilibrium prior to initiating the malic enzyme reaction. One of these (Outlaw, Manchester 1980 Plant Physiol 65: 1136-1138) might cause an underestimation of NAD reduction by malic enzyme due to the oxidation of NADH during reversal of the malate dehydrogenase reaction. A second effect may result in overestimation of malic enzyme activity, as Mn(2+)-catalyzed oxaloacetate decarboxylation causes continuing net NADH formation via malate dehydrogenase. These effects were studied by assaying the activity of a partially purified preparation of Amaranthus retroflexus NAD malic enzyme in the presence or absence of purified NAD malate dehydrogenase.A model was developed which allowed the generation of theoretical curves describing the influence of malate dehydrogenase on the assay of malic enzyme activity. The experimental data obtained agreed closely with these curves. The conditions included 5 millimolar malate, 2 millimolar NAD, and 4 millimolar Mn(2+) (pH 7.2 to 7.8 at 30 degrees C). At low activities of malic enzyme (1 nanomole per minute per milliliter or less), the presence of malate dehydrogenase leads to a substantial overestimation of malic enzyme activity due to the Mn(2+)-catalyzed decarboxylation of oxaloacetate having a dominant effect. When the level of malic enzyme is greater than 1 nanomole per minute per milliliter, reversal of malate dehydrogenase has a dominant transient effect, causing a lag of up to several minutes, after which the change in absorbance reflects the true rate of malic enzyme. Independent of this effect is a lag in the activator-dependent rate, which could be eliminated by preincubating the enzyme with activator (coenzyme A).An assay procedure designed to minimize the influence of these effects is described. New data are presented on the activity of NAD malic enzyme in leaves of different subgroups of C(4) plants.

Multistage bicycle ergometer exercise testings with Frank vectorcardiogram and M-mode echocardiogram were performed on 12 patients with effort angina pectoris. The left atrial and left ventricular end-diastolic volume (LAV and LVEDV) were calculated as a cube of the left atrial and left ventricular end-diastolic dimension. The mean pulmonary artery wedge pressure (mPAWP) was measured with a Swan-Ganz catheter during the testing. At peak exercise a statistically significant increase was observed in mPAWP (p less than 0.001), LAV (p less than 0.005), the maximal horizontal P-vector magnitude (Hmax) (p less than 0.05) and the percent change in Hmax (%Hmax). %Hmax showed a significant correlation with the increment of mPAWP (delta mPAWP) (r = 0.66, p less than 0.05), the increment of LVEDV (delta LVEDV) (r = 0.83, p less than 0.01) and the increment of LAV (delta LAV) (r = 0.81, p less than 0.001). Multiple regression analysis was performed on %Hmax as a dependent variable with delta LAV, delta mPAWP, and the increment of heart rate (delta HR) as independent variables (r = 0.84, p less than 0.05), but the partial correlation coefficients of delta mPAWP and delta HR were not significant. The present study demonstrated that the increase in Hmax had a close relationship with the increase in mPAWP and LVEDV and that the preload of the left ventricle during exercise-induced anginal attack could be predicted noninvasively by %Hmax. The increase in Hmax was thought to be due to the increase in LAV during anginal attack.

The relationship of supratentorial intracranial pressure (ICP) and cerebral perfusion pressure (CCP) with serial changes in auditory evoked brain stem responses was investigated. Eighty-one patients without primary brain stem damage admitted to our emergency unit were studied. When ICP over 50 mm Hg persisted for 4 hours, the I-V interpeak latency was significantly prolonged. The threshold of this prolongation was 8 hours for the ICP over 45 mm Hg and 24 hours for that of over 40 mm Hg. The ICP of 35-40 mm Hg for 24 hours was the border zone. CCP did not show a significant relation with I-V interpeak latency changes. The loss of wave V was observed in a wide range of the ICP (30-147 mm Hg) and CPP (0-60 mm Hg). Wave III disappeared when the ICP exceeded 50 mm Hg. Wave I became undetectable with an ICP above 50 mm Hg or a CPP below 40 mm Hg. These results indicate that an increase of ICP over 40 mm Hg definitely initiates secondary brainstem dysfunction if it lasts for more than 24 hours and that the ICP should be reduced below this level, preferably below 35 mm Hg, to maintain brain function. The fact that both low CPP and high ICP were involved in the loss of wave I clearly shows that both ischaemia and displacement of the brain stem are the important pathophysiological factors for the disappearance of wave I.

The authors measured alkaline phosphatase isozyme I (ALP-I) in sera of 24 brain-damaged patients and four with disorders other than brain damage. The study population comprised three patients with postresuscitation encephalopathy, four with ruptured cerebral aneurysms, 14 with acute subdural hematoma and cerebral contusion, and three with nontraumatic intracerebral hemorrhage. ALP-I detected in brain damage is physicochemically different from the other known ALP-Is that appear in patients with obstructive jaundice or hepatoma. In the brain-damaged patients, ALP-I became elevated about 7 days after admission and markedly increased as secondary brain damage developed. Excluding patients who died within 9 days of admission, the maximum serum ALP-I concentration was well correlated with the functional outcome. In cases in which barbiturate therapy was effective, the appearance of ALP-I was delayed and its elevation was suppressed. The results of this study suggest that measurement of serum ALP-I is useful not only in the management but also in predicting the prognosis of brain damage.

Reported are two cases of a cardiac tamponade complicated by a malignant, effusive pericarditis were treated by a pericardial, peritoneal window. In both cases, a reaccumulation of pericardial fluid was noticed, within a month after percutaneous, continuous pericardial drainage, and a tumor invasion was seen to the anterior mediastinum creating a pericardial, peritoneal window was considered useful for the treatment of the cardiac tamponade, secondary to the malignant, effusive pericarditis.

In order to clarify the role of dopamine on the pathophysiology of essential hypertension, mean arterial pressure (MAP), heart rate (HR), urine volume (UV), urinary sodium excretion (UNaV), endogenous creatinine clearance (Ccr), fractional excretions of sodium (FENa), inorganic phosphorus (FEP) and potassium (FEK), plasma renin activity (PRA), plasma aldosterone concentration (PAC) and plasma noradrenaline concentration (PNA) were measured before and after intravenous infusion of dopamine (3 micrograms/kg/min, 60 min) in normotensive (NT) and essential hypertensive subjects (EHT). Following dopamine infusion, a significant decrease of MAP and an increase of HR were observed in EHT but not in NT. UV, UNaV, Ccr, FENa, FEP and FEK increased significantly in both NT and EHT, and changes in these except for Ccr were significantly greater in EHT than in NT. In EHT, following dopamine infusion, PNA was clearly elevated, but no remarkable change was found in PRA and PAC. A significantly positive correlation was found between delta UNaV and delta FENa or delta FEP, and between delta FENa and delta FEP, while no significant relation was observed between delta UNaV and delta Ccr, delta MAP or MAP before dopamine infusion. A significant inverse correlation between supine PRA before dopamine infusion and delta FENa or delta FEP and a positive correlation between age and delta FENa or delta FEP were also observed in these patients. The changes in UNaV positively correlated with delta FENa and delta FEP in both low renin (group L) and normal renin EHT (group N) and with delta Ccr i group N but not in group L. The mean values of delta FENa, delta FEP and delta FEK were significantly higher in group L as compared with those in age-matched group N. These results suggest that, since the enhanced response to infused dopamine may reflect reduced dopaminergic activity, attenuation of renal dopaminergic activity might exist and be involved through a distribution of water-sodium metabolism, at least in part, in the pathophysiological mechanism in EHT, particularly in group L.

Hemodynamic effects of isosorbide-5-mononitrate (ISMN) were studied in 14 patients with effort angina pectoris. Hemodynamic and echocardiographic data were obtained by angina-limited supine multistage bicycle ergometer exercise testing before and 120 minutes after single oral administration of 20 mg of ISMN. Compared with control exercise testing, the ST segment at peak exercise showed less depression after administration of ISMN (p less than 0.001). At rest, systolic and diastolic blood pressure decreased significantly after administration of ISMN (p less than 0.001 and p less than 0.01, respectively). At rest and at peak exercise, pulmonary artery wedge pressure (both p less than 0.001), left atrial volume (both p less than 0.001) and left ventricular end-diastolic volume (both p less than 0.05) decreased, whereas cardiac index, pressure-rate product and systemic vascular resistance did not change significantly after administration of ISMN. Average time to peak plasma ISMN concentration was 90 minutes and average peak plasma concentration was 460 ng/ml with an elimination half-life of 7 hours. These data suggest that the main mechanism of the antianginal action of ISMN is a reduction in left ventricular preload followed by diminution of myocardial oxygen requirements.

Retinal artery embolism that had arisen as a complication of a left atrial myxoma was diagnosed in a young man who had suddenly developed a visual disorder in his left eye. A tumor in the left atrium was surgically excised. Pathologically, retinal embolism secondary to atrial myxoma is rare. To our knowledge, only 15 cases have been documented so far. The present case was only the second case of an isolated retinal embolism that had developed without systemic involvement, and the first case of retinal artery branch embolism that had resulted from a left atrial myxoma.

A novel glycosphingolipid, provisionally named Lipid IV (Hori, T., Sugita, M., Ando, S., Kuwahara, M., Kumauchi, K., Sugie, E., and Itasaka, O. (1981) J. Biol. Chem. 256, 10979-10985), was obtained from spermatozoa of the fresh water bivalve, Hyriopsis schlegelii. The yield of the glycolipid was 2.2 mg/g of dried spermatozoa. The structure of the glycolipid was elucidated by partial hydrolysis, permethylation analysis, and proton nuclear magnetic resonance. The following structure is proposed: GlcA4Me beta 1-4(GalNAc3Me alpha 1-3)Fuc alpha 1-4GlcNAc beta 1-2Man alpha 1-3(Xyl beta 1-2)Man beta 1-4Glc beta 1-Cer. The acidic glycolipid is unique in containing 4-O-methylglucuronic acid as well as an internally located fucose. Palmitic acid, stearic acid, and C18-sphingosine are the major aliphatic components. This composition is similar to those of other neutral spermatozoan glycolipids, Lipid I (Hori, T., Sugita, M., Kanbayashi, J., and Itasaka, O. (1977) J. Biochem. (Tokyo) 81, 107-114) and Lipid II (Hori, T., Takeda, H., Sugita, M., and Itasaka, O. (1977) J. Biochem. (Tokyo) 82, 1281-1285), suggesting a possible metabolic relationship among them.

Polysomnography was carried out in 11 adult outpatients with stable chronic heart failure (CHF) due to valvular heart disease in order to investigate respiratory abnormalities during sleep. The subjects consisted of 6 males and 5 females and their ages ranged from 54 to 76 years. A coexisting central dominant sleep apnea syndrome (SAS) was found in 4 males, 3 of whom had evidence of nasal obstruction. A successful mitral valve replacement in one patient with central dominant SAS was associated with a reduction in the frequency of sleep apnea. The results suggest complications caused by respiratory abnormalities during sleep are common and should be considered in the management of patients with CHF.