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Here we examined whether intellectual disability is independently associated with hyperglycaemia.We recruited 233 consecutive young and middle-aged adults with intellectual disability. After exclusion of subjects on medication for metabolic diseases or with severe intellectual disability (IQ35), 121 subjects were divided by IQ into a group with moderate intellectual disability (35 ≤ IQ ≤ 50), a mild intellectual disability group (51 ≤ IQ ≤ 70) and a borderline group (IQ70).HbA1c level was higher in subjects with moderate intellectual disability (42 ± 9 mmol/mol; 6.0 ± 0.8%) than those in the borderline group (36 ± 4 mmol/mol; 5.5 ± 0.3%) and mild intellectual disability group (37 ± 5 mmol/mol; 5.5 ± 0.5%) groups. HbA1c level was correlated with age, BMI, blood pressure, serum triglycerides and IQ in simple linear regression analysis. Multiple regression analysis indicated that IQ, age, BMI and diastolic blood pressure were independent explanatory factors of HbA1c level.An unfavourable effect of intellectual disability on lifestyle and untoward effect of hyperglycaemia on cognitive function may underlie the association of low IQ with hyperglycaemia.

Patients with idiopathic Parkinson’s disease (PD) appear to have reduced capacity for detoxification of certain environmental compounds. The glutathione S-transferases (GSTs) are candidate genes for PD because they are involved in the metabolism of pesticides and cigarette smoke. We investigated the relationship of the seven GST polymorphisms ( GSTM1 deletion, GSTT1 deletion, GSTP1 rs1695, GSTO1 rs4925, GSTO1 rs11191972, GSTO2 rs156697 and GSTO2 rs2297235) and PD risk with special reference to the interaction with pesticide use or cigarette smoking among 238 patients with PD cases and 370 controls in a Japanese population. None of the GST polymorphisms were associated with PD. GSTO1 rs4925 and GSTO2 rs2297235 were found to be in strong linkage disequilibrium ( D ′ = 0.98). Cigarette smoking was significantly associated with decreased risk of PD. However, no interaction of smoking with any of the GST polymorphisms was observed. Self-reported pesticide use was not associated with increased risk of PD. There was no evidence of interaction between self-reported pesticide use and either GST polymorphism. Our results suggest that the tested GST polymorphisms did not play an important role in PD susceptibility in our Japanese population. Our study does not give evidence of interaction between the GST polymorphisms and smoking may although this study provided sufficient statistical power to detect modest interaction. As for interaction between GSTP polymorphisms and pesticide use, the power of this study to detect an interactive effect was low due to a small number of pesticide users. Future studies involving larger control and case populations and better pesticide exposure histories will undoubtedly lead to a more thorough understanding of the role of the GST polymorphisms in PD development.

Aims To assess the prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with impaired glucose metabolism in Japanese subjects. Methods One thousand, nine hundred and fifty subjects enrolled in a general health examination programme from September 2002 to February 2003 were recruited. NAFLD was diagnosed if a person showed ‘fatty liver’ on ultrasonography, and his/her alcohol consumption, estimated by questionnaire, was

A case of accidental death after occupational exposure to an atmosphere containing dichloromethane (DCM) is reported. The concentrations of DCM in the blood and tissues of a 40-year-old man who died while observing an industrial washing machine filled with DCM vapour were blood 1660 mg/l, urine 247 mg/l, brain 87 mg/ kg, heart muscle 199 mg/kg and lungs 103 mg/kg which are 3–7 times higher than previously reported fatal levels. The body was left undiscovered in the machine filled with DCM vapour for about 20 h. The present study was designed to determine whether all the DCM detected in the tissues and body fluids had been inhaled while alive using rats as the experimental model. The concentrations of DCM in the tissues and body fluids of a rat that died from DCM poisoning and was left for 20 h in a box containing DCM vapour were the same as those in the tissues and body fluids of a rat that had died from an injected overdose of barbiturates and had then been placed in the DCM box in a similar manner. Moreover, the concentrations of DCM in the tissues and body fluids of the carcasses that were exposed to the DCM vapour increased gradually throughout the period of exposure. These findings imply that DCM is able to penetrate the tissues and body fluids of rat carcasses through a route other than inhalation such as through the skin.

There exists limited information about the usefulness of hemopoietic stem cell transplantation (HSCT) for the treatment of patients with refractory Langerhans cell histiocytosis (LCH). We report here four Japanese pediatric patients with multisystem LCH disease who underwent HSCT between 1994 and 1997. Two of the four patients are doing well without any relapse. However, neither of them shows improved sequelae 3 to 4 years after allogeneic HSCT, although the graft was rejected in one of the cases. The remaining two patients died of septic shock. A review of the literature of 11 patients revealed four fatalities after the use of HSCT in the treatment of LCH. Three of these were due to active LCH and three deaths occurred within 2 months after HSCT. To establish the usefulness of HSCT for refractory LCH, further studies are required.

The systemic use of steroids and habitual alcohol intake are two major causative factors in the development of idiopathic osteonecrosis of the femoral head (ONFH). To examine any interaction between oral corticosteroid use and alcohol intake on the risk of ONFH, we conducted a hospital-based case-control study of 71 cases with ONFH (mean age 45 years (20 to 79)) and 227 matched controls (mean age 47 years (18 to 79)). Alcohol intake was positively associated with ONFH among all subjects: the adjusted odds ratio (OR) of subjects with ≥ 3032 drink-years was 3.93 (95% confidence interval (CI) 1.18 to 13.1) compared with never-drinkers. When stratified by steroid use, the OR of such drinkers was 11.1 (95% CI 1.30 to 95.5) among those who had never used steroids, but 1.10 (95% CI 0.21 to 4.79) among those who had. When we assessed any interaction based on a two-by-two table of alcohol and steroid use, the OR of those non-drinkers who did use steroids was markedly elevated (OR 31.5) compared with users of neither. However, no further increase in OR was noted for the effect of using both (OR 31.6). We detected neither a multiplicative nor an additive interaction (p for multiplicative interaction 0.19; synergy index 0.95), suggesting that the added effect of alcohol may be trivial compared with the overwhelming effect of steroids in the development of ONFH.Cite this article: Bone Joint J 2013;95-B:320–5.

Nearly all epidemiologic studies examining the association between the risk of Parkinson's disease (PD) and diet have focused on single foods and specific nutrients. However, epidemiologic evidence for the association of dietary pattern with PD, namely the measurement of overall diet by considering the cumulative effects of nutrients is extremely limited. We conducted a hospital-based case-control study in Japan to examine the relationship between dietary patterns and the risk of PD.Patients with PD diagnosed using the UK PD Society Brain Bank criteria (n = 249) and controls without neurodegenerative diseases (n = 368) were recruited. At the time of recruitment, dietary intake during the preceding 1 month was assessed using a validated, self-administered diet history questionnaire. Dietary patterns from 33 predefined food groups (energy-adjusted food g/day) were extracted by factor analysis.Three dietary patterns were identified: 'Healthy', 'Western' and 'Light meal' patterns. After adjustment for potential non-dietary confounding factors, the Healthy pattern, characterized by a high intake of vegetables, seaweed, pulses, mushrooms, fruits and fish, was inversely associated with the risk of PD with a border-line significance (P for trend = 0.06). Multivariate Odds ratio (95% confidence intervals) for PD in the highest quartile of the Healthy pattern was 0.54 (0.32-0.92) compared with the lowest quartile. No associations with PD were detected for the other two dietary patterns.In this case-control study in Japan, a dietary pattern consisting of high intakes of vegetables, fruits and fish may be associated with a decreased risk of PD.

A camptothecin derivative, 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxycamptothecin (CPT-11), shows a potent antitumour activity in experimental tumour models and in clinical trials. However, CPT-11 induced early diarrhoea and vomiting at high dose levels in clinical studies and showed an acetylcholine-like action on the guinea-pig ileum and trachea. In the present study, we investigated the activities of camptothecin derivatives in inhibiting acetylcholinesterase (AChE) and in binding to muscarinic acetylcholine receptors (AChR). CPT-11 inhibited AChE and binding of the specific ligand to AChR with respective 50% inhibition concentrations of 0·2 and 5 μm. These inhibitions were induced by camptothecin derivatives having an amino group at the C-10 position (or the C-4 position of hexacyclic derivatives), but were not or were only slightly induced by the others. Early defecation and vomiting in dogs were observed after intravenous injection of DU-6596 and DU-6888, two hexacyclic derivatives having the aminomethyl group at the C-4 position, and of CPT-11. DU-6174, however, which has a hydroxy group at this position, induced no early defecation and little vomiting. Plasma concentrations of CPT-11, DU-6596 and DU-6888 after intravenous treatment at doses causing such early adverse effects were maintained for 1 h or longer at levels sufficient to inhibit AChE. These results suggest that the inhibition of AChE by camptothecin derivatives with an amino group at the C-10 position (or the C-4 position) relates to the early defecation or diarrhoea and vomiting.

Three previous cohort studies in the USA reported that dairy product consumption was significantly associated with an increased risk of Parkinson's disease (PD) in men, but not in women. We examined the relationship between consumption of dairy products, calcium, and vitamin D and the risk of PD using data from a multicenter hospital-based case-control study in Japan. Included were 249 cases within 6 years of onset of PD based on the UK PD Society Brain Bank clinical diagnostic criteria. Controls were 368 inpatients and outpatients without a neurodegenerative disease. Information on dietary factors was collected using a validated self-administered diet history questionnaire. Adjustment was made for sex, age, region of residence, pack-years of smoking, years of education, body mass index, and dietary factors including cholesterol, dietary glycemic index, vitamin E, β-carotene, vitamin B(6), caffeine, iron, and alcohol. Total dairy product consumption was not materially associated with the risk of PD (P for trend = 0.62). No evident relationships were observed between intake of milk, yogurt, cheese, or ice cream and the risk of PD (P for trend = 0.75, 0.63, 0.59, and 0.35, respectively). There were no measurable associations between consumption of calcium or vitamin D and PD (P for trend = 0.37 and 0.69, respectively). No significant interactions were observed between the dietary exposures and sex regarding PD. Our results suggest that intake of dairy products, calcium, and vitamin D was not related to PD, regardless of sex. However, such null relationships might be a consequence of PD.

antioxidant vitamins are expected to protect cells from oxidative damage by neutralizing the effects of reactive oxygen species. However, epidemiological evidence regarding the associations between antioxidant vitamin intake and Parkinson's disease (PD) is limited and inconsistent. We investigated the relationship between dietary intake of selected antioxidant vitamins, vegetables and fruit and the risk of PD in Japan using data from a multicenter hospital-based case-control study.included were 249 patients within 6 years of onset of PD. Controls were 368 inpatients and outpatients without a neurodegenerative disease. Information on dietary factors was collected using a validated self-administered diet history questionnaire. Adjustment was made for sex, age, region of residence, pack-years of smoking, years of education, body mass index, dietary intake of cholesterol, alcohol, total dairy products, and coffee and the dietary glycemic index.higher consumption of vitamin E and β-carotene was significantly associated with a reduced risk of PD after adjustment for confounders under study: the adjusted odds ratio in the highest quartile was 0.45 (95% confidence interval [CI]: 0.25-0.79, P for trend = 0.009) for vitamin E and 0.56 (95% CI: 0.33-0.97, P for trend = 0.03) for β-carotene. Stratified by sex, such inverse associations were significant only in women. No material relationships were shown between intake of vitamin C, α-carotene, cryptoxanthin, green and yellow vegetables, other vegetables, or fruit and the risk of PD.higher intake of vitamin E and β-carotene may be associated with a decreased risk of PD.

To assess the association between active and passive smoking and the risk of Parkinson's disease (PD), a case-control study with 249 PD patients and 369 controls was carried out in Japan.Information on smoking was obtained through a self-administered questionnaire. Adjustment was made for age, sex, region of residence, educational level, and occupational exposure.Ever having smoked cigarettes was associated with a reduced risk of PD [adjusted odds ratio = 0.38; 95% confidence interval (CI): 0.24-0.59]. Risk for former smokers was intermediate between the high risk for never smokers and the low risk for current smokers. Adjusted odds ratios for former and current smokers were 0.51 (95% CI: 0.32-0.82) and 0.12 (95% CI: 0.05-0.26), respectively. There was an inverse dose-response gradient with pack-years smoked. No significant association was detected for passive smoking exposure.Our results appear to confirm data from previous epidemiological studies.

Two previous cohort studies showed inverse relationships between maternal vitamin E and zinc intake during pregnancy and the risk of wheeze and/or asthma in the offspring. We investigated the association between maternal intake of vegetables, fruit, and selected antioxidants during pregnancy and the risk of wheeze and eczema in the offspring aged 16-24 months.Subjects were 763 Japanese mother-child pairs. Data on maternal intake during pregnancy were assessed with a diet history questionnaire. Data on symptoms of wheeze and eczema were based on criteria of the International Study of Asthma and Allergies in Childhood.Higher maternal intake of green and yellow vegetables, citrus fruit, and beta-carotene during pregnancy was significantly associated with a reduced risk of eczema, but not wheeze, in the offspring {adjusted odds ratios (ORs) between extreme quartiles [95% confidence intervals (CIs)] = 0.41 (0.24-0.71), 0.53 (0.30-0.93), and 0.52 (0.30-0.89), respectively}. Maternal vitamin E consumption during pregnancy was significantly inversely related to the risk of infantile wheeze, but not eczema [adjusted OR (95% CI) = 0.54 (0.32-0.90)]. No statistically significant exposure-response associations were observed between maternal intake of total vegetables, vegetables other than green and yellow vegetables, total fruit, apples, alpha-carotene, vitamin C, or zinc and the risk of wheeze or eczema in the children.Higher maternal consumption of green and yellow vegetables, citrus fruit, and beta-carotene during pregnancy may be protective against the development of eczema in the offspring. Higher maternal vitamin E intake during pregnancy may reduce the risk of infantile wheeze.

Summary We developed a technique for blind bronchial suction using a curved-tip catheter with a guide mark, for the treatment of atelectasis of the lower and middle lobes of the lung. Suction of the upper lobe bronchi could not be performed because of the combination of the peculiar anatomy of the upper lobe bronchi with catheter design. We treated successfully two cases of atelectasis of the right upper lobes using a Rusch Metras bronchography catheter with a guide mark which is not readily available. Therefore we devised a J-shape tipped catheter with a guide mark. We have successfully treated 13 episodes of atelectasis of the right upper lobe in 10 patients and one episode in the left upper lobe in one patient with this new catheter.

Methotrexate (MTX) is most widely used for the treatment of rheumatoid arthritis (RA). However, it has certain drawbacks with regard to individual differences in its therapeutic effects as well as the differences in the patients' response to MTX therapy. We investigated whether multi-drug resistance-1 (ABCB1) C3435T, reduced folate carrier-1 (RFC1) G80A, 5-aminoimidazole-4-carboxamide ribonucleotide transformylase (ATIC) C347G and a 6bp-deletion polymorphism in the 3'-untranslated region of the thymidylase synthase (TYMS) gene are predictive of MTX sensitivity and its adverse effects.Patients whose last maintenance dosage of MTX wasor= 6 mg/week were regarded as responders, while patients whose last maintenance dosage of MTX was6 mg/week or those in whom MTX therapy was changed due to poor response to MTX were regarded as non-responders. The data of 124 RA patients who had received MTX treatment were retrospectively analyzed for polymorphisms in the ABCB1, RFC1, ATIC and TYMS genes, MTX sensitivity and MTX toxicity.There were no significant differences in MTX sensitivity among the genotypes of RFC1, ATIC and TYMS genes. ABCB1 3435TT cases included statistically significantly more non-responders than 3435CC cases according to univariate analysis (crude odds ratio (OR) = 8.91, p = 0.001) and multivariate analysis (adjusted OR = 8.78, p = 0.038). There were no significant differences in MTX toxicity among the genotypes of all the genes.These results suggested that the genetic diagnosis of ABCB1 C3435T can be applied to determine MTX sensitivity for the treatment of RA patients. However, further pharmacokinetics studies are required in this regard.

This study was performed to evaluate the significance of pS2 and MUC1 expressions in ulcerative colitis (UC)-associated colorectal neoplasias. Tissues were collected from 6 patients with UC-associated colorectal neoplasias treated surgically. Specimens were 13 adenocarcinomas, 40 dysplasias (20 high-grade dysplasias, 20 low-grade dysplasias), and 60 normal mucosae. Tissues were also collected from patients without UC treated surgically or endoscopically. pS2, p53, and MUC1 expressions were examined immunohistochemically and compared. The K-ras codon 12 mutation was investigated by single-strand conformation polymorphism analysis. In patients with UC, the incidence of pS2 expression was significantly higher (p

We performed a multicenter, an early phase II clinical trial to evaluate the feasibility, safety and efficacy of myeloablative therapy supported by autologous peripheral blood stem cell transplantation (auto-PBSCT) for the treatment of acute myelogenous leukemia (AML) in first remission. A total of 105 patients were enrolled in the study, and 56 patients in first complete remission received auto-PBSCT. The median age was 44 years. Of the 56 patients, 34 (60.7%) had M2 or M3 AML by the French-American-British Classification system. The median concentration of infused CD34+ cells was 2.3 x 10(6)/kg by recipient body weight. Median days to reach an absolute neutrophil count500/microliter and a platelet count20000/microliter were 14 and 16, respectively. The median disease-free survival rate was estimated to be 62.0% at a median follow-up time of 534 days. Although the study enrolled a small number of patients and the follow-up period was relatively short, the preliminary results were encouraging and indicated that myeloablative chemotherapy with auto-PBSCT is feasible and can be performed safely as a post-remission therapy for AML. A prospective randomized clinical trial of auto-PBSCT versus standard chemotherapy alone will be necessary to assess the efficacy of high-dose therapy facilitated by auto-PBSCT as a post-remission therapy for AML.

The 150 male patients exposed to Thorotrast who were confirmed by a 1975-1978 national survey with diagnostic X rays of 50,860 war-wounded soldiers were followed up between 1979 and 1998 (Aichi series or second series). Age-adjusted rate ratios of deaths from all causes were 3.0 times higher in Thorotrast patients compared to controls; this was statistically significant. Rate ratios for liver cancer, liver cirrhosis and leukemia were 35.0, 7.5 and 18.2, respectively.

A cross-sectional study on the association between the results of blood test and the blood concentration of PCB was conducted on the chronic Yusho patients. The subjects were 265 Yusho patients (134 men and 131 women) who received the annual nationwide health examination for Yusho in 1993. The results of the blood test and questionnaire survey at the annual health examination were used for the analyses using ANCOVA. Serum levels of triglycerides, total cholesterol, GOT, GPT, gamma-GTP, total bilirubin, and conjugated bilirubin were associated with the blood concentration of PCB adjusting for sex, age, drinking habit, smoking habit and body mass index (BMI). Because the distribution of the serum levels was strongly skewed to the right except that of serum concentration of total cholesterol, they were log transformed to approximate to the Normal distribution. The association between age and the blood concentration of PCB was significant (P0.001), although the associations of sex, drinking habit, smoking habit and BMI to the blood concentration of PCB were not significant. With the adjustment for sex, age, drinking habit, smoking habit and BMI, the serum concentrations of triglycerides and total cholesterol were significantly associated with the blood PCB level expressed by loge (blood concentration of PCB in ppb-1) (P = 0.02 and P0.001, respectively). The associations of serum levels of GOT, GPT, gamma-GTP, total bilirubin and conjugated bilirubin to the PCB level were not significant. The results of this study suggests the need of careful observation on the serum lipids of Yusho patients, especially those with high concentration of blood PCB, because the serum concentrations of total cholesterol and triglycerides are prominent risk factors of heart diseases.

An in vivo gene transfer technique for living mouse testes was used to develop a novel transient expression assay system for transcriptional regulatory elements of spermatogenic specific genes. The combination of DNA injection into seminiferous tubules and subsequent in vivo electroporation resulted in an efficient and convenient assay system for gene expression during spermatogenesis. The transfer of the firefly luciferase reporting gene driven by the Protamine-1 (Prm-1) enhancer region revealed a significant increase in the activity of the reporter enzyme. Histochemical studies of the transfer of the lacZ gene driven by the Prm-1 enhancer showed specific lacZ expression only in haploid spermatid cells in adult testes, corresponding with the expression pattern of endogenous Prm-1. We were able to detect long-lasting transgene expression in the transfected spermatogenic cells. A group of spermatogenic differentiating cells maintained the transfected lacZ expression after more than 2 mo of transfection, suggesting that spermatogenic stem cells and/or spermatogonia could also incorporate foreign DNA and that the transgene could be transmitted to the progenitor cells derived from a transfected proliferating germ cell.

An 82-year-old man was admitted to our hospital in September 1996 due to dysphagia and cardiomegaly. Physical examination detected the fourth heart sound and a Levine III/VI systolic murmur in the cardiac apex. Surface lymph nodes were not palpable. LDH 662 IU/I was detected by laboratory examinations, and ultrasound cardiography showed grade 3 mitral regurgitation. Computed tomography revealed a huge mass in the posterior mediastinum, pressing the heart from the posterior direction. Thereafter, a left pleural effusion developed and aspiration was performed. Cytological examination of the fluid showed clusters of lymphoid cells with a positive immunophenotype for CD10, CD19 and HLA-DR. Chromosome analysis revealed complex abnormal karyotypes including t(8;14) (q24;32). A diagnosis of B cell lymphoma was made, and combination chemotherapy consisting of cyclophosphamide, THP-adriamycin, vincristine, and prednisolone was initiated. The patient's mass disappeared promptly, and his mitral reguration subsided. We reported this case because malignant lymphoma of the posterior mediastinum is rare, and because we are unaware of any previous reports of malignant lymphoma causing acute mitral regurgitation.

Aprindine was administered for 12 months to 8 hemodialysis patients suffering from arrhythmias. The serum aprindine concentration ranged from 0.3 to 0.6 microgram/ml, and did not increase with time during the 1-year treatment period. The PQ interval was temporarily prolonged in the first and second months, but the QRS and QT intervals were not changed by chronic aprindine treatment. The changes of the PQ interval in the second month of treatment were directly correlated with the serum aprindine concentration. No alterations of the ECG findings were observed when aprindine was discontinued. The cardiothoracic ratio (chest radiography) and laboratory findings were also not influenced by either aprindine treatment or its withdrawal. In conclusion, aprindine may be safely administered for at least 1 year to arrhythmia patients on maintenance hemodialysis.

We conducted a clinical trial to increase the chemosensitivity of residual leukemic cells by combining G-CSF to marrow-ablative chemotherapy, including cytosine arabinoside (Ara-C), and facilitated by autologous blood cell transplantation (ABCT) for treatment of acute myelogenous leukemia (AML) in first complete remission. A total of 16 patients were consecutively treated with granulocyte colony-stimulating factor (G-CSF)-combined high-dose chemotherapy (busulfan, etoposide and Ara-C) followed by autotransplantation of peripheral blood progenitor cells, which had been collected after the consolidation chemotherapy. At a median follow-up time of 44.5 months, the probability of 5-year event-free survival was 74.5% with only three leukemic relapses. This preliminary observation suggests the effectiveness of G-CSF-combined conditioning and ABCT as a post-remission therapy for AML.

Patients with poorly controlled noninsulin dependent diabetes mellitus (NIDDM) are shown to have higher bone mass. However, the influence of changes in glycemic control on bone turnover is not known. To clarify whether metabolic improvement of poorly controlled NIDDM affects bone turnover, markers for glucose, mineral, and bone metabolism were assessed before and after glycemic control for 3 weeks in 78 poorly controlled NIDDM patients with initial hemoglobin A1c over 8%. Metabolic improvement caused a reduction in urinary calcium (Ca) and phosphate (Pi) and serum 1,25(OH)2D levels, and an increase in serum Pi without changes in serum Ca or parathyroid hormone levels. Bone resorption markers, urinary deoxypyridinoline (Dpd) and type I collagen carboxy-terminal telopeptide (CTx), as well as a bone formation marker, serum bone type alkaline phosphatase (BALP), were reduced. However, another bone formation marker, serum osteocalcin (OC), was low before treatment and was elevated after treatment. The decrease in Dpd, CTx and BALP, but not the increase in OC, correlated with each other and with the improvement in glycemic indices. In conclusion, metabolic improvement of poorly controlled NIDDM decreases bone turnover within a short period. Thus, glycemic control may protect NIDDM patients from bone loss. It is possible that serum OC is affected by hyperglycemia per se, and may not correctly reflect bone turnover.

To investigate the frequency of symptoms and signs and their relationships with blood PCB (polychlorinated biphenyls) levels, twenty-five years after outbreak, we analyzed the data of 276 Yusho patients (male/female: 137/139) who had received health examination in 1993. For this purpose, 31 examination items which correspond or relate to the diagnostic criteria for Yusho (1976) were selected from the examination form. Mean blood PCB concentration in the subjects was 4.69 ppb with the highest value of 31.0 ppb (median : 4.0 ppb). The symptoms for which the proportion exceeded 60% were general fatigue, headache and numbness in extremities. Chronic bronchitis-like symptoms, such as cough and sputum, were observed in 50% of the subjects. Next, the subjects were classified into approximate quartiles of blood PCB:3.00, 3.00-4.06, 4.07-5.99, and 6.00+ppb. The distributions of subjects at four levels of blood PCBs were compared between the groups with or without each symptom or sign, using the Cochran-Mantel-Haenszel test. Significant differences were observed for comedones in the trunk (P = 0.02) and other regions (P = 0.02); acneiform eruptions in the genital regions (P = 0.01) and gluteal regions (P = 0.01); and hypersecretion in the Meibomian gland (P = 0.04). Thus, the typical skin and eye symptoms in Yusho patients still persist showing a close relation with blood PCB concentration.

Nicardipine is a potent arteriolar vasodilator with a negligible negative inotropic effect. Although intravenous administration of this drug has been reported to be effective in the treatment of heart failure, the optimal dose by this route is not clear. This study was designed to determine the optimum dose for the intravenous infusion of nicardipine in the treatment of heart failure. In Trial 1, nicardipine was administered intravenously at a dose of 0.5 microgram/kg per min to 14 patients with acute heart failure. The dose was increased to 1.0 microgram/kg per min in 13 cases with marked improvement at 2 h. In Trial 2, nicardipine was administered in a double-blind manner to 53 patients at 3 different rates of infusion for 2 h: 1.0 (Group 1, n = 19), 2.0 (Group 2, n = 15), and 3.0 (Group 3, n = 19) micrograms/kg per min. Neither heart rate nor mean right atrial pressure changed in any of the 3 groups. Favorable hemodynamic effects were evident in all groups beginning 30 min after the start of infusion, with an increase in cardiac index (control vs 2 h after infusion, L/min per m2) (Group 1: 2.2 +/- 0.4 vs 3.1 +/- 0.8, Group 2: 2.2 +/- 0.4 vs 2.9 +/- 0.5, Group 3: 2.3 +/- 0.3 vs 3.1 +/- 0.7, all p0.01 compared to the control) and a decrease in diastolic pulmonary artery pressure (Group 1: 26 +/- 10 vs 19 +/- 7, Group 2: 27 +/- 10 vs 20 +/- 8, Group 3: 26 +/- 7 vs 18 +/- 5 mmHg, all p0.01). The decrease in systolic pressure was greatest in Group 3 (Group 1: 141 +/- 31 vs 119 +/- 18, Group 2: 149 +/- 25 vs 118 +/- 17, Group 3; 147 +/- 27 vs 107 +/- 14 mmHg, all p0.01 compared to control, and p0.05 between Groups 1 and 3). The intravenous drip infusion of nicardipine is effective in the treatment of heart failure by inducing an increase in cardiac output and a decrease in pulmonary artery wedge pressure. The optimal dose in this study was 1.0 microgram/kg per min.

To identify the clinical significance of the isointegral body surface map of the QRST interval (QRST map) and the occurrence of repolarization abnormalities in patients with hypertrophic cardiomyopathy (HCM), the QRST map and signal-averaged electrocardiogram were evaluated in 50 patients with HCM, in 33 of whom the results were compared with nuclear images both for radioiodine-labeled fatty acid metabolism and for radiothallium perfusion. The QRST departure map was used to determine two parameters of difference between patient and control recordings: the subnormal area (the number of lead points at which the departure index values were negative and lay more than 2 SDs from the mean of the normal control group) and the subnormal minimum (the absolute value of the minimum in the departure map). Late potentials were detected in 6 (12%) of the 50 patients; they were observed in 3 of the 5 patients with dilated-phase HCM but in only 3 (7%) of the other 45 patients. The subnormal area and minimum values were lower in nonobstructive HCM than in dilated-phase HCM. Of the 33 patients examined by myocardial imaging, 28 (33%) had a filling defect or decreased uptake, as shown on fatty acid metabolic images, and 10 of the 28 also showed abnormal myocardial perfusion images, while the 18 others showed normal perfusion images. These 28 patients showed significantly larger values of the subnormal area and minimum than patients with normal results in both image tests, regardless of whether or not myocardial perfusion imaging abnormalities were present. The localization of filling defects or of decreased uptake presented in fatty acid metabolic images corresponded to the position of the minimum on the QRST departure map. These results suggest that the QRST map is useful for detection of repolarization abnormalities in HCM and that these abnormalities are highly related to impaired fatty acid utilization of the myocardium.

Using a prospective, randomized design, we tested our hypothesis that the augmentation of diastolic pressure by intraaortic balloon counterpulsation (IABP) would improve the late patency of the occluded coronary artery in patients with early failure of thrombolytic therapy.Rescue angioplasty is often performed in patients in whom thrombolysis has failed, although 30% to 60% of the infarct-related arteries that are closed early after thrombolytic therapy will open later with conservative therapy.The study included 45 patients in whom thrombolysis had failed, despite treatment with intravenous tissue-type plasminogen activator (alteplase 0.75 mg/kg body weight) delivered over 60 min within 12 h of the onset of symptoms. All patients underwent coronary angiography 60 min after initiation of thrombolytic therapy (baseline), and Thrombolysis in Myocardial Infarction (TIMI) grade 0, 1 or 2 flow was defined as failed thrombolysis. The patients were randomized to groups receiving IABP for 48 h (n = 23) or conservative therapy (n = 22, control subjects) at the end of cardiac catheterization. The late patency of the infarct-related artery, the primary end point of the study, was evaluated 3 weeks after myocardial infarction. Stenosis of the infarct-related artery was measured using a computer-assisted quantitative angiographic system in blinded manner. Data are expressed as mean value +/- SEM.There was no difference with regard to the baseline value for TIMI flow grade between the groups. However, 3 weeks after myocardial infarction, the patients treated with IABP had a significantly higher frequency of TIMI flow grade 3, lower residual percent stenosis and larger minimal lumen diameter of the infarct-related artery than did the control subjects (74% vs. 32%, p0.05; 42 +/- 5% vs. 68 +/- 6%, p0.01; and 1.6 +/- 0.1 vs. 0.9 +/- 0.2 mm, p0.01, respectively).These findings suggest that in patients with early failure of thrombolytic therapy, IABP may improve late patency of the occluded coronary artery, probably due to augmented perfusion pressure.

In this study, our induction methods of endotracheal anesthesia was evaluated with reference to electrocardiogram, hemodynamic status and arterial blood gas analysis on 153 patients. From the beginning of induction, electrocardiogram was recorded continuously to the completion of intubation. The blood pressure and heart rate were also measured. Arterial blood samples were taken at 40 seconds of apneic period after the mask was removed from the patient's face (CONT group), at 40 seconds of apnea with intratracheal spray (LIDO group), and after intubation following intratracheal spray (INT group). In the electrocardiographic survey, arrhythmias during intubation were rare (1/113, 0.9%). PaCO2 values in INT group showed a significant elevation (+ 14.0 mmHg; p0.01) compared to these in CONT group. As a result of careful and gentle induction techniques, the incidence of arrhythmias during intubation was very low. However, an elevation of PaCO2 was not avoidable, even in smooth and successful intubation. In conclusion, the importance of more adequate ventilation coupled with skillful intubation in a shorter period to avoid hypercapnia and arrhythmias is appreciated again in the endotracheal anesthesia for the maxillofacial surgical patients with anatomical airway problems.

Immunostimulative effects of chicken egg white derivatives (EWD) on phagocytic responses of peripheral blood mononuclear cells (MNC) and polymorphonuclear cells (PMN) in dogs were evaluated by flow cytometric analysis. Peripheral blood leukocytes (PBL) cultured with EWD showed the enhanced phagocytic response. The response was maximal when PBL were cultured with 100 - 400 micrograms/ml of EWD for 3 - 12 hr. Furthermore, significantly increased phagocytic responses were also induced even when PBL were cultured with protein components (200 micrograms/ml) of EWD such as conalbumin, flavoprotein and ficin-papain inhibitor for 3 hr. In addition, the enhancing effect of EWD on the phagocytic responses was also observed in MNC cultured with EWD (200 micrograms/ml) for 4 hr but not in PMN cultured with EWD in the same procedures. The supplement of the supernatant (20%) of MNC cultured with EWD (200 micrograms/ml) for 24 hr at 37 degrees C to PBL and MNC resulted in the enhancement of their phagocytic responses. In contrast, the supernatant of PMN cultured with EWD for 24 hr at 37 degrees C did not show any significant enhancing effect on the phagocytic responses of PBL, MNC and PMN. These results suggest that EWD has an enhancing effect on phagocytosis of MNC and PMN, which may be mediated through active humoral substances produced by EWD-stimulated MNC.

The correlation between blood PCB concentration and clinical manifestation of symptoms was investigated in 259 chronic "Yusho" patients, using the information obtained from the nationwide health examination conducted in 1988, twenty years after the outbreak. Concentrations of blood PCBs ranged 0.6-32.0 ppb (mean; 4.78), and they were categorized into approximate quartile for analysis. For general fatigue, odds ratios at 2.7+, 4.1+, and 6.1+ ppb were 2.4, 3.6, and 3.1, respectively, with a reference category of2.7 ppb (test for trend; p0.005). For numbness in extremities, the corresponding odds ratios were 2.8, 2.8, and 2.9(p0.005). For comedone, they were 1.4, 1.0, and 4.0 on face (p0.025); and 3.6, 4.6, and 9.5 on trunk (p0.005), respectively. A distinctive increase in odds ratio was observed at 2.7 ppb for these two subjective symptoms; and at 6.1 ppb for skin symptoms. The blood PCB concentrations among patients were relatively close to the normal subjects. Therefore, the observed correlations may be due to the effects of PCBs with a peculiar pattern in components, PCQs or PCDFs, taken and retained in the patients. Association with blood PCBs was also suggested for headaches; abnormal breath sounds; and acneiform eruptions in the genital region, but were statistically insignificant. None of the eye symptoms showed significant association with blood PCBs.

An increasing number of dental patients are taking beta-adrenergic blockers for the treatment of hypertension or angina pectoris. If epinephrine-containing local anesthetics are administered to such patients, interactions between epinephrine and the beta-blocking agent may induce cardiovascular complications. We assessed in volunteers the effects of intraoral injection with 2% lidocaine containing 1:80,000 epinephrine (L-E) on cardiac function after pretreatment with the beta-blocking agent pindolol. M-Mode echocardiography was used for the assessment. The injection of L-E after administration of pindolol did not alter cardiac preload, whereas it reduced the stroke volume, due to an increase in afterload and a decrease in myocardial contractility. Reductions in stroke volume and heart rate led to a decrease in cardiac output. Because total peripheral vascular resistance increased markedly, blood pressure was elevated despite the reduced cardiac output. These results suggest that cardiac function of dental patients on beta-blocker therapy can be adversely affected by epinephrine-containing local anesthetics. Therefore, when such an anesthetic solution has to be used in patients on beta-blocker therapy, careful systemic monitoring is needed.

In order to evaluate the benefit derived by conventional views in the initial diagnosis of fractures of the orbital walls, a clinical study was designed to compare the results of evaluations by plain films and coronal CT scans. The conventional Caldwell's and Waters' views will provide a fairly reliable result as to the presence of orbital fractures: orbital floor (anterior in 78%, posterior in 73%), medial orbital wall (anterior in 71%, posterior in 72%), and ethmoid-maxillary plate in 64%. False-negative diagnosis was seen at the anterior portion of the floor in 13%, at the anterior portion of the medial orbital wall in 7%, and at the ethmoid-maxillary plate in 11%. False-negative diagnosis was seen at the orbital floor (anterior in 9%, posterior in 10%), at the medial orbital wall (anterior in 21%, posterior in 29%), and at the ethmoid-maxillary plate in 21%. Our results agree well with those of the past reports.

Associations of blood PCB concentration with serum levels of triglyceride, gamma-GTP, total-, and conjugated-bilirubin were investigated in "Yusho" patients twenty years after outbreak, using the information obtained from the medical examinations in 1988 and 1989. Study subjects were 259 patients in 1988, and 268 patients in 1989, including 190 patients who consecutively received both examinations. Blood PCB concentrations (mean +/- SE) were 4.78 +/- 0.22 ppb in 1988, and 4.47 +/- 0.17 ppb in 1989. The results of blood-chemical analysis were compared among four categorized concentrations of blood PCB, using the analysis of variance. Significant difference was observed for triglyceride (1988: p0.025, 1989: p0.005), but not for gamma-GTP, total-, and conjugated-bilirubin. In 1988, the mean triglyceride levels were 108, 137, 145, and 166 mg/dl at2.7,or = 2.7,or = 4.1, andor = 6.1 ppb of blood of PCB, respectively. Corresponding figures in 1989 were 106, 129, 154, and 156 mg/dl at2.7,or = 2.7,or = 4.0, andor = 5.7 ppb of blood PCB, respectively. Thus, clear positive association between blood PCB and serum triglyceride was observed in the patients twenty years after exposure.

Each of 36 patients who underwent tracheotomy for removal of malignant or benign tumors or for treatment of pneumothorax was infused with 2 g of aspoxicillin (ASPC, Doyle injection) intravenously over 1-hour period. ASPC concentrations determined at 1 postoperative time-point in tissues of the lung and trachea and in serum of each patient were analyzed pharmacokinetically to elucidate the transfer of ASPC to the thoracic tissues. The preventive effect of ASPC against postoperative infections was also investigated in 39 tracheotomy patients. 1. The analysis of ASPC concentrations in 36 patients with tracheotomy gave the following results; 1) The peak blood level (about 80 micrograms/ml) was attained at the end of infusion. The serum level then decreased with time to below about 10 micrograms/ml at 6 hours after the start of infusion, with an elimination half-life of about 1.4 hours, which was comparable to that in healthy adults. 2) Peak levels in the lung and tracheal tissues were achieved at about 30 minutes after the start of infusion, at levels of about 30 and 40 micrograms/g, respectively, which decreased to about 5 micrograms/g in both tissues at 6 hours after the start of infusion. 2. Thirty nine patients who were treated with ASPC before operation were examined for the preventive effect of ASPC against postoperative infections for 1 week after operation. No postoperative infection was noted in any patients and ASPC was found to be useful for prevention of postoperative infections. 3. No side effects or abnormal laboratory findings were noted in any patients. Based on the results of the transfer into the tissues of respiratory organs and preventive effect against postoperative infections, we have concluded that ASPC is useful for prevention of infections after thoracic operation.

A patient developed strongly negative T waves following anesthesia for maxillofacial surgery. The electrocardiogram was normal preoperatively, except for a single premature ventricular depolarization, and no abnormalities were noted during the operation. Postoperatively, the T wave gradually inverted in almost all leads and approached the criterion of -10 mm for giant negative T waves in V3 2 days postoperatively. The T wave returned to normal approximately 4 months later. Although the T-wave inversion in this patient may have been caused by surgical trauma to the sympathetic nerve supply to the heart or by myocardial infarction, the exact cause remains undetermined.

Sandwich ELISA were developed to quantitatively determine conglutinin (CG), mannan-binding protein (MBP), and serum amyloid-P component (SAP) in the sera of cattle. The ELISA system was found to have high repeatability for quantitation of these serum proteins at concentration as low as 5 ng/ml. From results obtained for 10 healthy cows aged 2 to 7 years, mean +/- SD serum concentrations were 56.5 +/- 14.4 micrograms of CG/ml, 2.37 +/- 0.87 micrograms of MBP/ml, and 11.14 +/- 3.92 micrograms of SAP/ml, respectively. Values in 6 healthy heifer calves aged 6 months were 3.45 +/- 1.22 micrograms/ml for CG, 1.71 +/- 0.96 micrograms/ml for MBP, and 5.45 +/- 2.75 micrograms/ml for SAP, respectively. Concentrations in 9 healthy bullocks aged 6 months were 1.83 +/- 0.66 micrograms/ml for CG, 1.04 +/- 0.63 micrograms/ml for MBP, and 4.9 +/- 1.13 micrograms/ml for SAP, respectively.

A 10 month-old boy presented with fever. He was diagnosed as having acute myelo-megakaryocytic leukemia by electron microscopic cytochemical examination. In spite of aggressive chemotherapy, complete remission could not be achieved and he died seventeen months after the diagnosis was made. G-band karyotypes of the bone marrow cells revealed 45, XY, -17, -21, + dir tan dup (17;21) (17pter----cen----17q25::17q21----17q25;21q11 ----21qter). Furthermore, the same chromosomal aberrations were detected in the cells which were tetraploid and octaploid. Although, neoplastic changes in the progenitor cells immediately before differentiating to CFU-Meg and CFU-GM, are suggested there is a possibility of clonal evolution.

To observe the clinical course after reperfusion and recovery from myocardial stunning of the left ventricular anterior wall, we prospectively reviewed and analyzed cardiac enzymes, ECG changes, echocardiograms, and cineangiograms in 8 patients with the acute ischemic syndrome who fulfilled the following criteria: 1) no history of previous myocardial infarction, 2) repeated and/or prolonged episodes of chest pain, 3) critical stenosis of the left anterior descending artery with wall motion abnormalities, 4) successful emergency percutaneous transluminal coronary angioplasty, and 5) normal wall motion on repeat cineangiography 4 to 8 weeks later. Creatine kinase (CK) and/or its cardiac isoenzyme (CK-MB) were minimally elevated in all cases. Wall motion was normalized with the reduction of end-systolic volume (end-diastolic volume: from 139 +/- 25 to 140 +/- 37 ml, ns, end-systolic volume: from 68 +/- 16 to 39 +/- 13 ml, p0.001, ejection fraction: from 51 +/- 6 to 71 +/- 6%, p0.001). Serial echocardiograms showed normalization of wall motion within 4 to 28 days. T wave inversion in the left precordial leads developed 30 min to 5 hours after the cessation of chest pain or successful reperfusion, and prominent negative T waves (1.6 +/- 0.6 mV) with QT prolongation (0.56 +/- 0.08 sec) in V3 or V4 reached their peak values within one to 5 days. ECG abnormalities resolved after 21 to 95 days. These ECG findings may indicate reperfusion injury and the presence of myocardial stunning in the anterior wall of the left ventricle.

Thirty-one patients suffering from single vessel exertional angina with collaterals (Group A) were evaluated by stress 201T1 myocardial emission CT (Tl-SPECT) with 16 controls of severely stenotic single vessel exertional angina without collaterals (Group B). Group A included 21 patients (68%) who showed an extensive perfusion defect in double artery myocardial regions, including the normal donor artery myocardial region (DMR). However, there were no such cases in Group B, giving a significant difference between these 2 groups (p less than 0.001). Four patients in Group A, having a perfusion defect both in DMR and in the collateral dependent myocardial region (CMR) underwent a successful percutaneous transluminal coronary angioplasty (PTCA) with disappearance of collaterals. Tl-SPECT findings after PTCA showed no perfusion defect either in CMR or in DMR. This has been explained on the basis that the coronary collaterals stole blood and produced perfusion defect in DMR.

Per-rectal portal scintigraphy using I-123 IMP was performed before and after TAE in 29 patients with hepatoma. Index of porto-systemic shunt (PSS index) was obtained by lung/(lung + liver) uptake ratio at 30 min after administration of IMP. The influence of TAE on portal circulation was evaluated by using this PSS index. PSS index increased 16 of 29 patients (55.2%) after TAE. PSS index increased after TAE especially in cases of severe liver dysfunction before TAE, marked portal involvement, and embolization of a larger liver volume. PSS index also increased when there was deterioration of esophageal varices, ascites, and hepatic coma after TAE. PSS index is useful for evaluation of portal circulation after TAE.

To investigate relationships between blood PCB (polychlorinated biphenyls) level and symptoms of Yusho patients, twenty years after outbreak, a comparative study was designed in accordance with the results of medical examination conducted in 1988. For this examination, standardized forms were introduced in 1986, and a whole system for data-processing has been completed through two-years' efforts. Study subjects were 259 Yusho patients (male: 136, female: 123) for whom PCB concentration in blood was reported, among a total of 285 patients examined (91%). And 31 examination items which correspond or relate to the diagnostic criteria for Yusho (1976) were selected from the examination form for analysis. Mean blood PCB concentration in the subjects was 4.78 ppb ranging 0.6-32.0 ppb. The subjects were stratified for four blood PCB levels, less than or equal to 2.6 ppb; less than or equal to 4.0 ppb; less than or equal to 6.0 ppb; greater than 6.0 ppb, by dichotomized categories (normal/abnormal) for the results of each examination. This two-by-four table was transformed to two-by-two table with a cut-off point where the largest chi 2-value was obtained. Then the odds ratio (OR) adjusted for gender and age was calculated for the examination item which showed a statistically significant decrease or increase in crude odds ratio, to assess the association between blood PCB level and symptoms of Yusho patients. (ABSTRACT TRUNCATED AT 250 WORDS)

A 59-year-old man with a 10-year history of hypertension was admitted to the Osaka Medical College Hospital because of left shoulder pain, lower blood pressure in left arm, and nasal lower quadrant defect of the visual field of the left eye. After admission, he underwent coronary angiography and aortography. The examinations revealed that, although coronary arteries were normal, the orifice of the left subclavian artery was occluded almost completely. Two weeks after the examination, he underwent intra arterial DSA of the cerebral artery. After manipulation of the DSA, the patient complained of severe calf pain, developed blue toe and progressive renal failure with severe proteinuria. He died of uremia about three months after the DSA. Autopsy revealed multiple cholesterol emboli in small arteries in the visceral organs, urogenital organs and thyroid gland. In the kidneys, especially, damage by cholesterol emboli was large with irregular cortical necrosis. Examination of the brain was not permitted. This case shows that cholesterol embolism of the kidneys can be a lethal complication of angiography.

The purpose of this study was to evaluate the antihypertensive effect of a new calcium antagonist, clentiazem, on inpatients or outpatients with essential hypertension. After blood pressure was stable and greater than 160/95 mmHg with placebo for at least a 2-week observation period, oral clentiazem was administered once daily and dosage was increased stepwise from 10 to 40 mg over 10 weeks. Blood pressure significantly decreased by the second week of the study, and this hypotensive effect was maintained until the eighth week. Cumulative effective rate (percent of patients whose blood pressure decreased in 20/10 mmHg) in 62 outpatients were as follows; 10.3% at 10 mg, 39.6% at 20 mg, 70.2% at 30 mg, 76.6% at 40 mg. There was no significant postural change observed in the blood pressure from supine to standing position. Side effects such as dizziness, general malaise and gait disturbances were observed in 3 (3.9%) of 76 patients. No abnormal changes in clinical laboratory examinations or electrocardiograms were caused by clentiazem. Thus these data demonstrated that clentiazem produces certain antihypertensive effects with sufficient safety.

Phase I study of YNK01 (1-beta-D-arabinofuranosylcytosine-5'-stearylphosphate), a derivative of cytosine arabinoside (Ara-C), was conducted by cooperative study groups between January 1986 and June 1987. The dosage for the single and 5-day oral administration ranged 50 to 1,200 and 100 to 900 mg/body/day, respectively. The main adverse effects were myelo-suppression and gastrointestinal toxicities such as nausea, vomiting, anorexia and diarrhea. In the single administration, the maximum tolerated dose (MTD) could not be determined, however, in the 5-day schedule MTD was considered to be 700 to 900 mg/body/day, and the dose limiting factor to be thrombocytopenia. After the single administration (800 mg/body/day) of YNK01, the plasma concentration of Ara-C, an active metabolite of YNK01, was 3.43 ng/ml (Cmax) at 24 hrs. and 0.82 ng/ml at 72 hrs. During the 5-day administration for 300 mg/body/day and 500 mg/body/day, the Ara-C concentration changed from 2.3 to 4.1 ng/ml, and from 1.5 to 11.9 ng/ml respectively, and sustained almost the same concentration as to during the administration period until the 2nd day after the completion of the administration.

N-isopropyl-p[123I]-iodoamphetamine (IMP) single photon emission computed tomography (SPECT), X-ray computed tomography (X-CT) and magnetic resonance imaging (MRI) were performed in 18 children with idiopathic seizures. In children with idiopathic seizures SPECT identified abnormal lesions in the highest rate (50%) compared with X-CT (11%) and MRI (13%), but the findings of SPECT poorly correlated with the foci on electroencephalography (EEG). Idiopathic epilepsy with abnormal uptake on SPECT was refractory to medical treatments and frequently associated with mental and/or developmental retardation. Perfusion defects identified on SPECT probably influenced the development of the brains in children. IMP SPECT is useful in the diagnosis and medical treatment in children with seizures.

Prospective evaluation of gastrointestinal complications after transcatheter arterial embolization (TAE) was performed on 149 TAEs of 133 patients with endoscopy in order to evaluate whether the use of antiulcer medication can prevent such complications. In 21 of 141 TAEs (14%) there developed gastrointestinal complications. The incidence of complications with administration of H2-blocker was 30.4%, whereas the incidence with administration of PGE1 and without medication were 2.8% (p less than 0.01) and 9.0%, respectively. It has been suggested that such complications are mainly due to backflow of the embolic materials to the gastric artery. These findings indicates that decrease of gastric mucosal blood flow due to backflow of the embolic materials to the gastric artery cause the gastrointestinal complications.

Fifteen patients (8 male and 7 female) with multiple myeloma, who were admitted to our hospital between July 1986 and August 1988 and suffering from pain and hypercalcemia, were treated with synthetic calcitonin derivative (elcatonin: ECT). ECT was administered intravenously at a dose of 10-640 units twice daily. Seven patients were treated with ECT (ECT group), and eight patients received combination treatment with ECT and other form of chemotherapy (combination group). With regard to the pain score (PS), significant analgesic effects in both groups were observed during 1-4 week treatments (p less than 0.05). There were no significant differences in PS between two groups. Serum calcium levels in the combination group at 1 and 4 weeks were significantly lower than the initial value (p less than 0.05). Hypocalcemia was not seen in any of the patients. Urinary excretion of calcium at 1 week in ECT group was higher than the initial value (p less than 0.05). The observed toxicities of ECT were slight nausea and vomiting in only 2 patients. These findings suggest that ECT is an useful agent for the treatment of pain and hypercalcemia accompanied with multiple myeloma.