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Visual interpretation of 123I-BMIPP (BMIPP) myocardial images has difficulties in detecting mild reduction in tracer uptake. We studied the significance of the objective assessment of myocardial BMIPP maldistributions at rest by using a Bull's-eye map and its normal data file for detecting ischemic heart disease. Twenty nine patients, 15 with prior myocardial infarction and 14 with effort angina were studied. The initial 15-min BMIPP image was evaluated by visual analysis and by generating the extent Bull's-eye map which exhibits regions with reduced % uptake under mean-2SD of 10 normal controls. The sensitivity for determining coronary lesions in non-infarcted myocardial regions with the extent map was superior to that with visual analysis (67% vs. 33%). In the regions supplied by the stenotic coronary artery, those which showed visually negative but positive in the map and which showed positive in both had higher incidence of wall motion abnormalities and severe coronary stenosis than those with normal findings in both. These results suggest that the objective assessment based on the normal data file in a Bull's-eye polar map is clinically important for improving the limitation of the visual interpretation in 123I-BMIPP imaging.

Modifying effects of dietary exposure of S-methyl methane thiosulfonate (MMTS) isolated from cauliflower Brassica oleracea L. var. botrytis on rat colon carcinogenesis induced by azoxymethane (AOM) and on the expression of cell proliferation biomarkers were investigated in two experiments. In experiment 1, male F344 rats were given three s.c. injections of AOM (15 mg/kg body weight) and fed 100 ppm MMTS for 5 weeks, starting 1 week before the first dose of AOM. The frequency of colonic aberrant crypt foci was determined at 5 weeks after the start. Feeding of 100 ppm MMTS for 5 weeks significantly decreased the number of aberrant crypt foci/colon. Colonic mucosal ornithine decarboxylase activity and the number of silver-stained nucleolar organizer regions per nucleus in colonic epithelium were significantly decreased by MMTS treatment compared with those of AOM alone. In experiment 2, effects of dietary feeding of MMTS at two doses (20 and 100 ppm) during the postinitiation phase on intestinal tumorigenesis initiated with AOM were investigated by using a long-term experiments in male F344 rats. Incidence of intestinal neoplasms of rats fed MMTS-containing diets after AOM exposure were reduced in a dose-dependent manner. Feeding of MMTS during the postinitiation phase decreased the number of aberrant crypt foci/colon, colonic ornithine decarboxylase activity, 5-bromodeoxyuridine-labeling index in colonic epithelium, and polyamine level in blood compared with those of AOM alone. These results suggest that MMTS might be a possible chemopreventive agent for intestinal neoplasia.

To characterize regional cardiac sympathetic dysfunction due to myocardial ischemia, we examined 123I-metaiodobenzylguanidine (MIBG) myocardial distribution of initial 15-min and 4-hr delayed SPECT images in 14 patients with recent myocardial infarction (MI), 25 patients with vasospastic angina which was angiographically proven with elgonovine maleate (Gp VSAP) and 16 patients with chest pain syndrome and normal CAG findings (GpCP). In those with MI, the study was serially done at 2 weeks after (Gp MI-1) and at 3 months after the onset of MI (Gp MI-2). We estimated regional tracer uptake in 20 segments of tomographic images by using a 4-point scoring system (0 = normal, 1 = mild, 2 = moderate, 3 = severe reduction) and calculated the total defect score (IDS). In all patients with MI, the area of reduced MIBG uptake was more extensive than the 201Tl perfusion defect in the acute stage (Gp MI-1) indicating the presence of viable but denervated myocardial tissue. Also, the MIBG defect was persistently observed from initial (TDS: 24 +/- 13) to delayed imaging (TDS: 26 +/- 12). However, in the chronic stage (Gp MI-2), the initial MIBG uptake improved (TDS: 18 +/- 9) but the delayed uptake remained almost the same (TDS: 22 +/- 10) indicating high washout of MIBG from the ischemic myocardium. Fourteen in Gp VSAP and 14 in Gp CP showed the regional MIBG defect in the delayed image more extensively than in the initial image indicating high washout of MIBG in the involved myocardial regions. These results suggest that neuronal uptake of MIBG is impaired in the acute stage of MI although neuronal retention of MIBG is predominantly impaired in the chronic stage of MI or in Gps VSAP and CP.

We evaluated the relationship between free fatty acid metabolism using 123I beta-methyl-iodophenyl pentadecanoic acid (BMIPP) and cardiac function in acute myocardial infarction. Twenty-five patients were examined with 123I-BMIPP and 201Tl dual SPECT. The 123I-BMIPP images were compared with the 201Tl images and the left ventricular wall motions. The 123I-BMIPP images showed a larger uptake defect than the 201Tl images. This was marked in the patients after revascularization therapy. The uptake decrease of 123I-BMIPP was in good agreement with the decrease in regional wall motion. The incidence of accordance was 79% of the wall segments. The correlation between 123I-BMIPP defect size and ejection fraction was higher (r = -0.54) than that of 201Tl (r = -0.44). Subtraction of ejection fractions four weeks and soon after infarction correlated well with the subtraction of 123I-BMIPP and 201Tl defect sizes (r = 0.55). In conclusion, 123I-BMIPP is more closely related to wall motion, than 201Tl and might be valuable in predicting the functional improvement of acute myocardial infarction.

The purpose of this article is to report the finding of transient focal increased attenuation of the liver adjacent to the gallbladder on enhanced CT scans in patients with acute cholecystitis. This finding should not be confused with primary liver abnormalities.Five patients with acute cholecystitis were studied. Because a thickened gallbladder wall was seen on sonography, all patients were examined preoperatively with incremental dynamic helical CT to exclude carcinoma of the gallbladder. CT findings were compared with results of sonography for five patients, MR imaging for two patients, and surgery for five patients.Transient focal increased attenuation of the liver adjacent to the gallbladder was seen in the early phase of incremental dynamic CT in five patients and extended into the medial segment anterior to the porta hepatis. The areas showing increased attenuation adjacent to the gallbladder had a curvilinear shape around the gallbladder. No hepatic masses were seen on sonograms, on MR images, or at surgery.Transient focal increased attenuation of the liver may occur on CT scans in patients with acute cholecystitis. The increased attenuation associated with acute cholecystitis has a typical location and pattern. This finding is probably attributable to hepatic arterial hyperemia and to early venous drainage caused by the adjacent inflamed gallbladder. This finding should be differentiated from hypervascular hepatic tumors.

A 50-year-old man was admitted to our hospital, because of weakness in his right leg. On admission, he had generalized hyperreflexia and positive Babinski signs bilaterally. After admission, weakness in his left leg and confusion developed. A cerebrospinal fluid examination revealed increases in cell counts and protein but was negative for malignant cells. Blood chemistry was normal except for elevated LDH. A bone marrow biopsy yielded lymphoma cells. Successive T2-weighted cranial MRI showed a progressively expanding high signal area in the right parieto-occipital lobe. His confusional state improved after chemotherapy; however, two months later another cranial CT showed multiple enhanced mass lesions. The patient died 20 months after the onset of illness. Postmortem examination revealed widespread intravascular aggregates of malignant lymphomatous cells in the cerebrum, lungs and kidney, as well as multiple infarcts without atherosclerosis in the cerebrum. These pathological findings are compatible with those of intravascular malignant lymphomatosis. In addition, extravascularly expanding tumor cells formed multiple nodular lesions in the cerebral hemisphere. An immunohistochemical study showed that the tumor cells were positive for B-cell marker L26. Intracranial lymphomatous mass lesion rarely occurs in cases of intravascular malignant lymphomatosis. In the present case, tumor cells were presumably restricted to intravascular spaces, occluded them and resulted in ischemic lesions in the cerebrum in the early phase, but they expanded extravascularly and developed mass lesions in the terminal stages. In conclusion, intravascular malignant lymphomatosis is considered to be phenotypes of malignant lymphoma. This is the first case of intravascular malignant lymphomatosis associated with intracranial lymphomatous mass lesions in Japan.

To evaluate the inflammatory response to the cardiopulmonary bypass, we investigated the serum levels of tumor necrosis factor alpha (TNF alpha), interleukin 8 (IL-8), and the expression of leukocyte adhesion molecule CD18. Six patients who underwent elective coronary artery bypass grafting were studied. TNF alpha was elevated significantly 30 minutes after the start of CPB and returned to the baseline 60 minutes after CPB. IL-8 increased significantly after the start of CPB and reached a peak at 10 minutes after release of the aortic cross-clamp, remaining significantly elevated until 10 minutes after the end of CPB (P0.05). Circulating neutrophil count and granulocyte elastase increased significantly 10 minutes after release of the aortic-cross clamp and remained high until the first postoperative day. The increase of the neutrophil CD18 expression was not observed. This study demonstrates elevated TNF alpha and IL-8 levels during CPB followed by increases of the neutrophil and the granulocyte elastase, which may be of importance in the systemic inflammatory response to CPB, especially in the development of postperfusion lung injury.

We have recently encountered three patients who developed prolonged muscle paralysis after long-term infusion of muscle relaxants and administration of large doses of steroids. Among many factors implicated in the cause of this paralysis, steroids and muscle relaxants were suggested to be most likely causative agents. In order to avoid such muscle paralysis, we must be careful to limit the dose of relaxants as small as possible. For this purpose, monitoring of neuromuscular blockade is indispensable.

The modifying effects of two natural products, curcumin and hesperidin, given during the initiation and postinitiation phases of oral carcinogenesis initiated with 4-nitroquinoline 1-oxide (4-NQO) were investigated in male F344 rats and compared with that of beta-carotene. At 6 weeks of age, rats were divided into experimental and control groups and fed the diet containing beta-carotene, hesperidin, or curcumin at a dose of 0.5 g/kg diet (500 ppm). At 7 weeks of age, all animals except those treated with each test chemical alone and control groups were given 4-NQO (20 ppm) in the drinking water for 8 weeks to induce oral cancer. Seven days after the 4-NQO exposure, groups of animals fed the diets containing test chemicals were switched to the basal diet and continued on this diet until the end of the study. Starting 1 week after the stop of 4-NQO exposure, the groups given 4-NQO and a basal diet were switched to the diets containing beta-carotene, hesperidin, and curcumin and maintained on these diets for 22 weeks. The other groups consisted of rats given 500 ppm beta-carotene, hesperidin, or curcumin alone or untreated rats. All animals were necropsied at the termination of the experiment (week 32). The incidences of tongue neoplasms and preneoplastic lesions, polyamine levels in the tongue tissue, and cell proliferation activity estimated by bromodeoxyuridine-labeling index and by morphometric analysis of silver-stained nucleolar organizer region proteins were compared among the groups. Feeding of curcumin and beta-carotene during the initiation and postinitiation phases and hesperidin at the initiation stage caused a significant reduction in the frequency of tongue carcinoma (41-91% reduction, P0.05) and the order of chemopreventive efficacy was curcuminbeta-carotenehesperidin. The incidences of oral preneoplasia in rats fed the diets mixed with these compounds were also decreased (P0.05). There were no such lesions in rats treated with test compounds alone or those in an untreated control group. Dietary administration of these compounds significantly decreased the labeling index of bromodeoxyuridine and the number and area of silver-stained nucleolar organizer region proteins per cell nucleus that are proliferation biomarkers, of the tongue squamous epithelium (P0.05). In addition, polyamine levels in the oral mucosa were lowered in rats treated with 4-NQO and three test compounds when compared to those give 4-NQO alone (P0.05).(ABSTRACT TRUNCATED AT 400 WORDS)

One year ago, a 48-year-old man complained of dyspnea, and was diagnosed as mitral valve regurgitation and aortic dissection. He underwent mitral valve replacement and aortic arch grafting. He was also pointed out to have an inflammatory aortic aneurysm (IAAA) in the infrarenal abdominal aorta, but did not undergo surgery. At this admission, he had lumbago and low grade fever probably due to deterioration of the IAAA. On the preoperative radionuclide studies, inferior vena caval obstruction and bilateral ureteral obstruction or severe stenosis were demonstrated by 99mTc-MAA venography and 123I-OIH renogram, respectively. 67Ga scan showed faint abnormal accumulation at the IAAA. He underwent surgery. IAAA had a thick wall in white and hard fibrotic tissue adhered closely to duodenum, jejunum, inferior vena cava and bilateral ureters. After surgery, his renal function was improved. In this case, radionuclide studies were useful for detecting the inferior vena caval obstruction, assessing renal function and inflammatory activity.

To standardize the regional cerebral count with 99mTc-HMPAO, equilibrium blood count of which trapping mechanism is the same as the brain was used in seven patients with cerebrovascular disease. We injected 99mTc-HMPAO 740 MBq in 10-15 sec and got sequential arterial sampling in patients who were undertaken with PET. Four hours later 99mTc-HMPAO brain SPECT was taken and a venous sampling was drawn for determining the equilibrium blood count. Correlation between the area of arterial time activity curve and equilibrium venous blood count was 0.93. After 44 regions (36 in cortical area, 8 in deep area) with 99mTc-HMPAO brain SPECT were placed, SPECT counts were corrected by standardization of equilibrium venous blood count. The correlation between rCBF determined from C15O2 PET and corrected SPECT counts was 0.80 and 0.67, cortical area and deep area, respectively. We concluded that 99mTc-HMPAO brain SPECT count can be corrected by equilibrium blood count to standardize the regional cerebral counts.

Plasma cell leukemia is a rare disorder with poor prognosis. We present a case of non-secretory primary plasma cell leukemia (Bence-Jones kappa type), which was treated successfully by VEP-IFN-alpha therapy. A 82-year old man was admitted to Kanazawa Medical University in May 1991, because of emaciation and dehydration. Clinical findings showed decreased level of gamma-globulin (IgG, IgA and IgM were all decreased markedly), hypercalcemia, renal dysfunction and increased serum beta-2 microglobulin. The peripheral blood leukocyte count was 30,100/microliters with 64% plasma cells, and 80.4% plasma cells were also observed in the bone marrow. Only light chain-kappa was detected in plasma cells by an immunohistochemical staining method, but immunoelectrophoresis showed no M-bow either in serum or urine. Electron microscopy revealed typical plasma cells with prominently developed rough endoplasmic reticulum. From these results, the diagnosis of non-secretory primary plasma cell leukemia was established. He was treated with VEP-IFN-alpha regimen, and plasma cells decreased markedly in both peripheral blood and bone marrow. Serum immunoglobulin recovered to within the normal range. After 6 courses of VEP-IFN-alpha, complete remission was achieved and the remission was maintained until he died of an unrelated event, bronchial obstruction due to misswallowing, in April 1992.

We report a case of T-lymphoblastic lymphoma in which lymphoma cells infected with cytomegalovirus were found in the pleural fluid. A 16-year-old boy with an anterior mediastinal mass developed pleural fluid accumulation. Immunoperoxidase staining of pathologic cells in the pleural fluid revealed them to be CD4+/-, CD7+, CD8-, CD34+, CD20- and HLA-DR+. The diagnosis of lymphoblastic lymphoma T-cell type was made. Electron microscopic examination revealed virus particles with an electron-dense core and capsid, late structures of virus, in the pleural fluid cells. Polymerase chain reaction (PCR) amplification was used to detect human cytomegalovirus (HCMV) DNA in pleural fluid cells. A pair of synthetic oligonucleotide primers from the CMV phosphoprotein 71, an early structural protein, coding region (HindIII fragments L, c and b of the Ad 169 strain) could amplify DNA from the pleural fluid cells from the patient. Immunoperoxidase staining of the pleural fluid cells with anti-HCMV positive sera also revealed a positive reaction. These findings suggest the entry of HCMV into lymphoma cells with positive PCR amplification of DNA encoding an early structural protein, and replication from the presence of late structures of virus, electron-dense core and capsid. Replication of lymphoid cell lines of B and T origin were reported in the literature but replication of HCMV in lymphoma cells in vivo has not been reported.

We measured cerebrospinal fluid (CSF) levels of manganese superoxide dismutase (Mn SOD) using an enzyme immunoassay method in 19 patients with bacterial meningitis (BM), 33 with aseptic meningitis (AM) and 13 with encephalitis (EN), and examined the significance of their elevations, especially in BM. 1) In BM, the Mn SOD levels were obviously high, ranging from 10.4 to 1179.2 ng/ml. The mean level of Mn SOD was 234.6 +/- 306.7 (SD) ng/ml and 18 patients showed abnormal levels of Mn SOD (more than 13.1 ng/ml). On the other hand, in the remaining 2 diseases, the elevation of SOD levels was not remarkable: the mean levels of Mn SOD in AM and EN were 20.6 +/- 11.6 ng/ml and 41.9 +/- 23.6 ng/ml, respectively. 2) In AM and EN, Mn SOD levels well correlated with NSE or S-100b levels which are the markers of nervous tissue damages. But there was no correlation between the Mn SOD levels in BM and these markers. 3) In BM, there was a positive relationship between Mn SOD and total protein levels, but the disease days showing peak levels were different between them. In addition, Mn SOD levels showed no correlation with cell counts in CSF. 4) In BM, CSF levels of TNF-alpha and IL-1 alpha were remarkably high, whereas in AM and EN, the increases of these cytokines were not marked. And these cytokines in BM showed the peak values in the disease day before or when Mn SOD reached the peak levels.(ABSTRACT TRUNCATED AT 250 WORDS)

4029 Background: Combination chemotherapy with gemcitabine (GEM) and S-1 has been reported to be promising treatment for advanced pancreatic cancer. In order to evaluate its efficacy and safety, we conducted a multicenter randomized phase II study in patients (pts) with unresectable pancreatic cancer, comparing the combination of GEM and S-1 (GS) with GEM alone (G). Methods: Eligible pts had histologically or cytologically confirmed locally advanced or metastatic pancreatic adenocarcinoma with measurable lesion. Other main inclusion criteria were an age between 20 and 80 years, no prior anticancer treatment, well preserved function of major organs and Eastern Cooperative Oncology Group (ECOG) PS of 0-2. Pts were randomly assigned to receive either GS or G. GS regimen consists of intravenous GEM 1,000 mg/m2 over 30 minutes on days 1 and 8, combined with oral S-1 80 mg/m2 twice daily on days 1-14, repeated every 3 weeks. On the other hand, G includes intravenous GEM 1,000 mg/m2on days 1, 8 and 15, repeated ...

The detectability of coronary diagonal (Dx) branch disease in 24 patients (16 with myocardial infarction, 8 with angina pectoris; mean age of 56) with other branch (left anterior descending branch [LAD], left circumferential branch [LCX], or right coronary artery [RCA]) diseases was reviewed with 201TlCl exercised myocardial planar and SPECT images. In Dx branch disease with LAD #7 lesion (n = 10), Dx perfusion abnormality was detected in planar and SPECT images in 3 (30%) and 8 patients (80%), respectively. In Dx branch disease with LCX lesion (n = 7), Dx perfusion abnormality was detected in planar and SPECT images in 3 (43%) and 4 patients (57%), respectively. In Dx branch disease with RCA lesion (n = 7), Dx perfusion abnormality was detected in only 1 (14%) and 2 patients (29%), respectively. In conclusion, SPECT is a useful modality for detecting Dx branch disease, but it is sometimes hard to detect Dx branch disease with LCX and RCA lesions.

Seventeen of 19 patients (67 +/- 8 yr, 17 males and 2 females) had more than 75% unilateral stenosis or occlusion of the internal carotid or middle cerebral artery and two patients had carotid endarterectomy that previously had 90% stenosis of the internal carotid artery. They were studied during upright 99mTc-HMPAO brain SPECT. HMPA was injected immediately after arising from a supine position. Patients were classified into Group A (n = 10) with occlusion of the internal carotid or the middle cerebral artery or Group B (n = 9) with more than 75% unilateral stenosis of the internal carotid or the middle cerebral artery and with carotid endarterectomy. Additional cerebral blood flow perfusion abnormalities between upright and supine 99mTc-HMPAO brain SPECT were detected in seven patients in Group A and in only one patient in Group B. Semiquantitative analysis showed that the asymmetric ratios between upright and supine positions changed significantly in Group A from 0.82 +/- 0.15 to 0.89 +/- 0.10 (p0.01), but not in Group B, from 0.89 +/- 0.11 to 0.92 +/- 0.12 (ns). Additional perfusion abnormalities were relevant to occlusion of the internal carotid or middle cerebral artery indicated postural cerebral hypoperfusion. We conclude that upright 99mTc-HMPAO brain SPECT visualizes postural cerebral hypoperfusion possibly related to silent cerebral ischemia.

Acute autonomic and sensory neuropathy (AASN), characterized by acute onset of extensive autonomic dysfunction and severe sensory deficits, was first described by Colan et al. (1978). We present two female patients with AASN in whom magnetic resonance imaging (MRI) confirmed such findings in the posterior column of the spinal cord. One patient was a 44-year-old woman who developed an upper respiratory tract infection followed in 2 weeks by numbness of the limbs and gait disturbance. There was orthostatic hypotension with syncope, paretic ileus, anhidrosis and urinary retention. There was a loss of sensation over the entire body, including the face, and deep tendon reflexes were generally absent. Neurophysiologic studies showed that sensory nerve action potentials and SSEPs were not evoked in the nerves examined. Sural nerve biopsy demonstrated severe axonal degeneration of the myelinated and unmyelinated fibers. Our second patient, a 27-year-old woman, exhibited similar clinical and laboratory features. The autonomic dysfunction in both patients improved gradually without drug treatment, but the sensory deficits--predominantly a loss of deep sensation--persisted for several years. In both patients, MRI revealed the T2*-weighted high intensity area in the fasciculus gracilis of the posterior column of the spinal cord. Such high intensity areas were present in all spinal segments. The severe and persistent sensory disturbance in these patients may have been caused by a lesion of the posterior column of the spinal cord following the involvement of the dorsal root ganglion cells, or ganglioneuronopathy, as demonstrated by MRI.

123I-MIBG (MIBG) regional defects in myocardial regions with preserved 201Tl (Tl) uptake have been observed in patients with idiopathic dilated cardiomyopathy (DCM). To evaluate whether the presence of Tl/MIBG mismatched regions is related to the occurrence of ventricular tachycardia (VT), we performed myocardial dual SPECT imaging with Tl (111 MBq) and MIBG (111 MBq) in 17 patients with DCM, 11 (Gp A) with and 6 (Gp B) without VT. Myocardial dual SPECT imaging was performed at 15 minutes after and 4 hours after the tracer injection. The regional tracer uptake was scored visually in 6 segments of the basal, middle, and apical short-axial images and in 2 apical segments of the midventricular vertical long-axial image by a four-point scoring system (0 = normal, 1 = moderate, 2 = severe and 3 = complete defect). Then, the severity of tracer maldistributions was assessed by the difference between total defect scores (TDSs) of Tl and MIBG (delta TDS). TDS was not different between Gps A and B in both Tl and MIBG images. However, delta TDS was larger in Gp A than in Gp B (13.5 +/- 6.5 vs. 5.8 +/- 3.0, p0.05). Also, the number of segments with the mismatched tracer uptake was larger in Gp A than in Gp B (12.5 +/- 3.0 vs. 8.3 +/- 1.5, p0.01). In the electrophysiologic study, we found that the fractionated area corresponded to the mismatched region in 3 of 5 patients in Gp A. These results suggest that regional sympathetic denervation is a possible factor which provocates VT, and myocardial dual SPECT imaging with Tl and MIBG is a useful method for predicting VT in patients with DCM.

We reported a 51-yr-old female with radiation-induced chronic constrictive pericarditis. At age 29, she had received a mastectomy and postoperative irradiation because of left breast cancer. At age 45, she had syncope and was diagnosed with complete atrioventricular block and a pacemaker was implanted. At that time, pericardial thickening with effusion was noted. The following year, tricuspid regurgitation was noted. On catheter study, a dip and plateau pattern of the right ventricular pressure curve appeared. At age 50, tricuspid regurgitation worsened due to the lead wire of the pacemaker compressing the leaflet, and the pacemaker was reimplanted. However, the following year, she complained of general fatigue and dyspnea and was admitted to our hospital. On 67Ga study, diffuse accumulation in the cardiac region appeared. There was no perfusion defect detected in the left myocardium, but right myocardial damage was suspected by thallium study. In 99mTc-HSA RI angiography, right atrium dilatation appeared and a pericardial halo around the ventricles was seen. She underwent pericardectomy, tricuspid replacement and pacemaker reimplanted, but she died. On autopsy, pericardial thickening and adhesion, right myocardial fibrosis, the fibrotic change of the bundle branches were seen. We reported a case of radiation-induced constrictive pericarditis. Radionuclide studies were useful in diagnosing and following the patient.

There is a lack of information on the rates of growth of aortic aneurysms. In the present study, the growth rates and survival rates of thoracic and abdominal aortic aneurysms were determined. One hundred seventy-one patients with aortic aneurysm managed nonoperatively have been followed more than 6 months with sequential X-ray computed tomography. The number of aneurysms was 211 (thoracic aortic aneurysm: 82, abdominal aortic aneurysm: 129). The growth rate of thoracic and abdominal aortic aneurysms were 0.42 and 0.28 cm/year, respectively. Aneurysms at the aortic arch (n = 34) grow at a higher average rate (0.56 cm/year) than aneurysms arising at other levels (p0.05). The survival rates showed the tendency that the higher the growth rate, the worse the survival rate. The survival rate of aortic arch aneurysm was significantly decreased when the growth rate was higher than the mean value. It is recommended that thoracic aortic aneurysms, especially aortic arch aneurysms, be followed frequently with computed tomographic examination of size.

Human TCR gamma/delta cell clones were produced from both CD2-depleted normal peripheral blood mononuclear cells (PBMC) and leukemia and lymphoma cell-predominant PBMC, effusion cells and lymph node cells in in vitro cultures with rIL-1 and rIL-2 and using limiting dilution techniques. These clones were then analyzed as to their cell morphology, phenotype and non-major histocompatibility-restricted cytotoxicity (NMRC) to K562. The results of the cloning from CD2-depleted PBMC showed 112 WT31+ gamma/delta-1- clones, 62 WT31- gamma/delta-1+ clones and 101 WT31- gamma/delta-1- clones. These were produced in 17 serial experiments. The addition of EBV-infected B cell line cells as feeder cells resulted in better production of gamma/delta-1+ and non-T cell clones than that of WT31+ clones. One typical example of the cloning from lymphoblastic lymphoma cell-predominant PBMC resulted in the production of 8 gamma/delta-1+ and 3 WT31+ clones. Most of the clones proven to be gamma/delta-1+ clones had the CD2+ CD3+ CD4(-)-+ CD8(-)-+ TCR delta-1+ beta F1- alpha F1- and delta TCS-1- phenotype, but few clones displayed CD2- or delta TCS-1+ phenotype. These gamma/delta-1+ clones were morphologically large granular lymphocytes, but functionally they did not have NMRC to K562. It is possible to say that TCR gamma/delta clones were rather easily produced from TCR alpha/beta cell-depleted PBMC and effusion cells, and can be used for the study of their nature and characteristics.

To evaluate the effect of intraoperative plasmapheresis on intraoperative and postoperative homologous blood transfusion requirements, we assigned 89 patients undergoing primary CABG procedure to either the experimental group (plasmapheresis, n = 31, A group) or the control group (traditional method, n = 58, B group). All patients underwent hemodilution by withdrawal of autologous blood before cardiopulmonary bypass. In A group, the average volume withdrawn during plasmapheresis was approximately 948 ml (platelet rich plasma (PRP) and red blood cells). We removed an average of 751 ml of whole blood in B group. The percentage of patients without homologous blood transfusion in A group was 40% versus 32% in B group. The difference was not statistically significant. It was concluded that our method of plasmapheresis was effective in reducing homologous blood transfusion, but it was not more effective than the traditional hemodilution method.

We used autotransfusion in valvular heart surgery and evaluated its effect on perioperative homologous blood requirements. Methods of autotransfusion we used were intraoperative blood salvage using Cell Saver 4 and retransfusion (IAT), postoperative autotransfusion of shed mediastinal blood (PAT), and hemodilutional autotransfusion (HAT). The patients undergoing valvular heart operations were divided into three groups; group 1 (control group), group 2 (using IAT and PAT group), and group 3 (using IAT, PAT, and HAT group). Perioperative homologous blood requirements significantly decreased in group 3 compared to group 1 and group 2. Operations without homologous blood transfusion significantly increased in number in group 3 compared with group 1. In conclusion, autotransfusions described above were useful blood conservation techniques in valvular heart surgery.

A human plasmacytoma cell line (AMO1) was established. The AMO1 cells had the light and electron microscopic characteristics typical of plasmacytoma cells and did not harbor Epstein-Barr virus. These cells expressed cytoplasmic immunoglobulin A kappa and the immunoglobulin heavy-chain gene (JH) and kappa light-chain gene (C kappa) were rearranged. Coexpression of a CD4 antigen and plasma cell antigens (CD38 and PCA-1) was an unusual and sustained feature. Neither the T-cell receptor beta nor the gamma chain gene displayed the rearranged form. Other lineage-specific surface antigens, namely T, B, monocytoid, and myeloid antigens, were all negative in AMO1. In accordance with the surface CD4 expression, polymerase chain reaction analysis indicated constitutive expression of CD4 mRNA, and the cytogenetic findings revealed that AMO1 cells had a derivative chromosome 12, which had a structural abnormality of the short arm carrying the CD4 gene locus. These findings provide strong evidence for the presence of CD4-positive malignant plasma cells and raise the possibility that the CD4 expression in the AMO1 cell line is closely associated with the derivative chromosome.

A 13-year-old boy, whose bilateral retinoblastoma had been treated by enucleation (OD) and irradiation (OS), developed anterior staphyloma (OS) necessitating the second enucleation. Histopathological, immunohistochemical and electron microscopic studies revealed malignant teratoid medulloepithelioma of the ciliary body, with demonstrated multipotential histogenesis. This is the first report which demonstrates the development of a second malignant intraocular tumor in an eye previously affected by hereditary retinoblastoma. Careful monitoring of patients who have had hereditary retinoblastoma is necessary because of the potential for a second malignancy.

Sixty-four patients with single left anterior descending artery disease having effort angina (group A: 40 patients without hypertension, group B: 10 patients with hypertrophic hypertension, group C: 14 patients with non-hypertrophic hypertension) were assessed the influence of hypertensive left ventricular (LV) hypertrophy on detection of ischemic area. The criterion of hypertrophy by two-dimensional echocardiography was12 mm in the wall thickness of interventricular septal or posterior wall. Population in Group B might show low detectability in ischemic area by 201Tl myocardial scintigraphy (positive thallium rate 60%, defect score 2.7 +/- 3.6), and high lung thallium uptake and high frequence of ECG positive among three groups. In semiquantitative analysis, the washout rate of the posterolateral wall and %RD (delayed %uptake-initial %uptake) of the septal wall in patients with Group B were lowest among three groups. However, the washout rate in the septal wall against the posterior wall, and the initial %uptake and the delayed %uptake of the septal wall were not significantly different among three groups. We could conclude that the decreased washout rate in nonischemic area with hypertensive LV hypertrophy might make the ischemic area masked.

We investigated the clinical significance of carotid and ocular bruits in 250 consecutive patients with cerebrovascular disease (CVD). The incidence of bruits was compared with that in 100 age- and sex-matched neurological controls without CVD. In the cerebrovascular disease group, carotid bruits alone were found in 12 patients, both carotid and ocular bruits in 7, and ocular bruits alone in 2. Carotid bruits were found only in 3 controls. We then evaluated cerebrovascular disease in the 25 patients (16 men and 9 women) who had bruits. The patients ranged from 55 to 81 years in age (mean: 70.6 years). The patients with carotid bruits alone constituted the largest group, and those with ocular bruits alone were the smallest group. Carotid bruits were heard and abnormal blood flow was observed in 19/28 arteries of the 21 patients who underwent echo-flow studies. Carotid artery stenosis/occlusion was detected in 24/31 arteries (77%) in 23 patients who underwent digital subtraction angiography (DSA). Thus, the sensitivity was 0.77 and specificity of a carotid bruit 0.91, respectively. In 9/10 patients with unilateral ocular bruits, ipsilateral or contralateral carotid artery stenosis/occlusion was detected. Diminished cerebral blood flow was observed in 10/15 patients with bruits who underwent SPECT. Of these 8 had reduced cerebral blood flow ipsilaterally to the bruit. Blood flow was reduced in the carotid artery territory in all of the patients, and watershed reductions were commonest. Among the 25 patients, some showed neurological semiology of the vertebrobasilar territory in addition to that of the carotid territory.(ABSTRACT TRUNCATED AT 250 WORDS)

The detectability of diagonal branch disease in 10 patients (five with angina pectoris, five with myocardial infarction) with isolated diagonal branch lesions (more than 75% luminal stenosis in coronary angiography) was reviewed. In exercised 201TlCl myocardial scintigraphy, chest pain occurred in four of 10 patients, electrocardiographic change indicating myocardial ischemia was seen in four, and diagonal branch lesion was detected in only four patients by planar images. In contrast, diagonal branch lesions were detected in 10 of 10 patients by SPECT (single photon emission computed tomography). In planar images, perfusion defects appeared high in the anterolateral, posterolateral, and anterior walls of the left ventricle. In SPECT images they appeared high in the anterior to anterolateral wall. The extent of diagonal branch lesions could be quantitatively evaluated by coronary territory maps developed from unfolded maps of exercised SPECT. The mean ratio of the extent of diagonal branch lesion to left anterior descending branch territory was 24.7%, and the extent of myocardial infarction was significantly larger than that of angina pectoris (p0.05). In conclusion, SPECT is useful for detecting diagonal branch lesions and can quantitatively show the extent of these lesions by coronary territory map.

A 60-year-old man who had had chronic empyema following an artificial pneumothorax for pulmonary tuberculosis when he was 26 years old developed malignant lymphoma of the chest wall. The patient was admitted because of right pyothorax as a result of pseudomonas aeruginosa infection and underwent right thoracotomy. During lavage of the right thoracic cavity a tumor was found arising from the empyematic wall. Pathologic examination revealed that it was malignant lymphoma (diffuse large, immunoblastic, B cell type). Treatment with VEAP-Bleomycin elicited a good response. Seven months after chemotherapy, the patient underwent thoracoplasty in addition to packing the cavity with the latissimus dorsi and the greater omentum. Following this, the patient received chemotherapy once a month for one and a half years, after which he was kept under close observation without treatment. Complete remission has now lasted for 49 months since the initial treatment. This is the first reported lymphoma case with closure of the empyematic wall and is remarkable since this patient has remained in complete remission for the last two years without any treatment.

99mTc-HMPAO crossed the blood brain barrier instantly in proportional to cerebral blood flow. Raise up stress and supine resting 99mTc-HMPAO with brain SPECT was devised for detecting abnormal response in the changes of cerebral perfusion pressure. Asymmetric ratio in the middle cerebral artery area in patients with internal carotid artery occlusion (n = 5) was changed significantly from 0.82 +/- 0.06 to 0.90 +/- 0.06 and that of normal (n = 5) was not changed from 0.94 +/- 0.03 to 0.95 +/- 0.01. Raise up 99mTc-HMPAO brain SPECT enhanced the detectability in abnormality of regional cerebral blood flow and visualized the dys-autoregulated area during blood pressure falls.

To evaluate the growth rate of abdominal aortic aneurysms, sequential computed tomography (CT) examinations were performed on 125 nonoperated patients (M/F 101/24, mean age 67 +/- 8 years, 129 lesions) at intervals of at least 6 months. Growth rates of aneurysms were obtained by subtracting the first from the last diameter and adjusting for examination interval. Mean growth rate was 0.28 +/- 0.26 cm/year. Aneurysms with an initial diameter exceeding 4 or 5 cm showed significantly faster growth than smaller aneurysms. There was no significant correlation between growth rate and atherosclerogenic factors, but systolic blood pressure was significantly higher in patients whose aneurysms ruptured. Our study showed quantitatively that aneurysms with a large diameter have a rapid growth rate, the growth rate of infrarenal aneurysms is significantly faster than that of suprarenal aneurysms, and blood pressure control is important to prevent rupture.

To evaluate the efficacy of blood conservation technique at our center, 144 patients undergoing primary coronary artery bypass grafting were studied between Jan. 1988, and Dec. 1990. Combined intraoperative and postoperative autotransfusion technique reduced the requirement of homologous blood to a half and 24% of the patients were without homologous transfusion. With more use of dilutional autotransfusion, 41% of the patients were without homologous transfusion. Intraoperative and postoperative autotransfusion technique is effective and dilutional autotransfusion is also a relatively effective method to reduce homologous transfusion.

To determine the utility for detecting ischemic heart disease (IHD), Dipyridamole thallium myocardial images (DIP-Tl) have been performed in the 103 patients with atherosclerotic vascular disease who can't exercise fully. Of 103 patients, there were 36 patients with arteriosclerosis obliterans (ASO), 31 patients with aneurysm of the abdominal aorta (AAA), 24 patients with aneurysm of the thoracic aorta (TAA) and 12 patients with dissecting aortic aneurysm (DAA). Clinical evidence of IHD was found in 20 patients with ASO, 10 with AAA, 7 with TAA and 4 with DAA respectively. Positive evidence of DIP-Tl was identified in 66% of 41 patients who had clinical evidence of IHD, and particularly in the patients with AAA (80%) and ASO (65%). On the other hand, in the patients without clinical evidence of IHD, positive evidence of DIP-Tl was identified in 19% of 62 patients and particularly in the patients with AAA (39%). In all patients, the percentage of the positive DIP-Tl ratio was 38%. And, when the 38% patients of the positive DIP-Tl were added to the patients of the negative DIP-Tl who had clinical evidence of IHD, almost half patients (51%) were considered to be complicated with IHD. This study suggests that the atherosclerotic vascular disease is highly complicated with IHD and DIP-Tl is useful to detect IHD.

In order to study the factors responsible for glucose uptake in the mouse hippocampus, microvessel and astroglial cell densities were measured and compared in each laminal region. Microvessel density was examined on histologically prepared sections after injection of Indian ink and measured by means of an image analyser. Astroglial cell density was determined after the cells were stained immunohistochemically. Microvessel and astroglial cell densities were determined in 10 different hippocampal structures. Microvessel and astroglial cell densities were strongly correlated in all layers except the pyramidal cell layers. The highest density of perfused microvessels was found in the stratum lacunosum-moleculare, compared with other regions, and the lowest values were found in the stratum lucidum and dentate granular cell layer. Among pyramidal cell layers, microvessel density in sector CA3a was significantly higher than that in CA1.

The abnormal organization of actin-containing microfilaments and vimentin-containing intermediate filaments in neoplastic lymphocytes of T and B cell origin has been described. We investigated microtubules of pathologic cells from 34 lymphoid malignancies, by immunofluorescence microscopy, using monoclonal tubulin antibody. In most cases, apart from two cases of lymphoma, one T cell lymphoma and one B cell lymphoma, interphase leukemia cells, lymphoma cells, and myeloma cells were shown to contain well-organized microtubules which were associated with a microtubule organization center at one end. In the cells of a patient with T cell lymphoma, although microtubules were not visible in the lymphoma cells from lymph nodes, they became visible after 72 hours in culture with concanavalin A (Con A) and interferon alpha. Cap formation was observed with antitubulin monoclonal antibody in the peripheral blood lymphocytes from a chronic lymphocytic leukemia patient, but well-developed microtubules were observed on other occasions in the same patient. There were no obvious structural differences between microtubules in T and B cell lymphoid malignancies, but leukemia cells and lymphoma cells with irregularly shaped nuclei, such as adult T cell leukemia cells and B cell lymphoma cells with cleaved nuclei, had complicated microtubules surrounding their irregular nuclei. In general, after blastogenic stimuli with phytohemagglutinin-P (PHA-P), Con A, and pokeweed mitogen (PWM), the development of the microtubules was proportional to the incorporation of 3H thymidine (3H-TDR). In most cases, after incubation with granulocyte colony-stimulating factor (G-CSF) and interferon alpha, the number of intact cells decreased and the number of degenerated cells increased, but the intact cells had intact microtubules.

Magnetic resonance (MR) imaging was performed in 147 patients with compressive lesion of the cervical spinal canal. Intramedullary high intensity lesions were observed on T2-weighted or proton density spin-echo images in patients with cervical spondylotic myelopathy (20.0%) and ossification of the posterior longitudinal ligament of the cervical spine (25.7%), while such signal abnormality was not found in patients with cervical spondylotic radiculopathy. Frequency of this finding was proportional to clinical severity of myelopathy and degree of spinal cord compression. The pathophysiological basis of such signal abnormality was presumed to vary from acute edema to chronic myelomalacia. In most cases showing intramedullary high intensity lesion, the spinal cord was compressed at multiple levels, but the high intensity was usually found at a single level where the compression was maximum. There was a good correlation between the neurological level and the high intensity level on MR images. Thus the intramedullary lesion on MR images is considered to be the main site of lesion responsible for the neurological symptom.

House dust mite (Dermatophagoides farinae) antigen was measured by enzyme-linked immunosorbent assay in house dust samples obtained from the bed rooms of asthmatic children and normal controls. In 37 rooms where regular vacuum cleaning was performed, the mean of D.f. antigen was 4.42 +/- 7.55 micrograms/m2. In the 24 bed rooms of asthmatic children, mean levels of D.f. antigen decreased significantly (p less than 0.05) after intensive cleaning (systematic cleaning) was continued for 4 weeks (0.78 +/- 0.93 micrograms/m2) compared to prior to initiation of systematic cleaning (4.12 +/- 6.31 micrograms/m2). Symptom scores decreased in 65% of the asthmatic children. In 8 bed rooms of normal controls, mean levels of D.f. antigen also showed a decrease after systematic cleaning (0.43 +/- 0.62 micrograms/m2) compared to before (5.59 +/- 12.46 micrograms/m2). However there was no significant difference in D.f. antigen between the bed rooms of asthmatic children and normal controls. Intensive cleaning markedly decreased the allergen in both groups, clearly suggesting effectiveness in the reduction of asthmatic attacks in patients and perhaps also in preventing sensitization of healthy children.

Diagnostic ability of Magnetic Resonance Imaging (MRI) was evaluated in 41 patients with pancreatic cancer who underwent surgery 1 to 43 days following MRI. MRI of surgical specimens revealed that pancreatic cancer and caudal pancreatitis showed similar intensities when compared with the normal pancreas. The usefulness of the contrast medium, Gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA), was confirmed in the differentiation between cancer and caudal pancreatitis. In the diagnosis of tumor extension, portal vein invasion was better diagnosed by MRI than by angiography. (Spearman's rank correlation test showed higher correlation in MRI than in angiography, p = 0.501, 0.464, respectively.) In the diagnosis of the invasion to the anterior pancreatic capsule its sensitivity was 43%, specificity 81% and efficiency 59%. Retropancreatic invasion was diagnosed with a sensitivity of 48%, a specificity of 90% and an efficiency of 59%. Lymph-node metastasis was well demonstrated especially near the pancreas but beyond them it was difficult. The liver metastasis was correctly diagnosed in 7 of 9 cases and was confirmed by laparotomy.