岡山医学会Acta Medica Okayama0030-155810311-121991肺小細胞癌の化学療法に関する研究 第2編 肺小細胞癌完全寛解例における再発様式の検討13111321ENHidetoshiYamashitaBetween 1976 and 1987, a total of 180 patients with small cell lung cancer who were entered into three protocol studies of an intensive chemotherapy with or without radiotherapy was fully evaluated for tumor response and survival. Of them, 74 patients achieved a complete response (CR) : 47 out of 91 patients with limited disease (LD) and 27 out of 89 patients with extensive disease (ED). The author analysed the pattern of relapse among the 74 patients in an attempt to clarify the role of chest irradiation and/or prophylactic cranial irradiation. Of 47 patients with LD achieving a CR, 20 patients (43%) developed initial relapse in the chest and seven (15%) developed it in the brain. Of the 27 patients with extensive disease, the chest was also the most frequent site of initial relapse (44%) followed by the brain (19%). In patients with LD receiving chemotherapy plus chest irradiation, the rate of initial relapse in the chest and the cumulative actuarial probability for initial chest relapse 2 years later were 29% and 37%, respectively. These figures were siginificantly lower than the rate of 69% and the probability of 69% for patients receiving chemotherapy alone (p<0.05). The patient survival was improved by the addition of chest irradiation substantially, but not significantly. However, long-term disease-free survivors predominated in the group of patients receiving chemotherapy plus chest irradiation. Prophylactic cranial irradiation exerted no significant advantage for prolonging survival. However, it showed a trend for reducing the brain relapse in complete responders. These findings indicate that chest irradiation concomitant with intensive chemotherapy may be effective for prolonging suvival in patients with LD through preventing relapse from the chest.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991肺小細胞癌の化学療法に関する研究 第1編 Adriamycin 耐性ヒト肺小細胞癌細胞株の耐性解除に関する検討13011310ENHidetoshiYamashitaUsing adriamycin-resistant human small cell lung cancer cells (SBC-3/ADM), which were 30-fold more resistant to adriamycin than the parent cells (SBC-3), the ability of membrane-modifying agents to overcome the drug resistance was analyzed by a soft agar clonogenic assay. SBC-3/ADM was not circumvented by hyperthermia of 42℃ or amphotericin B at a concentration of 50μ M. Verapamil did not enhance the adriamycin cytoxicity in the SBC-3 cells at a concentration of 10μ M, but a 3.2-fold increase in the drug effect occurred in the SBC-3/ADM cells in terms of LD(70). The efflux of intracellular [H(3)] daunomycin from SBC-3/ADM cells was inhibited by verapamil, while the inhibition did not occur in the parent cells. Furthermore, quinidine (50μ M), cepharanthin (10μ M) and chloroquine (50μ M) enhanced the adriamycin cytotoxicity in the SBC-3/ADM cells. These findings suggest that some membrane-modifying agents could partially overcome the acquired resistance to adriamycin in human small cell lung cancer.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991高濃度分岐鎖アミノ酸を窒素源とする成分栄養剤の侵襲下における効果―肝切除ラットを用いて―12871299ENMinoruMizutaThe nutritional influence of branched chain amino acids (BCAA) and lipids in surgical stress was examined after 70% hepatectomy in rats. Two types of elemental diet (ED) were given through the gastrostomy tude for 7 days. Group A : ED containing 33% BCAA and 30% lipid (medium chain triglycerides 8.5g＋soy bean oil 1.5g/300 kcal). Group B : ED containing 17% BCAA and 1.5% lipid (soy bean oil 0.49g/300 kcal). Up to the 7th postoperative day, the excretion of nitrogen into urine decreased in group A, but no change occurred in group B. Up to the 5th postoperative day, molar ratio of 3MH to creatinine in urine in group A decreased more rapidly than in group B. Plasma concentration of albumin in group A was higher than in group B on the 7th postoperative day. Fischer ratio was significantly higher in group A than in group B on the 7th postoperative day. Both plasma and muscle levels of Tyr, Met and Gln were higher in group B than in group A, Glu and Ala were lower in group B than in group A. Essential fatty acid deficiency occurred more severely in group B than in group A. While fatty livers were microscopically observed in some livers in group B, there were few fatty deposits in group A.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991老人斑，Alzheimer 神経原線維変化，Pick 嗜銀球の超高倍率走査電顕的観察12671286ENKeisukeKuyamaSenile plaques, neurofibrillary tangles, and Pick bodies were examined by modified scanning electron microscopy from a low-power to an ultra high-power range. The amyloid core of the typical plaques was found to be composed of radially arranged rod-shaped components, which were made up of dense aggregation of meandering moniliform amyloid filaments about 15 nm in diameter. Bands with a mesh-like structure were observed outside the crown around the core. The compact plaques were nearly identical to the core alone of the typical plaques. The primitive plaques as a whole were analogous to the mesh-like structure around the typical plaques, and they both contained aggregates of filaments closely resembling amyloid fibers. In neurofibrillary tangles, the flamed shape stretched straight to the peripheries, the globosed shaped formed vortices, and only bundles of parallel filaments were observed. PHFs that constituted these structures were 25-30 nm in diameter, and many appeared constricted to a diameter of about 15 nm by rotating 180° to the left at a cycle of 70-80 nm. In Pick bodies, filaments were interwoven and formed a mesh-like structure, numerous granules were attached the filaments. Some filaments were large, being 20-30 nm in diameter, others were thin, being about 15nm in diameter.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991脂肪（MCT）および高濃度分枝鎖アミノ酸を含有した成分栄養剤の侵襲下における効果12531265ENKazunagaSuehiroThe effects of a new enteral diet (ED-9) that was mainly composed of BCAA enriched amino acids, MCT and maltose were examined. Rats were subjected to small bowel resection and were administered two different formula for 7 days. The animals were divided into the following four groups : Sham operation and ED-9 (Group A), sham operation and control diet (Elental) (Group B), small bowel resection and ED-9 (Group C), and small bowel resection and control diet (Group D). Body weight loss after operation was similar in both ED-9 and control diet groups. Nitrogen balance and uninary 3 Methy1-histidine excretion demonstrated that ED-9 tended to improve protein preservation. Rats given ED-9 showed elevated ketone bodies and plasma BCAA level but these levels were not extraordinarily high. In conclusion, the formula of enteral nutrition (ED-9) was as effective as Elental on postoperative nutrition in rats.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991Pick 病の脳幹病変―光顕所見ならびに計測的研究―12371251ENTeruyukiOdaLight microscopic and morphometric studies were performed on brain stem lesions in 8 patients with Pick's disease. Neuronal loss and gliosis were observed in the red nucleus, substantia nigra, and the nucleus of locus ceruleus, but its degree was slight or moderate. Argyrophilic inclusions were observed in 4 patients, strongly argyrophilic in 2 of them and slightly argyrophilic in the other 2. Demyelination was noted in the fronto-pontine tract of the cerebral peduncle in 5 patients, and degeneration was observed in the longitudinal pontine fascicules. Measurements of the specimens showed a smaller brain stem, midbrain, and the pons in the patients with Pick's disease than in the control group ; the difference was the most marked in the midbrain followed by the pons. The medulla oblongata did not differ between the two groups. Both tegmentum and the base were smaller in the midbrain, and the base was smaller in the pons. However, the area/brain weight did not differ between the two groups. The substantia nigra showed a reduction in number of cells and area in the patient group than in the control group. Cells containing melanin were significantly decreased on all the medial, central, and the lateral sides, but the number of cells not containing melanin was similar between the two groups. The decrease in area was more marked. Therefore, the cell density was higher in the patient group. Thus, in the patients with Pick's disease, degeneration was observed at various sites of the brain stem. Some of the changes were secondary to damage to the cerebrum and basal ganglia, but others were primary lesions.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991体外循環下における心筋の虚血再灌流に関する検討-h-SOD の効果と至適投与量-12251235ENYukioYamadaThe efficacy of recombinant human superoxide dismutase (h-SOD) was examined and its optimal dose when given before reperfusion in an experimental canine cardiopulmonary bypass (CPB) model was determined. Mongrel dogs were placed on total CPB for 130 minutes without aortic cross clamping (Group Ⅰ). Others were placed on CPB for 120 minutes aortic cross clamping with intermittent administration of cardioplegic solution and core cooling (Group Ⅱ). Before reperfusion, saline, and 1 mg, 3 mg, 10 mg and 20 mg h-SOD per kilogram were administered via the aortic root as a bolus injection (Group Ⅲ,Ⅳ,Ⅴ,Ⅵ,Ⅶ). Reperfusion after hypothermic global ischemia with aortic cross clamping deteriorated cardiac function (cardiac index, left ventricular maximum dp/dt), increased myocardial water content and increased cardiac enzyme release (creatinine kinase MB isozyme, α-hydroxybutyric dehydrogenase). Administration of 3 mg/㎏ h-SOD significantly ameliorated this reperfusion injury, protected myocardial function early after CPB and gave a desirable peak serum h-SOD concentration.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991光硬化性樹脂プレポリマーを用いる脱窒菌の固定化に関する研究12151224ENTsutomuItadaniThe denitrifiers isolated from the activated sludge of night soil treatment plant were immobilized using a photo-crosslinkable resin prepolymer. Denitrifying activity was strongly inhibited during the first period but the activity was increased in the medium containing nitrate and recovered after 1 day. Acetate was an effective hydrogen source and soap was also effective. Methanol could not serve as a hydrogen source. The optimum pH for denitrification by the immobilized bacteria was 7.0 for nitrite and 7.5 for nitrate, and the optimum temperature ranged 30℃ to 40℃. The lowest CH3COONa/NOx-N ratio nessary for getting the highest activity was 4 for nitrite (BOD/NO2-N＝2) and 5 for nitrate (BOD/NO3-N＝2.5). Photo-crosslinkable resin prepolymer gels exhibited stable denitrification activity to the secondarily treated sewage contained 70mg/l of soap.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991固定化活性汚泥を用いる排水処理実験12071214ENTsutomuItadaniYosikazuHiraiYasuhiroKanemasaEikoNagamachiActivated sludge obtained from the night soil treatment plant was immobilized using acrylamide and nitrification and the BOD removal of the sewage were studied by using the immobilized activated sludge which was packed in a single treatment tank. The findings indicated that the ratio of nitrification in the immobilized gel tank was larger than that in the free activated sludge tank in every operation period, and the rate of BOD removal in the immobilized gel tank was roughly equal to that in the free activated sludge tank in this condition. The findings indicated that the application of immobilized activated sludge to the sewage treatment enabled the sewage treatment process to be more efficiency and compact.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991体表面電位図による心肥大の病態の推定と鑑別診断―特に肥大型心筋症と高血圧性肥大心の鑑別診断を中心に―11931205ENKatashiMatsubaraThe present study was conducted to clarify electrophysiological characteristics of left ventricular hypertrophy (LVH) and to discriminate hypertrophic cardiomyopathy (HCM) from hypertension-induced LVH with body surface mapping. QRS area map, QRST area map and VAT map of body surface mapping were recorded on 37 patients with HCM, 37 with essential hypertension (EH) and 21 with aortic regurgitation (AR) using Yamada's method. HCM, EH and AR showed similar patterns of QRS area map. However, the maximum points of QRST area map located at the midsternal line (E5) in HCM, and positioned on the left midclavicular line (G4) in EH and AR. The minimum point of the QRST area map appeared at the left midclavicular line (G3) where the maximum point of the QRS area map was located. These findings indicate that the QRST area map would enable to differentiate HCM from EH and AR. With the VAT map, AR showed closed isochrone lines on the left precordium, which indicated delayed ventricular activation in this region. Statistical analysis revealed that the value of the maximum point of the QRST area (Max. QRST) and the sum of values of the positive QRST area (∑ positive QRST area) differentiates HCM from EH. When the Max. QRST was 0.6μVs or less and the ∑ positive QRST area was 14μVs or less, the diagnostic accuracy of HCM could be made more than 70%. These findings suggested that the diagnostic criteria derived from the QRST area map is of use to distinguish HCM from hypertension-induced LVH.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991製鉄所従業員における腰椎のX線学的研究―腰痛の発生とX線所見との関連について―11831191ENMotoyukiIwagawaIn recent years, incidence of low back pain (LBP) has been increasing. To clarify the relation between instability of the lumbar spine and LBP in heavy industry workers, radiographic findings were compared with a questionnaire on 2863 workers in a steel plant, as a preliminary study in 1986. In 214 males, 4-direction X-ray examinations of the lumbar vertebrae were obtained and the results were analyzed along with a questionnaire survey. The examined subjects were classified into three groups according to their complaints into : A ; LBP free, B ; LBP moderate, and C ; LBP severe. Degeneration chages of the facet joint, lumbar disc narrowing, angles between vertebrae, and lumbar lordosis were investigated on the X-ray film. In general, the higher the intensity of LBP, the more intervertebral angles at all levels of the lumbar spine and the more severe the degeneration. There was a statistically significant difference between the A and C group in the intervertebral angles at lower levels. Incidence of the lumbar disc narrowing differed between the two groups. The instabilitiy of lumbar spine was found in the C group. Low back pain in the heavy industry workers can be caused by anterior motion factors such as lumbar disc narrowing rather than posterior motion factors such as degeneration of the facet joint.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991超音波パルスドップラ法による腎機能評価に関する検討―Dynamic CT 及び Ccr との比較を中心として―11771181ENShuheiSatohTakahiroKitagawaNobuoSatohIzumiTogamiShinKimotoYoshioHirakiSatoruUnoHiromiKumonHiroyukiOhmoriTo evaluate the clinical application of the ultrasonic Doppler technique, renal arterial blood flow was measured in 7 normal subjects and 3 patients with renal dysfunction. For the purpose of correction of blood flow measured by the Doppler technique, some basic studies were performed. The ratio of peak diastolic to peak systolic velocity (D/S ratio) correlated well with both the creatinine clearance and the CA ratio calculated from the results of Dynamic CT. There was no correlation between the corrected velocity of the arterial blood flow and the creatinine clearance. The D/S ratio obtained by the ultrasonic Doppler technique is thought to be a useful parameter in the evaluation of the renal function. However, the Dynamic CT is thought to be superior in objectiveness to the ultrasonic Doppler technique.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991癌化学療法が奏効し Tumor Lysis Syndrome を呈した結腸癌再発症例の一例11711176ENKazuhitoInoguchiHiromiIwagakiSoheiHamanakaLuis FernandoMoreiraHiroshiNanbaTakahiroOkabayashiAkioHizutaKunzoOritaA case of recurrence of colon cancer with marked tumor reduction after effective chemotherapy is reported. The patient was a 27-years-old female who was admitted to the 1st department of surgery because of a giant abdominal tumor. She had undergone surgery for cecal cancer 16 months before admission. Abdominal and pelvic CT-SCAN revealed a giant tumor (21×18cm) invading the rectum and uterus. Surgical cannulation was performed into bilateral internal iliac arteries, and anti-cancer drugs (5-FU : 5000mg, ADR : 40mg, CDDP : 200mg) were administered intraarterially. The occurrence of hyperkalemia and striking rises in LDH, CEA, CA19-9 after the chemotherapy strongly suggested the tumor lysis syndrome, which to our knowledge, has not been reported as a complication of the treatment of colon carcinoma.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991急性白血病並びに類縁疾患における造血幹細胞動態に関する研究 第2編 Myelodysplastic Syndrome における造血幹細胞の検討11591169ENMasatakaNishimuraPeripheral stem cell assay was done to examine the hematopoietic status of myelodysplastic syndrome (MDS). Four patients with refractory anemia with excess of blasts (RAEB) and 6 with RAEB in transformation (RAEBt) were studied. Efficiencies of colony and cluster formation were not different between RAEB and RAEBt, but colony/cluster ratios in RAEBt tended to be lower than in either RAEB or healthy individuals. Patients were classified into 2 groups, Group A and B, according to the colony/cluster formations. In Group A efficiencies of colony/cluster formation were higher than those in healthy individuals, and in Group B they were lower. Bone marrow nucleated cell counts and peripheral white blood cell counts were not different between Groups A and B. Leukemic conversions were recognized in 4 out of 5 cases in Group B and 2 out of 5 cases in Group A, respectively. On the other hand monocytosis developed in 3 out of 5 cases in Group A, but none in Group B. Some of the colonies and clusters were composed of myeloperoxidase (MPO)-negative neutrophils, although a significant increase of MPO-negative neutrophils was not present in original marrow or peripheral blood. Colonies and clusters in patients with leukemic conversions in Group A were composed of cells with blastlike morphology. These findings indicate that the quantitative and qualitative analyses of colonies and clusters are useful not only for the prediction of leukemic conversion but also for analyses of pathophysiological aspects such as ineffective hemopoiesis and monocytosis in MDS.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155810311-121991急性白血病並びに類縁疾患における造血幹細胞動態に関する研究 第1編 急性白血病における Leukemic Blast Progenitors 由来コロニー形成能並びに形成パターンの検討11471158ENMasatakaNishimuraColonies derived from leukemic blast progenitors were sequentially observed on Days 3, 5, 7, 10 and 14 to evaluate the relation between the kinetics of leukemic blast progenitors and types of acute nonlymphocytic leukemia (ANLL), chemotherapeutic response and leukemic cell kill kinetics. The cells were obtained from 34 patients with typical ANLL and 6 with hypoplastic ANLL. The leukemic colony assay was performed. Colony-counts (CCs) were somewhat higher in M2 and M5 patients than in patients with other FAB subtypes. CCs were significantly lower in patients with hypoplastic ANLL than in those with typical ANLL (22±25 vs 148±205, P<0.02). Time required for 50% reduction in CCs from maximum CCs (Days for 50% reduction) was longer in relapsed than in previously untreated ANLL patients (6.5±2.3 days vs 3.3±1.5 days, P<0.01). In patients with remission both of CCs on Day 7 and maximum CCs were higher than in patients without remission (198±187 vs 69±77, P<0.05 for CCs on Day 7/233±188 vs 107±66, P<0.05 for maximum CCs). Time for 50% reduction was significantly shorter in patients with remission (2.4±0.7 days vs 4.2±1.2 days, P<0.02). The correlation between 「days for 50% reduction」and「acceleration of decrease at PhaseⅡ of leukemic cell kill curve」was noted. These findings indicate that the sequential observation of colonies derived from leukemic progenitors is useful not only for the prediction of the chemotherapeutic response but also for analysis of pathophysiological aspects of ANLL.No potential conflict of interest relevant to this article was reported.