Occlusion of internal carotid artery (ICA) is one of the most common cause of stroke, and the single common arterial lesion considered for extraintracranial bypass. The symptoms of ICA occlusion are not uniform; some shows transient ischemic attacks (TIAs), others completed stroke at the onset. So, measurement of cerebral blood flow might be needed to evaluate the prognosis, or to select surgical candidate in ICA occlusion. Several methods, such as Xe-133 intracarotid method, Xe-133 inhalation method etc, have been applied for the assessment of cerebral blood flow in cases with ICA occlusion. No previous report was found by the newly developed 123I-IMP in this connection. The purpose of the present study is first to demonstrate the feasibility of 123I-IMP planar brain scintigraphy and its semiquantitative analysis in 17 cases with ICA occlusion. After intravenous injection of 3 mCi of 123I-IMP, brain scintigrams were obtained from anterior, Towne, vertex, posterior, right lateral and left lateral views, and were recorded on magnetic tape and Poraloid films. Semiquantitative analysis was performed as a percent index of asymmetry (PIA) from the difference of each hemispheric count in the scintigrams by use of on-lined minicomputer system. Clinical manifestations of these 17 cases were, completed stroke in 10, TIAs in 4, and no neurological symptom in 3. 123I-IMP brain scintigrams demonstrated low flow lesion in 10 out of 10 completed stroke, in 2 out of 4 TIAs and normal perfusion in all cases with no neurological symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

[A case of ulcerative colitis associated with acute pancreatitis].

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Acute Disease↗

PubMed1984

Human leukocyte elastase-like proteinase purified by affinity chromatography with Suc-L-Tyr-D-Leu-D-Val-pNA, and its identification with human spleen fibrinolytic proteinase.

Elastase-like proteinase ( ELP ) extracted with 2 M NaClO4 from human leukocytes was purified by a new affinity chromatography technique with Suc-L-Tyr-D-Leu-D-Val-pNA, following delipidation, salting out and Sephadex gel chromatography. The purified preparation contained practically no chymotrypsin-like proteinase activity, and it was homogeneous on SDS polyacrylamide gel electrophoresis. The enzyme so purified readily degraded fibrin, fibrinogen, elastin and -Val type synthetic peptide substrates, such as Suc-L-Ala-L-Tyr-L-Leu-L-Val-pNA and Suc-L-Tyr-L-Leu-L-Val-pNA. A special increase in ELP activity by adding chaotropic ions was observed. The enzymatic properties of the ELP were very similar to those of spleen fibrinolytic proteinase (SFP). ELP and SFP were identified immunologically using mice antisera against purified ELP .

Adult↗

PubMed1984

Intraarterial lymphocytes injection for treatment of lymphedema.

We noted a marked improvement of lymphedema in a patient with recurrence of cancer 3 years after amputatio recti and with post-thrombotic syndrome of the leg, as the result of injection of a suspension of lymphocytes administrated as therapy against advanced cancer. Subsequently lymphocytes-injections were given 39 times to 7 patients with lymphedema of one limb, of various causes. A suspension of lymphocytes was injected repeatedly into the proximal artery of the affected limb. In one patient, lymphocytes were injected 4 times at intervals of 1 or 3 weeks. In most cases, this injection resulted in a marked reduction in the swelling of the affected limb and improvement was seen for several weeks or months. In all cases, there was a marked, continuous softening of the tissue.

Adult↗

PubMed1984

Improvement of cerebral blood flow and/or CO2 reactivity after superficial temporal artery-middle cerebral artery bypass in patients with transient ischemic attacks and watershed-zone infarctions.

The effect of extracranial-intracranial bypass anastomosis on cerebral blood flow and CO2 reactivity during hypocapnia was investigated in ten patients with transient ischemic attacks or watershed infarctions due to carotid occlusive diseases. Six patients had occlusion and four had stenosis (greater than 50%) of the internal carotid artery. Those with infarctions had increased cerebral blood flow and CO2 reactivity postoperatively, and improved clinically. Those with transient ischemic attacks due to stenosis (greater than 50%) of the internal carotid artery had increased CO2 reactivity postoperatively but constant normal regional blood flow. Cerebral blood flow improved in those with poorer flow, CO2 reactivity increased in those with better reactivity, and better CO2 reactivity preoperatively brought about a greater flow increase. The pre- and postoperative evaluation of cerebral blood flow and CO2 reactivity is believed to be useful in evaluating the effectiveness of bypass anastomosis. Preoperative evaluation might be informative in selecting candidates for bypass.

Aged↗

PubMed1984

Comparative studies on the properties of a kininase in rat brain using bio- and fluorometric assay systems.

The properties of rat brain kininase that degrade bradykinin (BK) at the Phe5-Ser6 peptide bond were compared using two different assay systems. After an enzymatic reaction, the residual BK was bioassayed using a guinea pig ileum. BK and its degraded products were also determined fluorometrically by the combined procedures of microdansylation and thin-layer chromatography. The optimal pH of the kininase was within the neutral range in both assay systems. In the bioassay system, EDTA activated the kininase without dependency on its concentrations, while sulfhydryl (SH) reagents tended to inhibit the activity at a high concentration. However, in the fluorometric assay system, EDTA did not show any effect, while SH reagents activated the kininase. Furthermore, SQ14225 did not inhibit the kininase even at a high concentration. The effect could not be determined by bioassay because the compound increased the potential for a contractile response of the ileum induced by BK. These findings suggest that the results obtained using a bioassay should be compared with those from a chemical assay for the exact elucidation of the nature of some kininases.

Animals↗

PubMed1984

The alkaloidal constituents of Goda-manel (Crinum zeylanicum L.), a Sri Lankan folk medicine.

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Alkaloids↗

PubMed1984

Platelet accumulation in carotid atherosclerotic lesions: semiquantitative analysis with indium-111 platelets and technetium-99m human serum albumin.

To evaluate platelet accumulation in carotid atherosclerotic lesions semiquantitatively, a dual-tracer technique was applied, using In-111 platelets and Tc-99m human serum albumin. With this approach, we investigated the ratio of radioactivity in In-111 platelets deposited on the vascular wall to those circulating in the blood pool, platelet accumulation index ( PAI ). This study included 12 normal subjects and 25 patients with ischemic cerebrovascular disease (CVD). Angiographic abnormalities were observed at 34 of 50 carotid bifurcations in the CVD patients. The mean PAI value was significantly higher at the carotid bifurcations with angiographic abnormality than at the normal ones (p less than 0.001). Furthermore, elevations of mean PAI were prominent at the lesions with severe stenosis or ulceration. The degree of platelet accumulation was well demonstrated by this technique, which can also yield information on thrombogenicity and efficiency of antiplatelet therapy in carotid atherosclerotic disease.

Adult↗

PubMed1984

A case of adult T-cell leukemia initiated with central nervous system symptoms.

We treated a 52-year-old Japanese woman with adult T-cell leukemia (ATL) initiated with central nervous system (CNS) symptoms. Her chief complaints were paraplegia and left facial palsy. CNS-ATL was diagnosed because of the following three features. 1) Various sized lymphoid cells with marked nuclear convolution were numerous in her cerebrospinal fluid. 2) These cells were a monoclonal proliferation of T lymphocytes with OKT 4 marker. 3) The patient's serum was positive for anti-ATL associated antigen (ATLA). Although the neurological signs and symptoms improved markedly after intrathecal administration of combined chemotherapy (methotrexate, cytarabine and corticosteroid), these ATL cells were highly resistant to radiation therapy. The abdominal mass which developed in the course of the disease was diagnosed as a tumor formed of ATL cells, and VEPA (vincristine, endoxan, prednisolone and adriamycin) was administered with marked success.

Antigens, Neoplasm↗

PubMed1983

Interaction between calcium ions and surface charge as it relates to calcium currents.

Calcium ions affect the gating of Ca currents. Surface charge is involved but to what extent is unknown. We have examined this, using isolated nerve cell bodies of Helix aspersa and the combined microelectrode-suction pipette method for voltage-clamp and internal perfusion. We found that Ba and Sr currents produced by substitution of these ions for extracellular Ca ions are activated at less positive potentials than Ca currents. Mg ions do not permeate the Ca channel and changes in [Mg]o produce shifts in the activation-potential curves that are comparable to the effects of changes in [Ba]o or [Sr]o. Inactivation of Ba currents also occurs at less positive potentials. Perfusion intracellularly with EGTA reduced inactivation of Ca currents as a function of potential, but did not shift the inactivation-potential curve. Hence, Ca current-dependent inactivation which is blocked by intracellular EGTA probably does not involve a similar change of intracellular surface potential. The voltage shifts of activation and inactivation produced by extracellular divalent cations used singly or in mixtures can be described by the Gouy-Chapman theory for the diffuse double layer with binding (Gilbert & Ehrenstein, 1969; McLaughlin, Szabo & Eisenman, 1971). From the surface potential values and the Boltzman distribution, we have computed surface concentrations that predict the following experimental observations: 1) saturation of current-concentration relationships when surface potential is changing maximally; 2) the increase in peak current when Ca ions are replaced by Sr or Ba ions; and 3) the greater inhibitory effect of Mg on IBa than ICa. Theory indicates that surface charge cannot be screened completely even at 1 M [Mg]o and thus that Ca channel properties must be evaluated in the light of surface charge effects. For example, after correction for surface charge effects the relative permeabilities of Ca, Ba and Sr ions are equivalent. In the presence of Co ions, however, Ca ions are more permeable than Ba ions suggesting a channel binding site may be involved.

Animals↗

PubMed1983

Transient ischemic attacks: racial differences, treatment, and prognosis.

Prognosis of transient ischemic attack (TIA) in 45 patients, diagnosed as TIA out of 75 suspected TIAs, was investigated for an average follow-up of 12.9 months. Twelve (27%) of the 45 patients progressed to complete stroke during the follow-up period. Patients with severe atherosclerotic lesions and with intracranial arterial lesions or with lesions of both intracranial and extracranial sites were predominant among the 29 cases examined angiographically, and the majority progressed to stroke. The prognosis was poorer than in the cases with mild atherosclerotic lesions or cases with only extracranial arterial lesions. From such characteristics of cerebral atherosclerosis of TIA in the Japanese with predominant intracranial severe arterial lesions, a different genesis for the development of cerebral atherosclerosis between Japanese and Americans or other Caucasians may be expected in cases with TIAs. With respect to the relation of recurrence of TIA to prognosis, a single episode of TIA in the past placed the patient at a greater risk of early infarction, where a high incidence (57%) of progression to stroke was found during the follow-up period. Treatment by superficial temporal artery to middle cerebral artery anastomosis or anticoagulant drug medication seemed to improve the prognosis of TIA as compared with antiplatelet aggregation therapy. These results suggest that embolus formation from an embolic source of arterial lesions may play some part in the pathogenesis of TIA and occurrence of subsequent stroke.

Adult↗

PubMed1983

Effects of a transfusion with a blood substitute (Fluosol-DA, 20%). Part II: Human cerebral blood flow.

In 24 patients suffering from cerebrovascular diseases, alteration of the cerebral blood flow was investigated by means of the 133Xe clearance technique before and after the intravenous infusion of perfluorochemical suspension (Fluosol-DA, 20%, 10 ml/kg). Since perfluorochemicals exhibit high solubilities for not only oxygen but other kinds of gases, the partition coefficient of Xe (lambda tb) is considered to change depending on the amount of perfluorochemicals contained in the blood (Fct). The solubilities of Xe in the perfluorochemicals contained in the solution were then measured by gas chromatography to obtain an equation for lambda tb: lambda tb = 1.50/(Hct/100 + 12.48Fct/100 + 0.95). The cerebral blood flow was found to increase significantly by 10.1% in the lesional hemisphere and by 10.8% in the healthy one. The cortical small artery with a diameter between 0.1 and 0.2 mm appeared to dilate by 13% after its administration. From these results, the decrease of blood viscosity and some vasodilating effect of the solution might be responsible for the increase of the cerebral blood flow.

Blood Substitutes↗

PubMed1983

Bi-hemispheric CBF and its CO2 reactivity of TIAs and completed strokes in ICA occlusions.

Bi-hemispheric cerebral blood flow (CBF) measurements during rest and hyperventilation, with intra-arterial 133Xe injection method, were investigated in 19 cases, angiographically diagnosed as unilateral internal carotid artery (ICA) occlusion, including 8 cases with TIAs and 11 cases with completed strokes as the onset. Indices of cerebral vascular resistance and CO2 reactivity with decreasing arterial PCO2 were also investigated. A significant decrease (P less than 0.05) of hemispheric mean CBF was noted in the ischemic hemisphere, but normal flow values in the unaffected hemisphere and preserved CO2 responsiveness during hyperventilation were observed in both the affected and unaffected hemispheres in patients with TIAs. Moreover, a direct relationship between CBF and blood pressure, observed in 11 cases with completed strokes, was not recognized in 8 cases with TIAs. A degree of the abnormalities of the affected hemisphere in cerebral circulation was suggested to be somewhat different between TIAs and completed strokes in ICA occlusions, and bi-hemispheric CBF measurements would be an useful method for evaluating the various indices of the CBF in ICA occlusions.

Adult↗

PubMed1983

Cerebral blood flow and CO2 reactivity in transient ischemic attacks: comparison between TIAs due to the ICA occlusion and ICA mild stenosis.

Hemispheric mean cerebral blood flow (CBF), together with its CO2 reactivity in response to hyperventilation, was investigated in 18 patients with transient ischemic attacks (TIAs) by intraarterial 133Xe injection method in a subacute-chronic stage of the clinical course. In 8 patients, the lesion responsible for symptoms was regarded as unilateral internal carotid artery (ICA) occlusion, and in 10 patients, it was regarded as unilateral ICA mild stenosis (less than 50% stenosis in diameter). Resting flow values were significantly (P less than 0.05) decreased in the affected hemisphere of TIA due to the ICA occlusion as compared with the unaffected hemisphere of the same patient, regarded as the relative control. It was not decreased in the affected hemisphere of TIA due to the ICA mild stenosis as compared with the control. With respect to the responsiveness of CBF to changes in PaCO2, it was preserved in both TIAs, due to the ICA occlusion and ICA mild stenosis. Vasoparalysis was not observed in either types of TIAs in the subacute-chronic stage. However, in the relationship of blood pressure and CO2 reactivity, expressed as delta CBF(%)/delta PaCO2, pressure-dependent CO2 reactivity as a group was observed with significance (P less than 0.05) in 8 cases of TIA due to the ICA occlusion, while no such relationship was noted in 10 cases of TIA due to the ICA mild stenosis. Moreover, clinical features were different between TIAs due to the ICA occlusion and ICA mild stenosis, i.e., more typical, repeatable TIA (6.3 +/- 3.7 times) with shorter duration (less than 30 minutes) was observed in TIAs due to the ICA mild stenosis, while more prolonged, less repeatable TIA (2.4 +/- 1.4 times) was observed in TIAs due to fixed obstruction of the ICA. From these observations, two different possible mechanisms as to the pathogenesis of TIA might be expected, e.g., TIA of microembolic origin due to the ICA mild stenosis, and TIA of hemodynamic origin due to fixed obstruction of the ICA, for whom the bypass surgery might be beneficial, i.e., all TIAs are not based on the same mechanism.

Arterial Occlusive Diseases↗