Nagoya Journal of Medical Science

Although many theories have been reported as to the cause of venous thrombus, the three factors listed and explained by Virchow are still widely accepted. Various experimental studies have been done based upon the assumption that the disturbance in blood vessel intima was the main causing factor for the formation of thrombus due to mechanical or chemical injuries to the intima.
A report was made by Abramson in 1927 as to the negative charge nature of the surface of blood cells, and later in 1953, Sawyer et al., reported that the intima of blood vessels was negatively charged in the physiological condition, and that thrombus was not caused by the electric repulsion of the blood cells and the intima. Furthermore, it was said that when the intima was mechanically or chemically injured, the negative charge of the intima underwent reversion of polarity, and the thrombus formed.
This investigation was carried out in vitro by using autoradiography to deter· mine the necessary intensity of electricity, duration of electrification, and other factors which were required for the formation of thrombus by positive charge under normal condition. At the same time, to test the effect of thrombus prevention, experiments using negative charge were conducted in which the intima was mechanically injured to easily make thrombus. And, after applying electrification, the intimal surface of the blood vessel was observed microscopically. Negative charge was applied to the transplantation of artificial blood vessel for vein. Wrinkled teflon graft about 3 em in length was transplanted to the inferior vena cava of an adult dog. A platinum electrode was coiled around the part of end to end anastomosis and electrified as a negative electrode. After a certain period of time, patency was examined by venography. Patent cases were all of very early stage of electrification, and no thrombus formation occurred with a case of negative electrode of platinum coil used to prevent kinking and pressing.

In recent years, the improvement in surgical techniques have been greatly improved with the development of medical electronics. And yet, there remains many incidences in which the surgeon should use the classical techniques rather than the recently developed procedures. For example, when oozing or uncontrollable bleeding is encountered from injured organ in which ligation or suturing, application of pressure, or application of alternating electro-coagulation may be used, but no satisfactory result may be obtained with any of these methods.
In this regard, the effect of the direct current on the living body has been studied by many investigators since the middle of the 18th century. Recently, the application of the direct current electro-coagulation has been applied clinically by some investigators. This electric hemostasis is merely a skillful application of the bio-electric phenomena to living body. In these experiments, the investigation was carried out on the bio-electric phenomena, especially on the potential difference of the blood vessel wall which previously had been studied in the various aspects by many investigators. However, different interfering factors ob- struct the measuring of potential difference across the blood vessel wall under the normal condition.
This paper describes the new apparatus for measuring of potential difference of the removed blood vessel wall using a special electrode which is not affected by the phenomena of polarization. Intravascular thrombus formation due to direct current was observed by the microscope and microphotographs were taken.
In animal experiments, stable injury on the organ (spleen), electro-coagulation was done under various ,conditions for oozing or uncontrollable bleeding and its effect on the injured portion was investigated. At the same time, blood pressure, platelets, and hematocrit (factors that are concerned in clotting mechanism) which is changed due to direct current, were measured, and the results were discussed.

Certain aspects of the etiology of the intimal arteriosclerosis were discussed by the development of the mathematical structure of an organism previously proposed.
One school supposed that an essential factor for intimal arteriosclerosis was glycoprotein, but not lipid. The abnormal deposition of glycoprotein into the intima of arteries and the subendotherial space of capillaries might take place only when glycoprotein was excessively synthesized in the liver more than the requirements of an organism. The metabolic tendency mentioned above arises from both elements in set X of genetic factors and in set Y of environmental factors.
It was explained that as for the elements in set Y, there were high fat diet, low protein diet. and pyridoxine deficient diet, while as the elements in set X hereditary deficiencies of hepatic key glycolytic enzymes were considered. A common element in set Z of vital phenomena derived from above mentioned elements, is the use of fatty acids as main source of energy in the liver which, in turn, spares both protein and glucides and scarcely uses glycolytic pathway for energy production.
Although elements in set X always predominate over elements in set Y in intimal arteriosclerosis, the stronger the elements of both set X and set Y have tendencies to suffer from this disease, the shorter the time factor t for onset of this disease will be. Even if all elements in set X are normal, one has to refrain from overeating in older age when he needs less energy and protein per kg body weight per day compared with the younger.

In the field of ultrasonic diagnosis, its attenuation property in the brain has been also explored. Investigated are the ultrasonic attenuation of the brain following experimental head injury as well as cerebral circulation and water content of brain, the purpose of which are to analyse the essential mechanism of ultrasonic attenuation as its relationship to the brain edema. I studied the continuous changes of brain by means of epidural air shot, intracarotid oil injection and by extreme reduction of cerebral blood flow. Reduction of ultrasonic attenuation on brain is primarily due to the increased water content of brain tissue, whereas reduction of cerebral blood flow increases ultrasonic attenuation values to some extent.

Ferrokinetics data on patients with blood disorders of diverse etiology were presented and the clinical implication of this test was discussed. Ferrokinetics data on normal adults as well as on the aged were also presented.
Ferrokinetic patterns of ineffective erythropoiesis were obtained on patients with pernicious anemia, erythroleukemia, myelofibrosis, paroxysmal nocturnal hemoglobinuria and refractory anemia as well. Ferrokinetic studies on patients with portal hypertension with congestive splenomegaly have disclosed that the erythropoietic activity in this condition is rather increased and the liver damage does not necessarily exert inhibitory effect on erythropoiesis in these patients.
The studies on patients with acute leukemia did not reveal the patterns typical of each cell type of leukemia, and the results indicate that the myelophthisic effect due to the encloachment of leukemic cells is a major factor in the development of anemia in acute leukemia.
Finally, it is stressed that the ferrokinetic measurements with body surface counting are of great use in diagnosis and treatment of patients with myeloproliferative syndrome.

Although extensive studies on the anemia and iron metabolism in patients with malignant neoplasms have been made, the pathogenesis of the anemia ob· served in cancer patients remains obscure.
The first purpose of this paper is to elucidate the functional impairment in red cell production in patients with malignant neoplasm by means of ferrokinetic studies. The second one· is to clarify how the reticulo-endothelial cells participate in alterations of iron metabolism in malignancy by means of ⁵⁹Fe labeled iron-dextran. The third one is to enumerate sideroblasts in bone marrow smears of cancer patients for assessing stainable iron in erythroblasts.
The results obtained were as follows:
1) Ferrokinetic studies with ⁵⁹Fe-citrate showed the increased rate of erythropoiesis in patients with malignant neoplasm. However, studies on cases with infections gave results very similar to those in malignant neoplasms, suggesting the· existence of a mechanism common in both conditions.
2) The studies with ⁵⁹Fe labeled iron-dextran revealed a significant decrease of utilization of radioiron for hemoglobin synthesis from iron-dextran captured in reticulo-endothelial cells in malignant diseases.
3) The percentage of bone marrow sideroblasts in patients with malignant neoplasms showed a significant decrease with the mean value of 28 percent. The evidences obtained above demonstrated that the erythropoietic activity in patients with malignant neoplasms is maintained above normal, while there is an evident impairment of iron release from reticulo-endothelial cells. However, the mechanism responsible for the defect of iron release in malignancy is not clear and required further study.