Nagoya Journal of Medical Science

Antigenic relationships between an isolate (B/Aichi/1/73) from the epidemic of influenza B in 1973 and earlier strains of the same type were studied by hemagglutination-inhibition and neuraminidase- inhibition tests. The results showed that B/Aichi/1/73 underwent considerable antigenic variation in hemagglutinin but not in neuraminidase.

A simple EIA technique for the quantitation of red-cell-bound immunoglobulin (IgG) was devised and applied to normal and pathologic states, including autoimmune hemolytic anemia (AIHA) and other disorders. The mean red-cell-bound IgG value for normal subjects was 73.2 ± 25.8 ng/l0¹⁰ red cells (mean ± ISD). Fifteen patients with AIHA had an increased level of red-cell-bound IgG ranging from 109 to 10,000 ng/l0'o red cells. The concentration of red-cell-bound IgG in AIHA patients was well correlated with the percentage of reticulocytes in the peripheral blood and showed a rapid fall after the initiation of steroid therapy. Red-cell-bound IgG levels in Fisher-Evans syndrome, idiopathic thrombocytopenic purpura (lTP), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and IgG myeloma measured by this technique are also presented. A significant correlation was found between red-cell-bound IgG levels and serum IgG levels in normal subjects and in patients with these pathologic conditions, except in the cases of AIHA and Fisher-Evans syndrome. The quantitation of red-cell-bound IgG by this EIA technique is of great value for clarifying the pathophysiologic significance of red-cell-bound IgG in health and disease.

Early changes in the vascularity of grafted skin after X-ray irradiation were evaluated using the microangiographic technique. There was a correlation betweeen the vascular density at the time of irradiation and the vascular density two weeks after irradiation. The grafts irradiated in the early hypovascular stage showed mild-moderate vascular reactions to irradiation, whereas those irradiated in the hypervascular stage showed severe vascular reactions. The grafts irradiated in the late hypovascular stage showed mild vascular reactions. There was also a relation between the skin reaction and vascular reaction to irradiation. It was concluded that primary consideration should be given to the vascular damage of grafted skin when determining the proper time for postoperative irradiation.

Rabbits were immunized with the supernatant of a homogenate of non-cancerous gastric mucosa to obtain an antiserum. This antiserum, after absorption by human jejunal mucosa and liver tissue, produced precipitin lines with the supernatants of homogenates of gastric carcinoma and gastric mucosa. Fluorescent staining was attempted using this antiserum. Well-stained cytoplasms were observed in cells of tissue imprints of normal gastric mucosa and gastric carcinoma. When frozen sections of peroperatively extirpated materials were likewise stained, the cells and the lumen of the glands were stained to a large extent in the non-cancerous gastric mucosa and tubulary adenocarcinoma of the non-scirrhous type. In scirrhous gastric carcinoma fluorescence-stained substances were scantly in the lumen of the glands but observable to some degree in the tumor stroma. It is suggested that infiltration of the interstitium by glandular antigens induces proliferation of stroma in gastric carcinoma.

Fifty g glucose, 50g maltose and 50g sucrose were loaded to 12 nonobese healthy male volunteers with and without 100 or 300 mg α-glucosidase inhibitor, acarbose, and the inhibitory effect on digestion and absorption of these saccharides was studied. In another series of investigations, acarbose 100 mg a day were orally administered to 12 non-insulin-dependent diabetics for 3 months together with meals. Blood glucose was determined to investigate the effect of acarbose on blood glucose control in non-insulin-dependent diabetics. In the saccharide loading tests, orally administered 300 mg acarbose did not practically inhibit absorption of 50g glucose or 50g maltose. When 50g sucrose was loaded, however, 100 or 300 mg acarbose markedly decreased absorption of this disaccharide, resulting in inhibition of increases in blood glucose and insulin. Non-insulin-dependent diabetics had significantly lower fasting blood glucose and HbA₁ in 3 months of acarbose ingestion as compared with the corresponding levels in the preceding 3 months. Meteorism, increased flatulence and loose stools were complained of as adverse effects of acarbose, but they were not so serious as to require the discontinuation of medication. Acarbose might afford a safe and effective supplementary means for controlling blood glucose in diabetics.

A new enzyme activity that resembles terminal deoxynucleotidyl transferase (TdT-like activity) was found in rat liver. Upon treatment of rats with a hepatocarcinogen, N-2-fluorenylacetamide, the TdT-like activity increased in parallel with DNA polymerase α and γ.. By phosphocellulose column chromatography, the TdT-like activity was separated from DNA polymerase α, β, and γ. With a poly(dA)-initiator, dGTP or dCTP was the most efficient substrate in the presence of Mg²⁺ or Mn²⁺, respectively. In the presence of Mg²⁺, the enzyme utilized poly (dC) as an initiator most efficiently. The TdT-like activity differed from previously described terminal deoxynucleotidyl transferase (E.C. 2.7.7.31.) in its Km value for dGTP and in its sensitivity to ATP or to an antibody against calf thymus terminal deoxynucleotidyl transferase.

Excluding cases of early carcinoma, curative surgery for gastric carcinoma was performed in 149 patients from 1969 to 1978. Among them 77 had adenocarcinoma with a large amount of interstitial connective tissue (scirrhous type), and 72 had adenocarcinoma with a comparatively small amount of connective tissue (non-scirrhous type). The overall survival rate was low among those with scirrhous type (P≒0.095). However, in comparing 14 cases (18.1%) of pT2 carcinoma of scirrhous type with 22 cases (32.7%) of pT2 carcinoma of non-scirrhous type, the survival ratio of those of scirrhous type exceeded that of those of non-scirrhous type (P≒0.045). The proliferation of interstitia in metastatic lesions of the lymph nodes was not always the same as that in the primary lesion. The prognosis of carcinoma in cases of lymphatic metastasis with a large amount of connective tissue (scirrhous type) was better than that in those with a small amount of connective tissue (non-scirrhous type).

Pancreatic transplantation is still partly experimental and involves a variety of problems, such as handling of exocrine secretion, prevention of arterial thrombosis of the graft, and immunosuppression. Aiming at the best method of handling exocrine secretion and at prevention of thrombosis, pancreas transplantation with the duodenum (pancreaticoduodenal transplantation) was performed in eighteen pairs of mongrel dogs. Nine recipients (control group) were transplanted without immunosuppression, and the other nine were immunosuppressed with cyclosporin A (CsA group) after transplantation. Five dogs which died of intussusception, strangulation, hemorrhagic pancreatities etc. were not evaluated in this study. In the control group, survivals were 16, 14,8,7 and 6 days; in the CsA group, survivals were >395, >150, 89, 70, 25, 18, 18, and 12 days, respectively. In the CsA group there were two long-term surviving dogs without rejection; and the grafted pancreas of one of these dogs was judged to be almost normal in exocrine and endocrine glands microscopically from a specimen biopsied on the 260th postoperative day. This result is worthy of special mention in the animal experiment. CsA was more effective in prolonging survival of the dogs which received pancreaticoduodenal transplantation when compared with conventional immunosuppression. In the pancreaticoduodenal transplantation with aortic cuff, which was expected to increase the blood flow of the graft followed by a decrease in the incidence of thrombosis, there were 6 cases with thrombosis of the graft among 13 recipients. It was concluded, therefore, that CsA is effective in prolonging the survival of dogs which receive pancreaticoduodenal transplantation with physiological drainage of exocrine secretion into the duodenum, but that prevention of thrombosis by means of adequate anti-thrombosis treatment is essential.

Submaximal treadmill exercise testing up to 80 percent of the maximal heart rate predicted for age was performed on 138 normal men and 142 normal women. Sex difference was analyzed in terms of 3 ST-T items: J, midpoint between J and the peak of T (mid-ST), and the peak of T in leads II, V₄ and V₆ at rest and after exercise. A greater mid-ST point depression at rest, during and after exercise was found in normal women than in men (p< 0.001). Sex-adjusted 95% confidence limits were estimated. Using these norms, similar evaluations were carried out on 133 patients who were being evaluated for possible coronary insufficiency, eighty-four (64 men and 20 women) of whom had significant angiographic disease (≥ 75% narrowing) and forty-nine (26 men and 23 women) of whom had not. The most sensitive and specific correlate with anatomic coronary disease was the absolute change in mid-ST point. Using criteria developed in the normal group, sensitivity for angiographic positives was 70.3% (45 of 64) in men and 70.0% (14 of 20) in women (P =not statistically significant); specificity was 92.3% (24 of 26) in men and 87.0% (20 of 23) in women (P = not statistically significant). When these male standards were used in female patients, there was a decrease in specificity from 87.0% to 43.5% (P< 0.001). Sex-adjusted standards render the ECG exercise test as effective a diagnostic tool in women as in men.