VOLUME 30 NUMBER 2 September 1967

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ISSN 2186-3326
(Online ISSN)
ISSN 0027-7622
(Print ISSN--v.72no.3/4)

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An Experimental Study on Hypothermic Cardiopulmonary Bypass with Hemodilution Technique

pg(s) 129 - 155

<Abstract> - < PDF >

Twenty-six adult mongr-1 dogs were subjected to a study on hypothermic cardiopulmonary bypass with hemodilution technique. The extracorporeal system used consisted of a rotating disc oxygenator, two roller pumps and two heat exchangers designed specially for this series of experiments. Five percent dextrose in water was the principal diluent. Saving the blood, keeping an adequate microcirculation and preventing possible homologous blood syndrome were the main purposes of hemodilution.
A lowered efficiency of the oxygenator due to the reduction in size was covered by inducing hypothermic perfusion at a low flow rate,
The efficiency of the heat exchanger was excellent enough to accomplish this perfusion technique satisfactorily. The model change of the heat exchanger resulted in the exclusion of the bubble trap and the reservoir from the extracorporeal system.
Complete bypass was achieved at an average rectal temperature of 25.1°C (esophageal 27.2°C) for 30 min at an average flow rate of 30ml/kg/min.
The lowest hematocrit averaged 70% of the control value. Entering rewarming after complete bypass, changes in hematocrit, oxrygen content, blood pressure, EEG and ECG caused by the perfusion began to disappear progressively. The lowered pH and pC02 were thought to be corrected by using sodium bicarbonate, THAM or C02.
Fifteen animals out of 26 tolerated the procedure well, and the result of the clinical application of this perfusion technique was excellent.
Analysis of Constitutions by Mathematical Principles
I. The Analysis of Obese-Diabetic and Obese Normal Constitutions

pg(s) 157 - 168

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There are numerous empirical knowledge in the field of clinical medicine. In this article the authors intend to analyze such knowledge logically. A mathematical structure of an organism is proposed, using the "theory of sets", and the development of axiom was adopted into practice for the analysis of obese-diabetic and obese·normal constitutions.
Define X, Y and Z as the sets of genetic, environmental factors and of vital phenomena; x, y, and z the elements in each set and t as time factor of aging, when z can be shown by the formula: Of course, the law given to "correspondence" f is of paramount importance. An organism is at least representing itself as having the responses of fitness to y within some limits by its x at t in the physiologic state. Therefore, the authors gave correspondence f, the law, that an organism would fitly respond to y or its own x with deficiency of minimal type. This axiom should not be applied to the pathologic state-that is, vital phenomena with cancer, autoimmunity or functio laesa etc.
A man with glucokinase (GK) deficiency and without others will become a hyperinsulinar obese-diabetic; a man with deficiencies of phosphofructokinase (PFK) or pyruvate kinase (PK) in the liver, or of both enzymes, will become a hyperinsulinar obese-normal subject. One will recognize hyperinsulinism (one element in set Z) to be a response of fitness (correspondence f) in a person with any deficiency of hepatic key glycolytic enzymes, GK, PFK, and PK, (one element in set X), because insulin is the inducer of biosynthesis of hepatic key glycolytic enzymes.
It is well known that rats fed on high fat diet show a diabetic status. Weber et al. reported that the hepatic key glycolytic enzymes, GK, PFK, and PK, were inhibited by physiological concentrations of fatty acids. Without genetic deficiencies, however, these organisms will become normal by removal of the insults.
Thus, diets of environmental factors in set Y can regulate the appearance of genetic factors quantitatively, but not qualitatively.
An enzyme with deficient activity needs to be produced in a larger quantity in order to compensate for the deficiency. Therefore, a person with GK deficiency shows hyperinsulinism. It is reported that insular function of pancreas decreases with age even in normal man and suggested that senile changes in the insular apparatus are significant factors in the development of diabetes. A person with hyperinsulinism will show a decrease in insular function with age more rapidly than a normal man will. Therefore, diabetes and obesity are in conformity with the "wear and tear theory" as a mechanism underlying the aging process.
Thus, a constitution is composed of combinations of abnormal key enzymes and the interrelations between these enzymes and neural or hormonal systems which work on these key enzymes. Furthermore, the great variety of combinations between abnormality of elements in set X and modifications by elements in set Y should decrease or increase the time factor "t" when a pathologic state should occur.
Some Clinical Aspects of Chemotherapy in Malignant Lymphomas

pg(s) 169 - 176

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In the chemotherapy of cancer, leukernia and malignant lymphoma are two diseases that may be considered to respond best to this type of therapy1)~4). Herein is described the chemotherapy of malignant lymphoma, based mainly on our experiences.
Clinical Studies on So-called Whiplash Injury, Especially on the Significance of Retrograde Brachial Arteriography

pg(s) 177 - 192

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In recent years an increasing number of so-called whiplash injury of the neck following a rear-end collision have been seen at our Hospital and the problem of this whiplash injury has come to receive national importance to in· sure safety of the people.
So far, although many studies have been made on so-called whiplash injury, an important problem left is the clarification of the pathogenesis of this type of injury of the neck.
From times past, "the Barré-Lieou syndrome" (the posterior cervical sympathetic syndrome) after whiplash injury has been considered to be a form of traumatic neurosis or a compensatory neurosis. But from clinical experience, I have come to suspect the occurrence of vertebral artery involvement in some cases of whiplash injury presenting the Barré-Lieou syndrome.
Patients examined by the method of retrograde brachial arteriography with the head turned to either side, consisted of 36 cases seen at the 1st Surgical Department of Nagoya University Hospital and the Neurosurgical Division of the Chubu-Rosai Hospital. They consisted of two groups; 20 patients with the BarréLieou syndrome and 16 without the syndrome.
By the above means it was made clear that in cases with the Barré-Lieou syndrome, there are various changes in the vertebral artery angiographically with the head turned to either side and that as a cause of the Barré-Lieou syndrome following whiplash injury the changes in the vascular system are believed to play an extremely important role.
Studies on Thromboplastin Generation Test

pg(s) 193 - 209

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In this paper, an attempt to devise a most satisfactory method of thromboplastin generation test (TGT) was made and the results were as follows :
1) As anticoagulant for the preparation of plasma, sodium citrate is superior to potassium oxalate, because the various factors in the former are more stable than those in oxalated plasma.
2) In adsorption of plasma, BaSO4 and Al(OH)3-gel are both useful. In citrated plasma, the optimum dose was 200 mg/ml and preferable adsorption time at 37°C ranged from 5 to 20 minutes with BaSO4,, and with AL(OH)3 0.03 ml/ml, 1-3 minutes. However, there is need to use BaSO4, of purity above 99% and with grain size mostly of 1-2µ
3) Serum should be separated 1 hour after initiation of the incubation in case of normal whole blood clotting time, and 3 hours after in hemophiliacs. There is no need to activate the serum with glass beads.
4) The optimum concentration of platelet su~pension was found to be 200,000- 300,000/cmm and washing of platelets should be made for at least 4 times. But in general, platelet substitutes should be used, and the potency of such substitutes should preferably possess minimal substrate clotting time of about 10 seconds.
5) The normal value of TGT was 9.97± 0.938 seconds for the minimal substrate clotting time, or 100± 23.3% in thromboplastic activity.
6) The standard dilution curve of TGT can be plotted linearly on a bilogarithmic scale and they should be prepared for each time of measurement, and the results of TGT indicated by percentages of the normal value.
Factors Elevating Liver Tyrosine: 2-OXoglutarate Aminotransferase Activity in Tumor-Bearing Mice

pg(s) 211 - 223

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In the later stage of tumor-bearing mice, the activity of liver tyrosine: 2-oxoglutarate aminotransferase was markedly elevated, whereas no particular change was noted in liver tyrosine : pyruvate aminotransferase activity. Adrenalectomy abolished the elevation of tyrosine: 2-oxoglutarate aminotransferase activity in tumor-bearers. In tumor-bearing mice, liver glycogen level was lowered in contrast to increased tyrosine: 2-oxoglutarate aminotransferase activity. Increased activity of the enzyme was reversed by glucose feeding. Increased activity of the enzyme in tumor-bearing mice was tentatively related to protein catabolism, conversion of protein to carbohydrate in the liver of the host under carbohydrate deficiency, and its possible relation to cancer cachexia was discussed.
Age and Sex Differences in the Fine Structure of the Mouse Adrenal Cortex

pg(s) 225 - 251

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Sex and age differences were examined in the adrenal cortices of thirty five mice with special reference to their zonation.
The zonal variety was found in the shape and inner structure of the mitochondria. Elongated form of mitochondria was characteristic in the glomerulosa cells, and frequent in young animals. The internal structure of the mitochondria was almost tubular or rectimembranous. In general the former was predominant in the deeper zone of the cortex, and the latter in the outer zone. In old animals, however, most mitochondria of all zones possessed tubular internal structures.
In old males, lipid droplets were localized at the upper part of the cortex, particularly in the zona glomerulosa. Golgi apparatus was, in general, more developed in young animals, mainly in the zona glomerulosa.
Vacuoles bounded by a smooth membrane were abundant in the deeper cortical cells. Rough surfaced endoplasmic reticulum was characteristic in the glomerulosa cells. Both the light and the dark cells were recognized in all zones of the cortex, though the latter were very frequently observed in the deepP.r zone.
Pigment bodies were noticed in the zona reticularis. more frequently in males than females.
X zone was well preserved only in young females.
Changes of Aspartate Aminotransferase and Alanine Aminotransferase Activity in Vitamin B6 Deficient Rat

pg(s) 253 - 258

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Studies on the Intracellular Change of Vitamin B6 Content and Kynurenine Aminotransferase Activity in the Vitamin B6 Deficient Rat

pg(s) 259 - 268

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