Nagoya Journal of Medical Science

One analysis of the outcome of 159 cases of head injuries was based on patients' admission Glasgow Coma Scale (GCS), score, age, CT scan findings and uniform protocol of management. Fifty-three percent of the patients were children below the age of 10 years and 70 % of all patients were Saudis. Eighty-point-five percent (80.5 %) of the patients had a GCS score of 8 or more and their outcome was favorable. By contract, the 19.5 % who had an initial GCS score of 7 or less tended to be older and had a worse prognosis (mortality 68 %). A high initial GCS score, old age, associated multiple injuries and a shift of more than 4 mm of the midline structures on CT scan of the brain are useful prognostic indices in predicting the outcome of head injury.

The present study investigated whether or not, in addition to the oral glucose tolerance test, oral alanine loading was a useful diagnostic tool for hormonal and metabolic diseases. Fifty g of L-alanine was administered orally in 14 normal, 12 diabetic, and 8 liver cirrhotic subjects. The influence of oral alanine loading on hormones and metabolites was compared with the results of 100g oral glucose loading. The results obtained were as follows: 1) In the normal subjects and cirrhotics, lactate and pyruvate concentrations gradually increased with time and reached their peak levels at 60 min, whereas they remained unchanged throughout the course in the diabetic group at glucose loading. 2) Alanine administration accelerated ureogenesis but did not affect blood glucose levels. 3) In both glucose and L-alanine administration, free fatty acid, glycerol and ketone body levels declined nonspecifically in all groups. 4) Serum glucagon levels during L-alanine loading increased in all groups, especially in liver cirrhotics. 5) L-alanine was a potent stimulus for insulin secretion in diabetics, while no insulin release during glucose loading was observed. 6) The molar ratio of insulin levels (during glucose loading)/glucagon levels (during L-alanine loading) was a good indicator of systemic glucose homeostasis from the hormonal aspect.
It is suggested that, in addition to the oral glucose tolerance test, the oral administration of L-alanine can be a useful tool for the diagnosis of the status in diabetes mellitus and cirrhosis.

Isolated adipocytes from severely diabetic rats exhibited hypersensitivity to epinephrine at low concentrations (0.05-0.1μM) on lipolysis, compared with isolated adipocytes from normal and mildly diabetic rats. Hypersensitivity to dibutyryl cyclic AMP and theophylline at concentrations from 0.05 to 0.50mM was not observed in adipocytes of severely diabetic rats. Insulin could not exert an inhibitory effect on epinephrineinduced lipolysis in adipocytes of severely diabetic rats. In isolated adipocytes from normal rats, hyperosmolarity due to the combination of 50mM glucose and 100 mM sodium chloride only had an inhibitory effect on 0.25μM epinephrine-induced lipolysis. Ten mM β-hydroxybutyrate did not inhibit lipolysis caused by epinephrine although any lipolysis stimulated by epinephrine, dibutyryl cyclic AMP and theophylline was inhibited by insulin. Our present findings may partly explain insulin resistance in the severely diabetic state and the pathogenesis of the absence of ketosis in hyperglycemic hyperosmolar conditions.

The mode of natural killer (NK) cell migration to the sites of inflammation and transplanted tumors was investigated by using dry ice for physical irritation and l-fluoro-2,4 dinitrobenzene (DNFB) for chemical irritation in mouse ear. In experiments with transplanted tumors, NK cell sensitive tumor cells (RL♂I) and insensitive tumor cells (p815) were transplanted into the ears of C3H and BALB/c mice, respectively. Employing a polyclonal rabbit antiserum against asialoGM1 (GA1), and a monoclonal rat antiserum against Thy-1 in an immunohistochemical double-staining technique. we enumerated the number of Thy-1-positive and asialoGM1- positive (Thy-1⁺GA1⁺) cells and Thy-1-negative and asialoGM1-positive (Thy-1^-GA1⁺) cells at various times of irritation. Following physical irritation, Thy-1^-+GA1⁺ cells (108.8 ± 4.5/mm² at 24 hand 71.2 ± 3.8/mm² at 48 h) were found in the epidermis, whereas Thy-1⁺GA1⁺ cells were not found. In delayed-type skin reaciton by DNFB, Thy-1⁺GAI + cells (87.1 ± S.8/mm² at 24 hand 60.7 ± 2.9/mm² at 48 h) and Thy-1 +GA I + cells (26.4 ± 3.6/mm² at 24 hand 15.3 ± 4.3/mm² at 48 h) were found in the dermis. Since it was reported by previous investigators that Thy-1⁺GA1⁺ cells are NK cells, we assumed that NK cells infiltrated nonspecifically in the dermis in delayed-type skin reaction by DNFB. In the tumor transplant experiments. the GA1⁺ cells were found near both types of tumors, but they were in contact with RL♂1 and not with p815. Because it was reported that GA1⁺ monocytes do not have cytotoxicity against tumor cells, our findings suggest that GA1 + cells migrate nonspecifically to the sites of inflammation, and that the NK cells among them may make direct contact with the tumor cells when they encounter NK cell sensitive tumors.