Cerebral perfusion MR imaging using FAIR-HASTE in chronic carotid occlusive disease: comparison with dynamic susceptibility contrast-perfusion MR imaging.

To determine the efficacy of flow-sensitive alternating inversion recovery using half-Fourier single-shot turbo spin-echo (FAIR-HASTE) in detecting cerebral hypoperfusion in chronic carotid occlusive disease, we subjected 12 patients with various degrees of cervical internal carotid artery stenoses and/or occlusion (Stenosis group) and 24 volunteers (Normal group) to FAIR-HASTE. In addition, 10 out of 12 patients in the Stenosis group underwent dynamic susceptibility contrast-perfusion magnetic resonance imaging (DSC-pMRI) before and after revascularization in the dominantly affected side. The absolute asymmetry indexes (AIs) of both cerebral hemispheres in the Normal and Stenosis groups were compared in FAIR-HASTE. In addition, the AIs were compared with those in the Stenosis group before and after revascularization in both FAIR-HASTE and regional cerebral blood flow (rCBF), calculated with DSC-pMRI. A statistically significant difference was recognized between the AIs in the Normal and Stenosis groups (AI = 2.25 +- 1.92, 8.09 +- 4.60, respectively ; p < 0.0001). Furthermore, in the Stenosis group the AIs on both FAIR-HASTE (8.88 +- 4.93, 2.22 +- 1.79, respectively ; p = 0.0003) and rCBF (7.13 +- 3.57, 1.25 +- 1.33, respectively ; p = 0.0003) significantly decreased after revascularization. In the Stenosis group, before revascularization, signal intensity on both FAIR-HASTE and rCBF had a tendency to be lower in the dominantly affected side. FAIR-HASTE imaging was useful in the detection and evaluation of cerebral hypoperfusion in chronic occlusive carotid disease

Evaluation of Esophageal Varices by Multidetector-row CT: Correlation with Endoscopic ‘Red Color Sign’

<P>To evaluate the ability of multidetector-row CT (MDCT) to predict a risk of hemorrhage in patients with esophageal varices, a total of 40 MDCT scans were performed in 29 patients who had been diagnosed with esophageal varices by conventional upper gastrointestinal tract endoscopy. In 11 patients, MDCT was performed both before and after endoscopic injection sclerotherapy (EIS). Endoscopically, the red color sign (RC sign) was present in 28 scans. Of the 11 patients who underwent EIS, the RC sign disappeared after EIS in 9. The MDCT scans were obtained in the arterial, portal, and equilibrial phases, and the portal phase images were used in this study. Subsequently, the extent of esophageal varices was categorized into four MDCT scores. The variceal score, the maximum short axis of the varices, and the presence of palisade vein dilatation obtained from MDCT had significant correlation with endoscopic variceal forms, and the presence and severity of RC sign, respectively (p<0.01). All cases with a maximum minor axis of more than 4 mm showed positive RC sign. MDCT was useful in the evaluation of esophageal varices for predicting a risk of hemorrhage

血清の成分及びアミノ酸の濃度に対するビタミンの効果

Effects of different vitamins on concentration of blood serum components and amino acid were studied, using male rats of the Wister strain. Five kinds of vitamins, namely vitamin A, v. B1 (thiamin), v. C (ascorbic acid), v. D (calciferol), v. E (tocopherol) were used in this study. They were injected sub cutaneously in a single dose of 500 IU, 2.5 mg, 2.5 mg, 1000 IU and 2.5 mg, respectively. The animals were sacrificed by decapitating at four hours following the injection. Blood sample taken at the time of sacrifice was centrifuged for separation of serum after 10 hours-standing at room temperature. The serum was determined for concentration of its components, using Vet-Aid described previously and analyzed for amino acids, using a full automatic amino acid analyzer previously described. Concentration of cholesterol in the serum was elevated by the administration of vitamins A, B and C, and it was lowered significantly by the administration of vitamins D and E. These vitamins seemed to have a close relation to fat deposition in the meat. The effect of vitamins on fat deposition in beef would require further study

Correlation Between Fat Deposit in Eye Muscle and Concentration of Plasma Lipoprotein in Fattened Steer

肥育牛の血漿のHDL,LDL,TG,TCho,Echo,LPO,NEFAなどの脂質,GH,Cort,Insu,TSH,T4,T3,LHなどのホルモン,総蛋白質,Ca,Mg,無機リンなどの濃度を測定した. 血漿HDL濃度は第8-9肋間におけるロース芯の脂肪交雑値(サシ)と正の相関があり,またTChoとは有意な非常に高い正相関がある. 一方,高脂肪交雑牛ではHDLはLPOとも有意な高い正相関があった. 血漿HDL濃度はホルモン濃度と有意な相関は無かったが,LHの濃度との間には負の相関の傾向がみられた. 血漿LDLの濃度はTG濃度と正相関があり,高脂肪交雑牛群においてはHDL,TChoの濃度と有意性の高い正の相関があった. また血漿のLDL濃度はGHと負の相関があり,IPとは正の相関があった. 血漿のHDLおよびLDLの濃度は組織の代謝機能の低い時,換言すれば脂肪交雑の進んだ段階で増加する. 人体保健上,HDL/LDL比の大きい牛肉の生産の必要性が提唱された

Effect of Growth Hormone on Fat Deposit in Muscle of Cattle

黒毛和種去勢肥育牛30頭のと殺時血液を採り,その血漿中の成長ホルモン(GH)の濃度を測定した. また血漿の脂質,ホルモンその他血漿成分の濃度を測定し,GH濃度との相関を求めた. 血漿GH濃度と枝肉ロース芯の脂肪交雑値との間には負の相関関係が得られた. これは成長ホルモンは筋肉の脂肪交雑に対する負の要因であり,牛の肥育の仕上期にはGH分泌の刺激要因を避ける必要のあることが示唆された

<原著>副腎腫瘤の臨床的検討

We reviewed the records of 13 patients with adrenal masses operated on over a ten-year period to clarify clinical characteristics of adrenal tumors. Tumors were found incidentally in seven of nine patients with primary adrenal tumors (78%); however, three of these seven patients (43%) proved to have shown symptoms related to adrenal hyperfunction when re-e、raluated. Other adrenal tumors (metastatic in three patients and inflammatory in one) were found without any symptoms referable to the tumors. In nine of 13 patients (69%), tumors were discovered by computerized tomography (CT). All patients with primary tumors have been gotten free of disease postoperatively. In contrast, although all three patients with metastatic adrenal tumors underwent resection of all known disease tissue, they died of the recurrence of malignancies within 10 months. This study suggests that a number of functional adrenal tumors are possibly left undiagnosed until found incidentally, and that CT is the most powerful tool to detect adrenal tumors. Our data did not support surgical intervention in cases of metastatic adrenal tumors.副腎腫瘤の臨床的特徴を明らかにするために過去10年間に当科で手術された13例を検討した. 原発性腫瘍9例中2例は臨床症状より原発性アルドステロン症を疑われ副腎腫瘍を発見されているが, 残りの7例(78%)は偶然腫瘍が発見された, いわゆる incidentaloma であった. しかしながら, retrospective にみるとこの7例中3例(43%)で副腎機能亢進によると考えられる症状を呈していた. 転移性腫瘍3例, histoplasma による肉芽腫1例は全て無症状であった. 13例中9例(69%)はCTにより, 2例は超音波, 1例は血管造影, 1例は scintigraphy によりそれぞれ病変を発見され, CT で副腎腫瘤を指摘できなかったのは1例のみであった. 13例中11例は経腹的に, 2例 は開胸開腹で手術されたが, 術後合併症は1例に創感染を認めたのみであった. 原発性腫瘍例は全例術後再発を認めていないが, 転移性腫瘍の3例は全例, 術後10ヶ月以内に再発死した. 以上の結果は機能性副腎腫瘍でも偶然発見されるまで診断されない場合が多いことを示唆しており, 臨床症状を注意深く検討し常に副腎腫瘍の可能性を考慮にいれることが肝要であると考えられる. また, 今回の結果より CT が副腎腫瘤の診断において重要な位置を占めるものと考えられた. なお, 転移性副腎腫瘍に対する手術療法は今回の検討ではそれを積極的に支持する結果は得られず, 今後さらに検討を要する問題と思われる

Relation of Function of the Liver to Weight Gain and Fat Deposit in the Muscle of Fattened Steer

和牛の若令去勢肥育牛50頭のと殺時の血液を採取し,その赤血球数(RBC),白血球数(BC),ヘマトリット(Ht),硫安反応(ASR),を検査し,さらに血清中の全蛋白質(TP),総コレステロール(TCh),遊離コレステロール(FCh),エステル型コレステロール(ECh),アルブミン(Al),α-グロブリン(α-Gl),β-グロブリン(β-Gl),γ-グロブリン(γ-Gl),などの濃度の測定およびA/G比を求めた. 血清ASR値はTPおよびγ-Glと正相関,Al,A/G北および日令体重とは負の相関があった. また脂肪交雑とは負の相関の傾向がみられた. 増体および脂肪交雑の増進のためには強い肝機能の必要なことが実証された

<症例>胃癌手術 (脾摘術合併胃全摘術) 後の門脈血栓症の1例

A 48-year-old woman underwent total gastrectomy, splenectomy, and distal pancreatectomy with en bloc regional lymph node dissection for gastric carcinoma. Dull pain in the right upper quadrant and the back developed postoperatively. Contrast-enhanced computed tomography and ultrasonography disclosed portal vein thrombosis (PVT). Heparin and urokinase were given in conjunction with antbiotics. This treatment resulted in clinical improvement, but failed to achieve complete thrombolysis. Cavernous transformation of the portal system was confirmed. Although PVT after splenectomy has been reported mainly in patients with hematological disorders, our case suggests that splenectomy for en bloc node dissection in gastric carcinoma is a possible cause of PVT.門脈血栓症は肝硬変や肝癌の患者で時に認められる病態であるが, 術後の門脈血栓症は稀であり, そのほとんどが脾腫に対する脾摘術後に発生している. 我々は胃癌根治術に伴う脾摘術後に門脈血栓をきたした症例を経験したので報告する. 症例は48才の女性で, 胃体上部後壁を中心とする5型胃癌に対し, 胃全摘術, 脾摘術, 膵尾側切除術を行なった. 病変は組織学的には低分化腺癌, 深達度ss, No, Po, Ho の stage I b で, 摘出した脾重量は 150g であった. なお, 術前の出血凝固系検査には異常を認めなかった. 術後18日目より右上腹部から背部の鈍痛が出現し, 白血球数, CRP, 血清アルカリフォスファターゼ値も上昇してきた. 術後19日目の造影CTで, 門脈, 上腸間膜静脈がほとんど造影されず, 門脈から上腸間膜静脈におよぶ血栓形成が考えられた. 抗生剤の投与とともにただちにへパリンの持続静注とウロキナーゼ投与を併用したところ, 臨床症状や検査所見は軽快した. ただし, 血栓は完全に消失せず, その後の腹部血管造影では側副血行路としての肝十二指腸間膜内の静脈拡張, いわゆるcavernous transformation が認められた. へパリン, ウロキナーゼの投与からワーファリン内服に切り替え, 患者は術後66日目に退院した. 現在, 術後2年経過したが, 食道静脈瘤の出現や消化管出血などの門脈血栓, 門脈圧充亢進に起因すると思われる症状は認めていない. 我々の症例は, 進行胃癌根治術の際にしばしは合わせ行われる脾摘術後にも門脈血栓症の出現する可能性があることを示唆しており, そのような手術を受けた患者が術後原因不明の腹部症状や白血球増加を来たした時には門脈血栓症も疑い精査を進める必要があると考えられる

Genetic drivers of heterogeneity in type 2 diabetes pathophysiology

Type 2 diabetes (T2D) is a heterogeneous disease that develops through diverse pathophysiological processes1,2 and molecular mechanisms that are often specific to cell type3,4. Here, to characterize the genetic contribution to these processes across ancestry groups, we aggregate genome-wide association study data from 2,535,601 individuals (39.7% not of European ancestry), including 428,452 cases of T2D. We identify 1,289 independent association signals at genome-wide significance (P &lt; 5 × 10-8) that map to 611 loci, of which 145 loci are, to our knowledge, previously unreported. We define eight non-overlapping clusters of T2D signals that are characterized by distinct profiles of cardiometabolic trait associations. These clusters are differentially enriched for cell-type-specific regions of open chromatin, including pancreatic islets, adipocytes, endothelial cells and enteroendocrine cells. We build cluster-specific partitioned polygenic scores5 in a further 279,552 individuals of diverse ancestry, including 30,288 cases of T2D, and test their association with T2D-related vascular outcomes. Cluster-specific partitioned polygenic scores are associated with coronary artery disease, peripheral artery disease and end-stage diabetic nephropathy across ancestry groups, highlighting the importance of obesity-related processes in the development of vascular outcomes. Our findings show the value of integrating multi-ancestry genome-wide association study data with single-cell epigenomics to disentangle the aetiological heterogeneity that drives the development and progression of T2D. This might offer a route to optimize global access to genetically informed diabetes care.</p