土茯苓酚苷类成分研究

目的 研究土茯苓的化学成分。方法 用硅胶、大孔树脂、ODS柱色谱及HPLC方法进行分离纯化，根据理化性质和光谱数据进行结构鉴定。结果 得到6个化合物，分别为2，4，6-三羟基苯乙酮-2，4-二-O-β-D-吡喃葡萄糖苷(Ⅰ)、3，4，5-三甲氧基苯基-1-O-β-D-吡喃葡萄糖苷(Ⅱ)、3，4，5-三甲氧基苯基-1-O-[β-D-呋喃芹糖基-(1→6)]-β-吡喃葡萄糖苷(Ⅲ)、3，4-二羟基苯乙醇-3-O-β-D-吡喃葡萄糖苷(Ⅳ)、8，8′-双二氢丁香苷元葡萄糖苷(8，8′bisdihydrosyringenin glucoside，V)、白藜芦醇-3-O-β-D-吡喃葡萄糖苷(Ⅵ)。结论 化合物Ⅰ为首次从天然界中分得，其余化合物为首次从土茯苓中分得。     

Systemic sclerosis in children: A national retrospective survey in Japan

A retrospective questionnaire survey of pediatric departments, for childhood collagen disease from 1985 to 1994 was used to clarify the clinical features of scleroderma in Japan. In the primary survey, 0.9% of the children with a rheumatic condition had scleroderma. Answers to this questionnaire were received on 18 (localized 9; systemic 9) patients from 15 institutions. In order to examine systemic sclerosis (SSc), seven cases of SSc in Japanese articles during the same period as the questionnaire were added to these answers and compared to the Japanese epidemic study investigated by Fukuyama in 1974. There were 16 children, seven boys and nine girls, with SSc during the 10-year period in Japan. The mean age of onset of symptoms was 8.0 ± 2.8 years and the age at diagnosis was 10.1 ± 3.0 years. Eighty percent of children had Raynaud's phenomenon at the onset of SSc, and skin and musculoskeletal involvement was highly recognized during the course of the disease. Atrophy of the frenulum linguae and lung fibrosis were commonly seen in SSc. In serological studies, 80% of children have antinuclear antibodies and approximately 50% of patients have anti-Scl-70 (topoisomelase I) antibodies at the onset and during the course of childhood SSc. The prognosis is poor, as remission occurred in only one child. The clinical symptoms and examination of serological autoimmune antibodies were supportive of an early diagnosis of SSc. When compared to the previous national survey of children with SSc, the present results showed that the male-to-female ratio was reduced, the age at onset was low, the positive incidence of serological autoimmune antibodies elevated, and the usage of vasodilators and nonsteroid anti-inflammatory drugs (NSAID) increased, with corticosteroids decreased. But, the positive percentage of clinical symptoms were not changed in both studies. For a complete retrospective nationwide epidemic survey carried out on children with scleroderma, especially SSc, it is important to include dermatology departments.     

A girl having congenital chloride diarrhea treated with spironolactone for seven years

We report on a girl having congenital chloride diarrhea (CCD) who has been followed for 7 years and 6 months sequentially. Dilated intestinal loops, marked enlargement of the abdominal circumference of the fetus and hydramnios were noted by ultrasound examination at 31 weeks of gestation. After delivery by cesarean section for hydramnios, she excreted profuse watery yellow green stools with marked abdominal distension. At 4 months of age, hypochloremia, hyponatremia and a high concentration of chloride in the stool were identified. She was diagnosed as having CCD. Because it was difficult to administer a large volume of potassium chloride (KCl), and sodium chloride (NaCl), we decided to administer spironolactone. After administration of spironolactone, we could generate correct serum electrolytes using less amounts of KCl. At 7 years and 6 months of age, her body size was within normal limits and her intellectual, mental and physical development had been normal. In spite of normal serum electrolytes, blood pH and the presence of chloriduria, secondary hyperaldosteronism was noted. We consider that spironolactone may be useful to decrease the amount of KCl administration in the neonatal period, but frequent measurements of renin, angiotensin and aldosterone would be necessary for adequate control in CCD cases.     

Biological and Clinical Implication of Neuron-Specific Enolase and Creatine Kinase BB in Small Cell Lung Cancer

The specificity of neuron-specific enolase (NSE) and creatinekinase BB (CK-BB) for small cell lung cancer (SCLC) was determinedby biological and immunohistochemical procedures in lung cancertissues and cultured cell lines. Average values of extractableNSE and CK-BB of SCLC tissues were significantly higher thanthose of non-SCLC and normal lung tissues. A large amount ofNSE and CK-BB was demonstrated in SCLC cell lines. Immunohistochemical examination showed positive staining forNSE and CK-BB in most cases of SCLC and in a few cases of non-SCLC.From these data NSE and CK-BB should be considered to be highlyspecific for SCLC. In a clinical study serum values exceeding 10 ng/ml for NSEand 1.5 ng/ml for CK-BB were set as positive for the enzymes.Positive rates in SCLC were 71.4% for NSE and 65.3% for CK-BB,which were significantly higher than those in non-SCLC. Allpositive cases were in an advanced stage. Consecutive dailyNSE determinations during induction chemotherapy showed transientelevation immediately after the initiation of drug administration(tumor lysis syndrome), followed by a decline to the normalrange in responders. This phe nomenon seems to indicate tumorsensitivity to cytotoxic drugs. NSE positive non-SCLC was assensitive to cytotoxic drugs as SCLC. These findings indicatethat lung cancer with elevated serum NSE and CK-BB levels atdiagnosis should be strongly suspected of being SCLC in theadvanced stage.     

Effect of H-2 Complex on the Growth of Embryo-Derived Teratomas in Mice

ABSTRACT: Seven-day-old embryos of several H-2 congenic strains were transplanted under the kidney capsules of syngeneic adult recipients to determine the genetic factors(s) governing the in vivo growth of embryo-derived teratomas. A.TH(H-2^t2) and A.TL(H-2^t1) strains showed significantly greater tumor weights than A.BY(H-2^b) and A.SW(H-2^S) strains. The A(H-2^a) strain was intermediate in tumor size. A comparison of the genic constitution of the H-2 complex in each congenic strain suggested that the H-2D locus and/or its distal regions affected the growth of embryo-derived teratomas. The teratoma induced in the B10.A(H-2^a) strain was smaller than that in the A(H-2^a) strain, indicating that the genetic background of the A strain is favorable for teratoma growth. Histological observations demonstrated that the existence of embryonal carcinoma cells was necessary for the growth of teratomas. A radiation-sensitive immunological factor in the recipient probably plays a role in stimulating teratoma growth.     

A Descriptive Epidemiological Study of Hematopoietic Neoplasms in Japan

In 1982, the number of deaths from hematopoietic neoplasms was5,885 for males and 4,237 for females, which corresponded toabout 6%; of all malignant neoplasms. The increase in the age-adjusteddeath rate in the last 10 years was highest for lymphatic leukemia(1.8 times), followed by multiple myeloma (1.7 times), malignantlymphomas (1.3 times) and myelogenic leukemia (1.1 times). Inthe old-age group, i.e., over 70, the death rate for all typesof hematopoetic neoplasms increased markedly during this period,particularly for multiple myeloma. In children, however, anincrease in lymphatic leukemia and a decrease in myelogenicleukemia were observed. Geographical variation showed a markedexcess in the death rates for malignant lymphomas and lymphaticleukemia in the Kyushu district, especially in the middle- andold-age groups. This may be attributed to the high incidenceof adult T-cell leukemia/lymphoma in the southwestern part ofJapan. The age-adjusted death rate for malignant lymphomas wasslightly higher in rural areas than in urban areas in malesin Kyushu.     

The behaviour of red cells in narrow tubes in vitro as a model of the microcirculation

To investigate the behaviour of red cells in the microcirculation, we established a new capillary method using narrow fluorinated ethylenepropylene copolymer tubes with internal diameters of 12.5 and 25.0 μm. Red cell flow in the tubes under a given range of pressure was analysed through a video system connected to a microscope. The experimental condition was adjusted so that the velocity of the control normocytes would be compatible with that in corresponding vessels in vivo , 0.5–1.5 mm/s. In the 12.5 μm tube, normocytes obtained from 12 young normal volunteers ran in an axisymmetric edge-on orientation with a folded shape at higher pressures, but rolled along freely without deformation at lower pressures. Deformation during the passage of the microcytes obtained from four patients with polycythaemia vera complicated with iron-deficient microcytosis and 10 patients with iron deficiency anaemia was relatively mild, whereas that of the macrocytes obtained from eight patients with refractory anaemia was marked. Even after the screening effect at the tube entrance was taken into consideration, the velocities of both microcytes and macrocytes were found to be significantly lower than the control normocytes. Therefore this method may be a new way to investigate the flow properties of red cells in the microcirculation.     

The nocturnal secretion of cardiac natriuretic peptides during obstructive sleep apnoea and its response to therapy with nasal continuous positive airway pressure

The nocturnal secretion profile of the newly identified natriuretic peptide (NP), brain natriuretic peptide (BNP), was studied in 14 patients with obstructive sleep apnoea syndrome (OSAS) (apnoea hypopnoea index: 60.5±3.4, mean±SE) during two separate nights before and during nasal continuous positive airway pressure (NCPAP) therapy. Plasma levels of NPs (atrial natriuretic peptides; ANP and BNP) were measured at 2-h intervals during sleep. Simultaneously, blood pressure was measured by a non-invasive method (Finapres^®, Ohmeda, Englewood, CO, USA) and urine was collected for determing volume and catecholamine levels. Urinary and serum sodium concentration were determined before and after the study. Eight non-snoring subjects were also studied for the investigation of normal nocturnal profiles of BNP levels. To understand the discrete secretion profiles of the two NPs during sleep, blood was sampled from an additional seven patients every 5 min over a 30-min period around 00.00 and 04.00 hours before NCPAP. In patients with OSAS, plasma BNP levels increased from the beginning of sleep (22:00 h) to the morning (06:00 h) before NCPAP therapy (P< 0.01, anova ). Baseline BNP levels were not significantly correlated with patient's clinical and poly- somnographic parameters. However, in the latter half of the sleep period (02:00–06:00 h), increases in BNP levels during the night before NCPAP therapy were significantly correlated with blood pressure elevations (systolic: r=0.784 P< 0.01, diastolic: r=0.587 P< 0.01) and with apnoea duration (r=0.582 P< 0.01). In normal subjects BP and BNP levels were not changed significantly during sleep. Plasma BNP levels were well correlated with concomitant ANP levels (P< 0.001). NCPAP therapy reduced ANP and BNP levels during sleep and in the morning (P< 0.01). Plasma levels of BNP at 5 min intervals before NCPAP therapy revealed few variations. On the other hand, ANP levels fluctuated over the 30-min period. Changes in BNP levels during sleep in the patients with OSAS may be related to blood pressure variations, but may be too small to play a significant physiological role in regulating diuresis in OSAS. Further work is required to determine the precise role of dual natriuretic system in cardiovascular load and natriuresis in OSAS.     

Estimated nutritional intake based on the reference growth curves for extremely low birthweight infants

BACKGROUND: Although the optimal goal of extremely low birthweight (ELBW) infants has been debated, it can be argued that the best nutritional strategy for ELBW infants is one which achieves better growth while preventing neurological sequelae due to nutritional inadequacy, even if it does not mimic fetal growth. Our aim is to propose an advisable and practically feasible nutritional intake for ELBW infants. METHODS: We retrospectively investigated the nutritional intake in 16 ELBW infants (gestational age 26.7 weeks, birthweight 879.6 g), who exceeded the standard growth curves for Japanese infants of ELBW. We also analyzed the nutritional composition of human milk from 15 mothers delivering before term (PT milk) until the 12th week of lactation. The nutritional intake was calculated according to the composition of the parenteral and enteral regimen. RESULTS: The infants tolerated more than 100 mL/kg per day of milk until the fourth week of life. An average weight gain of more than 15 g/kg per day was achieved by the sixth week. An advisable nutritional intake capable of sustaining ELBW infants in a stable growing phase was calculated as the sum of the mean plus 1SD of the daily nutritional intake. CONCLUSIONS: To exceed the ordinary growth curves for ELBW Japanese infants, it was suggested that more than 100 mL milk/kg per day could be fed until the fourth week of life, while the advisable daily intake of nutrients after six weeks of life should be as follows: water 160 mL/kg, protein 3.2 g/kg, fat 7.4 g/kg, carbohydrate 12.8 g/kg, energy 544 kJ/kg, the following minerals in mg/kg: sodium 45, chloride 82, potassium 110, calcium 140, phosphorus 70, magnesium 11, zinc 0.5 and copper at 60 micrograms/kg. Further studies will be needed to confirm the safety and effectiveness of this advisable intake for ELBW infants.     

LEARNING CURVE AND CONVERSION TO OPEN SURGERY IN CASES OF LAPAROSCOPIC ADRENALECTOMY AND NEPHRECTOMY

Purpose

We examine how the level of experience acquired by the laparoscopist affects the outcome of laparoscopic adrenalectomy and nephrectomy, and what is necessary to avoid complications in these surgeries.

Materials and Methods

We retrospectively evaluated the experience levels of 8 urological laparoscopists between 1991 and 1995. In addition, other cases that were converted to open surgery were collected from the institutes with which the 8 laparoscopists were affiliated.

Results

The rates of conversion to open surgery were 6.4% in 204 cases of adrenalectomy and 14.3% in 63 of nephrectomy. Conversion rates were related to blood loss volume but not operative time. The major causes of conversion were bleeding in 45% of cases and adhesion in 34%. There were no mortalities. Mean operative time decreased significantly, reaching that of open surgery as the number of procedures increased up to 20 adrenalectomies and 10 nephrectomies. The volume of blood lost remained low from the early experience. Blood transfusion rates were 4.4% for adrenalectomy and 11.1% for nephrectomy.

Conclusions

Operative time of these procedures decreased significantly with surgeon experience and reached that of open surgery. Cases in which adhesion is anticipated should be restricted to avoid conversion. These laparoscopic procedures are acceptable as a standard operative techniques for adrenal and renal diseases.