Immunochemical Studies on Carcinoembryonic Antigen: (1) Quantitative Determination in Carcinomatous and Noncarcinomatous Tissues

Anti-CEA serum was prepared by immunizing rabbits with a crudeCEA fraction obtained from perchloric acid soluble extractsof adenocarcinoma of the stomach. After absorption, the antiserumproved to be monospecific for CEA. With Mancini's technique,CEA concentrations in perchloric acid extracts of carcinomatousand noncarcinomatous tissues were quantitatively determinedand expressed in terms of unit/ml, equivalent to mg/ml proteinconcentration of standard CEA solution. Finally, ratios of CEAunits per mg protein (CEA/P) of tissue extract were calculated. The CEA/P ratios tended to be higher in extracts from colonic,rectal and pancreatic carcinomas than in those from gastriccarcinoma, whereas they were lower in those from primary hepatomaand lung cancer. In the same patients with cancer, the ratiosfor carcinoma tissues were remarkably higher than those forthe noncarcinomatous counterparts. However, the ratios werenot related to the histological types of cancers. Relativelyhigh ratios were also observed in diseased intestinal mucosaof colonic polyposis and Crohn's disease, as well as in partsof gastric mucosa with a marked intestinal metaplasia obtainedfrom a cancerous stomach. More studies will be required to evaluatethe significance of occurrence in precancerous changes in tissues.     

Guidelines for the treatment of Crohn''s disease in children

This paper shows guidelines for the treatment of Crohn's disease in children by the Working Group of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition (Chair: Yuichiro Yamashiro) and the Japanese Society for Pediatric Inflammatory Bowel Disease (Chair: Akio Kobayashi). The points in which these guidelines differ from those for adult patients are as follows. (i) Total enteral nutrition in the form of an elemental formula is indicated as primary therapy for children with Crohn's disease at onset as well as the active stage. Oral mesalazine is used together. (ii) Total parenteral nutrition (TPN) with oral mesalazine is required for children with serious illness. The use of a corticosteroid should be withheld for at least 1 week after TPN has been started. (iii) When TPN is not considered to be effective, additional corticosteroid is used. Full doses of corticosteroid should be used for at least 2 weeks after clinical improvement has been achieved, and then the dose of the corticosteroid should be tapered carefully. (iv) When surgery is indicated in pediatric patients with stricture or fistula formation and complicated by persistent growth failure despite medical therapy, the optimum time for surgery is thought to be before epiphyseal plates have been closed.     

High expression of the fee gene product in murine testicular germ cells and erythroblasts

Tec is a novel non-receptor-type protein tyroslne kinase that was originally Identified from a murine liver cDNA library. While the function of Tec remains unknown, it was shown recently that two Tec-related kinases are involved directly in the growth and differentiation of bone marrow stem cells. As the localization of Tec protein has not been reported yet, immunohlstochemical and immunochemlcal studies of various murine organs were conducted in the present study to clarify which cells express this kinase protein. An intense immunohistologic reaction was observed in neonatal and adult testicular germ cells, and neonatal and fetal hepatic erythroblasts. In addition, a clear immunostaining was noted in neonatal and adult tubal epithelial cells, hepatocytes, basal cells of the non-glandular stomach, foveolar epithelium of the glandular stomach, sebaceous cells of the skin and fetal cartilage. The immune reaction of germ cells and erythroblasts was observed in the cell membrane, although this protein does not have a transmembrane domain. Supportive western blotting of testis, adult liver, spleen and heart of adult C.B-17 mice with the use of anti-Tec antibody demonstrated a heavy 70kDa band in the liver and testis, and a much weaker, small band in the heart and spleen. These results suggest that Tec protein has a specific role in testicular germ cells and erythroblasts.     

Effect of Low Dose Aspirin on Augmented Piasminogen Activator Inhibitor Type 1 Activity in Patients with Permanent Pacemakers

To clarify the activity states of coagulation and fibrinolysis in patients with a permanent pacemaker, we studied 29 patients more than 4 months after operation. They were divided into a single pacemaker lead group (S, n = 14) and a double lead group (D, n = 15). Prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin III, tissue-type plasminogen activator (tPA) activity, plasminogen activator inhibitor type-1 (PAI-1) activity, and platelet aggregation were measured and compared to those in an age-matched control group (C, n - 7). The effects of low dose aspirin (81 mg/day) in the patients (n = 21) were also studied 2 weeks after administration. PAI-1 activity in groups S and D was significantly higher than that in the group C (53.5 ± 36.5, 86.8 ± 59.2 ng/ mL vs 19.4 ± 7.2 ng/mL; P < 0.01 and P < 0.005). Platelet aggregation induced by collagen was slightly higher in groups S and D than group C. Other parameters were not significantly different. In the patients, low dose aspirin significantly suppressed collagen induced platelet aggregation (71.8 ± 20.3% vs 41.7 ± 28.3%; P < 0.005), but not PAI-1 activity. tPA activity was increased significantly by the low dose aspirin administration (3.94 ± 1.85 ng/mL vs 2.48 ± 1.19 ng/mL; P < 0.005). Thus, PAI-1 activity in patients with a permanent pacemaker is elevated, and the activity is not suppressed by low dose aspirin unlike the platelet aggregation.     

Relation of Exocrine Pancreatic Function to the Diameter of the Pancreatic and Common Bile Ducts

One hundred and thirty-nine patients were examined for possible chronic pancreatitis by means of both pancreozymin-secretin test and endoscopic pancreatography of pancreatocholangiography. Pancreatic function as assessed by the pancreozymin-secretin test was impaired in 89 (64%) of the entire group. No significant relationship was demonstrated between pancreatic secretion of fluid, bicarbonate and amylase and the diameter of main pancreatic duct in both the entire group of the subgroup of patients with pancreatic dysfunction. On pancreatogram no gross morphological abnormalities were found in a high proportion of patients whose pancreatic function was impaired in minimal to moderate degree. There was a significant linear correlation between the diameters of the main pancreatic duct and common bile duct. These data question the value of endoscopic pancreatography in the diagnosis of low to moderate grade chronic pancreatitis.     

Idiopathic Left Ventricular Tachycardia with Block Between Purkinje Potential and Ventricular Myocardium

We performed radiofrequency current catheter ablation in a patient with idiopathic LV. While mapping the inferoapical LV septum during tachycardia, spontaneous termination of tachycardia was observed with block between Purkinje (P) potential and ventricular electrogram (P-V block). The cycle length of the tachycardia was associated with prolongation of P-P interval and P-V interval. P potential recording at this site was earliest and at very low amplitude during tachycardia. The radiofrequency current at this site was successful. These findings indicated that Purkinje fiber was a critical part of the tachycardia circuit. Ablation was successful at a site where both an earliest and low amplitude P potential was recorded during tachycardia, and where P-V block that was induced by catheter manipulation was observed during tachycardia.     

Pancreatic Internal Fistula to the Left Pleural Cavity

A case of recurrent pancreaticopleural effusion is presented. The pleural effusion with high enzyme and protein eouteuts resulted from a pancreatic internal fistula to the left pleural cavity. A sinus tract passing throngh esophageal hiatus was demonstrated by the endoscopic retrograde pancreatography (ERP). Surgical intervention afforded complete relief of abdominal pain and elimination of the pleural effusion.