[Gastroesophageal reflux after esophageal surgery--evaluations based on esophageal transit scintigram].

By means of esophageal transit scintigram using 99mTc-DTPA, 15 patients (13 esophageal carcinomas and 2 cardia carcinomas) were studied, in whom esophagogastric anastomosis was done according to the posterior invagination anastomosis technique we had devised. In all 8 patients with anastomosis at cervical region, gastroesophageal reflux was not seen on both scintigrams before and after meals, and the average pressure gradient of high pressure zone at anastomosis was 39.8 cmH2O. In 2 of 7 patients with intrathoracic anastomosis, the scintigram before meals showed severe reflex, and the endoscopic findings showed diffuse and moderate erosion in the esophageal mucosa. The average pressure gradient across the anastomosis was 6.5 cmH2O. In these 2 patients, the new fornix with a sharp angle of His was not formed. In the remaining 5 patients with intrathoracic anastomosis, reflux was not seen on the scintigram before meals. However, in 2 of them, the scintigram after meal and endoscopic examination revealed mild reflux and mild esophagitis respectively. Furthermore in one patient very mild reflux was observed only on the scintigram after meals but the endoscopic findings showed the normal esophageal mucosa. In these 5 patients, the average pressure gradient across the anastomosis was 17.0 cmH2O, which was significantly higher (p less than 0.01) than that in 2 patients with severe reflux and was significantly lower (p less than 0.01) than the mean value of high pressure zone in 8 patients with cervical anastomosis. In conclusion, it is presumed that the formation of a large fornix enough to store food and a sharp angle of His are important factors in maintaining an anti-reflux mechanism. The esophageal transit scintigram was proved to be an excellent technique in detecting and evaluating quantitatively gastroesophageal reflux.

[The correlation of serum parathyroid hormones among patients with dementia of vascular type, hemodialysis, and bone-joint disorders].

PTH levels were analysed in sera of patients receiving maintenance hemodialysis, with the vascular type of dementia and orthopedic patients with bone-joint disorders, using PTH assay kits. There were significant interrelationship among all kinds of PTH levels in the hemodialysis patients, but not in patients with the vascular type of dementia and the bone-joint disorders. Renal functions might be responsible for fragmentation of PTH in blood stream. These results suggested that the measurement of PTH levels is needed to examine various kinds of amino-sequence of PTH levels in keeping normal function of kidney.

[Effect of age on markers of bone metabolism in renal hemodialysis patients].

Bone metabolic markers were investigated in the male hemodialysis patients within and over 60 years old and the female hemodialysis patients within and over 50 years old. Our results indicated that bone metabolic markers were more increased in the lower values of serum estradiol in the male patients, but inversely were more enhanced in higher values of serum estradiol in the female patients.

[The relation of various metabolic bone markers in renal hemodialysis patients classified by serum estradiol levels].

The bone metabolic markers showed the significant differences in age and sex of the hemodialysis patients with renal insufficiency. It is likely that the evaluations of bone change and biochemical metabolic markers should be based on serum estradiol level, sex and age of the renal hemodialysis patients.

[Markers of bone pain in hemodialysis patients with renal insufficiency].

The patients receiving maintenance hemodialysis were divided into two groups in the absence and the presence of bone pain and investigated the markers of bone pain in these patients. These results suggested that the duration of receiving hemodialysis, serum concentrations of alkaline phosphatase, osteocalcin and parathyroid hormone became to be the markers of bone pain.

[Accumulation velocity of 99mTc-HMDP in hip joint diseases].

The accumulation rate and velocity of 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) in hip joints were determined within four minutes after a bolus of injection of 99mTc-HMDP in the patients with hip joint disorders. There exist a significant relationship between accumulation velocity of 99mTc-HMDP in the affected joint and serum osteocalcin in the patients with eight cases of degenerative osteoarthropathy and six cases of femoral necrosis. This result indicates that the accumulation velocity of 99mTc-HMDP in the affected joint is likely to become a marker of bone turnover in hip joint disorder.

[Magnesium, parathyroid hormone and osteocalcin in the sera of hospitalized patients with chronic alcoholism].

Levels of parathyroid hormone (PTH) and osteocalcin in hypomagnesemic sera of chronic alcoholism patients were carried out to evaluate the roles of chronic alcohol poisoning on bone metabolism. Serum gamma-GTP activity showed inverse relationships among serum Mg and osteocalcin in these patients and PTH levels were also more decreased in these patients than in healthy subjects. These results indicated that the direct actions of alcohol might be brought about by the deterioration of bone metabolism, due to the decrease of serum PTH and osteocalcin levels by chronic alcohol poisoning.

[Parathyroid hormone and bone mineral content in male and female patients receiving hemodialysis].

Relative bone mineral content in the lumbar spine was measured by phantom B-MAs with the apparatus of computerized tomography in order to study the relationships between bone mineral content with age and parathyroid hormone in sera of randomized out- and in-patients and the hemodialysis patients. There exists a significant difference between male and female in the loss of bone mineral content of three groups.

[Clinical evaluation of osteocalcin in sera of the patients with neoplasms of bone].

The clinical significance of osteocalcin in sera of bone tumors were measured in sera of various kinds of bone tumors. The levels of osteocalcin were higher in bone tumors than those in normal subjects. Serum osteocalcin levels in hypercalcemic groups of bone metastasis and myeloma showed a remarkable increase in a parallelism with serum ALP and LDH levels. These results suggested to be directly or indirectly activated on osteoblast by bone tumors and to be synthesized osteocalcin in osteoblast.

[Influences of serum magnesium on measurements of serum parathyroid hormone].

The amino sequence recognizable parathyroid hormones (PTH) in lower and non-lower magnesemic groups in randomized samples were measured by using various kinds of the well established PTH kits. The levels of carboxy terminal, mid-region and intact PTH in lower magnesemic group were more decreased than these in non-lower magnesemic group. It is likely that the shortage of magnesium in serum makes a suppression of PTH secretion.

[Relationship between parathyroid hormone and magnesium in sera of the dementia patients].

The dementia patients with central nervous or neuro-cerebro vascular disorders seemed to be decreased serum Mg due to abnormal Mg uptake in diet. An increment of PTH level was paralleled with a rise of serum Mg and hypomagnesemic group was shown to have a lower PTH level in these patients. Our results suggested that secondary hypoparathyroidism was likely to be induced by normo-calcemic hypomagnesemia.

[The measurements of parathyroid hormones in sera of elderly osteoporotic patients with serum high alkaline phosphatase activity].

This study was carried out to investigate effects of drugs treated in the elderly osteoporotic patients on measurements of carboxy terminal, mid-region and intact PTH, by using the various kinds of PTH kits. The drugs such as 1 alpha(OH)D3, calcitonin and so on, in the treatment of osteoporotic patients, was brought about no significant inter-relationships among carboxy terminal, mid-region and intact PTH in sera of the elderly osteoporotic patients with serum high alkaline phosphatase activity.

[The measurement of parathyroid hormone in sera of hemodialysis patients with renal insufficiency by employing the various kinds of parathyroid hormone kits].

This study focussed on elucidating difference of blood PTH levels, by employing the various kinds of PTH kits. We carried out the measurements of PTH levels in sera of the hemodialysis patients with renal insufficiency presumably inactivated PTH degradative regulation in kidney. Our results showed the remarkable significant relationships among blood PTH levels of carboxyl and mid-region PTH and intact PTH in hemodialysis patients and was deduced that the difference of PTH levels by using various kinds of PTH kits was responsible of PTH cleavage effect in the kidney.

[A study of hepato-biliary and alimentary scintigrams using a triple tracer method].

In order to evaluate the gastric emptying and postprandial mixing of bile with food, the scintigraphies of hepatobiliary and gastrointestinal tracts by using three different kinds of radioisotopes were performed simultaneously (99mTc-E.HIDA for hepatobiliary scintigraphy, 111In-DTPA containing orange juice and 131I-albumin containing scrambled egg for gastrointestinal scintigraphy). This method was available for observation of gastric emptying of liquid and solid foods and also examination of the mixing effect of bile and food quantitatively.

[The study in the relationship between serum calcium and serum parathyroid hormone (PTH) by employing the various kits of PTH assay].

In order to evaluate the influences of serum PTH assay in the various concentrations of serum calcium, we divided into three groups which serum calcium had below 8.0 mg/dl, 8.2 mg/dl to 9.8 mg/dl and above 10.0 mg/dl at random samples and assayed PTH in serum sample, using various kits of PTH assay obtained from commercial sources. Our results suggested that the measurement of serum PTH influenced by the concentration of serum calcium and therefore, should be taken an attention of serum calcium in each sample.

[The measurement of serum human parathyroid hormone (h-PTH53-84) and effect of exercise on calcium metabolism].

This study was focussed our attention on the measurement within the upper physiological level of human serum parathyroid hormone (PTH), using kits of human PTH 53-84. This assay kit was able to detect serum PTH in sera with subtle changes of serum calcium concentrations before and after short term exercise. These serum PTH levels before and after exercise seemed to be changed within the upper physiological levels of PTH. Thus, this study suggested that the assay kit was likely to become a useful tool of the measurement of the physiological level of serum PTH in humans.

[A study of the intestinal 47Ca absorption test employing a scintillation camera].

In order to evaluate the clinical application of the calcium absorption test from the intestine, the intestinal 47Ca absorption test by using a scintillation camera was carried out in our laboratory. The results in the intestinal 47Ca absorption test using a scintillation camera showed a good correlation to the results which were estimated by using an arm counter previously reported by us. The rate of intestinal 47Ca absorption in 8 healthy volunteers (5 male, 3 female, average age: 37.6 +/- 9.5 years) was 52.0 +/- 3.8%, 74.3% in a patient with primary hyperparathyroidism 30.4% and 32.7% in two patients with idiopathic hypoparathyroidism respectively. This method is more easily handled and can be performed for only 4 days in institutes that are set up with scintillation camera without any special preparations, and it is recommended to be of clinical usefulness for the diagnosis of calcium metabolic disorders.

[Serum thymidine kinase activity of various cancer and HBV positive liver diseases].

Clinical utility of determination of serum deoxythymidine kinase (TK) activity is described. It is well known that elevated TK level is observed in leukemia and other malignant diseases, or some viral infectious diseases. The TK activity was assayed on normal subjects, hepatitis B virus (HBV) positive liver diseases and various cancer by a newly developed high sensitive method, radio enzyme assay (REA) utilizing 125I-iododeoxyuridine as the substrate. Measurement of TK activity by the REA is revealed to be useful for "the marker of DNA metabolism anomaly" in leukemia, etc.