[Complete testicular feminization syndrome associated with thermolabile androgen receptor]. Radioreceptor assay and thermostability test for the androgen receptor in two cases with complete testicular feminization syndrome were performed in regard to the fibroblasts cultured from genital skin on the basis of dispersed whole cell binding assay (Eil et al., 1980). No [3H]dihydrotestosterone binding to the androgen receptor was observed in case 1 (receptor negative), while maximum binding capacity and dissociation constant of androgen receptor for [3H]dihydrotestosterone in case 2 were 21000 sites per cell and 1.67 x 10(-10) M (receptor positive). The specific binding of [3H]dihydrotestosterone to the androgen receptor in case 2 decreased remarkably to 6.6% after high temperature (42 degrees C) incubation in comparison with that at 22 degrees C incubation. The specific binding of [3H]dihydrotestosterone to the androgen receptor in normal controls decreased down to 81.6% at high temperature incubation. Thermostability test was useful to demonstrate qualitative abnormality of androgen receptor in receptor positive testicular feminization syndrome.


[Monotherapy with extracorporeal shock wave lithotripsy for renal and ureteral stones]. We performed extracorporeal shock wave lithotripsy (ESWL) as a monotherapy using the Medstone STS lithotripter on 288 patients with renal and ureteral stones between June, 1989 and June, 1991. We compared our results with previous reports on ESWL as used in combination therapy. Our cases consisted of 121 patients with renal stones and 167 patients with ureteral stones. A total of 437 sessions of lithotripsy were performed on 288 patients, for an average of 1.52 sessions of lithotripsy per patient. The percentage of stones measuring less than 4.0 mm in diameter that were fragmented was 94.3% for renal stones and 87.6% for ureteral stones. The stone-free rates 3 months after ESWL were 60.3% and 90.4%, respectively. Our results of the monotherapy with ESWL did not differ from those reported on ESWL as used in combination therapy, in terms of the rate of stone destruction and stone-free rates. We studied the other reports carefully and determined that ESWL monotherapy could have been performed in most those cases. We concluded that ESWL monotherapy is an excellent therapeutic method in the light of fewer complications and side effects compared with those from combination therapy, and the fact that the rate of recurrence for renal and ureteral stones is high makes ESWL monotherapy very useful because the procedure can be repeated.


[A study of quantitative and qualitative abnormality of androgen receptor in patients with hypospadias associated with enlarged prostatic utricle]. The prostatic utricle, a rudimentary structure present in the male prostatic urethra, is currently thought to be of mixed origin, with its cranial portion being derived from müllerian duct and caudal segment from wolffian and müllerian ducts and the urogenital sinus. Enlargement of prostatic utricle has often been demonstrated in patients with hypospadias and its incidence increased according to the severity of hypospadias. It has been suggested that insufficient androgenic stimulation of the urogenital sinus and urethral groove during the critical period of sexual differentiation may cause this entity. Since 5 alpha-dihydrotestosterone (DHT) is a major androgen for the normal development of urogenital sinus, androgen receptor levels in the patients with hypospadias associated with enlarged prostatic utricle may concern this ontogenesis. Fibroblasts derived from penile skin in these patients were assayed for androgen receptor levels using dispersed whole cell binding assay after Eil (1970). Thermostability of androgen receptor in the same fibroblasts was also evaluated by the remaining androgen receptor activity after incubation at 42 degrees C, and expressed as a ratio (percentage) to the androgen receptor activity in the incubation at 22 degrees C. Preputial skin of endocrinologically normal boys in the same range of age (3 to 8 years) was served as controls. There was a significant difference in averages of maximum binding capacities of [3H]DHT to the androgen receptor between those of controls (n = 4) and patients with grade II utricle (n = 4) (89 +/- 5.7 (SE) x 10(2) sites/cell vs. 37 +/- 7.1 x 10(2) sites/cell).(ABSTRACT TRUNCATED AT 250 WORDS)


[Immunological and biochemical characterization of urinary carcinoembryonic antigen and its clinical significance]. The immunobiochemical properties of urinary carcinoembryonic antigen (U-CEA) purified from non-tumor-bearing patients with urinary tract infection were investigated. Moreover, immunohistochemical localization of CEA in the normal urothelium was studied and clinical significance of U-CEA was also analyzed statistically. The purified U-CEA showed a molecular weight of approximately 160,000 by the Western blotting and an antigenicity identical to the purified CEA (Calbiochem Corp.). Amino acids analysis of U-CEA revealed nearly the same values as the purified CEA or the theoretical values of CEA, except for several amino acids susceptible to hydrolysis and sugar chains. Therefore, it was assumed that the U-CEA was a new CEA-related antigen, different from nonspecific cross-reacting antigen (NCA) or even CEA itself. Immunohistochemically, CEA was found mainly at the cytoplasmic membrane in normal urothelial cells. The urine samples, collected from patients with various urological disorders, were divided into the inflammation group, showing 5 leukocytes/hpf or more in the urine, and the non-inflammation group, showing less than 5 leukocytes/hpf. The groups were subdivided and U-CEA levels were statistically studied; it was found that the U-CEA levels strongly reflected the presence of inflammation, rather than the presence of urothelial tumors. Consequently, it was considered that CEA was present in the normal urothelium and that destruction and regeneration of these cells due to tumor or inflammation might release CEA, not NCA, into the urine.


[Autologous blood retransfusion in transurethral resection of prostate (TURP)]. Blood collected from the irrigation fluid used during TURP was retransfused in 17 patients. Of the 17 patients, 8 cases were also transfused preoperatively reserved blood. The weight of resected adenoma (g), resection time (minutes), the volume of salvaged blood (ml) of 9 cases who were transfused only salvaged autologous blood were 30.6 g, 63 min. and 355 ml, respectively, and those of 8 patients who were given both salvaged and preoperatively reserved autologous blood were 46.1 g, 78 min. and 703 ml, respectively. No patient was transfused homologous blood. Preoperative urine cultures showed contamination of bacteria in 12 cases (70.6%), and the blood concentrated from irrigated fluid was positive for bacteria in 2 cases (11.8%). Blood count (RBC, Hb, Ht) just after TURP, after blood retransfusion, at the next and the 7th day after the operation were compared to those of just before TURP (Blood Count Ratio). The ratio of the 9 cases who received only salvaged blood were 83.5%, 96.8%, 90.9%, 85.2% each and the ratio of the 8 cases who were transfused both salvaged and preserved blood were 86.9%, 102.6%, 101.4%, 97.5% each. There were no adverse effects due to the autologous blood retransfusion. Retransfusion of salvaged autologous blood from the irrigating fluid of TURP was clinically safe and effective. No homologous blood was transfused in TURP when salvaged autologous blood with or without preserved blood was retransfused to the patient.


[Effects of magnesium ions on the contraction of the rat detrusor muscle]. Effects of magnesium (Mg) ions on the contraction of the rat detrusor muscle induced by intramural nerve stimulation were investigated in vitro. 1. Frequency-response curve demonstrated that contractile responses increased in magnesium-free Krebs' solution and decreased in high magnesium solution (MgCl2 5 mM) in comparison with those in normal Krebs' solution. 2. When MgCl2 was added into an organ bath with cumulative way, the magnitude of detrusor contraction decreased dose-dependently. The contractile response was completely abolished by 30 mM MgCl2. 3. Mg ions suppressed the detrusor contraction induced by a high KCl concentration. 4. The effect of Mg ions on the detrusor contraction was enhanced by verapamil but was inhibited by Bay-K8644. 5. Procaine agonized the effect of Mg ions on the detrusor contraction. On the other hand, caffeine did not modify the effect of Mg ions. These results suggest that Mg ions seem to play an inhibitory role on 2 types of Ca-channels existing on the cell membrane and to inhibit release of Ca ions from the intracellular deposit.


[Management of multicystic dysplastic kidney detected in perinatal periods]. We analyzed 17 cases of multicystic dysplastic kidney (MCDK) to document the natural history of MCDK and its management. One patient was nephrectomied for respiratory failure associated with MCDK. Follow-up studies of 14 kidneys revealed that 5 kidneys (36%) did not change in size, 7 kidneys (50%) decreased in size. Two kidneys (14%) increased in size during the follow up periods and were nephrectomized. Hypertension and malignancy was not observed in our cases. Evaluations for the contralateral kidney and urinary tract system were performed in 15 patients and 5 (33%) revealed abnormalities--two patients with VUR, 1 with PUJ stenosis, 1 with ureteral stricture and 1 with ectopic ureterocele. In our hospital, the management for MCDK is conservative in most cases. Nephrectomy is indicated when there are complications resulting from the size of MCDK, or when the kidney continues to increase in size after the second year of life.


[Adjuvant chemotherapy for invasive bladder cancer. Multicenter study]. During 2 years and 10 months from November 1985 to September 1988, 50 patients with invasive bladder cancer (pT2-4, pN0-2, M0) were treated with total cystectomy followed by adjuvant combination chemotherapy including cis-platinum. In addition, so-called immunopotentiator (OK-432) and Kanpo (Juzentaihoto: TJ-48) were given to the patients in a random fashion to evaluate whether or not these agents had any significant effect on patients' prognosis. The 3- and 5-year survival rates for 48 evaluable patients were 71% and 67%, respectively. Histologic grade of primary tumors and number of cycles of adjuvant chemotherapy administered had a significant correlation to patients' survival: patients with grade 2 anaplasia had a better 3- and 5-year survival rates than those with grade 3 anaplasia, and patients receiving 3 or more cycles of chemotherapy had a better 3-year survival rate than those with 2 or less cycles. pT and pN categories also affected patients' survival, though not statistically significant. Administration of OK-432 or TJ-48 and pre-operative treatment such as irradiation and intra-arterial chemotherapy had no favourable effects on the survival. Side effects of the adjuvant chemotherapy were minimal to moderate and more than 70% of the patients tolerated at least 3 cycles of chemotherapy. It is likely that adjuvant chemotherapy, when given in a post-operative setting, should be repeated at least 3 cycles or more.


[A study of inhibitory effect of chondroitin polysulfate on stone formation of calcium oxalate]. Chondroitin polysulfate (CPS) have inhibitory activity on stone formation of calcium oxalate. This study compared the inhibitory effect of three CPS (CPS S-I, CPS S-II, CPS S-III) with sodium pentosan polysulfate (SPP) and chondroitin sulfate (CS). Crystal growth inhibition was measured in a seeded crystal growth system with 14C-oxalate, and CPS S-I and CPS S-II were the most active substances inhibiting crystal growth. Since CPS S-II and CPS S-III had remarkable hemorrhagic adverse effect, these two substances were excluded from the following study. The study of administration of the rest of the substances (CPS S-I, SPP, CS) to rats revealed that CPS S-I highly inhibited formation of stone in kidney. About 65 percent of CPS S-I administered subcutaneously was excreted in 24 hours urine. Therefore it may be of value to study clinical usefulness of CPS S-I for treatment of patient with urolithiasis.


[Double-blind trial of oral prostaglandin E1 on impotence]. The effect of oral prostaglandin E1 (limaprost) on erectile function was studied in a double-blind placebo controlled trial. Fifty one patients who agreed to participate were examined for their subjective symptoms and nocturnal erection was recorded using an erectometer at the beginning of the study, after an initial 6 week period, and again after a second 6 week period. Patients were randomly assigned to a group which received placebo followed by limaprost or to a group which received limaprost followed by placebo. Ten cases dropped out. In the remaining forty one patients, NPT during the limaprost phase was significantly different from that during the placebo phase. Patients with the history of diabetes mellitus, hypertension, or pelvic surgery showed relatively poor responses to oral prostaglandin E1. Oral prostaglandin E1 achieved 42.9% effectiveness in the psychogenic impotence, and this effectiveness is significantly higher than that of placebo. Oral prostaglandin E1 was suggested as an additional or alternative therapy in the management of psychogenic impotence. Psychogenic impotent who didn't respond to sex therapy and patients with slight organic causes would seem to benefit from oral prostaglandin treatment.


[Incidence of renal cell carcinoma in Chiba Prefecture, Japan; ten years experience]. Many reports about the increase of renal cell carcinoma patients have been published in Japan recently, however, the real fluctuations in the total number of patients in relation to the change of population have not been reported yet. Most of the patients with renal cell carcinoma in the last 10 years were examined in Chiba prefecture, which has a population of about five million and 25 active urological offices. Histologically confirmed cases were investigated by sending questionnaire letters. The items were as follows; sex, age, address, occupation, family history, past history, symptoms, examination methods that first detected the tumor, operation date, tumor diameter and clinical stage. Twenty two offices returned answers and 560 cases who lived in Chiba were found to have renal cell carcinoma from 1980 to 1989. Yearly incidence rates per 100,000 persons demonstrated a significant increase from 0.32 to 2.07. Small, asymptomatic and low stage cancers have been increasing rapidly, however, the rate of metastatic disease has not shown any decrease. The main cause of rapid increase seems to be attributed to progress in diagnostic methods and increase of early detection, but the possibility of an increase in some carcinogenic factors can not be ruled out.


[Single-dose captopril test and captopril renal scintigraphy in the evaluation of renovascular hypertension]. The effectiveness of single-dose captopril test (CP-T) and captopril renal scintigraphy with 99mTc-DTPA (CP-RG) in the diagnosis of renovascular hypertension (RVH) was evaluated in 27 patients with (Group I, 16 patients) or without (Group II, 11 patients) renal vascular disease. Group I consisted of RVH in 8 patients (bilateral in 3, unilateral in 5), arteriovenous malformation in 3, renal artery aneurysm in 4, including 2 with essential hypertension, and asymptomatic renal artery stenosis in 1. Group II consisted of 6 hypertensive patients (2 with essential hypertension and 4 with renal hypertension) and 5 normotensive patients. Sensitivity of CP-T and CP-RG in the diagnosis of RVH was 29% (2/7) and 86% (6/7), respectively, indicating the latter was more sensitive than the former. In 3 patients with bilateral RVH, positive response in CP-RG was observed only in the unilateral kidney. Specificity of CP-T and CP-RG was 86% (6/7) and 100% (5/5), respectively in Group I, 100% (8/8) and 83% (5/6), respectively in 16 hypertensive patients. CP-T and CP-RG before and after the treatment of RVH were evaluated in 4 patients. The change of positive response in CP-T and CP-RG into negative after percutaneous transluminal renal angioplasty (PTA) or surgery were found in 3, all followed by a fall in blood pressure, which was not observed in the other patient with positive response after PTA.(ABSTRACT TRUNCATED AT 250 WORDS)


[Endopyeloureterotomy via transpelvic extraureteral approach]. Endopyelotomy has been established as a valuable procedure to relieve the obstruction of ureteropelvic junction or upper ureteral stenosis. However, in a case with a long stenotic segment and in a case with high insertion type of ureteropelvic junction obstruction, we had often poor results by the conventional technique. To resolve these problems, we developed a new technique of endopyeloureterotomy via transpelvic extraureteral approach. We made an auxiliary incision in renal pelvis or dilated ureter involved with stricture to pass a 22 Fr. urethrotome equipped with a cold knife into the retroperitoneal space. Then we incised a stenotic segment by the knife through the urethrotome until the normal caliber of ureteric lumen was found. A 10-16 Fr. stent was left in place in the incised segment for 3 weeks. We treated 38 patients with ureteropelvic junction stenosis or upper ureteral stenosis by this procedure between August 1988 and June 1990. A total of 39 procedures were performed on 39 ureteropelvic junctions or upper ureters. Original disease were congenital anomalies in 23 patients, strictures secondary to urinary calculi in 12 and postoperative strictures in 4. The length of incision was 2 to 6 cm with the average being 3.2 cm. Postoperative follow-up period ranged 4 to 32 months with the average being 19 months. Obstructive changes disappeared or improved in 37 procedures (95%). In two procedures we failed. Thus this new technique of endopyeloureterotomy might be an useful procedure to relieve ureteropelvic junction stenosis or upper ureteral stenosis with a long stenotic segment or high insertion type of ureteropelvic junction stenosis.


[Percutaneous transabdominal whole layer core needle biopsy for staging the urinary bladder cancer]. Accurate staging is one of the most important determinants necessary in planning an effective treatment for bladder cancer, but at the present time, staging by the conventional clinical methods are not completely reliable. Accordingly, we have newly developed a percutaneous transabdominal core needle biopsy technique capable of obtaining good cylindrical specimens of the entire layer. In order to obtain the core specimen of the bladder wall, which is a vesico-elastic material, the biopsy needle must penetrate the bladder wall at an extremely high speed. We have developed an original automatic biopsy instrument and modified the head of needle for this purpose. With this method, we could obtain good core specimens for pathological staging in about 90% cases. The correlation between the pathological stagings of core specimens and those of cystectomy specimens were in good agreement. This technique is accurate not only for preoperative pathological staging, but also monitoring histopathologically the responsiveness of multi-disciplinary treatment for invasive bladder cancer. This method allows us to determine the optimal therapeutic modality for managing individual patient with invasive bladder cancer.


[Prophylaxis of superficial bladder tumor with the intravesical instillation of bacillus Calmette-Guerin or anti-cancer agents. A retrospective study]. It was retrospectively analyzed whether intravesical instillation of bacillus Calmette-Guerin (BCG) or anti-cancer agents had prophylactic effect or not after removal of superficial bladder tumors. The results over a follow-up period ranging from 6 to 40 months showed 23.8 per cent recurrence in group 1 patients treated with BCG (21 patients), 46.7 per cent recurrence in group 2 treated with anti-cancer agents (45 patients) and 52.3 per cent recurrence in the group 3 (127 patients) which were not received any intravesical drugs. Long-term results among the 3 groups calculated with Kaplan-Meier method demonstrated that the instillation of BCG or of anti-cancer agents was more useful for prophylaxis, compared with the actuarial non-recurrence rates of group 3. The instillation of BCG showed good prophylactic effects especially in recurrent, grade 2 and pTa bladder tumors. The instillation of anti-cancer agents showed to provide prolonged protection from recurrence, but the instillation of BCG did not.


[Antitumor effect of combined use of purified human natural tumor necrosis factor (N-TNF) and cis-diamminedichoroplatinum (II) (cisplatin) on the implanted bladder carcinoma (MBT-2) in mice]. The antitumor effect of tumor necrosis factor (TNF) in combination with Cis-diammine-dichloroplatinum (II) (Cisplatin) upon implanted bladder carcinoma (MBT-2) in mice was analysed together with the toxicity. Mice were implanted into the bladder wall with about 10(4) cells MBT-2 viable cells. TNF was the purified human natural tumor necrosis factor. The antitumor effects were evaluated by the volume of the tumor thus implanted and the drug-toxicity by the body weight of mice and microscopic as well as macroscopic findings of the main organs. As a result, 1) The toxicity of TNF to mice was not enhanced in a dose-dependent fashion when combined with Cisplatin. 2) The antitumor effect by combination of TNF and Cisplatin was significantly increased compared to control group. 3) The effects of TNF was enhanced in a dose-dependent fashion when combined with Cisplatin. 4) The antitumor effects was confirmed by pathological findings. These results suggest that the combined use of n-TNF and Cisplatin is promising as a clinically effective treatment against bladder cancer in human.


[Kock-rectal bladder. Augmented and valved rectum]. Eight patients with total cysto-urethrectomy underwent an augmented and valved rectum (Kock), a type of continent urinary diversion. A satisfactory outcome was obtained in 6 patients. These 6 patients urinated 6 to 8 times a day (1-2 times during the night). The volume each time was 350-450 ml. Urinary incontinence occurred only 1-2 times a month when deeply asleep, and there were no patients whose daily life was restricted. However, there were 3 patients with urinary tract complications. In 2 of them, urinary diversion was required, and unilateral total ureteral obstruction was observed in the remaining patient. The reason for the complications appeared to be that stapling of the intussusception of the sigmoid colon was performed in 5 placements as described in the original method. Following the 4th patient, we were able to prevent any complication in the urinary tract by stapling of the intussusception in 3 places (at 12, 5 and 7 o'clock), and by suturing mucosa to mucosa of the rectum and intussusception in 6 places with polyglycolic acid suture, and further suturing serosa to serosa of the sigmoid colon and rectum in 4 places with silk suture.


[Endoscopic operation of congenital anterior urethral valve. Application of flexible renoureteroscope for antegrade urethroscopy]. 4 children with anterior urethral valve were treated by TUR-Valve. Before TUR, valve anatomy could be easily seen by antegrade urethroscopy through cystostomy using a 10.8Fr caliber flexible renoureteroscope and destruction of the valve could be recognized after TUR. Antegrade urethroscopy with a flexible fiberscope was so helpful to TUR-Valve and the findings of voiding cystourethrography and micturition have remarkably improved. This technique is not so difficult to apply and thought to be one of the best methods to recognize valve anatomy and degree of resection. This technique is also applicable to other lower urinary tract lesions in children.


[A case of inverted Y ureteral duplication with an ectopic ureterocele]. A 29 year-old male with the complaints of two steps urination and sense of residual urine was admitted. At cystoscopy, a ureterocele was found between the normal left ureteric orifice and the bladder neck. Excretory urography demonstrated a radiolucent area in the bladder and a left lower hydroureter. Retrograde pyelography revealed that the left ureter was divided into two branches. Operative exploration demonstrated that the left ureter was an inverted Y ureteral duplication with an ectopic ureterocele; one opened into the ureterocele and the other into the trigone. We resected the ureterocele wall. Four months later, a voiding cystogram did not show vesicoureteric reflux. Now, he has no symptoms and the results of examination are normal. An inverted Y ureteral duplication is the rarest of all anomalies of the ureter. A review of the literature revealed 36 cases reported previously. Clinical analysis was obtained by reviewing 26 of these cases and adding our own (male 10: female 17, average age: 23 years). Complication included 6 cases of ectopic ureteral opening, 6 with blind-ending branch and 5 with ureterocele. The symptoms of this disease depended on the complicating anomalies. The present case was the 5th one of an inverted Y ureteral duplication with a ureterocele in the world literature.


[Successful local adoptive immunotherapy for pleuritis carcinomatosa due to renal cell cancer. A case report]. A 54-year-old woman who had undergone radical nephrectomy for renal cell cancer nine months before was admitted to our hospital because of difficulty in breathing. X-ray films of the chest showed massive pleural effusion on the left side and cytological examination of the effusion revealed malignant cells which may have originated from renal cell cancer. Intrapleural instillations of interleukin-2 and of tumor infiltrating lymphocytes isolated from the pleural effusion were performed. After the initiation of the treatment, the pleural effusion decreased and malignant cells disappeared from the pleural fluid. Partial response defined by the criteria provided by the Japan Lung Cancer Society was achieved. No serious side effects were observed. This would be a useful treatment for pleuritis carcinomatosa by renal cell cancer.


[Partial purification of oxalate degrading enzyme produced by human intestinal bacteria]. It is unclear whether the oxalate in foods degrades or not in the intestinal tract. We isolated oxalic acid decarboxylase from anaerobic bacteria present in human feces which was grown in the culture medium containing oxalic acid as the sole carbon source. The enzyme was partially purified by 80% ammonium chloride precipitation, DEAE-cellulose chromatography and molecular sieve chromatography. The amino acid composition was found to be relatively rich in glycine and alanine, but to have low basic, hydrophobic and aromatic amino acid residues compared with average proteins.


[Effects of extracorporeal shock waves on renal morphology, renal function and blood pressure in rats--follow-up for one year]. Effects of extracorporeal shock waves on renal tissue, renal function, and blood pressure were studied by applying 500 shock waves to both kidneys in 72 female Wistar rats. Six groups, 12 rats in each, were sacrificed on days, 1, 7 and at months 1, 3, 6 and 12 after the procedure, when serum levels of BUN, creatinine, urine levels of beta 2-microglobulin (beta 2-MG), N-acetyl-beta-D-glucosaminidase (NAG), 28-kDa carbindin-D and creatinine clearance (Ccr) were determined. Findings were then compared with those from the control group. In each group, both kidneys were weighed and histologically evaluated. In the treatment group, systolic blood pressure was measured at post-irradiation months 1, 3, 6, 9, and 12; plasma renin activity was studied 6 and 12 months after irradiation to make evaluation in comparison with the control group. In the treatment group, histologically, coagulative necrosis associated with bleeding around the renal tubules and tubular epithelial cell degeneration were marked on day 1, but the glomerulus was kept in relatively good shape. Inflammatory cellular infiltration and interstitial fibrosis were noted on day 7 and the addition of scar formation 1 month after irradiation. Interstitial fibrosis, inflammatory cellular infiltration, scar formation, and tubular epithelial degeneration remained significant even after 12 months. In the treatment group, kidneys weighed significantly more than in the control group from day 1 through month 3, with edema likely accounting for this. However, weight then significantly declined 12 months after irradiation, owing to suspected scarring atrophy.(ABSTRACT TRUNCATED AT 250 WORDS)


[Balloon dilation for ureteral stricture with stone fragments after ESWL]. We treated 5 cases of severe hydronephrosis with balloon dilation. Those hydronephrosis were due to the ureteral stricture with small stone fragments after ESWL (Lithostar). In each case, in situ ESWL had been done on a long-lodged ureteric stone with severe hydronephrosis. And even after the disintegration of stone with ESWL, hydronephrosis remained due to ureteral stricture with small stone fragments. Balloon dilation was done through percutaneous nephrostomy tract in 4 cases and via retrograde transurethral routine in 1 case. Balloon dilation catheter (7 fr. 6 mm diameter 4-10 cm length, Bard Co.) was used. There was no need for stone extraction. After dilation, ureteric stents (8.2/7 fr.) were kept in place for 4-8 weeks. Intravenous urogram was taken on 4-8 weeks after removing ureteric stents. In all of the 5 cases, improvement of hydronephrosis was remarkable. And there was no residual stone fragments in 4 cases. It is concluded that balloon dilation for ureteral stricture with stone fragments after ESWL is very useful. For the valid evaluation of balloon dilation, further experience and longer observation are requisite.


[Promotive effects of intravesical instillation of dimethylsulfoxide on bladder carcinogenesis in mice]. The effect of intravesical instillation of dimethylsulfoxide (DMSO) on bladder carcinogenesis was examined in mice. Experiment 1: Fifty-five female C3H/He mice were administered 0.05% N-butyl-N-(4-hydroxy-butyl) nitrosamine (BBN) in their drinking water for 8 weeks. In week 9 they were divided into two groups consisting of 25 mice each. Then, under nembutal anesthesia the first group was given weekly intravesical inatillations of 0.1 ml DMSO (minimum 99.0%) for 10 weeks. The second group received no treatment except anesthesia. All mice were killed 30 weeks after the begining of the experiment and their urinary bladder resected for histological examination. The incidence of bladder carcinoma was 93.7% (15.16) and 27.7% (6/22) in groups 1 and 2, respectively. These incidences differed significantly between the two groups. Experiment 2: One hundred and twenty female C3H/He mice were divided into two groups. The first group was given 0.05% BBN in their drinking water for 5 weeks and then tap water. The second group was not given BBN. In week 6, the first group was divided again into three groups (1, 2 and 3) consisting of 28, 26, and 27 mice, respectively. The second group was divided into groups 4 and 5 consisting of 21 and 18 mice, respectively. Under nembutar anaesthesia groups 1 and 4 received weekly intravesical instillation of 0.05 ml DMSO (minimum 99.0%) from weeks 6 to 13, Group 2 received weekly intravesical instillation of 0.05 ml distilled water from weeks 6 to 13. Groups 3 and 5 received no treatment except anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)


[Analysis of anchorage independent growth of human prostate cancer cell line LNCap]. LNCap, a human prostate cancer cell line, possess androgen dependent growth characteristics. We studied anchorage independent proliferation of LNCap cells using semi-solid agarose double layer culture. The cells formed colonies in the semi-solid medium supplemented with charcoal filtered steroid free fetal calf serum and maximal colony formation was obtained in the medium with 10% serum. The addition of several steroids (testosterone, dihydrotestosterone, ethinylestradiol) influenced the colony formation. Testosterone at the concentration of 10(-8) M to 10(-10) M stimulated colony formation with optiman of 10(-9) M. When LNCap cells were placed under the basal layer of the semi-solid culture as feeder cells, also stimulated was the colony formation of the LNCap cells cultured in upper layer of semi-solid medium. The addition of EGF, TGF alpha and TGF beta to the medium also stimulated the colony formation. The combined effect of EGF and TGF alpha was shown to be cooperative with testosterone. TGF beta, however, did not show such cooperative effect with testosterone on colony formation. The addition of the anti-body to EGF, TGF alpha or TGF beta to the medium decreased the colony formation of LNCap cells. These results suggest that LNCap cells excrete EGF, TGF alpha, TGF beta and/or similar substances and these factors autocrinely decorate the cell proliferation of LNCap human prostate cancer cells.


[Studies on vessel invasion by cancer of the renal pelvis and ureter]. The significance of vessel invasion by cancer of the renal pelvis and ureter was estimated with surgical specimens of 45 patients. The vessel invasion by cancer was observed in 25 out of 45 cases (55.6%). The incidence of vessel invasion increased with the grade of cancer and the extent of the primary tumor. The postoperative metastases by cancer was noted in 22 of the 25 patients with vessel invasion (88%) and in 4 of 20 (20%) patients without vessel invasion. The incidence of metastases in patients with vessel invasion was significantly higher than that without it (p < 0.01). The 5-year survival rate was 13.1% in the patients with vessel invasion and 80.6% in the patients without it (p < 0.005). Postoperative chemotherapy had no effect on the unfavorable outcome of the patients with vessel invasion. Therefore, vessel invasion by cancer may be one of the prognostic factors in renal pelvic and ureteral cancer. The patients with vessel invasion should be treated with more aggressive therapy to improve the poor prognosis.


[Chromosomal aberrations in cases of male infertility]. Mitotic chromosomal analysis was done on 130 cases of male infertility, 85 with azoospermia and 45 with oligospermia. Eighteen cases of chromosomal aberrations were found, consisting of eight cases of Klinefelter's syndrome, four with 46, XYq-(including one mosaic case), three translocations, one with 47, XYY, one with 46, XY, 15p+ and one with normal variant. Among these, 46 XYq- is a notable karyotype because it cannot be accurately diagnosed without Q-banding, and because 46, XYq- is important for determining the role of the locus on the long arm of the Y chromosome which is supposed to include spermatogenesis. Eleven cases of 46, XYq- in azoospermic males, including our cases, have been reviewed in the Japanese literature. Statistical analysis of the values of testicular volume and serum hormones in these azoospermia cases, revealed obvious differences between normal and abnormal karyotypes and also between 46, XYq- and Klinefelter's syndrome.


[Percutaneous renal cyst puncture and ethanol instillation]. Under ultrasound guidance 79 simple renal cysts in 65 patients were punctured and aspirated with our contrivance, a 5 Fr single J catheter on a 19 gauge needle. Forty-eight renal cysts were successfully punctured, that is, they had no bloody fluid and did not have any leakage of contrast medium. These cysts were instilled with absolute ethanol for 5 minutes. To follow up the patients, consecutive observation was done by sonography or CT every three months. Ethanol-instilled renal cysts were more markedly reduced (reduction rate: 93 +/- 17%) than not-instilled cysts (reduction rate: 32 +/- 28%). Thus, ethanol-instillation was useful in the reduction of renal cysts. After the puncture of cysts, hematuria disappeared in most patients.


[Effects of luteinizing hormone-releasing hormone agonist on bladder carcinogenesis in male rats]. In previous studies, it has been suggested that the suppression of testicular androgen had inhibits bladder carcinogenesis. In this study we investigated which phase of bladder carcinogenesis is inhibited by the hormonal change of the hypothalamus-pituitary-testicular axis induced by the depot form of the LH-RH agonist. All rats were treated with 0.05% BBN in tap water for 8 weeks and were observed for the following 16 weeks. They were divided into five groups. Group 1 (Control group); The LH-RH agonist was not administered. Group 2 (Initiation group); The LH-RH agonist (depot form) was administered subcutaneously two weeks before and after the initiation of the experiment. Group 3 (Promotion group); The LH-RH agonist (depot form) was subcutaneously administered at intervals of 4 weeks starting 6 weeks after the initiation of the experiment. Group 4 (Full term group); The LH-RH agonist (depot form) was administered subcutaneously at intervals of 4 weeks starting from 2 weeks before the initiation of the experiment. Group 5 (Castration group); Bilateral orchiectomy was performed one week before the beginning of the experiment. From our results, the followings were suggested, (1) more intensive inhibition of bladder carcinogenesis was observed in the group which received the LH-RH agonist (depot form), compared with the Castration group, (2) the bladder carcinogenesis was more intensively inhibited when the LH-RH analogue (depot from) was given in the promotion phase and (3) not only testosterone but also the regulatory system of the hypothalamus-pituitary-testicular axis is related to the bladder carcinogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)


[Effects of bombesin and its antibody on growth of human prostatic carcinoma cell lines]. Bombesin (BMBS), a tetradecapeptide isolated from frog skin, and its antibody were evaluated in vitro and in vivo for their growth modulating effects on human prostatic carcinoma cell lines DU-145 and PC-3. The two cell lines were maintained in DME medium containing 2% FCS and 1 microgram/ml insulin in a humidified atmosphere of 5% CO2/95% air at 37 degrees C. BMBS added at 0.1-10.0 nM caused a striking shift of the concentration-dependent increase in cell growth of DU-145 and PC-3 in the absence of any other exogenously added growth factors. The addition of 1:250 antibody versus BMBS (Ab-BMBS; rabbit antiserum) to the medium during the lag phase of growth resulted in specific inhibition of growth of DU-145 and PC-3 with or without BMBS. Nude mice were transplanted with DU-145 cells in order to evaluate the suppressing qualities of Ab-BMBS on carcinoma cells in vivo. After the inoculation of 10(7) cells/mouse DU-145 into nude mice, 20 microliters/mouse Ab-BMBS was intraperitoneally injected into mice three times weekly for three weeks. In mice administrated with Ab-BMBS, the growth of DU-145 was suppressed markedly. By immunocytochemical study, BMBS immunoreactivities were detected on DU-145 and PC-3 cells. These results suggest that BMBS can function as an autocrine growth factor for human prostatic carcinoma cells. Furthermore, on xenografts in mice, Ab-BMBS inhibits the increase of human prostatic carcinoma.


[Neuroanatomical studies on the urine storage facilitatory areas in the cat brain. Part I. Input neuronal structures to the nucleus locus subcoaruleus and the nucleus radicularis pontis oralis]. Input neuronal structures to the nucleus locus subcoeruleus (LSC) and the nucleus reticularis pontis oralis (PoO) were investigated by the horseradish peroxidase (HRP) study in cats. Under halothane anesthesia, a double barreled electrode was inserted into the LSC where electrical stimulation increased bladder capacity and the external urethral sphincter muscle activity, and into the PoO where chemical stimulation with carbachol increased bladder capacity and decreased the external urethral sphincter muscle activity. After identification of these regions, the HRP was ionphoretically injected into the LSC or PoO. By injecting the HRP into the LSC, retrogradely HRP labeled cells were located broadly in the frontal, rectal, orbitalis, rostral cingulate, internal aspect of posterior sigmoidal and anterior sylvian gyli, nucleus corticomedialis of amygdala, lateral area of the hypothalamus, paraventricular hypothalamic nucleus, substantia nigra, periaqueductal gray, reticular formation of the mesencephalon, pons and medulla, cerebellar nuclei and intermediate gray of the spinal cord. By injecting the HRP into the PoO, retrogradely HRP labeled cells were located broadly in the frontal, rectal, orbitalis, internal aspect of the posterior sigmoidal and anterior sylvian gyli, lateral area of the hypothalamus, paraventricular hypothalamic nucleus, periaqueductal gray, reticular formation of the mesencephalon, pons and medulla, cerebellar nuclei and intermediate gray of the spinal cord. These areas where HRP labeled cells were located mostly corresponded to the areas where electrical stimulation evoked either bladder relaxation or contraction in the previous reports. The LSC and the PoO seem to perform important roles in the neuronal mechanism for urine storage, receiving the inputs which facilitate or inhibit micturition from the extended areas between the cerebral cortex and the sacral spinal cord.


[Neuroanatomical studies on pontine urine storage facilitatory areas in the cat brain. Part II. Output neuronal structures from the nucleus locus subcoeruleus and the nucleus reticularis pontis oralis]. Output neuronal structures from the nucleus locus subcoeruleus (SLC) and the nucleus reticularis ponts roalis (PoO) were investigated by the wheat germ agglutinin-horseradish peroxidase (WGA-HRP) study in cats. Under halothane anesthesia, a double-barreled electrode was inserted into the LSC, PoO. After identification of these regions, the WGA-HRP was injected ionphoretically into the LSC or PoO. WGA-HRP labeled fibers were observed from the hypothalamus to the sacral spinal cord. Fiber connection was assumed between the WGA-HRP injection sites and areas where WGA-HRP labeled cells were located. There were input and output relationships between the LSC, the PoO and the nucleus locus coeruleus alpha which is the pontine micturition center. By injecting the WGA-HRP into the LSC, two major rostral pathways and four major caudal pathways from the LSC were recognized. Two short caudal pathways projected into the cerebellum and the nucleus raphe magnus. Two long caudal pathways passed through the ipsilateral ventral and contralateral funiculi, and projected into the sacral intermediate gray and the Onuf's nucleus. By injecting the WGA-HRP into the PoO, two major rostral pathways and four major caudal pathways from the PoO were recognized. Three short caudal pathways projected into the cerebellum, contralateral reticular formation of the brain stem and the ipsilateral nucleus reticularis gigantocellularis. One long caudal pathway passed through the ipsilateral ventral funiculus and projected into the sacral intermediate gray and the Onuf's nucleus. From these results, the LSC and the PoO seem to send and receive outputs and inputs each other and to integrate the informations.(ABSTRACT TRUNCATED AT 250 WORDS)


[Radiotherapy for stage B prostate cancer]. Thirty five cases with stage B prostate cancer underwent radiotherapy to the primary lesion from 1965 to 1989 in our hospital. Twenty two of them were given radiotherapy alone and 13 were treated by radiotherapy combined with hormone therapy. Twenty nine of them were given 113 or 127 TDF (Time, Dose and Fraction) of external radiotherapy using linear accelerator. Three of the other 6 cases underwent external radiotherapy combined with administration of bleomycin and the others received intraoperative irradiation by electron beam. We defined on digital examination a reduction in the primary lesion as improvement and complete flattening as atrophy for evaluation of the treatment. Rates of the improvement were 95% in radiation, alone, and 100% in hormone and radiation combination. Atrophy rates were 62% in the former, and 92% in the latter. Five-year non-relapse rates were 85% and 100%, respectively. Four cases relapsed in the radiotherapy alone group, in which two cases given intraoperative irradiation relapsed in the primary lesion and another two given external radiotherapy in the pelvic nodes and required further treatment. One of the 2 relapsed cases with intraoperative irradiation has been alive with cancer and the other died from dissemination. One of the 2 relapsed cases with external radiotherapy has been alive and well and the other died at home without any information of death. One relapsed in the combination group at 130 months but has been alive despite gradually progressive dissemination for 185 months. All relapsed cases were those with atrophy group. No relapse was seen in cases without atrophy of the prostate.(ABSTRACT TRUNCATED AT 250 WORDS)


[A case report of spermatocytic seminoma--clinical review of 17 cases in Japan]. A male aged 48 visited our department on October 17, complaining of swelling of his left scrotal content from July, 1990. Physical examination showed the testis to be swollen to the size of a chicken egg, and ultrasound examination disclosed the swelling to be solid and nodular. Left high inguinal orchiectomy was performed on October 29. The testis extirpated was 50 x 40 x 45 mm in size and weighted 80 g; the gross appearance of the cut surface of the testis was nodular with grayish-white color. The lesion was proved to be spermatocytic seminoma histopathologically, but no hemorrhage or necrosis was observed. Radiation in the dose of 36 Gy was given over the left hypogastrium and paraaortic region in 36 Gy each. The patient subsequently did will and has been followed up in our outpatient clinic without evidence of recurrence as of 10 postoperative months. This patient was the 19th reported case of spermatocytic seminoma in Japan. However, General Rules for Clinical and Pathological Studies on Testicular Tumors explain that spermatocytic seminoma is usually seen in a pure form, unassociated with other types of germ cell tumors, making our case actually the 17th case of this particular seminoma if spermatocytic seminomas combined with other germ cell tumors are exclude from the statistical analysis. Reports of spermatocytic seminoma thus defined are reviewed in this study.(ABSTRACT TRUNCATED AT 250 WORDS)


[Renal lymphoma. Report of 2 cases and review of the literature]. Two cases of renal lymphoma were reported. Case 1 was a 73-year-old, and case 2 was a 59-year-old female. Their chief complaint was flank pain. The findings obtained by CT and angiography were not compatible with renal cancer. The tentative diagnosis of case 1 was inflammatory disease or soft tissue tumor, and that of case 2 was renal subcapsular tumor. Histological specimen was obtained by open biopsy from case 1, and by nephrectomy from case 2. Immunohistochemical surface marker study revealed both tumors were B cell lymphoma. Chemotherapy (CHOP-Bleo, or PPA) in both cases and additional radiotherapy in case 2 markedly reduced the tumor size. Nevertheless, case 1 died 5 months later from recurrence, and case 2 died 14 months later of gastrointestinal bleeding. At autopsy, the renal subcapsular layer was infiltrated by lymphoma cells in both cases, and lymphadenopathy was not observed. Reviewing 16 cases previously reported as renal lymphoma, the capsular or subcapsular diffuse infiltration to the kidney is considered to be a characteristic feature of renal lymphoma.


Latex agglutination test: a simple, rapid and practical method for bovine serum CRP determination. A semi-quantitative latex agglutination test for bovine serum CRP levels has been established by mixing diluted serum (or diluted standard serum) with a 1% latex suspension containing 0.489 micron latex particles coated with affinity-purified antibody at a ratio of 20 micrograms/mg latex. The agglutination was performed on a glass slide in a moist chamber at room temperature with 45 min. incubation. This test is reliable, reproducible and the results correlate with those of the single radial immunodiffusion (SRID) test. The effect of low temperature storage on CRP concentration revealed a 30% degradation of CRP during 2 years storage at 4 degrees C. The possible role of EDTA addition to prevent a decrease in serum CRP concentration by freezing and thawing is also discussed.


Detection of equine immunoglobulin-secreting cells by a plaque assay. A protein A-hemolytic plaque assay was applied to detect immunoglobulin (Ig)-producing cells in horse peripheral blood, using pokeweed mitogen as a B lymphocyte activator. A maximum number of Ig-secreting cells was obtained when horse peripheral blood lymphocytes were cultured in a medium containing horse serum. The number of Ig-secreting cells in young horses (2 years old) was lower than that in adult horses (6 to 23 years old). In addition, the plaque formation was unchanged from blood samples kept at 4 degrees C for 24 hours, while blood samples kept for 72 hours did not yield plaques. These results indicate that the plaque assay is a reliable and useful method for detecting Ig-secreting cells in the peripheral blood of the horse.


Cardiac rehabilitation 1992.

Cardiac rehabilitation 1992. The goal of cardiac rehabilitation is to optimize function through attention to the patient's medical needs, risk factors for recurrent events, physical reconditioning, and psycho-social needs. Medical needs include beta-adrenergic blocking agents and aspirin unless contraindicated, angiotensin converting inhibitors for left ventricular dysfunction, and relief of residual ischemia. Smoking, lipid abnormalities, physical inactivity, and hypertension remain important predictors of reinfarction and death and must be controlled. Obesity must be addressed because it exacerbates these problems. Therefore, the principles of behavior change should be applied to help patients control their risk factors and adopt healthy lifestyles. Smoking cessation and appropriate dietary behaviors can be adopted by the patient while in the hospital. Physical reconditioning can also begin with twice-daily exercises. After discharge from hospital and after an initial submaximal exercise evaluation, the patient will benefit from three sessions per week of outpatient cardiac rehabilitation for six to eight weeks. These sessions should last about an hour and raise the patient's heart rate as much as 30 beats per minute. Along with physical reconditioning, the cardiac rehabilitation program provides an opportunity to address risk factor modification, return to work, return to sexual activity, management of depression and anxiety, and the presence of risk factors in the patient's family. The patient should attend reinforcing sessions every three months for the first year and as necessary after that to control risk factors and reinforce the necessity for physical fitness.


Quantitative analysis of mesenteric microcirculatory disturbances induced by autonomic nervous irritation. In this study, we have demonstrated that repeated electrical stimuli to the artery of the mesenteric pedicle can produce mesenteric microcirculatory disturbance by autonomic nervous irritation in rats. The parameters to demonstrate microcirculatory damage were observed and quantitatively analyzed using the intravital microscopy after electrical stimulation for 40 minutes. The blood flow of arterioles and venules in the mesentery showed ischemia-reperfusion pattern during the repeated electrical stimulations. The diameter of arterioles did not show significant change, while RBC velocity of arterioles was significantly decreased at 30 min after the irritation. The RBC velocity in venules was decreased from the early period to about 20%. But this values were not significantly dropped during the later observation period, suggesting the formation of short circuit flow by passing the collapsed capillary beds. The number of rolling WBC in the venules was notably increased at the time immediately after irritation, and thereafter the number of rolling WBC number was rather reduced. The number of sticking WBC in venules was time-dependently increased and reached its maximum at 30 min. When permeability of venular wall was determined by the injection of pontamine sky blue, significant increase in permeability was already shown immediately after irritation, suggesting that the integrity of microvascular wall was disturbed in this early period. The permeated area expanded thereafter in parallel with the increase in sticking WBC number. From these observations, it is suggested that endothelial cell damage and following leukocyte-endothelium interaction induced by autonomic nerve irritation appear to be an important factor in microcirculatory disturbances.


Role of the sympathetic system in impairment of the cerebrovascular CO2 responsiveness during moderate hypoglycemia. We examined the mechanism of impairment of the cerebrovascular CO2 responsiveness in moderate hypoglycemia. Twelve fasted cats were used. The brain-PO2, brain-PCO2 and brain-pH were measured continuously with electrodes placed on the brain surface. Hypoglycemia was induced with insulin. Intravenous injection of hexamethonium (a sympathetic ganglion blocker, C6; 0.1 mg/kg) was performed at the following stages: Control, hypoglycemia and recovery. Before and after the C6 administration, 5% CO2 in air was inhaled for 3 min at the respective stages. The CO2 responsiveness (cerebrovascular dilatory response to increased PaCO2) at the control stage was not altered after the ganglionic blockade. At the hypoglycemic stage, the increase in BrPO2 by CO2 inhalation was significantly less than that at the control stage. This reduction of delta BrPO2 was significantly improved after the administration of C6. At the recovery stage, the CO2 responsiveness before and after the administration of C6 was not significantly different. An impaired CO2 responsiveness in the hypoglycemic state was improved by sympathetic ganglion blockade with C6 which did not alter the reactivity during normoglycemia. It is suggested that the sympathetic activity plays an important role in impairment of the cerebrovascular CO2 responsiveness during moderate hypoglycemia.


Initial predictors of survival in patients with systemic sclerosis (scleroderma). We conducted a retrospective study of 86 patients with systemic sclerosis (SSc) to clarify the initial predictors of survival at the first visit to the hospital. A life-table analysis of survival was performed concerning 137 items from their histories, physical examinations, and laboratory data. The observed cumulative survival rates were 78.0 percent at 5 years and 68.2 percent at 10 years. Ten items were found to be the initial predictors of survival in patients with SSc. Of these 10 items, 9 items showed significant differences within 5 years of the first visit to the hospital. Patients with resting electrocardiographic abnormalities, such as atrial or ventricular arrhythmias, or conduction disturbances, pulmonary fibrosis on the chest x-ray films, or decreased vital capacity had significantly lower survival rates. However, patients with anti-centromere antibody had a significantly better survival rate. In addition, males, aged patients over 65 years old, and patients with proteinuria, leucopenia, or hypergammaglobulinemia had significantly lower survival rates. Only patients with proximal scleroderma at the first visit to the hospital had a significantly lower survival rate after 8 years. These results are useful in predicting individual patients at risk of shortened survival and in managing these patients.


Cell-mediated cytotoxicity of tumor infiltrating lymphocytes on rat bladder cancer. Tumor-infiltrating lymphocytes (TIL) were tested for cytotoxicity against autologous tumor cells in a study utilizing a chemically induced cancer of the bladder (transitional cell carcinoma), BC-47, in inbred ACI/N rats. From tumors grown after subcutaneous implantation of BC-47 in the rats TIL were separated by density gradient centrifugation and incubated in plastic dishes for separation of non-adherent from adherent cells. The non-adherent cells were further fractionated into T and B cells by the panning method using anti-rat F(ab')2 antibody. The cell fractions were each added to BC-47 in culture to be assessed for antitumor effect by the crystal violet dye exclusion method and 3H-thymidine incorporation inhibition assay. Peripheral blood mononuclear cells (PBMC) were also tested as described above. TIL expressed significantly higher cytotoxicity against BC-47 with the mean % cytotoxicity of 56.6 +/- 5.6% and 87.5 +/- 7.1% at E/T ratios of 10:1 and 20:1, respectively, as compared to PBMC (9.9 +/- 5.0% at E/T 10:1) (P < 0.001). The adherent cells, B and T cell fractions showed respective % cytotoxicity of 92.4 +/- 2.8%, 57.9 +/- 10.6% and 9.9 +/- 7.8% at an E/T ratio of 10:1. TIL pretreated with IFN or rIL-2 for 24 or 48 hours did not exhibit any noticeably enhanced antitumor activity at an E/T ratio of 5:1. Prevention of direct contact of BC-47 cells and TIL by an interposed Millipore membrane (0.45 microns) resulted in an unequivocal reduction of antitumor effect.(ABSTRACT TRUNCATED AT 250 WORDS)


Health profiles of workers exposed to acrylonitrile. The objective of this study was to reveal the health effects of acrylonitrile (AN) in seven Japanese acrylic fiber manufacturing factories. The study subjects were 157 AN-exposed male shift workers who had been exposed to AN for 17 years on the average and 537 control workers whose working conditions were similar to those of the AN-exposed workers. The seven factories were classified into two groups according to their AN exposure levels in 1987, and also into three groups on the basis of 1976 exposure levels. The most highly exposed group of subjects showed a mean AN concentration of 1.13 ppm by personal sampling. Medical examination failed to detect any health effects attributable to long-term exposure to AN, although the existence of some symptoms of acute irritation could not be completely ruled out. The results of this study may provide a "no observed effects level" for human on-the-job exposure with regard to the health effects examined here.


Phytosphingosine-containing neutral glycosphingolipids and sulfatides in the human female genital tract: their association in the cervical epithelium and the uterine endometrium and their dissociation in the mucosa of fallopian tube with the menstrual cycle. In human cervical epithelium and uterine endometrium, globo-series neutral glycosphingolipids with N-alpha-hydroxy fatty acyl phytosphingosine (4-D-hydroxysphinganine) as the ceramide and sulfatide (I3SO3-GalCer), which were contained in trace amount at the follicular phase, significantly increased in concentration at the luteal phase, comprising about 20% of the individual neutral glycosphingolipids and about 15% of the total acidic glycosphingolipids, respectively. However, in the mucosa of fallopian tube, neutral glycosphingolipids with the same polarity as those in the cervical epithelium and uterine endometrium at the luteal phase and sulfatide remained at a constant and higher level independently of the menstrual cycle. The structures of neutral glycosphingolipids in the fallopian tube, having the same polarity as that of N-alpha-hydroxy fatty acyl phytosphingosine-containing molecules appeared in the cervical epithelium and uterine endometrium at the luteal phase, were determined to be N-alpha-hydroxy palmitoyl 4-sphingenine-containing ones by negative-ion FABMS. Also, laminin, but not collagen type IV, was found to be contained in the concentration correlated well with that of sulfatide in the genital tract, when determined by western blotting with monoclonal anti-laminin and anti-collagen type IV antibodies, indicating a possible function of sulfatide as a receptor for laminin in the human female genital tract.


Positive and negative symptoms in schizophrenia: application of Jacksonism. Factors influencing prognosis and relapse in schizophrenia were investigated systematically. The results agreed with Jacksonism. Data were collected from 166 patients who suffered relapses and were readmitted to Hospital, into seven categories from Nov 15, 1971 to Dec 31, 1974. The psychiatric symptoms were classified from A to G, positive to negative. The initial symptoms were divided into 4 groups. There was interrelation between the somatic and psychiatric symptoms; in the initial symptoms and the prognosis, courses, and psychiatric symptoms. Based on the author's results, the author suggests that an evolutional and hierarchical interpretation, which Jackson emphasized, in the correlation between brain and mind is applicable in the psychopathology of schizophrenia.


Malignant and premalignant lesions of the esophagus. Squamous cell carcinoma is the most common malignant tumor of the esophagus and it is one of the most common fatal cancers worldwide. There is great geographic variation in occurrence of these tumors. Especially high-risk areas have been identified in Northern Iran, Central Asian Republics, Northern China and South Africa. In some of these areas annual mortality rates reach 133/100,000 and over 20% of the population dies of esophageal cancer. The mortality in the US is considerably lower (3 to 8 per 100,000). In common with squamous dysplasias elsewhere eg the cervix, squamous dysplasia of the esophagus also appears to be a precancerous lesion. We have found that squamous dysplasia and early cancer are characterized by a number of distinctive endoscopic changes, namely, mucosal friability, erosions, plaques and nodules. Another finding of interest is the failure on our part to confirm the frequency of esophagitis in high risk areas. Barrett's esophagus is an epithelial metaplasia which replaces esophageal squamous epithelium for variable lengths from the lower esophageal sphincter region cephalad. It is a complication that occurs in approximately 12% of patients with prolonged gastroesophageal reflux. The importance of this disorder is that it is associated with an increased risk of adenocarcinoma of the esophagus. In assessing biopsies from patients with Barrett's esophagus, the main role of the pathologist is to be on the alert for histologic features of dysplasia and adenocarcinoma. Since dysplasia in Barrett's is endoscopically invisible, multiple biopsies are necessary if surveillance is to be successful in detecting dysplastic lesions and early carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)


[Diagnosis of pulmonary tuberculosis in general hospital "a study of 114 cases"]. We conducted a study on the diagnosis of pulmonary tuberculosis at Chiba Kaihin Municipal Hospital. Examinations were performed to determine the presence of active Mycobacterium tuberculosis in sputum and gastric aspirate. For the sputum smear-negative cases, fiberoptic bronchoscopy was further used as a means for detecting the tuberculosis. The results obtained were as follows: 1. A total of 114 cases in the past six years diagnosed as active pulmonary tuberculosis (including 88 primary treatment cases) were analysed. 2. The 114 cases consisted of 74 males and 40 females, the mean age was 49.3 years old. Categorically, the main age groups were: 60s, 24 cases; 30s, 21 cases; and 40s, 20 cases. 3. Chest X-ray findings: Cavitary cases were 28.9% GAKKAI classification of the sizes of the affected areas being Type 1 (mostly limited cases), 58.9% of all total cases, and 68.4% in the cases under the age of 50 years old. The number of cases having infection in a solitary nodule was 19, and the ages of 15 out of the 19 patients were under 50 years old. 4. Sputum or gastric aspirate smear-positive cases totalled 37 (32.5%), and culture-positive cases totalled 77 (67.5%). Sputum or gastric aspirate cultures were positive in 52 out of 56 cases (92.9%) with extended shadows, GAKKAI classification Types 2 and 3, but were positive in 25 out of 58 cases (43.1%) with Type 1. 5. Fiberoptic bronchoscopy was performed on 49 out of the 77 smear-negative cases. 6. Definite diagnosis was obtained in 90 (78.8%) out of total 114 cases. The results of this study suggest that examination for active mycobacterium in sputum and gastric aspirate are very useful for the diagnosis of active pulmonary tuberculosis, especially in extended cases.


[A clinical study of tuberculous pleurisy]. Forty-eight cases of tuberculous pleurisy were examined and the following results were obtained. (1) Most of the patients were male, and there was no significant age and underlying diseases. (2) Fever and chest pain were observed mainly in younger patients, and sputum and dyspnea in older patients. (3) All of the cases examined had exudative pleural effusion, and increased ADA activity was frequently observed. (4) Mycobacterium tuberculosis was detected in the sputum of 65%, and also in the pleural effusion of 28% of the patients. The pathological diagnosis of tuberculosis was made by pleural biopsy in 83% of the patients, suggesting that pleural biopsy is very useful in the diagnosis of tuberculosis pleurisy. (5) The prognosis of the patients with tuberculosis pleurisy was good. Steroid therapy was generally ineffective.


[Correlation of tuberculin skin reaction with lymphocyte proliferation, interferon-gamma production and tumor necrosis factor-alpha production after in vitro stimulation with PPD and killed Mycobacterium tuberculosis using peripheral blood of healthy donors]. The quantitative relationships among the in vitro lymphocyte proliferation in peripheral blood in 19 healthy donors to purified protein derivative (PPD) and the killed Mycobacterium tuberculosis, interferon-gamma (IFN gamma) and tumor necrosis factor-alpha (TNF alpha) production in these culture supernatants, and the in vivo skin reaction to PPD which were simultaneously measured were studied. Statistical analysis was performed with t-test and multiple regression analysis: The results obtained were as follows; 1) The magnitude of the in vitro lymphocyte proliferation by PPD and the killed M. tuberculosis failed to correlate with the erythema and the induration of the in vivo skin reaction to PPD. 2) The erythema of skin test correlates with TNF alpha production in the culture supernatants that the lymphocytes in peripheral blood were cocultured with these antigens for 7 days. (R = 0.566062, 0.01 less than p less than 0.02) 3) There is a correlation between the erythema and the induration of skin test. (R = 0.526662, 0.02 less than p less than 0.05). 4) Though the magnitude of the lymphocyte proliferation to PPD correlates IFN gamma production in the culture supernatants (R = 0.525915, 0.02 less than p less than 0.05), these response to the killed M. tuberculosis correlates both IFN gamma production (R = 0.55049, 0.01 less than p less than 0.02) and TNF alpha production (R = 0.51283, 0.02 less than p less than 0.05) in the culture supernatants.(ABSTRACT TRUNCATED AT 250 WORDS)


[A recovered case of serious lung tuberculosis on wanderer]. This report is a case study of a vagrant whose state of tuberculosis showed noteworthy improvement due to clinical treatment. A 54-year-old male, vagrant, was admitted to the hospital in a state of preshock because of a serious stage of lung tuberculosis. The clinical course was severe, but after three months of intensive care the patient recovered. It was noted that the echocardiogram taken after recovery revealed improvement when compared with the one taken upon admission, which showed remarkable right ventricular overload. Furthermore, anti-tuberculosis agents proved to be very effective in this case. The patients respiratory functions improved more markedly than had been expected. The reason for reporting this case study is to bring attention to the improvements in the patient's clinical course and echocardiographic findings. These suggest that tuberculosis in vagrants may differ from the usual stage of tuberculosis diagnosed in elderly persons in terms of response to anti-tuberculosis agents and potential recovery.


[Rapid diagnosis of mycobacteria, especially Mycobacterium tuberculosis and Mycobacterium avium complex, using MB Check system]. Fourty-five sputum specimens were subjected to isolation for mycobacteria either MB Check system (MB method; F. Hoffmann-La Roche Ltd., Basel, Switzerland) or 3% Ogawa egg medium (Ogawa method). Test sputum was treated with 4 volumes of 4% NaOH for 1-2 min and 0.1 ml of the resulting mixture was inoculated onto 3% Ogawa egg medium. The remaining portion of the mixture was neutralized with IN HCl, diluted with 1/15 M phosphate buffer (PB; pH 6.8), and subsequently centrifuged at 3,000 rpm for 20 min. The sediment was suspended in 1.5 ml of PB and 0.5 ml each was inoculated into MB Check M bottle (20 ml) supplemented with M supplement (1 ml). In MB method, bacterial growth was measured on Middlebrook 7H11 agar medium and Middlebrook 7H11 agar medium containing NAP (p-nitro-alpha-acetylamino-beta-hydroxy-propiophenone). Among 45 sputum specimens, the number of positive specimens for mycobacterial growth in the above two cultivation methods and time required for growth were as follows: 3% Ogawa egg medium; 12 specimens (26.7%) gave positive growth, including 7 of M. tuberculosis complex strains on 14-35 days (average 22 days) and 5 of M. avium complex strains on 14-21 days (average 18 days); MB method; 15 of specimens (33.3%) gave positive growth, including 8 of M. tuberculosis complex strains on 7-21 days (average 15 days), 6 of M. avium complex strains on 7-14 days (average 11 days) and 1 of M. scrofulaceum strain on 28 days. There was no specimen which was positive for mycobacterial growth on 3% Ogawa egg medium but negative on MB medium.


[Phenotypic analysis in peripheral blood lymphocytes of patients with pulmonary tuberculosis]. In order to clarify the immunological aspects of tuberculosis, phenotype of peripheral blood lymphocytes was analyzed in 96 patients with pulmonary tuberculosis and 43 normal controls. In tuberculosis, CD8 positive T cells were significantly decreased in comparison with normal controls and regarding expression of CD3, CD4, CD19, CD16 and gamma delta T cell receptor (TCR), there was no significant difference between tuberculosis and normal controls, though in tuberculosis CD4 positive T cells tended to be high as compared to normal controls. With respect to previous therapeutic condition, the group with previous chemotherapy had significantly high CD4 positive cells, low CD8 positive cells and low gamma delta TCR positive cells as compared to the group without previous chemotherapy. Between groups divided by Type or Expansion of pulmonary tuberculosis without previous chemotherapy, there was no significant difference regarding any surface markers. Regarding pulmonary tuberculosis with previous chemotherapy, the group of Type II had significantly high CD4 positive cells and low CD8 positive cells as compared to Type III, and in the group of Expansion 3, CD19 positive cells were significantly high as compared to Expansion 2. Characteristic of phenotype in peripheral blood lymphocytes of patients with pulmonary tuberculosis is predominant CD4 positive cells in a corresponding decrease in the proportion of CD8 positive cells and is no elevation of gamma delta TCR positive T cells.


[Clinical characteristics of the patients with primary infection of Mycobacterium avium complex]. Clinical characteristics are analyzed in patients with primary infection of Mycobacterium avium complex (MAC). The definition of primary infection of MAC are determined as follows; 1) MAC is found several times since the beginning of the disease, 2) clinical symptoms or abnormal shadow corresponding to MAC infection on chest roentgenogram, 3) no old tuberculous lesions nor other abnormal shadows like bronchiectasis, 4) no abnormal serological results suggesting other bacterial or viral infections. According to this definition, 17 out of 84 MAC patients are diagnosed as primary MAC infection, and clinical features are analyzed in these 17 patients. Average age of patients is 61.1 +/- 12.9 year old. This age is significantly higher than that of inpatients with pulmonary tuberculosis in our hospital, and lower than that of all MAC patients including secondary infection. Five (29.4%) are male and 12 (70.6%) are female, the ratio of male to female is 1 to 2.4. This value is significantly different with that of inpatients with pulmonary tuberculosis in our hospital who show about 3 to 1. Most of the patients complained of cough with sputum, especially of hemosputum. Eleven out of 17 patients (64.7%) complained repeated hemosputum. The frequency of hemosputum is very high compared with that of the patients with pulmonary tuberculosis (about 20%). No compromised condition was present except for a patient with Behçet's disease who are taking steroid hormone. Roentgenographic features of primary infection are those of scattered small nodular lesions in the peripheral part of the lung, thin wall cavity formation, no contraction of the diseased lung nor dislocation of the trachea.(ABSTRACT TRUNCATED AT 250 WORDS)


[On the problems of the antituberculous drug resistance]. In this part, we will discuss exclusively about the technique of measurement. It is desirable especially for the proportion method that two inoculations with the same doses give the same number of colonies and when diluted, the colonies decrease exactly parallel to it degree of dilution. But this ideal is not necessarily realized and especially the difference between the dilution of 10(-3) and 10(-4) mg/ml on the drug free medium and that of 10(-2) and 10(-3) on the drug containing medium is fairly remarkable: the former is not so large but the latter sometimes varies tremendously with the drugs and their concentrations. So it is necessary to use always two inoculations for all specimens and the resistance is calculated on the medium inoculated with the same doses, for that, colonies on the control must be countable and suitable number that is 50-300. Further too concentrated solution like 10(-2) mg/ml must not be used for the proportion method. The selection of the most suitable two dilutions is specially important for this method. Original one is 10(-3) and 10(-5). Unfortunately we did not follow this formula and at first we adopted the combination of 10(-3) and 10(-4), then 10(-2) and 10(-4) finally 10(-2) and 10(-3) which was the worst. Now we searched for the dilution which gave the suitable number of colonies from our several thousand cases and found that 10(-4) was the most excellent and gave this number in 63%, next 10(-5) in 14%, and then 10(-3) in 7.2%, 10(-2) in only 1.0%. With the combination of 2 solutions 10(-3) and 10(-5)--original one--was most excellent (94.8%) then 88.4% with 10(-4) and 10(-5). The combination of 10(-2) and 10(-3) was worst, it gave only 8.9%. As the proportion method demands the most strict procedures for all cases, it is necessary as simplify as possible, thus in every day practice, only the drugs most frequently used (3 or 4 drugs) and one concentration for each drug could be examined. Further we discussed on the difference between DH-SM and SM, direct and indirect method and problem of plug.


[Tuberculous meningitis in Japanese children between 1980-1991]. We evaluated the clinical and laboratory findings of tuberculous meningitis admitted to Tokyo Metropolitan Children's Hospital from 1980 through 1991 retrospectively. They consisted of 26 patients (14 boys and 12 girls), and their age ranged from 4 months to 11 years. Seventeen patients were under 3 years of age. Mortality rate was 4% (1/26), and there were 13 patients with sequelae on discharge from the hospital, and 12 patients without any sequelae. The period to recover normal CSF findings was relatively long. Some cases which did not seem to respond well to chemotherapy at the initial stage, recovered from meningitis without sequelae. This suggests that it is not necessary to change the chemotherapy at the initial few weeks of therapy. The risk factors of poor prognosis were; age less than 2 years, decreased level of consciousness on admission, convulsion, CSF protein more than 70 mg/dl, and CSF glucose less than 20 mg/dl. Tryptophan reaction was not always positive. Chloride in CSF was not so important to diagnose tuberculous meningitis in children. For the proper diagnosis of tuberculous meningitis in children one should consider several factors such as tuberculin skin test, family history, chest X-ray findings and CSF study. BCG was inoculated in six children (three patients were under one year old and the rests were older than 4 years). In three patients under one year old BCG was seemed to be inoculated after Mycobacterium tuberculosis infection, and apparently not effective to prevent tuberculosis meningitis. We conclude that BCG vaccination is necessary in early infancy to prevent tuberculous meningitis.


[Mycobacterium fortuitum pulmonary infection in a healthy 17-year-old man]. A 17-year-old man was admitted with a 5-month history of intermittent dyspnea on exertion, 10 kg weight loss, cough, sputa and fever. He did not smoke, had no apparent underlying pulmonary disease, and was not immunocompromised. Mycobacterium fortuitum was cultured from sputa at admission. Chest radiograph showed many thin-walled cavities and infiltration in the bilateral middle and upper fields. Chest CT detected multiple cystic lesions that were not revealed in conventional X-ray. It was suggested that the formation of the cystic lesions was one of the predisposing factor of Mycobacterium fortuitum pulmonary infection in this patient. The pneumonic change improved after six-month treatment using isoniazid, rifampicin and streptomycin, despite in vitro resistance of the bacilli to all of these drugs.


[A complication of bronchoscopical brushing cytology and biopsy for pulmonary tuberculoma]. Although bronchoscopical brushing cytology and biopsy are useful tools for differential diagnosis of localized abnormal lung shadows, they have some complications, one of which is bacterial infection. The patient was a 42-year-old female with a RUL coin lesion on chest roentgenogram, which was diagnosed as pulmonary tuberculoma through the bronchoscopical examination. The exam. was followed, however, by perifocal lung abscess with a cavity, which was believed to be anaerobic infection, and cured rapidly with initial intensive chemotherapy including RFP. Prophylactic use of antimicrobial drugs, which are also sensitive to anaerobic flora, would be necessary for preventing or minimizing such complication after bronchoscopy.


[Percutaneous pulmonary valvuloplasty in 135 patients]. We present our 7 years experience with 135 pts aged 1.4-44 years (mean 10-yrs) in whom percutaneous balloon valvuloplasty (BPV) for congenital pulmonary stenosis was attempted. In 4 pts we failed to place the balloon at valvar level, in another four BPV was repeated so, 135 procedures in 131 pts were performed. Balloon diameter/pulmonary anulus diameter ratio (BD/PD) ranged from 0.9 to 1.85 (mean 1.37). In 10 cases double balloon technique was used. Immediate results: in the whole group of 131 pts the right ventricular-pulmonary artery gradient (RV-PAG) was reduced from 74 +/- 42 to 34 +/- 34 mm Hg, and right ventricular systolic pressure (RVSP) decreased from 92 +/- 41 to 54 +/- 34 mm Hg just after BPV. 86 pts (65.6%)--group I, had good immediate result of BPV (RVSP less than 50 mm Hg). 4 of them had dysplastic pulmonary valves (DPVs). RV-PAG in 82 pts with normal valves decreased from 53 +/- 25 to 15 +/- 7 mm Hg right after BPV. In 45 pts (34.4%)--group II, immediate result of valvuloplasty was recognised as unsatisfactory (RVSP greater than or equal to 50 mm Hg): in 4 of them BD/PD was smaller or equal 1.2 (subgroup IIa); 34 others had significant subpulmonary obstruction (SPO) that appeared or increased after BPV (subgroup IIb); and in remaining 7, DPVs were noticed (subgroup II c).(ABSTRACT TRUNCATED AT 250 WORDS)


[Preventive pharmacological treatment after cardiac electroversion for atrial fibrillation following surgical treatment of heart defects]. 265 patients (168 women, 97 men) after cardiac surgery (mitral valve replacement--74 pts, mitral commissurotomy--158 pts, aortic valve replacement--6 pts, replacement of both valves--16 pts, closure of ASD--11 pts) were randomized after successful electro-conversion of atrial fibrillation to quinidine (63 pts), verapamil (56 pts), amiodarone (50 pts), digoxin (56 pts) or control group (40 pts). The groups were comparable regarding age, sex and mitral valve disease distribution, heart volume, echocardiographic left atrium size and time from cardiac surgery to electro-conversion. After one year sinus rhythm was still present in 43% receiving quinidine, 43% receiving verapamil, 40% receiving amiodarone, 22% receiving digoxin, 20% in the untreated group, and after two years in 14%, 11%, 20%, 0% and 0%--respectively. The treatment was discontinued because of side effects in 13% of pts in the quinidine group, 8% of pts in the amiodarone group and 4% of pts in the verapamil group. It is concluded that quinidine, amiodarone and verapamil compared with control group are significantly (p less than 0.05--after one year) more effective in preventing late relapses of atrial fibrillation. Digoxin is ineffective in preventing recurrence of the arrhythmia. There are no significant differences between quinidine, verapamil and amiodarone regarding its prophylactic efficacy.


[Mitral valve prolapse. Atrial stimulation, ajmaline test and "pharmacological denervation" in the evaluation of ventricular repolarization]. In patients with mitral valve prolapse syndrome (MVP) various electrophysiological abnormalities occur. There are convergent opinions concerning QT distance variability and the influence of autonomic nervous system on ventricular repolarization in this syndrome. In 38 MVP patients (group I) and 24 subjects without this abnormality (group II) ecg was recorded during transvenous right atrial pacing at baseline, after ajmaline administration and after pharmacological autonomic blockade (atropine + propranolol). The following ventricular repolarization parameters were analysed: QTe (distance to the end of T wave), JTe (distance between J point and the end of T wave--so called "pure repolarization"), QTdys (repolarization dispersion) and the corrected QTc.QTe during 90/min right atrial pacing was significantly shorter than QTc in both groups. QTc was abnormally prolonged (above 440 msec) in MVP group. Ajmaline administration prolonged QTe in group II only, whereas autonomic blockade resulted in marked shortening of QTe in MVP group. QTdys was significantly prolonged only after ajmaline administration in group II. Based on above results, the following conclusions are made: 1) Right atrial pacing technique may be used for calculating standardized QT distance, an alternative to corrected QT. 2) Ajmaline test is useless in ventricular repolarization estimations in MVP patients. 3) In MVP patients the influence of adrenergic system on ventricular repolarization at rest appears to be greater than in non-MVP subjects.


[Anatomical correction of transposition of the great arteries in 7 newborn infants]. In the presented article, the course and results of anatomical correction of transposition of great arteries (TGA) in 7 neonates (2 females and 5 males) with mean body mass of 3250 g and 2 to 5 days old (mean 3 days) are reviewed. Surgery was performed in moderate hypothermia. St. Thomas cold cardioplegia was used. Mean aortic clamping time was 70 min (55-115), and the time of extracorporeal circulation was 165 min (117-210). Low cardiac output in all patients in the postoperative period required prolonged mechanical ventilation and positive inotropic drugs. Out of 7 patients operated, two died (29%). The cause of death in both cases was myocardial ischemia of right ventricle. The other 5 patients were discharged after healing of operational wound. In the control echocardiographic examination performed 3 to 12 months postoperatively, apart from one case of moderate pulmonary artery stenosis, no other haemodynamically significant complications were noted.


[Complex treatment concept of psoriasis vulgaris in childhood with integrated high altitude-climate therapy]. A sample of 102 inpatient children with psoriasis demonstrated differences in appearance and treatment to the psoriasis of adults. The complex therapy concept is based on 5 elements with dermatologic, high-altitude climatic and psychological treatment. Important additional factors are pre-school and school activities and vocational assistance. Of utmost importance is an early step-by-step education of the parents and of the psoriasis child about the disease. Medical treatment is effectively completed and optimised by an appropriate life style and multiple prophylactic activities in the premedical and environmental fields of the diseased. Dermatologists and pediatrists should aim at on-target and well-organised medical guidance of the young psoriatics.


[Sensitization to house dust mites: importance and possibilities of allergen elimination]. House-dust mite allergy (Dermatophagoides pteronissinus and Dermatophagoides farinae) is an important causative factor for allergic asthma or rhinitis in children. There is a clear relationship between the degree of allergen exposure and the subsequent development of asthma or the risk of sensitisation. It is therefore useful to know how intensive a patient is exposed to house-dust allergen. This can be managed either by counting all mites in the dust, by measuring of the content of Der p I and Der f I (major antigens of the two mites) per gram dust or using the Acarex test. These methods are also suitable for the control of sanitation measurements, e.g. avoidance of all dust sources in the bedroom and living-room, use of suitable materials for bedding, application of acaricide products and covering mattresses with polyurethane-coated materials.


[Failure to thrive in young children--disorders of carbohydrate absorption?]. We examined 31 formerly hypotrophic newborn children (birth weight < 5th Kyank percentile) with failure to grow in infancy (weight < 3th Prader percentile). The rates of digestion and absorption of carbohydrates were determined by segmental perfusion of the small intestine and compared to the results of 21 patients with florid coeliac disease. Despite the normal structure of the mucous membrane of the small intestine, the rates of absorption of glucose in 14 formerly hypotrophic children and, additionally, in 12 and 10 of these children, respectively, the rates of hydrolysis of lactose and sucrose were nearly as low as in patients with florid coeliac disease. The reduced absorption and digestion of carbohydrates, respectively, could be a cause of subsequent failure to grow in some of the hypotrophic newborn children.


[Kinetics of vaccination antibodies against tetanus toxoid, diphtheria toxoid, measles virus, poliomyelitis virus and pneumococcus after allogenic and autologous bone marrow transplantation and booster vaccination. 2: Kinetics of vaccination antibodies against diphtheria toxoid after allogenic and autologous bone marrow transplantation]. In the second part of the paper we report on the results of the diphtheria antitoxin valuation of 8 children after allogeneic bone marrow transplantation (BMT) with and without graft versus host disease (GvHD) as well as on the kinetics of the diphtheria antitoxin of 5 children after allogeneic BMT with and without GvHD and of 5 children after autologous transplantation. The antibody valuation was done by a cell-culture assay. Whereas the inspection of the isolated data gives the impression of a swift antibody decrease up to the non-protective level from the 7th month after BMT, the kinetic tests are more highly differentiated. Besides rapidly decreasing values below the accepted protection rate of 0.01 IU/ml in the allogeneic transplanted groups, there are patients with positive antibody titres within an observation period of up to 24 months after BMT in the allogeneic as well as in the autologous transplantation group.


[Treatment of atopic dermatitis with borage seed oil (Glandol)--a time series analytic study]. The therapy of atopic dermatitis with highly unsaturated fatty acids has witnessed a renaissance in the last years. Therefore, a study was conducted with borage oil (Glandol), rich in highly unsaturated, so-called omega fatty acids, against palm seed oil as placebo in a total of 12 patients. Evaluation of the severity of the skin changes was done by means of the ADASI (Atopic Dermatitis Area and Severity Index)-score system described by us recently. The ADASI-scores, forming a time series, were analyzed by trend analysis methods. These methods allow an evaluation of the effectiveness of the therapy in each case. The analysis revealed that five out of seven patients treated with borage oil showed a favourable effect with regard to the skin changes assessed by the ADASI-score. In contrast, only one out of the five patients treated with placebo showed a significant improvement in skin changes. In view of the positive effect ob borage oil in patients with atopic dermatitis, a trial therapy for a certain period seems justified. Our study demonstrates both the value of our ADASI-scoring system as well as the advantages that time series or trend analysis methods might have for the evaluation of therapeutic effects in chronic skin diseases such as atopic dermatitis.


[Combined resections in the surgery of lung cancer]. Operations were performed on 3,313 patients for lung carcinoma in the Department of Surgery of the Lungs and Mediastinum of the National Research Center of Surgery, AMS USSR, from 1963 till 1.01.90. Among these patients 263 (7.9%) were treated by combined operations (resection of the lung together with part of the chest wall, trachea and its bifurcation, pericardium, diaphragm, superior vena cava, pulmonary artery, aorta, and atrium, and also with removal of metastatic lymph nodes of the contralateral lung). Three types of combined resections were carried out--vasculo-atrial, tracheo-bronchial, and parieto-diaphragmatic. Postoperative complications developed in 38.6% of patients. Intraoperative mortality was 1.5%, 13.9% of patients died after the operation. More than 5 years survived 21.8% of patients who underwent operation, more than 10 years 10.2%, and more than 15 years 5.6% of patients.


[The surgical treatment of patients with benign tumors and cysts of the mediastinum]. The article deals with the experience in the surgical treatment of 315 patients with benign tumors and cysts of the anterior (in 58.8%) and posterior (in 41.2%) mediastinum. Various methods of intervention--transpleural and extrapleural--were employed. Some extrapleural approaches were developed at the clinic. The clinical postoperative data show that they cause little trauma. Indications in observance of which these approaches may be considered optimal are determined.


[The use of the CO2 laser in the surgical treatment of benign breast diseases]. Benign diseases of the breast of a noninflammatory character are a widely encountered pathological condition. Most surgeons claim the nodular form of mastopathy to be a precancer. Sectoral resection of the breast is the only grounded and justified method for its treatment. Unfortunately, wound complications develop often in the postoperative period, which increases the duration of in-patients treatment, prolongs the period of restoration of the working capacity, and leads to the formation of coarse scars which disfigure the breast. Dissatisfaction with the results is also explained by the development of a recurrence in a certain percent of cases. The results of treatment in 2 groups of patients were compared: patients of the main group (group 1) were operated on with the use of the CO2-laser, those of the control group (group 2) were operated on by the traditional method. Analysis of the results of treatment shows that the modified method of sectoral resection has advantages over the traditional method and can therefore be recommended for wide introduction into clinical practice.


[Puncture aspiration biopsy under ultrasonic control in the diagnosis of breast neoplasms]. The authors studied the results of sonography of the breast and zones of regional lymph drainage in 15,973 patients. In 154 of them puncture aspiration biopsy was conducted under ultrasonic control. Breast carcinoma was found in 23 patients, in 2 of them the tumor was not palpable. The examination was performed on the Aloka-SSD-630 apparatus. The sonographic picture was that of a structure with diminished echogenic properties, irregular notched contours, and non-uniform echo signals from the internal structures. Echography with puncture biopsy made it also possible to reveal the presence of nonpalpable axillary metastatic lymph nodes and to establish the precise differential diagnosis of benign and malignant intraductal tumors. The method of puncture aspiration biopsy under control of ultrasonic examination is highly effective in the differential diagnosis of breast carcinoma.


[Benign symmetrical lipomatosis with predominant localization in the neck area (Madelung's disease)]. Eighty-eight males with benign symmetrical lipomatosis (BSL) were subjected to complex examination, 68 of them were operated on. BSL is a slowly progressing disease marked by the development of nonencapsulated symmetrical fatty masses mainly in the region of the neck. It usually occurs in males at the age of 35-50 years. Chronic alcoholic intoxication was found in 46 (48%) patients, 36 (41%) patients had various functional disorders which caused invalidation in 5 (5.7%) cases. A familial character of the disease was revealed in four (4.5%) cases. A classification of the disease is suggested which takes into account the functional disorders and the degree of development of the lipomatous masses in the neck. The author discusses the stages of the treatment, the surgical anatomy, a method for revealing the salivary glands in the lipomatous tissue by staining them with methylene blue solution, the operative techniques, the complications and their prevention, and the late results of surgical treatment. Satisfactory esthetic and functional results were achieved in 94.2% of patients who were operated on.


[The potentials for the organ-preserving treatment of early stomach cancer]. The oncological substantiation of endoscopic and economical surgical treatment of T1N0-1M0 gastric carcinoma in 46 patients was appraised. The results were studied with due regard for the peculiarities of early gastric carcinoma (EGC) revealed in 290 patients after standard surgical management. It was established that organ-preserving treatment of ECG is possible--5-years survival was 96.2%. Endoscopic removal can be considered radical only in T1P1 tumors without invasion of the lymphatic vessels of the wall and was of a multistage character in 86.2% of cases. Careful surveillance after its completion is necessary. Surgical treatment in indicated in repeated recurrences; they were encountered in 44.8% of cases. The causes of the recurrences were noncoincidence of the macroscopic and histological boundaries of the tumor (33.6%), multicentric growth (30.4%), and invasion of the submucosa. Metastases are encountered in the lymph nodes in 9.1% of cases in economical treatment. In T1N0-1M0P1-2 carcinoma, absence of multicentric growth, and III degree dysplasia in the surrounding mucosa (reflecting increased risk of multicentric growth) the volume of organ resection may be limited on condition that P1 lymphadenectomy is performed. The results of organ-preserving treatment are comparable with those of surgical treatment conducted in a standard volume.


[The choice of an optimal variant in the reconstructive stage of gastrectomy]. The authors analyse 40-year experience in gastrectomy and extirpation of the gastric stump in carcinoma of the stomach. Operations were performed on 742 patients. The results show that the mechanical suture has advantages over the manual suture in the formation of the esophago-intestinal anastomosis. The functional results were found to be best when the continuity of the gastrointestinal tract was restored by establishing the esophago-intestinal anastomosis with a loop of the small intestine isolated according to Roux. Comparative appraisal of end-to-end and end-to-side esophago-intestinal anastomoses revealed the advantages of the last-named in relation to the incidence of postoperative complications and total outcomes. The effect of the surgeon's qualification on the frequency of postoperative complications is discussed.


[The surgical and combined treatments of locally disseminated cardioesophageal cancer]. The article deals with the experience in the treatment of more than 1,000 patients with cardioesophageal carcinoma in 1965-1989. The authors note increase of surgical activity and widening of indications for operative treatment at the cost of patients of the old age groups and those with locally-extending forms of the neoplastic process. In distinguishing the term cardioesophageal carcinoma the authors insist on the community of the surgical tactics and operative methods in carcinoma of the cardia extending to the esophagus and in esophageal carcinoma spreading to the stomach. Improvement of the results of tre treatment the authors attribute to the perfection of the methods of lymphodissection and formation of esophageal anastomoses. The authors claim that the development of effective methods of combined treatment underlies the prospects of improving the late-term results. Experience in preoperative hypoxyradiotherapy, adjuvant postoperative chemotherapy, and preoperative regional intraarterial polychemotherapy is analysed.