[Clinical study on ureterosigmoidostomy]

Clinical studies were made of 60 patients who had undergone ureterosigmoidostomy at our department. The 45 men and 15 women ranged from 35 to 73 years old, with a mean of 59.2 years. Ureterosigmoidanastomosis was performed using the modified Coffey II technique in this series. Bladder tumor was the reason for the operation in 55 cases, uterine cancer in 2, contracted bladder in 1, vesicovaginal fistula in 1 and urethral stricture in 1. In the excretory pyelogram one month after the operation, normal findings and slight hydronephrosis were observed in 37% and 63% of the patients, respectively. However, the pyelogram 6 months after the operation demonstrated normal findings in 61% of the patients, slight hydronephrosis in 34% and moderate hydronephrosis in 5%. None of them showed severe hydronephrosis. Slightly increased BUN level (less than 30 mg/dl) was seen in 15 out of 45 patients (32%) at one year after ureterosigmoidostomy. However, serum creatinine level was not above normal throughout the postoperative course. Although postoperative hyperchloremia was appreciably detected, it was easily managed by the administration of sodium bicarbonate. Serum sodium and potassium levels remained stationary. Of 35 patients observed for more than one year after operation, 11 patients (31%) had developed fever due probably to pyelonephritis, but sigmoidography failed to demonstrate any ureteral reflux. Either urinary or fecal fistula, a complication in the early postoperative period, occurred in 10 patients (17%). One of these patients died. Five patients were cured by conservative treatment. The remaining 4 patients underwent surgical treatment that was ureterocutaneostomy , nephrectomy, or colostomy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surveillance colonoscopy after ureterosigmoidostomy]

Twenty-two patients underwent surveillance colonoscopy for 2 to 54 months (average, 22 months) after ureterosigmoidostomy. The distance between site of ureterocolonic anastomosis and anal verge ranged from 13 to 30 cm (average, 18.3 cm) in right side and from 20 to 37 cm (average, 29.5 cm) in left side. The form of implanted site could be classified into 3 types which were flat, sessile and pedunculated types. Endoscopic biopsies performed on eleven polyp-like regions of ureterocolonic anastomosis revealed inflammation in 10 cases (90%) and adenoma without malignancy in one case (10%). The mucosa more than 5 cm away from implanted site showed findings of inflammation without constitutional abnormality in more than 60% of all patients. The periodical surveillance colonoscopy at intervals of approximately one year seemed to be useful for early detection of the tumors of the colon after ureterosigmoidostomy.

Distribution and morphological characteristics of the pit cells in the liver of the rat

Pit cells, on which almost no further contributions have been presented since the first report by Wisse et al. (1976), are described in detail in the rat liver. These cells show several characteristic features: 1) "rod-cored vesicles", a new type of vesicular inclusion observed first in our study; 2) electron-dense granules, which we consider to arise from multivesicular bodies by the accumulation of dense material; and 3) well-developed pseudopodia. Although these features clearly differentiate pit cells from conventional lymphocytes, these two cell types display similarities (i) in a number of ultrastructural features, (ii) in the pattern of their intralobular distribution, and (iii) in their presence in the spleen and peripheral blood.

Calcification of the ligamentum flavum of the cervical spine. Report of four cases

Four cases of calcification of the cervical ligamentum flavum are reported, all in women over 60 years of age. Neurological findings were not significantly different from those of other cervical compressive diseases. Among radiological examinations, computerized tomography was the most valuable diagnostic tool. Calcification might have been induced by the degeneration or abnormal nutritional state of the ligamentum flavum. Endocrine abnormalities and inflammatory processes might also have been contributory factors.

[Results of clinical application of cefpiramide in pediatrics]

After the intravenous injection of cefpiramide (CPM) at a dose of 10 mg/kg to 2 children, the average blood levels of CPM were 77.7 micrograms/ml at 15 minutes, 64.6 micrograms/ml at 30 minutes, 41.9 micrograms/ml at 1 hour, 31.9 micrograms/ml at 2 hours, 10.7 micrograms/ml at 4 hours and 3.28 micrograms/ml at 12 hours. The half-lives were 3.0 hours and 5.8 hours. When CPM was given to 22 pediatric patients with mainly acute respiratory tract infection at doses of 20 approximately less than 50 mg/kg/day divided into 2 times by intravenous injection (12 cases) and drip-infusion (10 cases) for 2 approximately 3 days (10 cases) or 4 approximately 6 days (12 cases), the effective rate was 90.9%. No side effects were observed except slight increase of eosinophil in 1 case slight elevation of GOT in 1 case. It was concluded that CPM is a useful drug for the treatment of infection in pediatric field.

Changes in the nucleus pulposus of the intervertebral disc in bipedal mice. A light and electron microscopic study

Bipedal mice were produced by clipping the forelimbs and tails of mice within one week of birth. Using light and electron microscopy, the nucleus pulposus of the lumbar intervertebral disc in the bipedal mice was compared with that in normal mice at three, six, and 12 months of age. In normal neonatal mice, the nucleus pulposus is composed of densely packed notochordal cells, which undergo degenerative changes and decrease in number with age. In the bipedal mice, degenerative changes in the nucleus pulposus were accelerated, and herniation of the nucleus pulposus occurred frequently. At the same time, active chondrocytes associated with cartilage matrix appeared in the nucleus pulposus. This sequence of morphologic changes in the nucleus pulposus of the bipedal mice resembles the age-related changes that occur in the nucleus pulposus of the human intervertebral disc. These morphologic changes can be accelerated by creating abnormal mechanical stress. Chondrocytes in the nucleus pulposus may develop from surrounding cartilaginous tissue--cartilage plates and annulus fibrosus.

Myelopathy due to ossification or calcification of the ligamentum flavum: radiologic and histologic evaluations

The clinical, radiologic, and histologic features of ossification and calcification of the ligamentum flavum were studied in 18 patients. Ossification (15 patients) usually occurred in the lower thoracic spine in men of various ages, while calcification (three patients) was found exclusively in the cervical region of older women. Histologic examinations of ossification showed mature lamellar bone associated with proliferated cartilage replacing the ligamentum flavum (endochondral ossification). This corresponded well with radiographic and computed tomographic (CT) appearances. In the cases with calcification of the ligamentum flavum, calcification within the degenerated ligamentous fibers was observed on histologic examination, and correlated well with an oval nodular density on radiographs and CT. The two conditions differ in clinical, radiologic, and histologic considerations. Pathomechanisms in the development of these lesions and clinical significance are also discussed.

Age-related changes in the nucleus pulposus of intervertebral disc in mice. An electronmicroscopic study

The nucleus pulposus of the intervertebral discs in mice from newborn to four months of age was examined by electron microscopy. The nucleus pulposus was packed with the cells which were distended with large vacuoles and aggregations of glycogen particles. These cells contained many filaments and poorly developed organelles. Numerous pinocytotic vesicles were present along the cell surface. Neighboring cells were connected with desmosomes. Thus, the cells composing the nucleus pulposus were similar to notochordal cells. The intercellular space contained granular substances as seen in the matrix of the cartilage. In the peripheral region of the nucleus pulposus, the cells relatively rich in organelles were occasionally observed. At two months or more of age, vacuoles of the cells of the nucleus pulposus became larger and more numerous, and the scanty cytoplasm contained fewer organelles but well-developed filaments. However, many pinocytotic vesicles could be still observed along the cell surface. Degenerated cells appeared.

Postnatal histogenesis of the cartilage plate of the spinal column: electron microscopic observations

The cartilage plate in the vertebral columns in mice, from birth to 45 weeks of age, were examined by light and electron microscopy. At the day of birth, the intermediate part of the vertebral body consisted of bone, and its cranial and caudal parts were composed of thick cartilage. The cartilage was divided into an outer and an inner zone, according to the shape and arrangement of chondrocytes. In the deep portion of the outer zone, calcification developed from one week, and ossification appeared at eight weeks of age. The matrix in the superficial layer of the outer zone remained metachromatic during the development of the vertebral body. The inner zone of the cartilage showed columnar arrangements of chondrocytes and a metachromatic matrix like cartilaginous growth plates in long bones. Thus, vertebral bodies show development similar to that of long bones. The findings suggest that histogenetically the cartilage plate belongs to the vertebral body but not to the intervertebral disc and that age-related changes in the cartilage plate are concerned with age-related degenerative changes of the nucleus pulposus.

Clinical evaluation of pivmecillinam in intractable urinary-tract infections with complications. A comparative study with amoxicillin by a randomized double-blind technique

A comparative study was made by the double-blind technique in order to make clear the usefulness of pivmecillinam in the treatment of intractable complicated urinary-tract infections using amoxicillin as a reference drug. Pivmecillinam was given in dosage of 400 mg (potency) per day which was one-fifth the dose of amoxicillin 2,000 mg (potency) per day. In global judgement, pivmecillinam was found superior to amoxicillin. It showed a "significant" superiority over amoxicillin for the treatment of, among others, the urinary-tract infections after prostatectomy, which are intractable diseases. When evaluated by symptoms, pivmecillinam improved bacteriuria "significantly" better than amoxicillin. When seen by causative organisms, the pivmecillinam treatment was "significantly" superior to the amoxicillin treatment against E. coli infections. Pivmecillinam was active against amoxicillin-resistant E. coli. Incidence of adverse reactions was less frequent with pivmecillinam than with amoxicillin. These results indicate that pivmecillinam is a drug of high usefulness for the treatment of intractable complicated urinary-tract infections when evaluated using amoxicillin as a reference drug.