Specific abnormalities of chromosome 14 in patients with acute type of adult T-cell leukemia/lymphoma

Chromosome analysis was performed on 1 patient with diffuse lymphoma of mixed type by histologic diagnosis and on 7 patients with the acute type of adult T-cell leukemia (ATL). Specific abnormalities in chromosome 14 at break band q11 with the assigned locus of the alpha-chain gene of the T-cell antigen receptor were identified in 6 of 8 patients. Inv(14) (q11q32) was found in 2 patients and translocation of chromosome 14 at break band q11 was observed in 4. Donor chromosomes involved in translocation of the 14q11 varied, i.e., chromosomes 3, 7 or X, with the exception of one patient whose donor chromosome origin could not be determined. The breakpoint in chromosome 3 was in band p25, a region reported to include the locus of the c-raf-I oncogene. In chromosome 7, it was in band p11, a region reported to include the locus of the c-erb-B oncogene, and in the sex chromosome X, it was in band q11. One patient also had a chromosome 14 aberration at break band q32. Of the 2 remaining patients, one had lost chromosome 14 and the other had an isochromosome 14q. Our observation and other reported findings suggest that the rearrangement of chromosome 14 at break band q11 is specific for lymphoma-type or acute-type ATL patients, and aberrations of proto-oncogene expression or the coding sequence by recombination involving a T-cell antigen receptor gene due to chromosome inversion or chromosome translocation may play an important role in T-cell neoplasia including ATL.

[Hyponatremia with high plasma ANP level--report of two cases with emphasis on the pathophysiology of cerebral salt wasting]

Two cases of hyponatremia with intracranial lesions are reported with emphasis on diagnostic value of measurement of antidiuretic hormone (ADH) and atrial natriuretic polypeptide (ANP). Case 1. A 77-year-old female was transferred to our hospital for further care of vegetative state after subarachnoid bleeding on May 23, 1986. She was operated by neck clipping of rt-IC bifurcation aneurysm and lt-internal carotid-posterior communicating aneurysm at another hospital. On admission, computed tomography showed diffuse low density at bilateral thalamus and centrum semiovale. Biochemical analysis revealed hyponatremia (120 mEq/t) with increased natriuresis. Endocrinological date revealed normal plasma ADH and high plasma ANP levels. Patient was treated with infusion of 1% NaCl. Case 2. A 65-year-old male was admitted to our department because of gradual impairment of consciousness and generalized convulsion. Computed tomography showed small low density area at rt-thalamus and lt-cerebellar hemisphere. Biochemical date revealed severe hyponatremia (91 mEq/t) with normal plasma level of ADH and high plasma ANP. He was treated with infusion of 3% NaCl and hyponatremia was improved. The hyponatremia is frequently associated with intracranial disorders such as brain tumor, subarachnoid hemorrhage and head injury. Originally, hyponatremia with natriuresis was thought to be caused by salt wasting. This syndrome was defined as the inability to prevent salt loss in the urine due to undefined natriuretic factor in the brain. However, since 1957, because of introduction of concept of SIADH, it has generally become accepted that patients with natriuresis had SIADH. (ABSTRACT TRUNCATED AT 250 WORDS)

[The development of a new flexible hysterofiberscope and its clinical application]

Hysteroscopy is a diagnostic method for intrauterine lesion. Most kinds of hysteroscope are rigid in type. Cervical dilatation and insertion of the trocar are necessary for hysteroscopy. These procedures can be very painful to the patient. Also subsequent blood clotting and injury to the endometrium may interfere with the diagnosis. With the help of Fuji Photo Optical Company, a new flexible hysterofiberscope (3.7 mm in diameter) was developed. The scope is divided into three portions; a front flexible part, a rigid middle part and a soft rear part. Cervical dilatation and anesthesia were not required even in a primiparous woman. The operator can observe the cervical canal, the uterine cavity and the tubal ostium very easily in a comfortable position. From Nov. 85 to Sep. 86 we carried out hysteroscopy in 411 patients with this new scope. The fluid medium which we used was a solution of 10% dextrose in water. The indications for hysteroscopy were abnormal uterine bleeding (187 cases), uterine myoma (80 cases), sterility (52 cases), post-transcervical surgery (22 cases) and others (70 cases). No complications were encountered during or after the procedure. The results were satisfactory. This new flexible hysterofiberscope has been proved an efficient tool for intrauterine diagnosis.

Three-contrasts method: an ultrasound technique for monitoring transcervical operations

The "three-contrasts method" of ultrasonography is designed to monitor transcervical operations for submucous uterine myomas and uterine septa when a pediatric urologic resectoscope is used. This monitoring method has proved more effective than concomitant laparoscopy. The pediatric resectoscope can also be used efficiently for diagnostic and therapeutic purposes without dilating the cervical canal.

Transcervical resection of submucous myoma

Thirteen women with chief complaints of menorrhagia and metrorrhagia underwent transcervical resection (TCR) of pedunculated submucous myoma using either an operating hysteroscope or urologic resectoscope. Eight women received TCR with a urologic resectoscope without further operation. Subsequent vaginal hysterectomy was performed on one woman after TCR of a large prolapsed submucous fibroid with a urologic resectoscope because of adenomyosis. Three women underwent TCR of the same type of large prolapsed submucous myoma with an operating hysteroscope. Later, due to other pathologic lesions of the uterus, subsequent vaginal hysterectomies were done on two women and a subsequent abdominal hysterectomy on another woman. Without TCR of these large prolapsed submucous myoma, subsequent vaginal hysterectomies were not possible. Only one woman underwent TCR of submucous myoma with an operating hysteroscope without further operation. All patients showed improvement in such clinical symptoms as menorrhagia, metrorrhagia, and anemia. Before TCR, we make it a rule to use a new diagnostic hysteroscope (4mm external sheath) to reevaluate the position and size of the fibroid. The fluid media used were 10% dextrose for diagnostic hysteroscopy, 5% dextrose for therapeutic hysteroscopy and 10% urigal for urologic resectoscopy. Three months after the operation, second look hysteroscopy is arranged. All patients except one have been followed up at our outpatient department.

[Clinical experience with ceftizoxime suppositories in pediatrics]

Ceftizoxime suppositories (CZX-S), containing 250 mg or 125 mg of CZX, were given to 6 children, 4 with acute bronchopneumonia and 2 with acute pharyngobronchitis, who were not suited to treatment with injectable or oral form of the drug. The clinical response was "good" in all the children and the causative organisms were eradicated in 2 children (H. influenzae or S. aureus). Adverse reactions consisted of 1 case each of diarrhea and transiently increased GPT. In conclusion, CZX-S proved to be highly effective in the treatment of bacterial infections in children.

[Clinical experience with aspoxicillin in the pediatric field]

Aspoxicillin (TA-058, ASPC) was given intravenously to 20 children with the following acute bacterial infections; 11 cases of bronchopneumonia, 5 cases of urinary tract infection, 2 cases of acute bronchitis, 1 case of staphylococcal scalded skin syndrome and 1 case of subcutaneous abscess. Clinical effectiveness was obtained in 14 cases out of 20 cases (70%) and bacteriological eradication in 8 cases out of 10 cases (80%). With ASPC the following side effects developed; transient diarrhea in 1 case, eruption in 1 case and slight elevation of GOT in 1 case. From the above clinical results, it is apparent that ASPC is an useful antibiotic for treating pediatric patients with various kinds of bacterial infections.

Incidence of adult T-cell leukemia-lymphoma and its familial clustering

The yearly incidence of ATLL in the Uwajima district is 6.6 patients per 100,000 inhabitants aged over 40. The yearly morbidity rate from ATLL of persons in this district who are positive for HTLV-antibody and older than 40 is 1 patient per 1,631. Familial occurrence was observed in 9/38 families available for pedigree analyses. Even in the endemic area, the existence of positive HTLV antibody is remarkably high in ATLL families, suggesting that HTLV has been transmitted from generation to generation mainly within these particular families.

[Clinical experience with cefminox in the pediatric field]

Cefminox (CMNX, MT-141) was given intravenously to 20 children with the following acute bacterial infections; 10 cases of bronchopneumonia, 4 cases of urinary tract infection, 2 cases of staphylococcal scalded skin syndrome, each 1 case of acute pharyngitis, acute tonsillitis, purulent cervical lymphadenitis and acute tonsillitis, and pleuritis. Good clinical responses were obtained in 18 patients out of 20 patients and bacteriological effectiveness in 13 strains out of 14 strains. No side effect was observed except for 1 case with diarrhea and 1 case with slight elevation of GOT and GPT. From the above clinical results, it is apparent that CMNX is a useful antibiotic for treating pediatric patients with various kinds of bacterial infections.

Clinical application of transvenous mitral commissurotomy by a new balloon catheter

A new balloon catheter was developed which allows mitral commissurotomy without thoracotomy. The procedure has been successful in five of the six patients with mitral stenosis so treated. In the remaining patient, the procedure could not be performed because of technical difficulties. The balloon is reinforced with a nylon micromesh and its shape changes in three stages, depending on the extent of inflation. It is inserted from the saphenous vein into the mitral orifice transseptally, fixed across the mitral orifice with partial inflation, and finally inflated to full its extent, separating the fused commissures by its expansile force. After the procedure, catheterization revealed a significant reduction in the mean diastolic pressure gradient across the mitral valve without resultant mitral regurgitation in each patient. Two-dimensional echocardiograms showed a marked to moderate degree of dilatation of the mitral orifice in each patient. All five patients are well with remarkable clinical improvements 2 to 16 months after the procedure.

Heritability of erythrocyte Na+-Li+ countertransport in relation to essential hypertension

The Na+-Li+ countertransport system in erythrocytes was investigated in patients with essential hypertension and control subjects. Furthermore, studies on the pairs of parent-offspring and husband-wife were added in order to evaluate heritability of the countertransport. The Na+-Li+ countertransport of patients with essential hypertension and normotensive subjects with the family history of hypertension was significantly increased in comparison with that of normotensive subjects without the family history. The correlation coefficient of the countertransport in pairs of parent-offspring was significant but not between husband-wife. These results support the concept of a genetic determinant for the countertransport system.

[Suprasellar arachnoid cyst--report of a case (author's transl)]

A 4-year-old boy with suprasellar arachnoid cyst was reported. At the age of 30-month-old his aunt was aware of his squint. During the observation by ophthalmologists from the age of 1y. to 3y., enlargement of the head and impairment of the visual acuity were manifested. Cranial CT scan revealed the enlargement of the ventricular system and a round low density area located superior to the sella. Absorption coefficient of the lesion was similar to that of the cerebrospinal fluid. No abnormal contrast enhancement was seen. Examination revealed the head circumference of 53.3 cm larger than doubled standard deviation, the right external strabismus, impaired vision (R:0.03, L:0.3) and optic atrophy but no other neurological signs. Cerebral angiography showed suprasellar mass lesion. After the ventriculography with water-soluble contrast medium, V-P shunt operation was performed and then the patient was transferred to the CT room. CSF enhanced CT scan showed no communication between the ventricles and the cyst. By frontotemporal approach, microsurgical removal of the cystwall was performed and the histological diagnosis was arachnoid membrane. Several days after the operation, bilateral subdural effusion was seen on CT scan and was treated with bilateral S-P shunt and the removal of V-P shunt. Follow up CT scan disclosed the disappearance of the subdural effusion and the suprasellar cyst. The visual acuity was improved well and the endocrinological study was normal. Analysis of the 45 reported cases of suprasellar arachnoid cyst suggested that direct removal of the cyst wall is better than the V-P shunt operation and the cyst shunting is advisable for repeat recurrence of the cyst. Removal of the ventricular shunting system may be effective for the prevention of the subdural effusion as a complication after direct operation.

[Laboratory and clinical studies on cefotaxime in obstetrics and gynecology (author's transl)]

The following results have been obtained in our basic and clinical studies to examine a new cephalosporin derivative, cefotaxime (CTX). For basic study purpose, we injected 1 g of CTX to 6 patients who had received simple total hysterectomy and measured its level in elbow vein, uterine artery, corpus uteri, cervix uteri, endometrium, oviduct and ovary. Any definitive conclusion should not be drawn from these results, since they have too big variation. However, slightly higher levels were achieved cervix uteri and oviduct than in other organs in a same patient. For clinical evaluation, we tried this drug to 12 cases of female genital infections and 91.7% response rate was obtained. Our studied population includes 8 cases of adnexitis, 2 with pelvioperitonitis, 1 with panperitonitis, and 1 patient with BARTHOLIN abscess. Organisms were detected only in 3 cases, including S. aureus in one patient, Micrococcus sp. in one, and mixture of Klebsiella sp. and B. fragilis in 1. Puncture of DOUGLAS pouch was performed in 3 cases after the completion of therapy and all had negative results. No side effect was observed, and no significant difference was noted between pre- and post-therapy examinations of peripheral blood, hepatic function and renal function.

Human lung cancer cell line (KSNY) producing colony-stimulating activity which affects both human and mouse marrow cells

A cell line (KSNY) in vitro, which produces colony-stimulating activity (CSA) for human and mouse marrow cells, has been established. A biopsy was performed on the tumor mass of a lung cancer patient who had developed extensive leucocytosis. A piece of the tumor was transplanted to a nude mouse. The seconarily transplanted mice, in turn, developed extensive leucocytosis. The mouse tumor was then removed and placed in culture bottles. To date, the KSNY cells have been maintained in vitro continuously for 15 months. By the use of a methylcellulose bone-marrow colony-formation technique, a high level of CSA in the supernatant of the tumor cell culture was recognized. Doubling time of the cell line is 46 hr. The modal chromosome number is 52, ranging from 45 to 106.