[Automated fetal heart rate analysis and its trendgram in relation to gas analysis and acid-base balance of umbilical cord arterial blood]

The gas analysis and acid-base balance of the umbilical cord arterial blood of 108 newborn infants were compared with the results of the automated analysis of the intrapartum fetal heart rate (FHR) and its trendgrams. The parameters of the automated analysis of the FHR, which consisted of fetal distress (FD) index, uterine contraction area, FHR score, number of dips, baseline heart rate, variability amplitude and lag time, were shown on the trendgram every 5 minutes using a microcomputer. 1) The mean pH, BE and HCO3- of the 4 groups, that showed 0, 1, 2 and 3 or more on the FD index, were gradually decreased as the FD index was increased. 2) The FHR score, that was accumulated for 10 minutes from 0-10 minutes to 50-60 minutes prior to the birth, was well correlated with the umbilical cord arterial blood pH (r = -0.47), BE (r = -0.60) and HCO3- (r = -0.45). 3) The intrapartum trendgrams were classified into the normal and ominous groups on the basis of the FHR score and FD index. The differences between the respective mean pH, BE, HCO3-, PO2 and PCO2 for these groups were highly significant. 4) The specificity and the sensitivity of the trendgram were more than 70% in the prediction of a pH value lower than 7.25 and of a BE value lower than -6.0 mEq/l.

[Consecutive intra-arterial infusion of cis-diamminedichloroplatinum with continuous intra-arterial infusion of 5-fluorouracil in locally advanced ovarian cancer]

Consecutive intraarterial infusion of cis-diamminedichloroplatinum (CDDP) with continuous intraarterial infusion of 5-fluorouracil (5-FU) (250 mg/day) was administered to 10 patients with locally advanced (peritonitis carcinomatosa) ovarian cancer. The dose of CDDP was 10 mg/5 min/body/day and it was administered for about 10-20 consecutive days per one course. Each course was repeated at about 3-week intervals. The main dose-limiting factor was the number of peripheral leucocytes. The results were 6 PR, 1 MR and 2 NC out of 9 evaluable cases, all of whom had had previous therapy. The antitumor effect needed over 200 mg of intraarterial CDDP and the response lasted from 2 to more than 9 months. Among 6 patients who obtained PR, 4 had failed to respond to intravenous or intraperitoneal infusion of CDDP, which suggested that a high concentration and a critical drug gradient across the tumor cell membrane were more essential for a significant tumor cell kill, with CDDP, than the time of exposure. The toxic effects of intraarterial infusion of CDDP were almost absent as compared with those of intravenous infusion, which consisted of nausea and vomiting. Renal dysfunction was also mild. Other toxic effects were not different from those observed in intravenous infusion. Our results with intraarterial infusion of CDDP clearly indicate that this approach can deliver a high therapeutic efficacy in patients with advanced ovarian cancer with markedly less toxic effects.

[Significance of CA 125 antigen levels in patients with ovarian cancer]

CA 125 antigen levels were measured in patients with ovarian cancer (54 cases) by the RIA method using a monoclonal antibody OC 125 and were examined as a marker for ovarian cancer. The upper normal limit of CA 125 of 35 U/ml was derived from the mean value (15.7 U/ml) + 2 SD (9.3 U/ml) of CA 125 in healthy controls. The mean value of CA 125 in patients with ovarian cancer (1160 +/- 1850 U/ml) was statistically (p less than 0.001) higher than those of healthy controls, benign ovarian tumors (28 +/- 20 U/ml) and cervical cancers (226 +/- 526 U/ml). Elevated CA 125 levels were also found in the early stages pregnancy and endometriosis, but these cases did not show such high CA 125 values as those of ovarian cancers. In addition, CA 125 levels were not affected by the menstrual cycle. Among ovarian malignancies, elevated CA 125 values were specifically demonstrated in serous cystadenocarcinoma (positivity 89%) and markedly low in mucinous cystadenocarcinoma (positivity 16%). No positive correlation of CA 125 values with clinical stage (FIGO) were found in any ovarian cancer patients. The rise or fall of CA 125 level was well correlated with the progression or regression observed in cancer patients with positive CA 125 levels. In conclusion, serum CA 125 determinations may be useful in patients with ovarian cancer (except for mucinous type) for diagnosis and for monitoring the results of treatment.

Ultrasonography and computed tomography in adenomyomatosis of the gallbladder

Ultrasonography and computed tomography were performed in 4 patients with adenomyomatosis of the gallbladder of segmental or diffuse type. Cholecystectomy was performed in all cases, and the diagnosis of adenomyomatosis was confirmed histopathologically. Ultrasonography revealed diffuse or segmental thickening of the gallbladder wall with small intramural diverticula. Small stones were also found. The characteristic findings of adenomyomatosis at computed tomography were soft tissue density masses in the gallbladder fossa, associated with a well-delineated, distinct tumor-free space between the mass and the liver, and with small intramural diverticula and calcified stones within the mass. Ultrasonography and computed tomography demonstrate a characteristic appearance of adenomyomatosis.

[Therapeutic effects of SM-4300 and antibiotics combination against severe bacterial infections]

A newly developed human immunoglobulin preparation for intravenous administration (SM-4300) was applied to the severe bacterial infections in the field of internal medicine. Nine cases of severe infections were treated with SM-4300 and antibiotics combination. Clinical effects of SM-4300 were excellent in 1 case, good in 5, poor in 1 and unknown in 2. The efficacy rate was summarized as 86%, and no side effects were observed.

Globular Mallory-like bodies in renal cell carcinoma: report of a case and review of cytoplasmic eosinophilic globules

The case of a patient who had renal cell carcinoma with cytoplasmic eosinophilic globular hyaline bodies antigenically similar to Mallory bodies, highly suggestive of globular type III alcoholic hyalin, is presented. Mallory bodies are not found exclusively in the liver, having also been demonstrated in the lung. The renal tumor in this case represents an additional extrahepatic site.

Protection against the photosensitized skin irritancy of chlorpromazine by cyclodextrin complexation

The efficacy of three types of cyclodextrins (CyDs) to reduce skin irritation in guinea pigs caused by photoirradiated chlorpromazine (CPZ) was in the order of beta-greater than gamma-much greater than alpha-CyD, depending upon the magnitude of the stability constant of the CPZ-CyD complexes. The inhibitory effects of CyDs may be attributable to the alteration in the photochemical reactivity of CPZ through inclusion complexation. By the photoirradiation of CPZ in the presence of CyDs, promazine, which is less toxic than CPZ, was produced and the yield decreased in the order of beta-greater than gamma-much greater than alpha-CyD. These results clearly indicate that beta-CyD complexation is particularly useful to reduce the CPZ-photosensitized damage to skin.

Improvement of dissolution and suppository release characteristics of flurbiprofen by inclusion complexation with heptakis(2,6-di-O-methyl)-beta-cyclodextrin

The inclusion behavior of methylated beta-cyclodextrins, heptakis(2,6-di-O-methyl)-beta-cyclodextrin and heptakis-(2,3,6-tri-O-methyl)-beta-cyclodextrin in solution and the solid state was compared with that of natural beta-cyclodextrin using an anti-inflammatory drug, flurbiprofen, as a guest molecule. Stability constants were determined by the solubility method at various temperatures, and the thermodynamic parameters were calculated for inclusion complex formation in aqueous solution. The solid complexes were obtained in a molar ratio of 1:1, and their dissolution behavior and release from suppository bases were examined. The data suggest that the inclusion mode of the complex with 3 is somewhat different from that of the complexes with 1 and 2. From a practical point of view, 2 seems to be particularly useful for improving the pharmaceutical properties of flurbiprofen in various dosage forms.

Improvement in the percutaneous absorption of beclomethasone dipropionate by gamma-cyclodextrin complexation

Inclusion complex formation of beclomethasone dipropionate (BMDP) with gamma-cyclodextrin (gamma-CyD) in water and in solid state was assessed by solubility analysis and X-ray diffractometry. The solid complex of BMDP with gamma-CyD in a molar ratio of 1:2 was prepared and its in-vitro release behaviour was investigated using an ointment release simulator. The release of BMDP from hydrophilic ointment was significantly improved by the gamma-CyD complexation. Permeation and uptake studies indicated that the enhanced release of BMDP from the ointment may be due to the faster dissolution and the lower binding affinity of the complex in the ointment base. The vasoconstrictor activity of BMDP in man was found to be increased by gamma-CyD complexation, suggesting an improvement in the percutaneous absorption of BMDP.

Preparation of 13N-beta-phenethylamine

Nitrogen-13-labelled beta-phenethylamine[( 13N]PEA) was synthesized by Hofmann rearrangement of [13N]phenylpropionamide prepared from phenylpropionyl chloride and aqueous [13N]ammonia solution. The reaction proceeded rapidly with a fairly good yield. [13N]PEA was isolated using preparative thin-layer chromatography, and organ distribution in mice was studied preliminarily. After i.v. administration of [13N]PEA, high accumulation and long-term retention of the radioactivity were observed in the brain and the heart.

Electron microscopic study of the in vitro calcium-dependent degradation of Mallory bodies and intermediate filaments in hepatocytes

Isolated crude fractions of intermediate filaments (IFs) from livers of control and griseofulvin-fed mice were incubated with calcium (Ca2+) or ethylene glycol bis(beta-aminoethyl ether)-N,N'-tetraacetic acid (EGTA). The fractions were semiquantitatively compared using electron microscopy to study the Ca2+-dependent degradation of Mallory bodies and IFs. Numerous intermediate filaments were observed in the cell cortex and cytoplasm of hepatocytes both in control and griseofulvin-fed mice at zero time and after incubation in EGTA. However, only rare IFs near desmosomes were seen after incubation with Ca2+ in the fractions from two control mice. In the remaining controls no IFs survived incubation with Ca2+. Although almost all IFs disappeared after incubation with Ca2+ in griseofulvin-fed mice, some IFs could be detected near desmosomes in all cases. In contrast, Mallory bodies were observed to survive both Ca2+ and EGTA incubations. There was no morphologic difference between the Mallory bodies incubated in Ca2+ or EGTA. The disappearance of IFs after incubation in Ca2+ indicates that the IF's protein of hepatocytes (cytokeratin) can not retain its filamentous structure in the presence of Ca2+. This suggests that Ca2+-dependent factor(s) may regulate IF's degradation. Whether the protein subunits of the IFs were chemically altered was not determined. The resistance of Mallory bodies to Ca2+ dependent degradation suggests that they may form in part as a result of an imbalance in the rate of filament formation and degradation favoring growth of the Mallory body filaments.

Mallory body formation runs parallel to gamma-glutamyl transferase induction in hepatocytes of griseofulvin-fed mice

To evaluate whether Mallory bodies (MBs) are linked to the induction of the enzyme gamma-glutamyl transferase (GGT), mice were fed 2.5% griseofulvin (GF). The experimental and control mice livers were examined at four time periods, i.e., after 4 months' of GF feeding, 1 month after GF withdrawal and 13 days after GF refeeding, and at sacrifice after 4 months of GF withdrawal. The livers from mice continuously fed GF or control diet for 10 months were also examined. Tumors and nontumorous livers were examined histologically, histochemically, electron microscopically, and immunocytochemically. The tumors consisted of hepatomas and hyperplastic nodules. To localize MBs inside GGT-positive cells, a double-staining method was employed; GGT-positive cells were identified histochemically followed by staining for MBs using the unlabeled immunoperoxidase technique. The per cent area of the GGT-positive foci was closely correlated with the frequency of MBs observed in the course of a GF feeding and withdrawal. Almost all of the MBs were located in GGT-positive cells in both tumors and nontumor liver tissue. MBs and GGT positivity involved the same liver cells. They both were found in high frequency in tumors induced by GF. These results indicate that MB formation, like GGT induction, is a phenotypic change induced by GF. The coexistence of the two phenomenon in the same cell throughout all phases of tumor formation suggests that MBs may be related to the neoplastic process in the GF-fed mouse model.

Reduction in the local tissue toxicity of chlorpromazine by beta-cyclodextrin complexation

Effect of beta-cyclodextrin (beta-CyD) on the local tissue toxicity of chlorpromazine (CPZ) was investigated following the intramuscular injection to rabbits. From the gross and histological examinations, beta-CyD was found to alleviate the muscular tissue damage produced by CPZ on M. vastus lateralis in rabbits. The protective effect of beta-CyD may be ascribed to the decrease in affinity of CPZ to the tissue membrane through inclusion complexation. The present data suggest that beta-CyD complexation is particularly useful to reduce the local toxicity of phenothiazine neuroleptics without altering the pharmacological efficacy.