[Clinical study of pregnant women with psychotic disorders during last 14 years in Osaka Medical College]

The clinical features and outcomes of 51 pregnancies (47 patients) complicated by psychotic disorders were studied. These patients were diagnosed as having the following psychotic disorders: 7 schizophrenias, 8 atypical psychoses, 6 mood disorders, 25 epilepsies, 4 anxiety disorders, and 1 personality disorder. The mean delivery age of women suffering from schizophrenia, atypical psychosis, and anxiety disorder was over 30 with deliveries 7-10 years after the onset of their psychoses. The predominant obstetrical complications for schizophrenias, atypical psychoses, and mood disorders were gestational toxicosis, threatened premature birth, and premature birth, respectively. Six out of eight (75.0%) patients with atypical psychosis, 4 out of 6 (66.7%) patients with mood disorder, and 2 of 4 patients with anxiety disorder became worse during pregnancy and/or postpartum. The rate of deterioration of the patients with schizophrenia was 14.3% (1/7) during pregnancy. An increasing rate of epileptic attack during pregnancy and/or postpartum were observed in 40.0% (10/25) of patients. Nine cases underwent cesarean section not due to their mental disorders but for obstetrical reasons. The present study suggests that the cooperation between obstetrician and psychiatrist, and the existence of a key person who knows the patient very well is required for a desirable outcome of the treatment.

Clinical observation of personality characteristics of perimenopausal women with undefined complaints

Personality tests, including the Self-Rating Questionnaire for Depression (SRQ-D), the Minnesota Multiphasic Personality Inventory Alexithymia Scale (MMPI-AS), and the Egogram Check List (ECL) were completed by 202 perimenopausal women with undefined complaints. Patients diagnosed as having mental disorders showed SRQ-D scores of over 16 points. Patients diagnosed as having mental disorders showed MMPI-AS scores of over 13 points, which can be estimated as alexithymia. Patients experiencing climacteric disorders and the ovarian deficiency syndrome showed slightly higher MMPI-AS scores than healthy middle-aged women. The average ECL scores of patients diagnosed as having mental disorders tended to show an N-shape pattern. The findings suggest that personality tests would be helpful for screening perimenopausal women with mental disorders who are seen at outpatient gynecology clinics.

[In vitro study on the effect of sex steroid and growth factor on growth and laminin, collagen IV, and tissue plasminogen activator production of normal endometrial cells and endometrial cancer cells in culture]

The mechanism of the invasion and proliferation of endometrial cancer is closely related to interactions between the endometrial glands and stroma. In this study, we examined the biological role of sex steroids (estradiol; E2, progesterone; P) and growth factors (epidermal growth factor; EGF, transforming growth factor-beta; TGF-beta) on cell growth and laminin, collagen IV and tissue plasminogen activator (t-PA) production of normal endometrial cells and endometrial cancer cells in culture. Normal endometrial gland cells and stromal cells, and endometrial cancer cell lines (Ishikawa, OMC-2) were used. E2, P, EGF and TGF-beta were added to the culture in physiological concentrations. The growth of normal endometrial gland cells was promoted by E2 and EGF, whereas that of Ishikawa cells and OMC-2 cells was promoted by EGF. E2 enhanced the effects of EGF in normal endometrial gland cells. The growth of normal endometrial stromal cells was not affected by them. OMC-2 was inhibited by anti-EGF receptor antibody. On the other hand, the production of laminin and collagen IV of these cultured cells was inhibited by EGF and promoted by TGF-beta, whereas that of t-PA was promoted by EGF and inhibited by TGF-beta. These results suggest that the growth of normal endometrial gland cells with estrogen receptor (ER) is controlled by both E2 and EGF, whereas that of endometrial cancer cells is affected only by EGF, and those cells without ER depend particularly on the autocrine growth mechanism of EGF.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pharmacokinetics and toxicological study on the intraperitoneal administration of cisplatin and etoposide in gynecological malignancies]

We administered cisplatin and etoposide into the peritoneal cavity of 13 postoperative patients with gynecological malignancies, and studied the pharmacokinetics and toxicity in the combination of both drugs. Cisplatin 100 mg/body and etoposide 200 mg-400 mg/body were mixed together in 500 ml or 1,500 ml of normal saline and administered intraperitoneally on the day of operation and two or three weeks later. The peritoneal peak level of free cisplatin, diluted with 500 ml, was about two times higher than that, diluted with 1,500 ml. However, there was no difference in the peritoneal and plasma AUC. The peritoneal level and AUC of etoposide, diluted with 500 ml, was about two times higher than that, diluted with 1,500 ml. Among the groups of 1,500 ml, peritoneal and plasma levels and AUC were almost proportional to the doses. Nausea and vomiting were experienced in all patients. With the increase of etoposide, more marrow suppression was observed. However, we encountered no other significant side effects. In conclusion, intraperitoneal administration of cisplatin and etoposide in this setting can be used safely with minimum side effects, and the dilution of 1,500 ml seems to be better.

Changes in cAMP-dependent phosphorylation of specific cytosol protein in the peri- and postmenopausal ovary

Changes in cAMP-dependent phosphorylation of 53 kDa protein in a human ovary with respect to the aging process were studied. The phosphorylation of endogenous proteins in ovarian cytosol decreased with aging. However, ovarian aging was accompanied by an increase in the cAMP-dependent phosphorylation of 53 kDa specific protein while the amount of this protein decreased with aging. The plasma gonadotropin levels of women with regular menstrual periods were significantly different from those of women whose menstrual periods had in the recent past become irregular (FSH: p less than 0.01; LH: p less than 0.05); however, there was no significant difference in the plasma estradiol levels between these two groups. Our data show the possible correlations between the non-steroidal ovarian factor (53 kDa protein) and/or its phosphorylation by cAMP-dependent protein kinase and the ovarian aging process.

A case of panic disorder induced by oral contraceptive

A 27-year-old woman experienced feelings of unreality and fear after taking an oral contraceptive in the form of birth control pills. She subsequently experienced a panic attack just after she had stopped taking the pills. This was characterized by palpitation, general fatigue, trembling of the whole body, and dyspnea. The panic disorder experienced by the patient could have been due to the drug's potentiating of the sympathoadrenal response to simple physiological stimuli, or possibly to a disorder in psychological functioning caused by an anxiotropic effect of rapid endocrinological change.

[In vitro studies on the expression of c-myc oncogene product in gynecological cultured cancer cells]

In this study, immunocytochemical and biochemical detection of c-myc protein in gynecological cultured cancer cells were performed together with gene expression of the cells. OMC-1 (cervical squamous carcinoma cell line), OMC-2 (endometrial adenocarcinoma cell line), OMC-3 (ovarian mucinous adenocarcinoma cell line) and OMC-4 (cervical adenocarcinoma cell line) were used. Immunocytochemically, c-myc protein was detected in both nuclei and cytoplasms of cultured cells when they were fixed in 95% ethanol, 10% formalin and 4% paraformaldehyde (PFA) including 10mM NaCl. However, it was detected in the nuclei of almost all of the cells in nuclei of the cells when they were fixed in 4% PFA including 1,000mM NaCl. Western blotting against a nuclear fraction of the cells demonstrated 66Kd protein in OMC-1 and 62Kd protein in OMC-2,3,4, respectively. They were completely absorbed by c-myc synthetic peptide. However, there was no reaction against the cytoplasmic fraction of the cells. Slot blot hybridization against the DNA of the cells demonstrated 15 times and 5 times c-myc gene amplification in OMC-2 and OMC-4, respectively. These results suggest that OMC-1,2,3,4 can be used as positive controls for the immunocyto- and histochemical detection of c-myc protein in clinical materials. However, it must be noted that the redistribution of c-myc nuclear protein into the cytoplasm may occur in the fixation process.

[Re-evaluation of hysteroscopy in the diagnosis of uterine endometrial cancer]

To evaluate the clinical value of hysteroscopy in the management of endometrial cancer, findings in 3,681 patients with endometrial cancer treated between 1985 and 1989 at 167 hospitals in Japan were analyzed. In 1,040 of these patients, hysteroscopy was performed before operation. Pre-operative staging by fractional curettage with or without hysteroscopy was compared with post-operative histological diagnoses. The accuracy rates of diagnosis at final stages I and II were 91.4% and 79.4%, respectively, with hysteroscopy. There figures were not significantly different from those of 91.4% and 77.7% without hysteroscopy. The accuracy rate for diagnosis at the final stage I was 98.0% with the hystero-fiberscope and significantly higher than that with rigid hysteroscopy (86.0%). Tumor cells in the pelvic cavity were examined at the time of operation in 1,115 patients. Tumor cells were found in 8.5% of those in stage I, 18.8% of those in stage II, 64.7% of those in stage III and 75.0% of those in Stage IV by hysteroscopy. These values were not significantly different from those of 7.3%, 22.7%, 57.1% and 81.1%, respectively, observed without hysteroscopy. These findings indicate that hystero-fiberscopy might be valuable for the pre-operative diagnosis of endometrial cancer, but has no effect on cytological malignancy in the peritoneal cavity.

Localization of prostaglandin endoperoxide synthase in neurons and glia in monkey brain

The localization of prostaglandin endoperoxide synthase in monkey brain was investigated by the immunoperoxidase method using the monoclonal antibody (PES-7) raised against the enzyme purified from bovine seminal vesicle. The frozen sections with 30-microns thickness were employed after the brain was fixed with perfusion of 2% paraformaldehyde in phosphate-buffered saline. The immunoreactivity was most intense in the neurons of cerebral cortex and hippocampus, and was moderate in the neurons of caudate nucleus, putamen, globus pallidus and amygdala, while it was relatively weak in glial cells in the whole brain regions including the white matter. The majority of neurons showed the immunoreactivity in the somata and proximal dendrites, but exceptionally in the pyramidal cells of the hippocampus, positive staining was also observed in the apical dendrites. In the cerebellum, the immunoreactivity in both neurons and glia was rather faint as compared with that in other regions. Positive staining was not significantly observed in the vasculatures and arachnoid membranes. These findings indicate that most of neuronal and glial cells in monkey brain contain the enzyme of the rate-limiting and initial step of the biosynthesis of prostaglandins which regulate a variety of neural functions.

Establishment and characterization of a cell line (OMC-3) originating from a human mucinous cystadenocarcinoma of the ovary

A new human ovarian carcinoma cell line, designated OMC-3, was established from the mucinous cystadenocarcinoma of a 59-year-old woman. This cell line has grown well for 65 months and has been subcultured more than 50 times. Monolayer-cultured cells are polygonal in shape, showing a pavement-like arrangement and a tendency to pile up without contact inhibition. The chromosomal number shows aneuploidy and the modal chromosomal number is in the hypodiploid range. The cells were transplanted into the subcutis of nude mice and produced tumors resembling the original tumor. Ten thousand OMC-3 cells produced CA-125 (228-580 U) and CA-19-9 (2900-5640 U) during 17 days in culture media. CA-125 and CA-19-9 were demonstrated immunohistochemically in the original tumor, heterotransplanted tumor, and OMC-3 cells. The cells contain no estrogen or progesterone receptors. OMC-3 cells were sensitive to actinomycin D, 4-hydroperoxycyclophosphamide, and mitomycin C in vitro. Three other reports of ovarian mucinous carcinoma cell lines are reviewed.

[Evaluation of magnetic resonance imaging in the diagnosis of extension in uterine cervical cancer cases with special attention to imaging planes]

To prove the usefulness of Magnetic Resonance Imaging (MRI) in determining the invasion of uterine cervical cancer with imaging planes, we evaluated 44 patients with histologically proved cervical cancer. MRI was performed with a Signa 1.5 T (General Electric), and a T2-weighted image was used. In coronal planes, the accuracy was 75.0% for parametrial invasion. It was impossible to diagnose in 77.8%, 92.1% and 63.2% the invasion of the uterine body, bladder and rectum, respectively. In axial planes, the accuracy was 76.3%, 92.1% and 78.9% for the invasion of parametrium, bladder and rectum, respectively. It was impossible to diagnose in 72.2% the invasion of the uterine body. In sagittal planes, the accuracy was 80.6%, 97.4% and 89.7% for invasion of the uterine body, bladder and rectum, respectively. In all 39 cases it was impossible to diagnose parametrial invasion. In five cases, MRI failed to detect the tumor in any of the three planes, but in three cases it was able to detect the tumor in at least one of the three. We conclude as follows: 1) MRI is a useful method in determining the invasion of cervical cancer. 2) Coronal planes are recommended for the determination of parametrial invasion, axial planes for the parametrium, bladder and rectum, and sagittal planes for the uterine body, bladder and rectum. 3) All three planes are needed to determine cervical cancer.

Lymphatics, intraepithelial lymphocytes and endometrial lymphoid tissues in the rabbit uterus: an electron microscopic and immunohistological study

Rabbit uterine intraepithelial lymphocytes, endometrial lymphoid aggregates and lymphatic capillaries were examined electron-microscopically and immunohistochemically at well-defined intervals after the injection of human chorionic gonadotropin (hCG). Lymphatic capillaries originated near the bases of the glands in the uterine cervix and in the border zone between the lamina propria mucosae and myometrium in the uterine body. The lymphatic capillaries were maximally dilated, and their endothelial cells were thinnest 8 hours after hCG injection. Patent junctions between the adjacent endothelial cells of lymphatics in the uterine body were observed in good accordance with the appearance of stromal edema and lymphatic dilatation. The numbers of intraepithelial lymphocytes and macrophages changed cyclically after the induction of ovulation. They were highest 11 hours after hCG injection when lymphocytes were seen occasionally in the lumens of lymphatics located in the lamina propria mucosae of the uterine body. Most of the intraepithelial and interstitial lymphocytes were cells labeled with T cell serum but some were labeled with IgA serum and were occasionally seen beneath the epithelium. Lymphoid aggregates were uniformly present in the stratum basalis and consisted of lymphocytes and macrophages. They had no germinal centers, surrounding lymphatics or high endothelial venules (HEV). The results suggest that lymphatic capillaries are the main route for the removal of edema fluid and for migratory lymphoid cells in the rabbit uterus.

[Bone marrow suppression in gynecological patients with malignant tumor treated with combination chemotherapy cyclophosphamide, pirarubicin and cisplatin]

We treated 14 patients with cyclophosphamide, adriamycin and cisplatin (CAP), and 16 patients with cyclophosphamide, Pirarubicin and cisplatin (CTP). Hematological changes in the peripheral blood were compared in the two groups to determine whether there was any difference in bone marrow suppression. 1) The lowest leukocyte counts were similar in the two groups. The leukocyte count reached its nadir at 11.6 +/- 2.1 days in the CTP group and at 15.1 +/- 2.8 days in the CAP group, a significant difference (p less than 0.01). 2) The leukocyte count recovered rapidly in the CTP group and was significantly higher (p less than 0.01) at 3 to 4 weeks than in the CAP group, and it returned to the pretreatment level in the CTP group in the fourth week. 3) The platelet count reached its lowest level in the second week in both groups. In the CTP group, it was significantly higher (p less than 0.01) than in the CAP group. 4) Reticulocyte count reached its lowest level in the first week in both groups, and then started increasing. 5) In the CTP group, a course of treatment was 28.0 +/- 2.3 days and it was 29.5 +/- 2.3 days in the CAP group. In 28% of the CPA group, it took 30 days or more for the leukocyte count to return to normal after one course, while none of the CTP group did the leukocyte count remain low for 30 days. These results show that CTP causes more rapid bone marrow suppression (particularly leukocytopenia) than CAP, does but that a recovery is more rapid with CTP. These CTP may be a better form of treatment than CAP.

Scatchard analysis of EGF receptor and effects of EGF on growth and TA-4 production of newly established uterine cervical cancer cell line (OMC-1)

Effects of epidermal growth factor (EGF) on growth and tumor antigen-4 (TA-4) production of newly established uterine cervical cancer cell line (OMC-1) are reported. OMC -1 was established from a metastatic lesion of Virchow's lymph node of a large cell non-keratinizing squamous cell carcinoma of the uterine cervix and successively subcultured for about 4 years. Scatchard analysis of EGF binding to OMC-1 cells indicated a single class of binding sites with a dissociation constant (Kd) of 360 pM. The theoretical maximum number of binding sites was 2.4 x 10(4) sites/cell. The growth of OMC-1 cells was stimulated by EGF at 0.01-0.1 nM and inhibited at higher concentrations. The TA-4 production of OMC-1 cells was slightly stimulated by EGF at 0.01-1 nM and significantly stimulated at 10 nM. OMC-1 may serve as one of the available model systems for studies of regulation of proliferation and tumor marker production by EGF, particularly in cervical squamous cell carcinomas.

Establishment and characterization of CA 125 producing cell line (OMC-2) originating from a human endometrial adenocarcinoma

A new human endometrial carcinoma cell line, designated OMC-2, was established from the endometrial adenocarcinoma of a 59-year-old woman. This cell line has grown well for 51 months and has been subcultured more than 50 times. Monolayer cultured cells are polygonal in shape, showing a pavement-like arrangement and a piling up tendency without contact inhibition. The chromosomal number shows aneuploidy and the modal chromosomal number is in the diploid range. The cells were transplanted into the subcutis of nude mice and produced tumors resembling the original tumor. 1 X 10(5) OMC-2 cells produced CA 125 (184-682 U) during 19 days in culture media. CA 125 was demonstrated immunohistochemically in the original tumor, heterotransplanted tumor, and OMC-2 cells. The cells contain no estrogen or progesterone receptors. Twenty-nine other reports of endometrial carcinoma cell lines are reviewed.

Lymphatics and lymphoid tissue of the fallopian tube: immunoelectronmicroscopic study

Lymphoid tissue of the human fallopian tube consists of follicles, lymphoepithelium, and lymphatic and blood capillaries and is located consistently in the interstitial part of the human fallopian tube. Using an immunoelectronmicroscopic technique, we have elucidated the ultrastructure of the lymphoid tissue of the human fallopian tube and the fine distribution and ultrastructure of the lymphatics associated with the rabbit fallopian tube. Lymphatic capillaries arise in the lamina propria mucosa and the periphery of follicles, where they are sparsely distributed, run through the muscular layer, and form a dense network in the subserosa. Characteristic features of the ultrastructure are aggregations of smooth muscle cells, alternating areas of densely and sparsely distributed collagen fibers, and unmyelinated nerve fibers beneath the lymphatic endothelium. Immunoelectronmicroscopic analysis has demonstrated an obvious difference in the distribution of T- and B-lymphocytes in the lymphoid tissue of the human fallopian tube. Many T-lymphocytes are present in the follicles and epithelium, but B-lymphocytes are either absent or rarely found. T-lymphocytes sometimes infiltrate into the basal lamina of the epithelium lying in close contact with the follicles. We conclude that the lymphoid tissue is constantly located in the interstitial part of the human fallopian tube and that intraepithelial lymphocytes, mainly T-lymphocytes, migrate via the basal lamina of the epithelium from follicles. Lymphatic capillaries in the fallopian tube may be the main migratory route of intraepithelial lymphocytes. The intraepithelial lymphocytes and epithelial cells of the fallopian tube have attracted considerable interest as a result of immunological studies of the recognition of spermatozoal antigens and the fertilized ovum.(ABSTRACT TRUNCATED AT 250 WORDS)

[In vitro studies of 5-FU sensitivity on uterine cervical cancer cell lines--comparison between squamous cell carcinoma and adenocarcinoma]

In order to improve the postoperative survival rate of patients with cervical cancer, we have treated them with adjuvant chemotherapy (oral Tegafur) and proved this treatment to be useful. However, the prognosis of cervical adenocarcinoma cases has not been improved yet. In this study, 5-FU sensitivity, morphological changes and DNA metabolism of cultured cervical cancer cells were examined using OMC-1 and OMC-4 cell line originating from cervical squamous cell carcinoma and adenocarcinoma, respectively. The EC 50 (Effective Concentration for 50% Cell Kill) of 5-FU on OMC-1 and OMC-4 cells after 96 hours of incubation with 5-FU was 0.13 micrograms/ml and 9.1 micrograms/ml, respectively. The morphological changes were more prominent in OMC-1 cells than in OMC-4 cells after 192 hours of incubation with 0.1 micrograms/ml of 5-FU. The incorporation of 3H-deoxyuridine into the DNA was inhibited more significantly in OMC-1 cells than in OMC-4 cells even at a low concentration of 5-FU. The intracellular FdUMP and thymidylate synthetase (TS) inhibition rate of OMC-1 and OMC-4 after 96 hours of incubation with 0.1 microgram/ml of 5-FU was 4.7 pmol/g and less than 2.6 pmol/g, 58.7% and 60.0%, respectively. These results suggest that 5-FU sensitivity of cervical adenocarcinoma cell line (OMC-4) is lower than that of cervical squamous carcinoma cell line (OMC-1) and it may owe much not to the TS inhibition rate but to the intracellular FdUMP.

Two patients with hypergonadotropic ovarian failure due to pituitary hyperplasia

Two patients with hypergonadotropic ovarian failure were examined. Plasma levels of LH and FSH were markedly elevated to over 113 mIU/mL (Second International Reference Preparation--human menopausal gonadotropin standard), but the FSH/LH ratio was 1 or less in both women. The plasma estradiol (E2) level was 65 pg/mL in one woman before medication, and in the other increased from below 25 to 130 pg/mL after large doses of clomiphene citrate treatment. The pituitary tissues removed by transsphenoidal surgery showed hyperplasia with numerous cells immuno-histochemically positive for LH and FSH. After surgery, the elevated plasma gonadotropins decreased and plasma E2 levels increased. Human menopausal gonadotropin after clomiphene citrate treatment induced ovulation in one patient, and cyclic administration of estrogen and progesterone induced ovulation in the other. These results suggest that elevated gonadotropins may suppress ovarian function in some cases.

[Effect of medroxyprogesterone acetate on side effects of CAP therapy in gynecological malignant tumors]

We concomitantly administered a large dose of medroxyprogesterone acetate (MPA) to gynecological malignant tumor patients undergoing CAP therapy (CAP). Hematological changes in the peripheral blood were compared between concomitant MPA patients and those not receiving MPA to examine the effect of MPA in reducing the marrow depression which is the major side effect of CAP. 1) Leukocyte count reached minimum at the second week of CAP in both groups. There was no significant difference in the count between the two groups. At the third week of CAP, the count improved to 84% of the pre-CAP level in patients receiving MPA and to 68% in those not receiving MPA, a significant difference (p less than 0.01). At the fourth week, leukocyte counts were 105% and 96% of pre-CAP levels, respectively. There was no difference between the two groups, but the leukocyte count returned to the pre-CAP level in the patients receiving MPA. 2) Platelet count showed changes similar to those in the leukocyte count. In patients receiving MPA, the count improved more rapidly within three weeks (118%, p less than 0.01), and was significantly higher at the fourth week (107%, p less than 0.05) than in patients not receiving MPA. 3) Reticulocyte count reached minimum in the first week, thereafter improving rapidly in both groups. No differences were noted between the two groups. 4) The periods needed for one course of CAP were 27.7 +/- 3.3 days in the patients receiving MPA and 29.5 +/- 3.7 days in the patients not receiving MPA, making for a significant difference between the two groups (p less than 0.05). These results show that MPA accelerates recovery from marrow depression caused by CAP. It is anticipated, therefore, that MPA will be helpful in the application of various chemotherapies which are expected to be frequently conducted in the future.