[Posterior sub-Tenon's injections of repository corticosteroids in uveitis patients with cystoid macular edema]

Repository corticosteroid was injected into the posterior sub-Tenon's space in 29 cases (39 eyes) of cystoid macular edema (CME) secondary to uveitis. They included 12 cases of Behçet's disease, 7 cases of Sarcoidosis, one case of tuberculous uveitis and 9 cases of etiology unknown uveitis. In some of the patients injections were repeated twice to seven times at intervals of more than 2 weeks. Twenty two of the 39 treated eyes (56.4%) showed visual improvement in at least two lines of visual acuity. Eleven eyes showed no improvement in vision. Most of them had already had bad visual acuity (0.2 or less) before the injections. Complications of the treatment included cataract in 6 eyes, glaucoma in one, and blepharoptosis in one. Injection of repository corticosteroids into the posterior sub-Tenon's space was effective in the treatment of CME secondary to uveitis. However, we have to beware of the complications of this treatment.

Percutaneous injection sclerotherapy with minocycline hydrochloride for simple renal cysts

Minocycline hydrochloride as a sclerosant for the treatment of simple renal cysts was evaluated. Cyst puncture was performed, and minocycline hydrochloride solution for intravenous administration was injected after aspiration. Of 154 cysts evaluated by ultrasound after 3 months or more, 69 were no longer demonstrable, 49 showed 50% or greater reduction in the maximum cyst diameter, and only 8 were unchanged or slightly increased in size. In contrast, only 1 of 20 cysts aspirated without minocycline hydrochloride injection (controls) showed 50% or greater reduction after 3 months. There was a significant difference in the reduction rates between the minocycline-treated group and control group (p < 0.01). These results suggest that minocycline hydrochloride is an effective sclerosant to treat simple renal cysts.

Detection of antibodies against Borrelia burgdorferi in patients with uveitis

We determined the antibody response against Borrelia burgdorferi strains isolated from Japanese Ixodes ovatus and Ixodes persulcatus ticks by enzyme-linked immunosorbent assay and indirect immunofluorescence assay of serum specimens from 127 patients with uveitis. We examined samples of serum from Japanese patients with unclassified uveitis, iridocyclitis caused by herpes zoster virus, Behçet's disease, Vogt-Koyanagi-Harada syndrome, sarcoidosis, or other conditions (sympathetic ophthalmia, Posner-Schlossman syndrome and acute anterior uveitis with ankylosing spondylitis). Serum from healthy individuals and patients with Lyme disease served as negative and positive control samples, respectively. Significantly higher antibody titers were demonstrated in patients with uveitis than in control subjects. Of 29 patients with unclassified uveitis, nine (31) had significantly increased antibody titers against B. burgdorferi strain H014 by ELISA testing. Five patients also showed higher IgG and IgM responses than in three control subjects with Lyme disease. All positive controls showed joint problems characteristic of rheumatoid arthritis. One of three patients had uveitis. The patients were diagnosed as having Lyme disease on the basis of their history and serologic tests. A positive antibody response was recognized in several patients with Behçet's disease, Vogt-Koyanagi-Harada syndrome, sarcoidosis, and other conditions (acute anterior uveitis with ankylosing spondylitis), but not in control subjects.

[Mediastinal hematoma due to thymoma hemorrhage--a case report]

A 70-year-old man came to our hospital complaining mainly of acute dyspnea. A chest X-ray, echocardiogram, and chest CT showed a mediastinal mass, and pericardial and pleural effusions. A thoracotomy revealed a cystic tumor along the thymus. The tumor contained bloody fluid, coagula, and fibrin calculi. Rapid specimens showed no tumor cells and the hematoma was assumed to have been caused by the thymus. Therefore, a thymectomy was performed and as much of the hematoma as possible was removed. After the operation, a careful pathological examination revealed a thymoma with a diameter of about 7 mm. In addition, coagula and fibrin calculi contained some tissue from the thymoma, and the diagnosis was made that a mediastinal hematoma had formed due to hemorrhage from the thymoma. Several cases of mediastinal tumor of cyst hemorrhages in the thorax have been reported. However, only a few cases of thymomal hemorrhages in the thorax have been reported; one case each of mediastinal hematoma, hemothorax, and cardiac tamponade. Great care is necessary when dealing with atraumatic mediastinal hematomas if malignant tumors such as thymoma are present.

[A case of malignant mesothelioma of the pleura]

An operative case of malignant localized mesothelioma of the pleura, a 63-year-old male, came to our clinic with the chief complaint of hemosputa. On suspicion of lung tumor, right upper lobectomy and lymph node cleaning were performed. The tumor was embedded in the lung; there was no infiltration into the chest wall. After the operation, radiotherapy was added but tumor recurrence occurred in the 5th month, and the patient died 7 months after surgery. From the form of the recurrence it was considered a diffuse-type transition case. The prognosis of this disease is known to be poor, but since there have also been cases of long survival, cases of resection are studied in Japan. Based on macroscopic tumor findings, cases of occurrence in the visceral pleura have poor prognosis if embedded in the lung, while cases of occurrence in the parietal pleura have varied prognoses, but the differentiation line is yet unclear. Among six cases of diffuse-type transition, including this case, five cases were of the histological type which included the epithelial component. Further study of these cases is necessary in the near future.

In vitro fertilization and development of in vitro matured bovine follicular oocytes

Bovine follicular oocytes matured in vitro were fertilized in vitro using epididymal spermatozoa from five different bulls and then cultured to the blastocyst stage in vitro. The fertilization rate, based on one pair of pronuclei and presence of one sperm tail, ranged from 55.2 to 64.3%. Embryo development (cleavage to blastocyst stage) ranged from 21.4 to 31.0% of the cultured ova reaching 8 cells at 3 to 4 d after insemination to 1.3 to 3.7% reaching hatched blastocysts at 9 to 10 d. It is concluded that individual variation among bulls is not a significant factor in fertilization and development rates of bovine follicular oocytes when epididymal spermatozoa are used.

Pregnancies after co-culture of cumulus cells with bovine embryos derived from in-vitro fertilization of in-vitro matured follicular oocytes

Bovine follicular oocytes surrounded by cumulus cells for more than one-third of their surface were matured, fertilized and developed in vitro utilizing a co-culture system with bovine cumulus cells. Embryos developed into blastocysts were non-surgically transferred to the uteri of cows at Day 6, 7 or 8 (Day 0 = oestrus). Out of 6 recipient cows (19 blastocysts transferred), 3 became pregnant. One of the 3 pregnant cows carried twins. The results of this study demonstrated the viability of embryos obtained from in-vitro maturation of bovine oocytes followed by in-vitro fertilization and culture to the blastocyst stage in vitro.

A case of penile tumor: combination of leiomyosarcoma and squamous cell carcinoma

Leiomyosarcoma of the penis is a very rare malignant tumor. We describe a patient with a combination of leiomyosarcoma and squamous cell carcinoma, apparently the first case in the world, and review previous cases of leiomyosarcoma.

Carcinosarcoma of the bladder diverticulum: a case report and review of literature

A 56-year-old man with carcinosarcoma of the bladder diverticulum is reported. Histologically, the tumor contained two elements: carcinomatous and sarcomatous components with a transitional phase between them. The related literature is also reviewed.

[A new treatment of simple renal cyst: percutaneous instillation of minocycline hydrochloride into simple renal cyst]

Minocycline hydrochloride was percutaneously instilled into simple renal cysts to prevent recurrence of renal cysts after the puncture and aspiration of cystic fluid. Fifty-six simple renal cysts in 51 patients were punctured with an 18-gauge needle under ultrasonographic guidance, and the cystic fluid was aspirated under fluoroscopic control. A single 100 mg or 200 mg dose of minocycline hydrochloride dissolved in 5 ml of distilled water was instilled through the needle into the renal cyst. The patients were followed up by computed tomographic (CT) scan and ultrasonography 1, 3, 6 and 12 months after the treatment. Efficacy was evaluated after 3 months or longer. Of 20 renal cysts instilled with 100 mg of minocycline, efficacy was excellent in 10, good in 6 and poor in 4. Of 22 renal cysts instilled with 200 mg of minocycline, efficacy was excellent in 10, good in 9 and poor in 3. No significant difference was noted between the efficacy rate of 100 mg and 200 mg treatments. Complications attributable to treatment were observed in 15 patients: moderate pain in one, slight pain in 6, slight fever in 8 and slight hematuria in one. Neither severe adverse reactions nor infections were observed in any of the patients. These results suggest that the percutaneous instillation of minocycline into simple renal cysts is a new, simple, safe and effective treatment to prevent recurrence of the cyst and additionally to prevent infection following the puncture.

[Clinical effect of UFT on prostatic cancer]

A phase II study of UFT, a mixture of futraful and uracil in a rate of 1:4, was performed for prostatic cancer in 5 cooperative institutions. UFT was orally administered at a daily dose of 600 mg (t.i.d.) for 4 weeks. Twenty-two patients treated with UFT were evaluated according to Koyama-Saito's criteria. Tumor staging determined by transrectal ultrasonography and other methods revealed stage B in 4 patients, stage C in 7, and stage D in 11. The overall response rate was 18.2%. Complete response was obtained in 1 patient with stage B disease, partial response in 3, minor response in 1, no change in 15, and progressive disease in 2. With respect to toxicity, anorexia was observed in 9 patients, nausea and vomiting in 8, stomatitis in 4, and diarrhea in 3. White blood cell count was less than 3,000 cells per mm3 in 1 patient, and in another case, hepatic function disorder was observed. From the results obtained, the use of UFT is TS considered desirable for prostatic cancer.

A case of insulin resistance associated with acanthosis nigricans

We described here a 12-year-old male patient with the syndrome of insulin resistance and acanthosis nigricans type A. Insulin levels at fasting state and after glucose loading were 149 +/- 63 microU/ml (mean +/- S.D.) and over 1,000 microU/ml respectively, while the fasting level of blood glucose was 77.7 +/- 8.9 mg/ml (mean +/- S.D.). A marked resistance to exogenous insulin was observed. Circulating levels of insulin antagonists such as growth hormone, cortisol and glucagon were within the normal range. Proinsulin was less than 5% of the radioimmunoassayable insulin. No insulin antibody or antireceptor antibody was detected. Insulin binding to mononuclear cells was decreased to about 50% of the controls. Analysis of membrane receptors demonstrated the normal average affinity, dissociation kinetics and negative cooperativity with a decreased number of receptors. After two days fasting, plasma IRI levels decreased to 27 microU/ml, while insulin binding kinetics were not affected; which suggests that the receptor decrease was not secondary to hyperinsulinemia. These findings indicate that the decreased number of receptors was one of the causes for insulin resistance in this patient.

Purification and characterization of a lectin from the beetle, Allomyrina dichotoma

A lectin was purified from the hemolymph of Allomyrina dichotoma larvae by affinity chromatography on acid-treated Sepharose 4B. The purified lectin showed two protein bands on polyacrylamide gel electrophoresis. These two lectin bands (allo A-I and -II) were separated by DEAE-Cellulofine column chromatography. By gel filtration on Sephadex G-100, the molecular weights of allo A-I and -II were estimated to be 65,000 and 66,500, respectively. On the other hand, by SDS-polyacrylamide gel electrophoresis after cross-linking of subunits with glutaraldehyde, they are estimated to be 38,000 and 39,000, respectively. On SDS-polyacrylamide gel electrophoresis, it was proved that both allo A-I and -II lectin consisted of two subunits, respectively. The molecular weights were 17,500 and 20,000 for allo A-I, and 19,000 and 20,000 for allo A-II. The isoelectric points of allo A-I and -II were estimated to be 6.4 and 5.9, respectively. On double immunodiffusion, allo A-I and -II gave single precipitin lines, which fused completely with each other, against the antibody to crude allo A. The hemagglutinating activity of allo A-I and -II was inhibited only by beta-linked D-galactose such as lactose and lactulose.

[Transfer of piperacillin into the body water and gallbladder tissue in cholestasis]

Acute inflammation becomes severe and the risk of perforation of the gallbladder increases every time gall stone colic occurs in patients with cholelithiasis. In the surgical treatment for these patients, interval operation is said to be preferable to emergency operation in the acute stage. Furthermore, the flow of bile into gallbladder is blocked by incarceration of stones at the neck of the gallbladder and other causes in the acute stage. In this case, therefore, how an antibacterial agent in blood moves to the gallbladder wall is important in suppressing infections of the gallbladder wall. We divided 15 patients with cholelithiasis into cases positive for cholecystogram and negative cases and made a comparative study of piperacillin (PIPC) levels after intravenous drip infusion. PIPC level in bile in the gallbladder was very low in the cases negative for cholecystogram compared with the positive cases. However, no definite difference in levels of the gallbladder tissue was observed between positive for cholecystogram and negative cases. Accordingly, it is concluded that administration of PIPC is not ineffective even in severe cholecystitis in which transference of an antibacterial agent from bile can hardly be expected.

[The distribution of cefotiam in body fluid]

All subjects were patients with malignant tumors on the gastroenterological system and in whose cases there were marked ascites (Table 1). In the study, each patient was subjected to the intravenous drip infusion of CTM 1 g for a period of 1 hour. Samples of peripheral venous blood and ascites were taken 4 times, at 1 hour after completion of infusion, and at 2, 3 and 4 hours. The test samples were kept at -80 degrees C until the CTM contents were determined (Fig. 1). Determination results 1. Blood concentrations of CTM decreased with the passage of time (Fig. 2). 2. There was hardly any difference in the concentration of CTM in ascites between the 1 hour and 4 hour samples. Furthermore, the concentration was maintained which exceeded the MIC against intestinal flora, including Escherichia coli, without Pseudomonas and Bacteroides (Fig. 3, Table 2). 3. The higher serum creatinine levels were the greater the concentration of CTM in blood (Fig. 5). 4. The maximum blood and ascites concentration of CTM indicated a correlation coefficient of 0.809, P less than 0.01 (Fig. 6). These results led to the following conclusions: 1. If 1 hour intravenous drip infusion of CTM 1 g/100 ml is to be carried out against postoperative peritoneal infection, such administration at interval less than 5-hours would not be reasonable. 2. The peritoneal invasion of malignant tumor is not a factor in the inhibition of CTM transition from blood to ascites.

[Insulin resistance with acanthosis nigricans: a case report]

We described a 12 7/12-year-old boy presenting the syndrome of insulin resistance and acanthosis nigricans Type A. Insulin levels at fasting state and after glucose loading were 149 +/- 63 microunits/ml (mean +/- SD) and over 1000 microunits/ml, respectively, while fasting levels of blood glucose were 77.7 +/- 8.9 mg/dl (mean +/- SD). A marked resistance to exogenous insulin was observed. Circulating levels of insulin antagonists such as growth hormone, cortisol and glucagon, were within the normal range. Proinsulin was less than 5% of the total radioimmunoassayable insulin. Insulin antibody and anti-receptor antibody were not detected. Insulin binding to mononuclear cells were decreased to about 50% of controls. Analysis of membrane receptors demonstrated the normal average affinity, dissociation kinetics and negative cooperativity with a decreased number of receptors. After two days fasting, plasma IRI levels decreased to 27 microunits/ml, however insulin binding kinetics were not affected. This might suggesting that the receptor decrease was not secondary to hyperinsulinemia. These findings indicate that a decreased number of receptors was one of the causes for insulin resistance in the patient.

Relationship between monensin and sulphur amino acid requirements in broiler chickens

1. Diets containing 80, 100, 125, 150, 175 or 200 mg monensin/kg were fed to broiler chickens from 0 to 28 d in cages that prevented access to excreta. 2. Growth was depressed with 125 mg monensin or more/kg and food intake tended to decrease. Feathering was adversely affected with 175 mg or more/kg. 3. In a similar experiment, diets containing 8.8, 9.1, 9.4, 9.7 and 10.1 g total sulphur amino acids (SAA)/kg were supplemented with 125 or 80 mg monensin/kg and compared with a diet containing 8.8 g SAA and 33 mg robenidie/kg. 4. With 125 mg monensin/kg, body-weight gain was significantly less than that of birds receiving robenidine if dietary SAA content was 9.4 g or less/kg. With 9.7 g SAA or more/kg, gain in birds receiving monensin was similar to that of birds receiving robenidine. 5. Monensin at 125 mg/kg therefore appears to increase SAA requirement.

Effects of oral administration of D-penicillamine on T- and B-lymphocytes in peripheral blood of rheumatoid patients

The effects of D-penicillamine on T-lymphocytes (rosette forming cells) and B-lymphocytes (surface IgG- and surface IgM-bearing cells) in peripheral blood of 13 patients with classical or definite rheumatoid arthritis were investigated at 4 weeks, 12 weeks and 24 weeks of treatment. At the same time, the determination of the concentrations of serum immunoglobulins and RA tests were carried out, and the rheumatoid activity index was calculated. The administration of D-pencillamine caused a gradual increase in the percentage of T-lymphocytes and a concomitant decrease in the percentage of B-lymphocytes with time. It was found that the tendency toward reduction of the percentage of surface IgM-bearing lymphocytes was more remarkable and accelerated than that of surface IgG-bearing lymphocytes. A decrease in the concentrations of serum IgM and IgG was observed in association with these findings. The agglutination in RA-test became significantly weaker in about half of the cases. Also the rheumatoid activity index became gradually smaller after treatment. The marked decrease in the percentage of B-lymphocytes and in the concentration of serum immunoglobulins may be related to the inhibition of the production of abnormal immunoglobulins.

Studies on anti-B specificity and heterogeneity of some invertebrate hemagglutinins

Hemolymph from Charybdis japonica and Lymantria dispar, and saline extract from Eunice kobiensis agglutinated human group B erythrocytes specifically. Multiple agglutinins were identified, and independent agglutinins were separated from hemolymph of Charybdis japonica (anti-Bcj+anti-Xcj) and Lymantria dispar (anti-BLD+RLD) by absorption experiments. By the agglutination and agglutination-inhibition experiments with simple sugars, the specificities of the anti-B agglutinins in these invertebrates were found to differ from each other.

Detection of antibody to a new antigen induced by Epstein-Barr virus in rheumatoid arthritis

A new antigen which is different from Epstein-Barr virion antigen was detected in NC-37 cells infected with Epstein-Barr virus (EBV). A significant elevation of the titer of antibody to this new antigen was observed in the sera of the patients with rheumatoid arthritis (RA), but not in the sera of controls. From the standpoint of the etiologic role of EBV in RA, it is interesting that the antibody to the new antigen is not detected in the healthy persons in contrast to other viral antibodies. Therefore, it differs from any other viral antibodies so far reported.

Effects of IRA in vitro on T- and B-lymphocytes from peripheral blood of patients with connective tissue diseases

The effect of immunoregulatory alpha-globulin (IRA) in vitro on T-lymphocytes (rosette forming cells) and B-lymphocytes (surface IgG and IgM) in peripheral blood of healthy subjects and the patients with connective tissue diseases were investigated. Marked inhibitory effects of IRA were observed on T-lymphocytes and surface IgG-bearing lymphocytes from healthy subjects. The effect of IRA was almost in parallel with the amount of IRA and with the length of incubation period at 37 degrees C. The inhibitory effects of IRA were more remarkable on surface IgM-bearing lymphocytes from the patients with rheumatoid arthritis (RA) and those with systemic lupus erythematosus (SLE) than on those from healthy subjects. On the other hand, the effects of IRA were more remarkable on surface IgG-bearing lymphocytes from the cases of SLE than on those from healthy subjects.

Subpopulations of B- and T-Lymphocytes in Peripheral Blood of Rheumatoid Patients

Using the immunofluorescent staining for detection of surface membrane immunoglobulin and the spontaneous rosette formation with sheep erythrocytes, B- and T-lymphocytes were identified in lymphocyte populations obtained from the peripheral blood of 36 patients with classical or definite rheumatoid arthritis and 13 normal adults. In all of three immunoglobulin subclasses, the mean percentage of B-lymphocytes in the peripheral blood of the patients was significantly higher than that of the normal subjects. On the other hand, the mean percentage of blood T-lymphocytes in the patients was remarkably low as compared with that of the normal controls.

beta2-glycoprotein I in rheumatoid arthritis

Serum beta2-glycoprotein I of the patients with rheumatoid arthritis was studied by means of single radial immunodiffusion method. There was a significant lowering of beta2-glycoprotein I concentration in patients with rheumatoid arthritis. An inverse proportional correlation was seen between the concentrations of beta2-glycoprotein I and of alpha1-antitrypsin, and between the former and C-reactive protein (CRP) rates in individual specimens. Slightly positive relationship was observed between the concentrations of beta2-glycoprotein I and of alpha2-HS glycoprotein. The beta2-glycoprotein I concentrations in healthy adults were significantly higher than those of previous reports.

Change of serum IgE concentration in asthmatic attack

Thirty-two patients with clinical diagnosis of bronchial asthma were evaluated. Serum IgE levels, measured by the Phadebas IgE test, were clearly increased in the patients with asthmatic attack compared with those without asthmatic attack. When the patients were grouped according to the clinical grading of severity of asthmatic attack, the levels showed the significant elevation in proportion to the intensity of asthmatic attack and were higher in the group of severe attack or moderately severe attack than in the group of mild attack. When the serial determination of serum IgE concentration was performed during the clinical course of the patients, a high correlation was observed between the levels and the intensity of asthmatic attack.

Alpha1-antichymotrypsin in rheumatoid arthritis

Serum alpha1-antichymotrypsin (alpha1-ACT) of the patient with rheumatoid arthritis was studied by means of single radial immunodiffusion method. There was a significant elevation of the alpha1-ACT concentration in the patients with rheumatoid arthritis, and positive relationships were observed between the concentrations of alpha1-ACT and of other glycoproteins such as alpha1-acid glycoprotein and alpha1-antitrypsin in individual patients, and between C-reactive protein (CRP) rates and the (CRP) rates and the alpha1-ACT concentrations in individual specimens. These facts suggest that alpha1-ACT belongs to a group of acute phase proteins like alpha1-antitrypsin or CRP. An inverse proportional correlation was revealed between alpha1-ACT and fibrinolytic activity. No influences were observed on the alpha1-ACT concentration, activity index or articular index by the oral administration of alpha-chymotrypsin in patients with rheumatoid arthritis.

Ultrasonic evaluation of anatomical abnormalities of heart in congenital and acquired heart diseases

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