Experimental validation of Monte Carlo and finite-element methods for the estimation of the optical path length in inhomogeneous tissue

To validate models of light propagation in biological tissue, experiments to measure the mean time of flight have been carried out on several solid cylindrical layered phantoms. The optical properties of the inner cylinders of the phantoms were close to those of adult brain white matter, whereas a range of scattering or absorption coefficients was chosen for the outer layer. Experimental results for the mean optical path length have been compared with the predictions of both an exact Monte Carlo (MC) model and a diffusion equation, with two differing boundary conditions implemented in a finite-element method (PEM). The MC and experimental results are in good agreement despite poor statistics for large fiber spacings, whereas good agreement with the FEM prediction requires a careful choice of proper boundary conditions.

Endoscopic extraction of lipomas using an ultrasonic suction scalpel

Lipomas were extracted with an ultrasonic suction scalpel, assisted by an endoscope, with good results. The combined surgical technique is described in this paper. Preoperative clinical findings and diagnostic imaging of the patients provided a preoperative diagnosis of lipomas. For the procedure, the endoscope was inserted through a small incision immediately above the tumor. The tumor was endoscopically confirmed and then extracted with an ultrasonic scalpel. Complete lipoma extraction was achieved in all patients without recurrence. The patients had good cosmetic results with only minimal postoperative scarring. The endoscopic extraction of lipomas with an ultrasonic scalpel is proven to be highly useful, especially for large tumors, and permits a less invasive and more reliable surgical operation.

The effect of overlying tissue on the spatial sensitivity profile of near-infrared spectroscopy

The exact volume of brain tissue interrogated in near-infrared spectroscopy (NIRS) studies of cerebral oxygenation in unknown, the inhomogeneity of the head and resulting variation in optical paths making determination of the interrogated volume difficult. In this study, the spatial sensitivity profiles in simple two-component inhomogeneous cylindrical models are predicted by Monte Carlo simulation in order to reveal the effects of the overlying tissue on the volume of tissue interrogated by NIRS. The predictions are validated by experimental measurements on solid "tissue equivalent' cylindrical phantoms. The phantom diameter is 30 mm and the thickness of the outer layer is 2 mm. The optical properties of the inner cylinder match those of adult brain white matter (mu' s1 = 6.4 mm-1 and mu' a1 = 0.02 mm-1), but those of the outer layer are changed (mu' s0 from 1.7 to 8.3 mm-1 and mu' a0 from 0.002 to 0.1 mm-1). Results show that the spatial sensitivity profile is largely confined to the outer layer at small optode spacing (< 15 degrees) and to the inner layer at large spacing (> 120 degrees). At intermediate angles, the sensitivity profiles are sensitive to the optical properties of the outer layer. A low mu' s0 or mu' a0 moves the profile toward the surface, at high mu' a0 it moves in towards the inner layer and at high mu' a0 it is similar to the homogeneous case.

Buttock deformity repair for congenital generalized lipodystrophy

A 3-year-old girl suffering from congenital generalized lipodystrophy is presented. Almost all features of CGL described by Seip were found in our patient. The deformity of the patient's buttocks was repaired using bilateral gluteus maximus muscle flap advancement, with good result.

The biphasic changes in splenic natural killer cell activity following ventromedial hypothalamic lesions in rats

The cytotoxic activity of natural killer (NK) cells in the spleen was measured by a standard 4-h chromium release assay following electrical lesioning of the ventromedial hypothalamic nucleus (VMH) in rats. The splenic NK cell activity of VMH lesioned rats was found to be significantly suppressed at effector:target cell ratios of 100:1 and 50:1 compared with that of sham lesioned rats on day 4 after the lesion. On the other hand, on day 49, the VMH lesioned animals that had become hyperphagic and obese showed an enhancement of splenic NK cell activity compared with sham lesioned animals. The mechanisms of the biphasic change in NK cell activity following the VMH lesions are discussed.

Selective intrathecal phenol block to improve activities of daily living in patients with spastic quadriplegia. A preliminary report

To eliminate severe leg spasms of 15 quadriplegics, 0.3 ml 10% phenol-glycerin was injected into the subarachnoid space at the T12/L1 interspace. The effectiveness for leg spasm was evaluated by the Penn spasticity and Ashworth rigidity scales. Three patients remained completely flaccid; however three had slight, six had moderate and three had complete recurrence of spasms in a follow up period of observation for 1 to 22 (average 13) months. The result of selective intrathecal phenol block was significantly valuable, improving the activities of daily living (ADL) of quadriplegic patients. There were no systemic side effects nor disturbance of bladder, bowel or sexual functions.

Mucoid degeneration of the atrioventricular valve caused by cardiac lymphostasis: An experimental study in dogs

We performed an experiment to examine the influence of cardiac lymph congestion on the cardiac valves in dogs. A total of 6 mongrel dogs underwent surgery to induce cardiac lymph congestion, and 6 other animals underwent sham operation. Two weeks after operation, the atrioventricular valves of the experimental animals were intensively stained by Alcian blue. The optical densities of the tricuspid valves measured by a microscopic photometer were 0.069 ± 0.033 in the proximal portion, 0.134 ± 0.030 in the middle portion, and 0.117 ± 0.023 in the peripheral portion. All corresponding values obtained from the sham-operated animals showed lower values of 0.048 ± 0.012, 0.046 ± 0.014 (p < 0.05), and 0.060 ± 0.028 (p < 0.01), respectively. Electron microscopic observation revealed dilatation of the lymphatic vessels in the experimental valves. The results suggest that cardiac lymph congestion causes accumulation of mucopolysaccharides in the valve.

[Factors related to postoperative hydronephrosis following ureteroneocystostomy in neurogenic bladders]

A total of 68 ureteroneocystostomies performed between 1980 and 1992 in 63 patients with vesicoureteral reflux (UVR) secondary to neurogenic bladder were reviewed to elucidate factors of postoperative hydronephrosis. Urogram, cystogram, and urodynamics were analyzed, and the cases were classified into two types (areflexia, hyperreflexia) of detrusor muscle response. Occurrence or progression of hydronephrosis was demonstrated in 26 operations (complicated group). Compared with the rest (uncomplicated group), significant difference was not observed concerning proportions of vesical deformity, VUR grades, preoperative hydronephrosis, cystometric types and operative factors. In cases of hyperreflexia maximum vesical volume, maximum vesical pressure or maximum urethral pressure was not different between both groups. However, in those of areflexia maximum vesical volume of the complicated group was significantly smaller than that of the uncomplicated group (290 +/- 35 ml vs. 370 +/- 35 ml, P = 0.03), and the proportion of bladders with compliance less than 10 ml/cmH2O was significantly higher in the complicated group than in the uncomplicated group (P = 0.05) though maximum vesical pressure or maximum urethral pressure was not different. In areflex bladder deformity was observed more in the complicated group than in the uncomplicated group (P = 0.06). Relative inactiveness of detrusor muscle in areflex bladder might render such preoperative findings as vesical deformity, contracted bladder and low compliance more prognosticative of postoperative hydronephrosis than in hyperreflex bladder. During the follow up (6 to 132, mean 42 months) no case showed progression of hydronephrosis or renal deterioration, nor did any case require revisional surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Asbestos fiber analysis in seven asbestosis cases

Asbestos bodies and fibers deposited in the lungs of seven asbestosis cases were counted after tissue digestion. The types and sizes of 100 asbestos fibers for each case were also analyzed. Asbestos bodies were counted with an optical microscope at 100x magnification, and asbestos fibers were counted with a transmission electron microscope (TEM) at 2000x magnification. Most asbestos fibers detected with TEM were longer than 3 microns (92.5%) and thicker than 0.1 microns (92.3%). Short fibers less than 2 microns--both chrysotile and amphiboles, as well as long, thin fibers less than 0.06 microns--would be missed at 2000x (TEM). An average of 1.37 (0.081-5.5) x 10(6) asbestos bodies and 164.8 (0.55-610) x 10(6) asbestos fibers per 5 g wet (0.88 g dry) lung tissue were found, and these values are higher than what was reported in mesothelioma cases without asbestosis that were reported previously. More than 13 (average = 266.2) asbestos bodies were found in a 4-micron-thick tissue section (average area = 3.24 cm2). One asbestos body in a section equaled approximately 5,000 per 5 g wet lung tissue. The intensity of fibrosis was minimal in one case, mild in four, moderate and severe in one each, and the intensity was correlated with the number of asbestos bodies and fibers. The fibrosis in the severe case may have been intensified by repeated infection. Crocidolite fibers were found most frequently (84.7%), were thin, and had a high aspect ratio by our counting rules. Crocidolite with a high aspect ratio may be most fibrogenic in the lung.

Microscopic laser Doppler velocimeter measuring blood velocity in single microvessel

A microscopic laser Doppler velocimeter to measure blood velocity in single microvessels was developed. In order to measure the blood velocity in microvessels correctly, the influence of stray scattered light from vessel wall should be removed. Because it provokes low-frequency spurious components. The spectra of the spurious components overlap with that of Doppler signal and induces considerable error in the result of the blood velocity when the velocity is reduced. The optical configuration of the velocimeter was optimized to eliminate the influence of the stray scattered light. The blood velocity in microvessels in rat mesentery was measured with the microscopic laser Doppler velocimeter and the periodical fluctuation of the velocity was analyzed. Pulsatile velocity fluctuation could be observed even in capillary.

A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage: report of three autopsied cases and review of the literature

Three autopsied cases of dissecting aneurysms with spontaneous subarachnoid hemorrhage of the intracranial posterior circulation are reported, and the literature is reviewed to investigate the pathological characteristics and pathogenesis of this lesion. The location and pathological features of the aneurysms were different in each of the cases presented. Subadventitial hemorrhage associated with the subarachnoid hemorrhage, multiple noncontiguous intramural hemorrhages, and new vessels in and around the arterial wall were noteworthy findings in our series. All 20 reported autopsied cases of the vertebrobasilar artery have a dissection between the media and adventitia with a rupture site in the thin adventitia. Seventeen of them had disruption of the entire arterial wall, but the remaining three cases had no apparent luminal connection. The clinicopathological features of this disease are various. On the basis of the pathological investigations of these reported cases, the pathogenesis of this lesion is discussed. Intramural hemorrhage associated with dissection without luminal connection should not be disregarded as a causative factor.

Combination chemotherapy with 254-S, ifosfamide, and peplomycin for advanced or recurrent cervical cancer

BACKGROUND

Based on the fact that combination chemotherapy with cisplatin, ifosfamide, and bleomycin generated a 69% response rate in patients with recurrent cervical cancer; that 254-S (a cisplatin analogue) monotherapy generated a 46.3% response rate for cervical cancer, which was higher than those generated by cisplatin and carboplatin in historic comparison; and that peplomycin is a bleomycin analogue with improved pulmonary toxic effects, a combination regimen with 254-S, ifosfamide, and peplomycin was evaluated in an animal experiment and a clinical study in patients with advanced or recurrent cervical cancer with an expectation that the regimen might show a higher efficacy than 254-S monotherapy and the combination regimen including cisplatin.

METHODS

In the clinical testing, 254-S was administered intravenously (IV) at 80-100 mg/m2, ifosfamide was administered IV at 1500 mg/patient for 5 days, and peplomycin was administered intramuscularly at 5 mg/patient for 6 days. This treatment was repeated every 4 weeks.

RESULTS

As a result, this regimen showed additive or synergistic antitumor effects in mice receiving B16 melanoma transplants. In the clinical study, 83.8% and 60.9% response rates were obtained in 37 previously untreated patients with Stage III or IV cervical cancer and 23 with recurrent cervical cancer, respectively. The dose-limiting factor was bone marrow toxic effects, which were tolerable. The other toxic effects were mild, and there were no deaths.

CONCLUSIONS

From these results, this combination regimen was thought worthy of evaluation in a Phase III comparative study in patients with advanced or recurrent cervical cancer.

Feeding suppression elicited by electrical and chemical stimulations of monkey hypothalamus

The effects of electrical (ES) and chemical stimulations of the hypothalamus were investigated in monkeys during bar-press feeding. ES elicited both prolonged and nonprolonged types of suppression of bar-press feeding in hungry animals. Prolonged type suppression persisted for greater than 1 min beyond one or more post-ES trials and was found after ES of the dorsomedial hypothalamus (DMH), the ventromedial hypothalamus (VMH), and the ventromedial part of the lateral hypothalamic area (LHA). Non-prolonged type suppression was observed only during ES at some sites of both in hypothalamic and extrahypothalamic areas. A microinjection of glutamate into the VMH and the DMH, but not into the LHA, was able to reproduce the ES-induced prolonged type suppression. In contrast, the ES of the LHA, but not the VMH and DMH, in a satiated state provoked feeding. The results, together with the previous findings, suggest that the neuronal inhibitory mechanism of feeding exists in the VMH and DMH, while both the neuronal facilitatory and axonal inhibitory mechanisms in the LHA are involved in the feeding regulation, and these mechanisms of the LHA are affected by the hunger/satiety state.

[Combination chemotherapy with 254-S, ifosfamide and peplomycin for advanced or recurrent cervical cancer]

From favorable results with 254-S, a new cisplatin analogue, single administration, we have conducted a clinical study to investigate the efficacy of combination of 254-S, ifosfamide and peplomycin, each of which has a different dose limiting factor. A total of 45 patients, including 22 patients with stage III and IV cervical cancer and 23 cases with recurrent cervical cancer, were treated with at least two courses of 254-S (100mg/m2, iv. Day 1), ifosfamide (1,500mg/body, iv. Day 1-5) and peplomycin (5mg/body, im. Day 1-6), and tumor response was evaluated clinically and by CT scanning. The response rate obtained in patients with advanced disease was 81.8% (PR = 17, CR = 1) and that in cases with recurrence was 60.9% (PR = 12, CR = 2). Myelosuppression was the dose limiting factor. In the 121 courses, grade 3 and 4 of leucopenia and thrombocytopenia were observed with an incidence of 44% and 32%, respectively and DIC occurred in 3 cases with poor PS though they recovered after reducing the 254-S dose to 80 mg/m2. The other toxicities were mild except for alopecia. Anaphylaxia was observed in a case at the second administration though the patient recovered in 15 minutes. There was no death. As to prognosis, a significant prolongation of survival period was observed in recurrent cases and 4 cases are alive (NED) after one and a half year. In the advanced cases, until now 3 cases of stage IV have died from the disease. We have concluded that this regimen is effective as a neoadjuvant chemotherapy for advanced cervical cancer and useful for the treatment of recurrent cervical cancer.

[Clinical study of intramuscular imipenem/cilastatin sodium in the field of obstetrics and gynecology]

The efficacy and the safety of intramuscular imipenem/cilastatin sodium (IPM/CS) were evaluated in 22 patients with obstetric and gynecologic infections. 0.5 g/0.5 g of IPM/CS was suspended in a lidocaine solution and administered in the gluteal muscle twice a day for 3-7 days. Nineteen patients with intrauterine infections were evaluable for the clinical efficacy and 22 for the safety. 1. Clinical efficacies were excellent in 6 patients, good in 11 and poor in 2, and the efficacy rate was 89.5%. Thirteen out of 14 patients who had not responded to treatments with other previously administered antibiotics showed excellent or good responses to IPM/CS. 2. Causative bacteria were eradicated in 5 patients, decreased in 2, unchanged in 3 and replaced in 3, with an eradication rate of 61.5%. 3. Among 22 patients treated with IPM/CS, an eruption and general itching were observed in 1 patient, but no abnormal laboratory test values were observed.

[Effects of frequent antral lavage on chronic sinusitis in children]

Eighty cases of pediatric sinusitis (4 to 15 years old, averaged 8 years old) were treated with frequent antral irrigations. Antral puncture was made through the inferior meatus with a Kyoto University needle under topical or general anesthesia. Then a plastic tube of 14G Medicut intravenous cannula was left in place to serve as an indwelling catheter. Antral lavages were performed through this tube 3 times daily for 7 to 10 days. The opacity of the maxillary sinus at post-treatment was improved significantly compared with that at pre-treatment in Waters view. This improvement was continued even at about 5.7 months after treatment. The opacity of the ethmoid sinus was also improved significantly after the treatment in occipito-frontal view. Our results suggest that the frequent antral lavage is an useful therapeutic modality for pediatric sinusitis.

Electrical stimulation of male monkey's midbrain elicits components of sexual behavior

We electrically stimulated the midbrain of male rhesus monkeys seated in a restraint chair facing the female partners and examined whether sexual behavior could be induced. When the midbrain was stimulated (0.2 ms, 50-500 microA and 50 Hz for 2.5 s), the male monkey touched and held the waist of his partner (latency; 0.9 +/- 0.4 s, mean +/- SD, n = 225), and then mounted her when she responded with presenting her hip toward him. However, this mounting, unlike when the hypothalamus was stimulated, did not lead to thrusting or ejaculation even if the stimulation continued. The sites in the midbrain where the stimulation elicited touching and mounting were the ventral tegmental area, the substantia nigra, the nucleus reticularis mesencephali and the nucleus reticularis pontis oralis et caudalis. Touching and mounting were not elicited when the partner was put away from the male or replaced by submissive male monkeys or humans. The findings suggest that the stimulation-evoked touching and mounting are components of copulatory behavior and that the midbrain structures may be involved in the sexual behavior of male monkeys.

Clinical records: a case report of Wegener's granulomatosis limited to the ear

A 12-year-old girl had a 1-week history of left otalgia with hearing loss in May, 1989. Audiometry showed a conductive hearing loss of 60 dB. The conventional medical treatment for acute otitis media was initiated, but the symptoms and signs failed to respond this treatment. Four weeks after initial presentation, a diagnostic mastoidectomy was performed. The histological findings of the granulomatous tissue in the mastoid cavity showed nonspecific granulomatous inflammation, infiltrated with multinucleated giant cells. Initial laboratory studies revealed elevated ESR, positive CRP and RA, inverted A/G ratio, and increased Ig level. She had no other sites of involvement, such as the nose, paranasal sinus, pharynx, and larynx, and also no pulmonary or renal involvement was indicated. The diagnosis of a limited form of Wegener's granulomatosis was made on the above clinical and histological findings and laboratory examinations. The patient was then treated with cyclophosphamide, 80 mg/day (2 mg/kg) and prednisolone, 60 mg/day. After 1 week her symptoms and general condition were dramatically improved. Out-patient follow-up 1 year later showed her hearing level was improved to 28 dB, and she continues to do well without evidence of recurrence of the disease.

[Pharmacokinetics of cis-diammine (glycolato) platinum (254-S), a new platinum antitumor agent, following an intravenous and intraperitoneal infusion bioactive platinum concentration profile]

The pharmacokinetics of cis-diammine (glycolato) platinum (254-S) was investigated in cancer patients following intravenous and intraperitoneal infusion. The serum concentrations of total and unbound 254-S were determined by bioassay and chemical assay as platinum. Platinum detected by bioassay was thought to be active and unchanged 254-S. Almost all of platinum in plasma were found to be active and unbound to protein because of no differences in the concentrations determined by bioassay and chemical assay and in plasma and plasma filtrate. In abdominal ascites, platinum concentrations determined by bioassay corresponded with those determined by chemical assay, suggesting that 254-S was stable in abdominal ascites. The Cmax and AUC of active 254-S in plasma determined by bioassay following an intraperitoneal infusion were about 60% and 60-80% of those following an intravenous infusion, respectively. These results showed that 254-S was well absorbed into systemic circulation from abdominal ascites as an active form. It is concluded that antitumor effect may be obtained following an intraperitoneal infusion of 254-S as well as for the reduction of abdominal ascites.

[Management of chronic sinusitis in children]

The managements and the results of therapy for children with chronic sinusitis were reported. During the period of 1980 to 1988, 190 patients, aged 3 to 15, were examined at our outpatient clinic. The pathologic conditions of the maxillary sinus were examined by the contrast x-ray study (X-MFT). The mild, moderate and severe lesions in the maxillary sinus evaluated by X-MFT were 22%, 44; and 34%, respectively. Sixty-two per cent of ethmoid sinus was opacified in occipito-frontal view. The degree of patency of the maxillary ostium was evaluated by an application of the constant pressure to the maxillary sinus. Almost all maxillary ostia of these patients were patent. Nasal mucociliary clearance was reduced in 37% of the patients examined after the saccharin method. Antral lavages were performed once in a week for the therapy of 72% of children with chronic sinusitis. The efficacy of this modality was evaluated by the above mentioned items. The maxillary and ethmoid lesions, and nasal mucociliary transit time were significantly improved by the modality after 25 months in average. These results indicate that the antral lavage is an useful therapy for chronic sinusitis in children.

[Comparison of preoperative and postoperative chemotherapy in the treatment of advanced ovarian cancer]

Temporary blockage of uterine and ovarian vessels with forceps led to an approximately two-fold increase in the transfer of LMOX and Carboplatin to uterine muscle, ovarian tissue and pelvic lymph-nodes after the release of forceps. This result suggests the importance of preserving these main vessels for the effective transfer of chemotherapeutic agents to target tissues. Ten cases in stage III or IV underwent cytoreductive surgery followed by three courses of CDDP, ADM, CPA chemotherapy and SLO (postop. group). A further 27 cases were given diagnostic laparotomy followed by the same chemotherapy and SLO (preop. group). Examination of both groups revealed the following: The efficacy rate of the CAP regimen was 77.8% in the preop. group and 50.0% in the postop. group; the surgical extirpation rate exceeding 90% at SLO was 76.1% and 50.0% in the preop. and postop. groups respectively. The survival period was longer in the preop. group, ie., two years in 69% versus 40% and three years 43% v 20% of the preop. and postop. groups, respectively. Preoperative (Neo-adjuvant) chemotherapy followed by aggressive surgery was concluded to be preferable to carrying out enforced reduction surgery first on such advanced cases where the mass of the residual disease cannot be left untouched is unavoidable.

Alteration of epicardial lymphatics in lymphostatic canine hearts

This study was conducted in an attempt to establish a method for evaluation of cardiac lymphostasis in autopsy cases and animal experiments. Ten mongrel dogs were operated on to induce cardiac lymphostasis in terms of ligation of coronary lymphatics. From the following day to 6 months after surgery, epicardial lymphatics were visualized to measure the volumes and densities of the lymphatics. The mean volume, measured after 1 week (0.27 +/- 0.09), 2 weeks (0.32 +/- 0.04), and 6 months (0.23 +/- 0.05) continued to be higher than that on the first day (0.16 +/- 0.04) (P less than 0.05). The density, measured after 1 week (2.6 +/- 0.3) and 2 weeks (3.7 +/- 0.7), also showed higher values, than that on the 1st day (1.7 +/- 0.7) (P less than 0.01). However, 6 months later, the measured value (1.9 +/- 0.03) showed no statistical difference compared to that of the 1st day. Observation under a binocular microscope revealed impressions of a progressive increase in both number and thickness of the lymphatics as late as 2 weeks after the induction. However, 6 months later, there was marked dilatation and a relative decrease in the number of lymphatics.

[Pharmacokinetic and clinical studies of imipenem/cilastatin sodium in the perinatal period]

Pharmacokinetic and clinical studies on imipenem/cilastatin sodium (IPM/CS), a parenteral carbapenem antibiotic combination drug, were carried out in patients in the perinatal period. The obtained results are summarized as follows. 1. Concentrations of IPM and CS in umbilical cord blood, amniotic fluid and maternal blood were determined in 13 patients after 500 mg/500 mg of IPM/CS was administered by a drip infusion over a period of 30 minutes. Peak levels of both drugs in umbilical cord blood were about 30% of those in maternal blood. Although the levels gradually declined thereafter, the decline was slower in umbilical cord blood than in maternal blood and the levels became higher in the former than in the latter after 2 hours or more. The transfer of both drugs into amniotic fluid was slower than into umbilical cord blood. Peak levels were observed 5-6 hours after administration, averaging about 30% of that in the maternal blood for IPM and 45% for CS. 2. A 500 mg/500 mg dose of IPM/CS was administered to 10 patients with postpartum infections by a drip infusion over a period of 30 minutes or more twice daily in the morning and in the evening. Clinical responses were excellent in 6 patients and good in 4, with an efficacy rate of 100%. Bacteriologically, all of the 19 strains identified previous to the treatment were eradicated except for 1 strain. However, one new strain of Enterococcus sp. appeared in 1 patient. No side effects or abnormal laboratory findings were observed. These results suggest that IPM/CS will be useful for the treatment of various infections in the perinatal period.

[Fundamental and clinical study on cefuzonam in the field of obstetrics and gynecology]

Cefuzonam (L-105, CZON), a new beta-lactam antibiotic, was studied for its transfer into intrapelvic tissues and for clinical efficacy in the treatment of obstetrical and gynecological infection. 1. Following an intravenous 1 hour drip infusion of 1 g, the transferred CZON into uterine tissues reached and was maintained at effective concentrations which were defined as levels exceeding MICs against clinical isolates frequently obtained from patients in the field of obstetrics and gynecology. The peak concentration of CZON in the pelvic dead space exudate was estimated to be 20 micrograms/ml at 0.5-1 hour after infusion. 2. Subjects studied were 5 patients with the following infections: pyometra (3 cases), puerperal intrauterine infection (1 case), vaginal cuff infection (1 case). Clinical efficacies were good in 4 cases and poor in 1 case. No notable side effects or abnormal laboratory test results were noted.

Light microscopy of GTP-binding protein (Go) immunoreactivity within the retina of different vertebrates

To examine species differences in the distribution pattern of guanosine triphosphate (GTP)-binding protein (Go) within the vertebrate retina, paraffin-embedded retinae from a number of vertebrate species, including the goldfish, frog, turtle, chicken, monkey, and human, were immunohistochemically stained with affinity-purified antibody against the alpha-subunit of Go. Go-immunoreactive products were found to be located in the neuropil, but not in the cell bodies of neurons, in the retina of all these species. However, some species differences were observed. In the frog, monkey and human, the inner plexiform layer (IPL) was homogeneously stained with this antibody, but in the goldfish, turtle and chicken, the IPL was heterogeneously stained. In the frog, chicken, turtle and human, the outer plexiform layer (OPL) was densely stained with this antibody, but in the goldfish and monkey, the OPL was rather faintly immunoreactive to the antibody. In the goldfish, monkey and human, the outer nuclear layer (ONL) was not immunoreactive to the Go-antibody, whereas in the frog, turtle and chicken, the ONL was immunoreactive to it. The implications of these species differences in Go localization in the vertebrate retina are discussed.

Classification of cardiac rupture complicated in myocardial infarction. Pathological study of 32 cases

Thirty of 32 cases with cardiac rupture (CR) complications in the myocardial infarction were found out of a total of 91 cases of acute myocardial infarction (AMI). The mean age of the ruptured group in females was significantly younger than that of the non-ruptured group. Twenty-one cases showed free wall rupture of the left ventricle, six perforation of ventricular septum and three double rupture. All cardiac ruptures occurred in cases of transmural infarction. The age of AMI was histologically estimated. Nine cases complicated within the first 24 hours of AMI showed rupture of the left anterior wall. CR in the periphery within the infarct occurred at any time during the first week after onset, and cases of the central rupture were increased in number after the 3rd day of AMI. Pathologic findings indicated that elevated wall tension was considered to be most closely related to the cause of CR. Thirty two cases of CR were classified into three types: (1) blowout type, (2) hemorrhagic dissecting type, and (3) thinning-with-rupture type. Hemorrhagic dissecting type was characterized by multiple endocardial ulcers and fissure canals extending from the ulcer with hemorrhage in the surrounding myocardium. Complex fissure was seen in two cases of this type.

[Fundamental and clinical studies of imipenem and imipenem/cilastatin sodium in the field of obstetrics and gynecology]

Fundamental and clinical studies of imipenem (MK-0787), a new type of carbapenem antibiotic, and MK-0787 combined with cilastatin sodium (MK-0791), a renal dipeptidase inhibitor, were carried out. The results obtained were as follows: MK-0787 500 mg alone or MK-0787 500 mg with MK-0791 500 mg was administered by intravenous drip infusion over 30 minutes. Plasma levels of the drug were similar either following the administration of 500 mg of MK-0787 alone or 500 mg of MK-0787 with 500 mg of MK-0791. When MK-0787 was administered with MK-0791, MK-0787 and MK-0791 levels at 2 hours after the end of infusion in uterine arterial plasma were 6.8 micrograms/ml and 3.2 micrograms/ml, respectively, and in venous plasma were 8.4 micrograms/ml and 4.7 micrograms/ml, respectively. MK-0787 tissue levels ranged from 0.8 microgram/g to 3.8 micrograms/g at 205 minutes after the end of infusion. Based on these results, the plasma and tissue levels of MK-0787 and MK-0791 with b.i.d. dosage exceeded the MICs of the drug against clinical isolates in the field of obstetrics and gynecology such as E. faecalis, E. coli Klebsiella sp., Peptococcus sp., Peptostreptococcus sp. and B. fragilis immediately after the administration. However, it seemed that the b.i.d. dosage was insufficient to maintain the in vivo concentration of these agents high enough to inhibit the growth of the above bacteria. Eighteen patients with obstetric and gynecologic infection (12 with intrauterine infections, 2 with pelvic dead space inflammation, 2 with pelvic peritonitis, 1 with a vaginal cuff abscess and 1 with a vulvar abscess) and 1 patient with other infection (abdominal wall abscess) were evaluated, but 1 patient with pelvic peritonitis was later excluded from the efficacy evaluation because of a serious illness. MK-0787/MK-0791 was administered twice daily in a 30-minute intravenous drip infusion. Clinical results were excellent in 1 patient, good in 16 and poor in 1, for an efficacy ratio of 94.4%. No side effects were observed. Only abnormal laboratory findings observed were elevation of S-GOT and S-GPT in 1 patient which normalized 2 weeks after the treatment was discontinued. These results suggest that MK-0787/MK-0791 will be useful for the treatment of obstetric and gynecologic infections.

[Fundamental and clinical studies on aztreonam]

Aztreonam (AZT), a new monocyclic beta-lactam antibiotic, was studied on the transfer into intrapelvic tissues and on the clinical efficacy in the treatment of 19 cases of obstetrical and gynecological infections. The AZT levels were examined in the pelvic dead space exudate in 6 patients who received radical hysterectomy due to uterocervical cancer. The simulation curves for AZT were well performed after the decision of the pharmacokinetic parameters using the two-compartment model. Following 1-hour intravenous drip infusion of 1 g of AZT, the peak concentration of AZT in cubital venous blood was estimated 73.3 micrograms/ml at the end of infusion. The peak concentration of AZT in the pelvic dead exudate was estimated 18.6 micrograms/ml at 2.31 hours after infusion. Following intravenous 1-hour drip infusion of 1 g, the transferred level of AZT into uterine tissues was maintained at the effective concentration which means the excess level of the MIC against clinical isolates often observed in the field of obstetrics and gynecology. AZT was administered 2-4 g/day in 2 times a day by intravenous drip infusion for 60-90 minutes. The subjects were 19 patients with the following infections; pyometra (1), puerperal intrauterine infection (4), postoperative parametritis (4), pelvioperitonitis (2), purulent lymphocyst (1), acute salpingoophoritis (1), vaginal stump abscess (1), Douglas abscess (2), pelvioperitonitis + pyosalpinx (2), vulval abscess (1). Clinical efficacy was; excellent in 2 cases, good in 11 cases and poor in 6 cases. No notable side effect or abnormal laboratory finding was noted.

[Fundamental and clinical studies on cefpiramide in the field of obstetrics and gynecology]

Cefpiramide (SM-1652, CPM), a new cephem antibiotic was studied for the transfer into intrapelvic tissues and clinical efficacy in the field of obstetrics and gynecology. The results were obtained as follows. Clinical results of 17 patients with obstetrical and gynecological infection were excellent in 10 cases, good in 6, and poor in 1 with the efficacy rate of 94.1%. Following a single intravenous 30 minutes-drip infusion of 1 g dose of CPM, the peak of serum level and intrapelvic tissues were obtained at 30-60 minutes after completion of the administration. No adverse reaction or abnormal laboratory findings were observed.

[Basic and clinical studies on cefminox in the field of obstetrics and gynecology]

Fundamental and clinical studies on cefminox (CMNX, MT-141), a new cephamycin antibiotic, were carried out and the following results were obtained. When CMNX was administered at a dose of 1 g by intravenous drip infusion taking 1 hour, the serum concentrations as high as 20 micrograms/ml and 21 micrograms/ml were detected even at 4 hours after administration for the uterine artery and elbow vein, respectively. From these results, CMNX was supposed to maintain in vivo concentrations high enough to inhibit 80 to 100% of the growth of bacteria such as S. aureus, E. coli, Klebsiella, Proteus and anaerobic bacteria, B. fragilis, which are the commonest clinical isolates in the field of obstetrics and gynecology. Clinically, in 7 cases of female genital infections (4 cases of parametritis, 1 case of intrauterine infection, 1 case of pyometra and 1 case of pelveoperitonitis), CMNX was administered at a daily dosage of 2 g in 2 divided doses as intravenous drip infusions taking 90 minutes each. The clinical results were excellent in 1 case, good in 3 cases and poor in 3 cases, with an efficacy rate of 57.1%. In 6 out of these 7 cases progressive carcinoma was present as the underlying disease. No side effects nor abnormalities in laboratory findings were observed in any of the 7 cases. These results suggest that CMNX is effective in the treatment of obstetrical and gynecological infections.

[A summary of the experience with cisplatin in the treatment of gynecological malignancies, with special reference to advanced ovarian cancer]

This report summarizes the results on the evaluation of Cisplatin in gynecological malignancies. A total of 51 evaluable cases, comprises 29 of which were advanced or recurrent ovarian cancer and 22 of other gynecological malignancies. The main results are summarized as follow: The overall efficacy rate was 58.3% on ovarian cancer and 13.6% on other malignancies. Seen histologically, almost the same good overall efficacy rates were obtained in all types except for the mesonephroid type. When Cisplatin therapy is used in combination with surgery, the preoperative use provides a higher efficacy rate (68.2%) than the postoperative use (28.6%). Also cases with a Second Look Operation showed a much higher one year survival rate (80.0%) than those of the cases without S.L.O. (25.0%). From these results, it is deduced that Cisplatin is the most useful agent for induction chemotherapy for S.L.O. on advanced ovarian cancer. The side effects observed were milder than those of anti-cancer drugs known so far with the usual dosage, and no fetal damage was observed.

[Treatment of stage I and II ovarian cancer (interim report of intraperitoneal chemotherapeutic perfusion and postoperative prophylactic intracavitary irradiation)]

74 cases of primary ovarian cancer treated here previously were classified into three groups, no residual (corresponding to Stage Ia, Ib), cell residual (Ic-IIc) and mass residual (III, IV), and prognoses were compared. The 5 year survival rates were 83.3%, 29.4% and 12.6% respectively. In Stage I and II cases, almost all of the tumor mass would be removed by operation. Therefore the target of postoperative treatment should be the residual cancer as cell units spread widely throughout the abdominal cavity. For this purpose, IPCP has been performed on 35 cases of Stage I and II since 1977. The 3 year survival rate for this series is as good as 88.6%, and the sites of recurrence were localized in the small pelvic cavity adjacent to the Douglas pouch in 5 out of 6 relapsed cases. This fact suggests that IPCP is capable of controlling the cancer cells in the upper abdominal cavity, but still insufficient to control them in the pelvic cavity where deeper invasion is suspected. In order to improve the local control ability, utilization of the uterus as the applicator for prophylactic intracavitary irradiation came to be considered. The spread of cancer to the uterus was found in 5 out of 38 cases in Stage I and II(13.2%), but silent invasion was found in only one case. These results suggests that the utilization of the uterus as the applicator for prophylactic intracavitary irradiation would be feasible if no macroscopical cancer extention to the uterus exists and the uterus is suitable for application. Several combinations with Tandem and Ovoid have been tested and an adequate method has been proposed.

[Fundamental and clinical study of ceftriaxone in the field of obstetrics and gynecology]

Ceftriaxone (Ro13-9904, CTRX), a newly developed cephalosporin antibiotic, was fundamentally evaluated through determination of the levels in the female genital organ tissues and in the pelvic dead space exudate. CTRX was also studied on its clinical efficacy in 13 cases with gyneco-obstetric infections. The transmission of CTRX into the female genital organ tissues was favorable: the peak level in each tissue was as high as 38 to 63 micrograms/g 18 to 37 minutes after administration. The level in each tissue even after about 18 hours remained around 10 micrograms/g, suggesting its better transmission into the tissues than other drugs. The transmission into the pelvic dead space exudate was also good: the level reached a peak of 100 to 120 micrograms/ml 1 to 3 hours after administration and still ranged from 74 to 76 micrograms/ml even after about 12 hours. The clinical efficacy was excellent in 5, good in 5 and poor in 3 out of 13 cases with gyneco-obstetric infections and the efficacy rate was 76.9%. Neither adverse reaction nor laboratory test abnormality was observed in any case. The above-mentioned results suggest that CTRX is a useful antibiotic for gyneco-obstetric infections.

[Fundamental and clinical studies on sulbactam/cefoperazone in the field of obstetrics and gynecology]

Fundamental and clinical studies on sulbactam/cefoperazone (SBT/CPZ), a combination drug of sulbactam and cefoperazone, were carried out in the field of obstetrics and gynecology. The following results were obtained: Transfer into female genital organ tissues Following 1 hour intravenous drip infusion of SBT/CPZ, favourable transfers of both of SBT and CPZ to female genital organ tissues and pelvic dead space exudate were observed. Clinical evaluation A total of 12 cases comprising 6 with intrauterine infection, 1 with pyometra, 1 with abscess of portio vaginalis, 2 with parametritis, 1 with pelvioperitonitis and 1 with purulent lymphocyst was treated with SBT/CPZ. Clinical efficacy was excellent in 6 cases, good in 5 cases and poor in 1 case, with overall efficacy rate of 92%. The bacteriological efficacy was judged as eradicated in 3, and as decreased in 2 out of 5 evaluable cases. In all of the 5 cases, isolated organisms were beta-lactamase producing organisms. No notable side effects or abnormal laboratory findings were observed except 1 case with elevations of GOT and GPT.

Progeria with cardiac hypertrophy and review of 12 autopsy cases in the literature

An autopsy of an 11 years 5 months old boy with progeria is presented. Hyaluronuria, low growth rate of skin fibroblasts, decreased number of T-cells in lymphocyte subpopulation, increase of anti DNA antibody, and antibody for microsome of thyroid gland were detected clinically. He had suffered an attack of cerebral infarct and died of congestive cardiac failure. Pathologic findings were scleroderma-like skin atrophy, moderate arteriosclerosis of the aorta and great arteries, severely narrowed coronary sclerosis with an extensive subendocardial fibrosis, a large left cerebral infarct with pin-holed stenosis of both internal carotid arteries, cortical atrophy of thymus, and atrophic lymph nodes. The cardiac muscle fibers were slightly hypertrophied and measured 15.5 +/- 2.8 microns in diameter. Histologic findings suggest that increasing of collagen in the connective tissue may play an important role in progeria. Further study of metabolic disturbance in the connective tissue of progeria is necessary.

Von Recklinghausen's disease (neurofibromatosis) associated with malignant pheochromocytoma

An autopsy case of von Recklinghausen's disease (vRD) associated with malignant pheochromocytoma is reported. The patient is a 36-year-old Japanese male and diagnosed as vRD both clinically and pathologically. He died from right adrenal tumor with wide spread metastases to lungs and bone marrow. The tumors presented satisfactory histological features in favor of pheochromocytoma and neurosecretory granules were demonstrated in both primary and metastatic lesions ultrastructurally. Statistical study of 182, 673 autopsy cases from Annuals of Japanese Autopsy Cases was also done in order to investigate the relationship between vRD and associating tumors including benign and malignant pheochromocytoma. Cases with vRD showed significantly higher incidences of malignant Schwannoma, neurofibrosarcoma, intracranial glioma, and pheochromocytoma compared to that of non-vRD cases. Other malignancies revealed rather smaller incidences than non-vRD cases. These neurogenic tumors are to be principal life threatening problems in patients with vRD. Rare incidence of malignant pheochromocytoma in vRD is to become from low incidence of pheochromocytoma, though significantly greater than that of non-vRD cases.

[Fundamental and clinical studies on ceftazidime in the field of obstetrics and gynecology]

Ceftazidime ( CAZ ) was studied for the transfer into intrapelvic tissues and for the clinical efficacy in the treatment of 20 cases of obstetrical and gynecological infections. Transfer into the tissues--Following intravenous 1 hour-drip infusion of 1 g, favourable transfer of CAZ into intrapelvic tissues was observed. The peak drug level of 50 approximately 66 micrograms/g was obtained at 5 approximately 36 minutes after completion of the administration. Clinical evaluation-- CAZ was administered at a daily dose of 2 approximately 4 g in 1 approximately 4 divided doses by intravenous drip infusion for 90 minutes. The subjects were patients with the following infections; pyometra (1), puerperal endometritis (3), parametritis (5), pelvioperitonitis (3), purulent lymphocytes (2), retroperitoneal abscess (1) and acute adnexitis (5). Clinical efficacy was; excellent in 15 cases, good in 3 cases and poor in 2 cases, with the overall efficacy rate of 90.0%. No notable side effects or abnormal laboratory findings were observed except for eruption in 1 case.

[Fundamental and clinical studies on T-1982 (cefbuperazone) in the field of obstetrics and gynecology]

Fundamental and clinical studies on T-1982 (cefbuperazone), a new cephamycin antibiotic, were carried out, and the following results were obtained. When T-1982 was administered at a dose of 1 g by intravenous drip infusion for 30 minutes or 1 hour, the concentration in serum showed as high as 23.0 micrograms/ml or 25.0 micrograms/ml even 2 hours after administration. The concentrations in the genital tissues about 5 hours after administration ranged 1.2-45.6 micrograms/g for 30 minutes drip infusion and 0.9-26.8 micrograms/g for 1 hour drip infusion. From these results, T-1982 was supposed to maintain the in vivo concentration to inhibit 80-100% the growth of bacteria such as S. aureus, E. coli, Klebsiella, Proteus, S. marcescens and Gram-negative anaerobic bacteria, B. fragilis which were often isolated clinically in the field of obstetrics and gynecology. When T-1982 was administered at a dose of 1-2 g twice a day to 14 patients with female genital infection; 2 intrauterine infection, 2 pyometra, 7 pelveoperitonitis, 1 adnexitis, 1 adnexal abscess and 1 vaginal cuff abscess, the clinical results were excellent in 9, effective in 4 and poor in 1. The efficacy rate was 92.9%. No side effects nor abnormalities in laboratory findings were observed in any of the 14 cases. These results suggest that T-1982 has efficacy for the treatment of obstetrical and gynecological infections.

[Laboratory and clinical studies on latamoxef in the field of obstetrics and gynecology]

Latamoxef (LMOX) is a new antibiotic synthesized by Shionogi Research Laboratory. Chemically LMOX is especially unique with a sulfur atom replacing the oxygen atom in the 1 position of the conventional cephalosporin nucleus, and in addition, this antibiotic has a cephamycin-like structure. The antibacterial activity of LMOX shows high potency against Gram-negative bacteria, but tends to be weak against Gram-positive bacteria. The tissue levels of LMOX in humans after intravenous injection of 1 g were examined. The levels in uterine and adnexa uteri tissue at 1 hour after administration were 25.4 and 27.4 micrograms/g respectively. LMOX was administered to 147 cases in infections of obstetric and gynecological field. The clinical effect according to disease was 94.6% for intrauterine infections, 95.0% for adnexitis, 87.0% intrapelvic infections, and 100% for external genital organ infections, making a total of 92.5%. The rate of occurrence of side effects or abnormal laboratory findings was similar to or slightly less than that seen with other beta-lactam antibiotics.

[Acute preoperative hemodilution in radical hysterectomy for carcinoma of the uterine cervix (author's transl)]

With an attempt to diminish the post-transfusion hepatitis following radical hysterectomy, the study was made on 27 cases of cervical cancer undergone the operation. Fifty cases with blood transfusion immediately prior to the study was taken as control group. Under general anesthesia, 800 ml of venous blood was drawn from the peripheral vein under simultaneous infusion of 1,000 ml of Saviosol to maintain the circulating blood volume. The blood was returned after hemostatizing procedures. Of the study group, the blood loss, operation time, urinary output during the operation, and drainage amount were 960 g, 157 minutes, 350 ml and 160 ml respectively, while those of control group were 930 g, 164 minutes, 150 ml and 280 ml. The circulation status remained within normal limits, no bleeding tendency was appeared. Blood loss of the study group was estimated 960 g, however the actual blood loss calculated was on l6 719 g. There were no particular complication in the study group, while there was 12% of hepatitis among the control group. The advantages were concluded as 1) Patient was under normovolemic state when the operation started. 2) The blood transfused had normal O2 transport and hemostatic capacity. 3) The management of the patient was not so difficult and no special equipment and technique were needed.

Immunocytochemical study on cholera toxin binding sites by monoclonal anti-cholera toxin antibody in neuronal tissue culture

An indirect method of immunocytochemistry showed that cholera toxin and its B-subunit served as specific neuronal surface markers in conjunction with monoclonal anti-cholera toxin and FITC labeled anti-mouse Fab. The cell types which get specifically stained in culture were peripheral neurons from dorsal root ganglion cells, superior cervical ganglion cells, and cerebral neurons, all of which were rat tissue, and NGF-treated PC12 cells. Non-neuronal cells, i.e. Schwann cells, fibroblasts and glia cells, were not stained. This method can, therefore, be used to distinguish neurons from non-neuronal cells in neuronal tissue cultures, as in the case of tetanus toxin described in the literature.

Basal lamina deficiency in Schwann cells induced by beta-aminopropionitrile (BAPN) in rat dorsal root ganglion culture

In cultures of rat dorsal root ganglion (DRG) treated with beta-aminopropionitrile (BAPN), the following abnormalities were observed. Abnormalities in the size and the shape of collagen fibers; longer periodicity of collagen fibers in BAPN (70 +/- 5 nm) than in control (66 +/- 6 nm) (P less than 0.025); lack of basal lamina of both unmyelinated and myelinated Schwann cells; and abundant amorphous materials in the interstitial area between fibroblasts or peripheral cells and Schwann cells associated with neurites. Detachment of the explant from the collagen substratum also occurred and showed dose dependency. In contrast to the alterations of connective tissue, the neurites were well preserved in this experimental regimen.