[Combination of transcatheter arterial infusion of SMANCS and embolization (SMANCS-TAE) for hepatocellular carcinoma--second report]

Patients with unresectable hepatocellular carcinoma (hepatoma) with hypervascularity were treated by SMANCS-TAE. A superselective catheterization technique was used to inject gelatin sponge particles after administration of SMANCS. In 30 patients of first hepatoma treated by SMANCS-TAE. Grade 4 was obtained after 1.7(1-3) courses. The 2-year survival rate was 22%. Some of the 24 patients of second hepatoma treated by SMANCS-TAE have survived over 2 years. Sixteen patients with advanced hepatoma (Vp2-3 or T4) were treated only by SMANCS injection, but none survived over 1 year. SMANCS-TAE appears to have the same potential and safety as L-TAE, when used selectively. Moreover, we can reduce the course of treatment and obtain good QOL for hepatoma patients except in advanced cases.

Uterine blood flow. Assessment in an intrauterine insemination program for unexplained infertility

OBJECTIVE

To evaluate the diagnostic usefulness of color Doppler velocimetry for infertility treatment.

STUDY DESIGN

Sixty-one women undergoing controlled ovarian hyperstimulation and intrauterine insemination with their husbands' semen due to unexplained infertility were enrolled in the study. The Doppler waveforms of the uterine artery, subendome-trial radial artery and intraovarian artery were analyzed around ovulation, and the calculated pulsatility indices (PIs) were correlated with subsequent pregnancy results.

RESULTS

Those women who conceived exhibited a significantly lower uterine artery PI and higher frequency of positive diastolic blood flow in the subendometrial arteries shortly after ovulation. The PI of the intraovarian arteries prior to ovulation was also significantly lower in conception cycles than in nonconception cycles. Uterine artery PIs between different cycles correlated well in the same individual. Lower uterine artery impedance was noted in women receiving supplementation with human menopausal gonadotropins as compared to clomiphene citrate alone.

CONCLUSION

Doppler velocimetry is a useful tool for evaluating uterine receptiveness in infertility treatment. Intrinsically poor uterine perfusion should be investigated in cases of unexplained infertility.

Chromosome analysis of aborted conceptuses of recurrent aborters positive for anticardiolipin antibody

OBJECTIVE

To elucidate the relationship between anticardiolipin antibody and recurrent abortion.

DESIGN

Prospective clinical study.

SETTING

Institutional practice in which patients with recurrent abortion were registered at the outpatient clinic for infertility of Niigata University Hospital.

PATIENT(S)

Five hundred sixty-one patients with recurrent abortions and 148 patients who were not recurrent aborters and who had experienced sporadic abortion.

INTERVENTION(S)

Aborted conceptuses for chromosome analyses were collected from the patients.

MAIN OUTCOME MEASURE(S)

The positive rate of anticardiolipin antibody was assessed in patients with recurrent abortion. Chromosome analyses of aborted conceptuses were performed in 10 patients with positive anticardiolipin antibody who had experienced another pregnancy that resulted in repeated abortion. Similar analyses of aborted conceptuses from 148 sporadic early abortions (controls) were performed.

RESULT(S)

The incidence of chromosome abnormalities in anticardiolipin antibody-positive recurrent aborters was 20.0% (2 of 10 cases), which was significantly lower than that of patients with sporadic abortion (60.1%, 89 of 148 cases).

CONCLUSION(S)

The low incidence of chromosome abnormalities in aborted conceptuses of patients with positive anticardiolipin antibody suggests that this antibody is strongly implicated in the genesis of recurrent abortions.

Mutational analysis of BRCA1 gene in ovarian and breast-ovarian cancer families in Japan

We analyzed the alteration of BRCA1 in DNA obtained from 83 individuals of 13 Japanese site-specific ovarian cancer families and 6 breast-ovarian cancer families. Six germline mutations were detected in 7 families, which consisted of 4 breast-ovarian cancer and 3 site-specific ovarian cancer families, by single-strand conformation polymorphism analysis, followed by direct sequence determination. The mutations included three frameshifts, two nonsense mutations, and one missense mutation causing loss of a zinc-binding motif. The frequency of loss of heterozygosity at the microsatellite markers on the BRCA1 gene was 57% (8 of 14 cases) in site-specific ovarian cancer families, and 100% (6 of 6 cases) in breast-ovarian cancer families. All tumors of the patients carrying a mutation of BRCA1 showed deletion of wild-type alleles, implicating BRCA1 as a tumor suppressor gene. These results suggest that germline mutations of the BRCA1 gene play an important role in the carcinogenesis of breast and/or ovarian cancer in a majority of breast-ovarian cancer families and in some site-specific ovarian cancer families.

Direct intratumoral gene transfer of the herpes simplex virus thymidine kinase gene with DNA-liposome complexes: growth inhibition of tumors and lack of localization in normal tissues

To constitute the site-specific expression of the herpes simplex virus thymidine-kinase (HSV-TK) gene in tumor cells, we have assessed the promoter function of the simian virus 40 (SV40) promoter and the 5'flanking region of c-erbB-2 gene using a luciferase-expressing reporter plasmid. After the transfection of the luciferase plasmid directed by the promoter region of c-erbB-2 gene, a large amount of luciferase activity was observed in c-erbB-2-expressing cells (Colo201, MCF-7, and HEC1-A), while none was detected in cells with no expression of c-erbB-2 protein (HRA and KF cells). On the other hand, a high level of luciferase activity was detected in all tumor cell lines tested, when the transfection was performed with SV40 promoter. The repeated transfection of the liposome-conjugated HSV-TK gene regulated by the SV40 promoter or by the promoter region of c-erbB-2 gene with cultivation in 100 micrograms/ml of aciclovir for 5 days in vitro resulted in growth inhibition for all four cell lines examined or for only c-erbB-2-expressing cells in the presence of SV40 promoter or c-erbB-2 promoter, respectively. Finally, direct injection of the DNA-liposome complex into established tumors in the presence of 50 mg/kg of aciclovir led to significant tumor volume reduction in all three tumors tested when SV40 promoter was employed. However, this anti-tumor effect was noted only in c-erbB-2-positive cells (Colo201 cells) upon intratumoral injection of HSV-TK gene regulated by c-erbB-2 promoter. In the case of intratumoral gene transfer, foreign DNA was detected in only one of seven mice by polymerase chain reaction (PCR) analysis performed 7 days following injection. When PCR analysis was carried out at 14 or 21 days following injection, no DNA signal was found at all. However, DNA was detected in several normal tissues at all three times tested in the case of intravenous injection. No abnormalities were seen in histologic examinations of normal tissues or in serum biochemical parameters following DNA liposome delivery. These results suggest that the direct gene transfer of HSV-TK gene regulated by tumor-specific transcriptional units may be one of the most clinically promising of the selective genetic strategies against cancer.

[Genetic testing of BRCA1 for familial ovarian cancers]

Ovarian cancer is the most lethal kind of gynecological malignancy. Though combination therapy has improved, the prognosis is still poor. It is a risk factor to have a member affected with breast or ovarian cancer in one's family or to have been affected with these diseases. Genetic testing will more effectively enable earlier diagnosis and cure of such diseases. Including the selected results of familial ovarian cancers, we discuss the effectiveness and difficulty of genetic testing of BRCA1 in Japan.

Transvaginal ultrasonographic cervical assessment for the prediction of preterm delivery

To determine the usefulness of transvaginal ultrasonographic cervical assessment for the prediction of preterm delivery in an apparently normal population, 729 pregnant women (between 15 and 34 weeks' gestation) were randomly enrolled in the study in ten tertiary perinatal centers in Japan. Cervical parameters, including cervical length, internal os dilatation, and funneling depth, were measured by transvaginal ultrasound. The predictive values of these measurements for preterm delivery were investigated in a prospective fashion. Among various cervical parameters, cervical length showed the best correlation with pregnancy outcome. Cervical length (mm) was gradually decreased as the gestational age progressed, the regression line being y = 41.21-0.22x. When the mean cervical length minus 1 standard deviation at each gestational age was chosen as a cut-off value, the group with a shortened cervix showed a significantly high preterm delivery rate exclusively in the primigravidae (odds ratio: 4.86, 95% CI: 1.85-12.72). Internal os dilatation, in contrast, was a useful predictor in multiparous women (odds ratio: 6.00, 95% CI: 1.65-21.71). It was concluded that tranvaginal ultrasonographic cervical assessment, especially the measurement of cervical length, was effective for the prediction of preterm delivery in the primigravidae.

The roles of oligomenorrhoea and fetal chromosomal abnormalities in spontaneous abortions

The pathogenesis of spontaneous abortions, other than fetal chromosomal abnormalities, is not fully understood. We examined the incidence of oligomenorrhoea in relation to fetal chromosomal analyses and ultrasonographic examination in women who aborted spontaneously. The data demonstrated that the incidence of oligomenorrhoea was higher in women with normal fetal karyotyped abortions, especially normal karyotyped anembryonic pregnancies, than in those with abnormal karyotyped abortions (34.0 versus 12.5%, P < 0.01). Furthermore, the incidence of oligomenorrhoea was inversely correlated with fetal size exclusively in abortions with normal fetal karyotypes. It is suggested that oligomenorrhoea, i.e. delayed ovulation, itself may be closely associated with sporadic spontaneous abortion.

Accumulation of Tc-99m HMDP in hepatic metastasis from colon carcinoma without detectable calcification

A 51-year-old man was found to have hepatic metastasis from colon carcinoma. Bone scintigraphy with 99mTc-hydroxymethylene diphosphonate showed a ringlike accumulation corresponding to the hepatic mass, which was without calcification on computed tomography. Treatment with chemotherapeutic agents was started. After 4 months, computed tomography showed that the mass was smaller than before and that the margin was calcified. The extraosseous accumulation of the radionuclide may be evidence supporting earlier speculation on calcification that could not yet be detected by computed tomography.

Studies on the cytogenetic and endocrinologic background of spontaneous abortion

OBJECTIVE

To determine whether chronic menstrual irregularity with elevated LH levels has a role in spontaneous abortion.

DESIGN

In 41 consecutively examined women with spontaneous abortions occurring within 11 complete gestational weeks, fetal chromosomal analyses were performed. The differences of endocrinologic background in relation to the result of fetal chromosomal analyses were investigated.

MAIN OUTCOME MEASURES

Endocrinologic profiles, including menstrual history, basal hormone levels (LH, FSH, and PRL), ovarian morphology on ultrasound, and fetal chromosomal karyotypes.

RESULTS

The women with normal fetal karyotypes compared with those with abnormal fetal karyotypes showed higher frequency of menstrual irregularity (47.1% versus 8.3%), elevated basal LH levels (7.42 +/- 5.12 versus 4.41 +/- 1.39 mIU/mL; conversion factor to SI unit, 1.00), and higher frequency of polycystic ovary (41.2% versus 8.3%).

CONCLUSION

Elevated LH-polycystic ovary may be involved in the genesis of spontaneous abortions that are not explainable by fetal chromosomal abnormality.

Treatment for patients with recurrent abortion with positive antiphospholipid antibodies using a traditional Chinese herbal medicine

Twelve patients with recurrent abortion who had shown positive antiphospholipid antibodies were treated through the administration of a Japanese modified traditional Chinese herbal medicine Sairei-To (Chan ling-Tang) The patients had experienced a total of 27 spontaneous abortions in their previous pregnancies and had no other pregnancy history except for one patient. The patients were treated with 9.0 g of Sairei-To per day before their next pregnancy. The positive value of antiphospholipid antibodies returned to negative in 9 patients out of 12 patients through the treatment. Out of 12 patients, in 10 patients, their new pregnancy continued uneventfully and delivered an offspring (Success rate: 83.3%). Thus, the current treatment was considered to be an effective therapy for patients with recurrent abortion who were found to be positive for antiphospholipid antibodies.

Establishment of two distinct anti-cardiolipin antibody-producing cell lines from the same individual by Epstein-Barr virus transformation

Two anti-cardiolipin antibody (ACA)-producing cell lines were established, using Epstein-Barr virus transformation followed by a repeated cluster-picking from the same individual with antiphospholipid syndrome who had a history of 8 consecutive fetal losses and deep venous thrombosis. Characterization of the two ACAs derived from these cell lines revealed that one (Ab-019, subclass IgM, kappa) reacted exclusively with cardiolipin and showed strong lupus anticoagulant activity, while the other (Ab-226, subclass IgM, lambda) reacted with negatively charged phospholipids such as phosphatidylserine and phosphatidylglycerol, as well as cardiolipin. Furthermore, Ab-226 showed reactivity with human umbilical vein endothelial cells whereas Ab-019 did not. It is suggested that ACA is heterogeneous even in the same individual, and that reactivity against negatively charged phospholipids corresponds to reactivity against endothelial cell.

[Significance of the glucose concentration in amniotic fluid for the prediction of chorioamnionitis in preterm labor]

For the rapid and accurate prediction of the presence of chorioamnionitis (CAM) in preterm labor, amniotic fluid analyses were performed in 46 women with preterm labor between 24 to 34 weeks' pregnancy. Ultrasound-guided transabdominal amniocentesis was performed on admission and the amniotic fluid was subjected to the measurement of cell count, glucose, protein and chlorine concentration according to cerebrospinal fluid and neutrophil esterase analysis. The data demonstrated that the amniotic fluid glucose concentration was significantly lower in women with preterm birth/CAM(+) than that with preterm birth/CAM(-) and term birth (19.0 +/- 9.1, 28.0 +/- 7.6, 51.6 +/- 14.5 mg/dl, respectively). All of the women with a glucose concentration of 20mg/dl or less showed signs of CAM. By setting up a cut off value of 25mg/dl, both high sensitivity (81.8%) and specificity (91.4%) for the prediction of CAM were obtained. Positive predictive values for CAM of a glucose concentration of 20mg/dl or less and 25mg/dl or less were 100% and 75% respectively. It was concluded that amniotic fluid glucose concentration measurement is useful for the prediction of CAM. The presence of CAM should be considered when the amniotic fluid glucose concentration is 25mg/dl or less.

Evaluation of threatened preterm delivery by transvaginal ultrasonographic measurement of cervical length

OBJECTIVE

To establish a nomogram for the length of the uterocervical canal and to determine whether this can be used to predict preterm delivery.

METHODS

Cervical length was measured by transvaginal ultrasonography in 32 women (21 primigravid, 11 multigravid) with threatened preterm delivery, and in 177 normal singleton pregnancies between 18-37 weeks' gestation. Regression analysis was used to create the nomogram. Student t test was used to compare the groups.

RESULTS

A linear relationship was found between cervical length and gestational age (r = -0.4, P < .001). Comparison of cervical length on admission in the patients with threatened preterm delivery showed that 11 preterm deliveries occurred in women who had a mean cervical length of 23.2 mm (range 17-29), whereas 21 term deliveries occurred in women with a mean cervical length of 31.7 mm (range 21-42). The difference was significant (P < .001). A cervical length of less than 20 mm on admission had a positive predictive value of 100%. These patients had preterm delivery despite tocolytic therapy during hospitalization.

CONCLUSION

The risk of preterm delivery is high in women whose cervical length on admission is less than 30 mm, and strict management is required for those with a cervical length of less than 20 mm.

Ultrasonographic detection of a live fetus in recurrent spontaneous abortion during the first trimester

To examine whether recurrent spontaneous abortion (RSA) can be distinguished from repeated sporadic spontaneous abortion, the clinical course of 38 cases with three or more consecutive and unexplained first trimester RSAs were retrospectively investigated in this study. For comparison with controls, the clinical course was examined of 38 fertile females, who had had sporadic abortions. In 19 (50%) RSAs and 6 (16%) controls, fetal cardiac activity was demonstrated by ultrasound during the course of pregnancy. The rate of detection of live fetus during pregnancy or at 8 weeks +/- 7 days gestation, was significantly greater in the RSA group compared to the control. The rate of vaginal bleeding before spontaneous abortion was significantly less in the RSA group than in the control group. There was no difference between the two groups in age or gestational age at spontaneous abortion. The patients with RSA were all examined for antiphospholipid antibodies in their sera and these were detected in eight of them. However, there was no difference in the rate of positive fetal cardiac activity between the RSA patients who tested positive or negative for antibody. These results reveal that the clinical course of RSA is very different from the course of sporadic abortion. Although sporadic abortion is a common complication of pregnancy, RSA is not a random repeated abortion, but rather a separate disease from sporadic abortion in normal fertile females.

Drug-specific T cells derived from patients with drug-induced allergic hepatitis

Drug-induced allergic hepatitis is a tissue-specific inflammatory disease caused by hypersensitivity to a particular drug. Although the frequency of drug-induced allergic hepatitis appears to increase in proportion to the medicine, the mechanism by which tissue specificity is determined is still to be elucidated. In this study, we established CD4+ T cell clones specific for particular drugs from patients with drug-induced allergic hepatitis accompanied with mild blood eosinophilia and analyzed the possible role of liver protein as a directing factor of liver-specific inflammatory reactions. All CD4+ T cell clones obtained from two patients with this disease proliferated in response to a combination of the particular drug plus liver specific protein (LSP), which consists of over 30 proteins. Some T cell clones were responsive to an antigenic conformation consisting of the 200-kDa glycoprotein (partly purified LSP), a component of LSP, plus the causal drug. In contrast, all CD4+ T cell clones from a patient with simple drug-induced eosinophilia responded to the causal drug in the absence of LSP and partly purified LSP. These data suggested that LSP or partly purified LSP of the appropriate Ag is the target that leads to liver-specific inflammation in drug-induced allergic hepatitis. Furthermore, T cell lines derived from patients with drug-induced allergic hepatitis and simple drug-induced eosinophilia produced large amounts of IL-5 after the appropriate antigenic stimulation, whereas CD4+ T cell clones from donors with a normal amount of peripheral blood eosinophils secreted a much less IL-5. Taken together, these results indicate that overproduction of IL-5 by the allergen-sensitized T cells may result in blood eosinophilia.

Drug-specific T cells derived from patients with drug-induced allergic hepatitis

Drug-induced allergic hepatitis is a tissue-specific inflammatory disease caused by hypersensitivity to a particular drug. Although the frequency of drug-induced allergic hepatitis appears to increase in proportion to the medicine, the mechanism by which tissue specificity is determined is still to be elucidated. In this study, we established CD4+ T cell clones specific for particular drugs from patients with drug-induced allergic hepatitis accompanied with mild blood eosinophilia and analyzed the possible role of liver protein as a directing factor of liver-specific inflammatory reactions. All CD4+ T cell clones obtained from two patients with this disease proliferated in response to a combination of the particular drug plus liver specific protein (LSP), which consists of over 30 proteins. Some T cell clones were responsive to an antigenic conformation consisting of the 200-kDa glycoprotein (partly purified LSP), a component of LSP, plus the causal drug. In contrast, all CD4+ T cell clones from a patient with simple drug-induced eosinophilia responded to the causal drug in the absence of LSP and partly purified LSP. These data suggested that LSP or partly purified LSP of the appropriate Ag is the target that leads to liver-specific inflammation in drug-induced allergic hepatitis. Furthermore, T cell lines derived from patients with drug-induced allergic hepatitis and simple drug-induced eosinophilia produced large amounts of IL-5 after the appropriate antigenic stimulation, whereas CD4+ T cell clones from donors with a normal amount of peripheral blood eosinophils secreted a much less IL-5. Taken together, these results indicate that overproduction of IL-5 by the allergen-sensitized T cells may result in blood eosinophilia.

Serum erythropoietin levels in gynecologic cancer patients during cisplatin combination chemotherapy

To investigate the participation of erythropoietin (Epo) in anemias induced by cisplatin combined chemotherapy, serum Epo levels were measured by radioimmunoassay on a serial basis in eight patients with gynecologic cancer undergoing this chemotherapy. The data demonstrated that serum Epo levels, the mean level before chemotherapy being 20.1 +/- 6.6 mU/ml, were significantly elevated after the first course of the chemotherapy (52.1 +/- 32.2 mU/ml; P less than 0.05) when anemia was not evident. The serum Epo level continued to increase as the course of chemotherapy advanced, and furthermore, patients with normocytic anemia after a multiple course of this chemotherapy still showed high Epo levels (115.2 +/- 53.5 mU/ml) that were appropriate for given degrees of anemia. It is suggested that cisplatin combined chemotherapy caused the elevated serum Epo levels through an unknown mechanism other than anemia, and that in anemias induced by cisplatin, Epo deficiency is not evident.

[Choleretic effects of taurine on experimentally-induced intrahepatic cholestasis]

When a lymphokine, the cholestatic factor, is intravenously injected into rats through a mesenteric vein, remarkable reductions in bile flow and bile acid excretion are observed. However when taurine was injected with the cholestatic factor, the reduction in bile flow and bile acid excretion were significantly suppressed. Moreover, injection of taurine with cholestatic factor resulted in the decreases of both bile acid-dependent bile flow and vesicular transport but not bile acid-independent bile flow. Not significant choleretic effects were noted when taurine alone was administered to normal rats.

Immunotherapy with paternal lymphocytes preceding in vitro fertilization-embryo transfer for patients with repeated failure of embryo transfer

Immunotherapy with paternal lymphocytes for unexplained recurrent aborters was applied, preceding IVF-ET, for infertile women with repeated failure of ET. In one patient showing close histocompatibility with the husband, the subsequent new IVF-ET was successful under positive MLR-blocking antibody induced by immunotherapy.

Effectiveness of prednisolone/aspirin therapy for recurrent aborters with antiphospholipid antibody

Seventeen women with recurrent fetal loss associated with anti-phospholipid antibody were treated by prednisolone and low-dose aspirin (PSL/ASP) therapy from the early gestational period. The success rate of pregnancy in the treated patients was significantly higher than that in 12 untreated patients of similar background, including age, number of previous fetal losses and anti-cardiolipin titre (76.5 versus 8.3%, P less than 0.01). The degree of fetal growth retardation evident in previous pregnancies was also improved by the therapy, suggesting that PSL/ASP itself has a beneficial effect against placental damage. These clinical improvements were accompanied by a reduction in anti-phospholipid antibody titre, especially that of anti-phosphatidylserine antibody (anti-PS), to within the normal range within 8 weeks after PSL/ASP administration in most of the treated patients. There was no reduction of antibody titre in the untreated patients during pregnancy. It was concluded that PSL/ASP therapy, when started in the early gestational period (prior to 8 weeks gestation), was effective for the achievement of successful pregnancy and the prevention of fetal growth retardation and that the anti-PS titre was a good clinical marker for evaluating the effect of PSL/ASP therapy.

Systematization of clinical management for recurrent aborters by combined immunological testing

The natural outcomes of successive new pregnancies of 66 recurrent aborters were analysed in relation to their immunological profiles. The data demonstrated that the presence of anti-phospholipid antibodies (success rate 6.7%), positive anti-paternal cytotoxicity (8.7%) and a negative mixed lymphocyte reaction (MLR)-blocking effect (33.3%) in the patients' sera were factors associated with a poor prognosis. By the combined evaluation of these testings, a rational scheme of clinical management for recurrent aborters was established.

Influence of immunotherapy on the cellular immunity of unexplained recurrent aborters

Changes in lymphocyte subsets in whole blood were analyzed sequentially by flow cytometry with an automated leukocyte differential system in 15 patients with unexplained recurrent spontaneous abortions, each of whom underwent vaccination(s) with her husband's lymphocytes. Mitogen responses of peripheral blood lymphocytes (PBL) were also examined in these patients. The reactivity of PBL against mitogens revealed no significant change in each patient before and after vaccination(s) with her husband's lymphocytes. The CD4:8 ratio was observed to decrease significantly during 22 and 28 days after the first vaccination with a significant increase in the percentage of T suppressor-cytotoxic (CD8) cells. This change was also observed after the second vaccination. The percentages of other subsets did not change significantly after vaccination(s). In 11 patients out of 15, the pregnancy continued successfully and correlated with a predominance of Ts/c (CD8) over TH/I (CD4) cells in the first trimester. These changes in lymphocyte subsets may indicate the induction of immune enhancing mechanisms and it is suggested that continuation of the predominance of Ts/c cells induced by immunotherapy might be important for the successful maintenance of pregnancy.

A new lymphocyte serotyping using cytotoxic antibodies from secondary recurrent aborters and its application in cases of recurrent abortion and infertility

Using nonanti-human lymphocyte antigen (HLA) lymphocytotoxic antibodies derived from women with an abnormal pregnancy history including secondary recurrent abortion, a new series of serotyping was performed on lymphocytes from 37 couples (74 individuals), and the compatibility between the couples shown by the typing was investigated. The data demonstrated that both couples with primary recurrent abortion and infertile couples with repeated failure of embryo transfers after in vitro fertilization showed significantly close reaction patterns between partners than normal child-bearing couples by principal component factor analysis. It was concluded that this serotyping provides useful information on histocompatibility in the field of pregnancy immunology and that some cases of infertility because of implantation failure, as well as primary recurrent abortion, might be caused by underlying immunogenetical problems.

The role of cerebellar flocculus in adaptive gain control of ocular reflexes

Sustained oscillation of the head of an alert animal with inphase or outphase combination of screen oscillation in the horizontal plane induced marked adaptive changes in the gain of the horizontal vestibulo-ocular reflex (HVOR). These changes are assumed to be a prototype of motor learning by the cerebellar flocculus. Several lines of experimental evidence, using rabbits or monkeys as experimental material, have consistently suggested that the plastic changes of neuronal activities of a particular group of floccular Purkinje cells (H-cells) are the sources of the HVOR adaptation.

[Isotonic contraction of rabbit superior rectus muscle]

It is well known that the mammalian extraocular muscle has slow muscle fiber morphologically. But the contraction speed of slow muscle fiber has not been mentioned in previous reports. We studied the isotonic contraction of slow muscle fiber and compared it with fast muscle fiber. Each fiber bundle was isolated from the rabbit superior rectus muscle. Both light microscopic findings and the reaction to isotonic contraction in Ca2+ free Ringer's solution could identify each of the two muscle fiber types. Contraction speed depended on the frequency of stimuli (40-200 Hz) in both slow and fast muscle fiber. Maximum velocities of slow and fast fiber bundles were 4.3 +/- 1.53 mm/sec and 26.9 +/- 3.48mm/sec at 200Hz, respectively. It was suggested that the relaxation of slow muscle fiber did not interfere with the contraction of the fast muscle fiber. The relation between contraction velocity and afterload showed an approximately right angle hyperbolic curve.

[Rapid etiologic diagnosis of epidemic keratoconjunctivitis]

We evaluated enzyme-linked immunosorbent assay (Adenoclone) in 253 cases of epidemic keratoconjunctivitis (EKC), pharyngeal conjunctival fever (PCF) and acute conjunctivitis. The clinical diagnosis due to adenoviral ocular infection was 86/114 (75%) in EKC, 26/50 (52%) in PCF and 25/89 (28%) in acute conjunctivitis, Adenoclone was positive only within 7 days after the disease onset. The specificity (87%) and sensitivity (74%) of Adenoclone were confirmed by isolate cell culture. Cases with corneal complication due to adenoviral infection show higher a value than the OD value in Adenoclone and the bulbar conjunctiva is a suitable site to detect adenoviral antigen. In this survey, isolated adnovirus type 4 was recognized in 53%, Ad8 in 14%, Ad3 in 13%, Ad37 in 5%, Ad19 in 2% and non typed Ad in 12%. Clinical findings due to Ad4 showed EKC in 50%, PCF in 30% and acute conjunctivitis in 20% respectively.

Result of immunotherapy on patients with unexplained recurrent abortion: a beneficial treatment for patients with negative blocking antibodies

Thirty-nine unexplained recurrent aborters underwent vaccination using husband's lymphocytes according to the previously reported protocol. No mixed lymphocyte culture reaction-blocking antibodies (MLR-BAbs) were observed in these patients prior to vaccination. Of 35 newly pregnant patients after vaccination(s), pregnancy successfully continued in 28 (80.0%) and have already been terminated with a liveborn offspring. Pregnancy outcome was also analyzed in unexplained recurrent aborters who revealed positive MLR-BAbs without immunotherapy. In this group, out of eight pregnancies in seven patients, five (62.5%) continued beyond their critical period of 14 wks of gestation. Three infants born from these pregnancies, however, presented severe abnormalities. Furthermore, outcome of 14 pregnancies in 12 unexplained recurrent aborters with negative MLR-BAbs was analyzed since they had become pregnant without immunotherapy; pregnancy was successfully continued in only four cases (28.6%). Thus, vaccination using husband's lymphocytes on unexplained recurrent aborters with negative MLR-BAbs is suggested to be effective. In addition, it is suggested that immunotherapy for patients with positive MLR-BAbs should be carefully followed.

Cytotoxic antibody against trophoblast and lymphocytes present in pregnancy with intrauterine fetal growth retardation and its relation to anti-phospholipid antibody

To elucidate immunological mechanisms involved in the genesis of intra-uterine fetal growth retardation (IUGR), an in vitro cytotoxicity assay against normal trophoblast and lymphocytes was performed. The data demonstrated the existence of cytotoxic antibody directed against trophoblast exclusively in the IgG fraction of the sera of 9 out of 15 mothers with IUGR, but in none of the sera from normal pregnant women. This antibody showed differential reactivity patterns that may be indicative women. This antibody showed differential reactivity patterns that may be trophoblast in common. Out of 9 IUGR mothers with this cytotoxic antibody, in 6 cases (66.7%) chronic villitis was evident upon microscopic examination of the placenta, the frequency being significantly higher than that in IUGR mothers without cytotoxicity or in control mothers (P less than 0.02). It is suggested that in situ inflammatory change triggered by this antibody might lead to IUGR through chronic villitis. This antibody showed cross-reactivity with anti-negatively charged phospholipid antibody, as confirmed by an absorption experiment, indicating that the trophoblast antigenic stimuli in pregnancy can induce the production of various autoantibodies including anti-phospholipid antibodies. These results are of interest in relation to the pathogenesis of autoimmune diseases.

Cardiac magnetic resonance imaging in evaluation of anatomical structure and function of the ventricles

Cardiac magnetic resonance imaging (MRI) is being widely employed for evaluation of cardiovascular anatomies and functions. However, the indications for cardiac MRI to obtain information which cannot be obtained using other conventional methods have not yet been determined. To demonstrate of usefulness of MRI in delineating the apex of the left ventricle and free wall of the right ventricle, end-diastolic short axis MRI images were obtained in 20 patients with apical hypertrophy and in 9 normal volunteers. To compare the accuracy of estimations of left ventricular volumes obtained using the modified Simpson's method of MRI with that using the MRI area length method, 19 patients, in whom left ventriculography had been performed, were studied. The apex of the left ventricle was evaluated circumferentially and distribution of hypertrophied muscles was defined. Sixty-five percent of the length of the right ventricular free wall was clearly delineated. Correlation coefficients of the ejection fraction between MRI and angiography were 0.85 with the modified Simpson's method of MRI, and 0.62 with the area length method of MRI. Three themes were chosen to demonstrate good clinical indications for cardiac MRI.

[Mitral valve prolapse in patients with surgically-closed atrial septal defect]

To evaluate the prevalence, causes and clinical significance of mitral valve prolapse (MVP) associated with surgically-closed atrial septal defect (ASD), 90 patients (M: 41, F: 49) were studied using two-dimensional and color-coded Doppler echocardiography. Among the 90 patients, preoperative echocardiograms were available in 27. MVP was found in 21 of the 27 patients (78%) preoperatively, but it was found in 59% (16/27) postoperatively. In total, MVP was detected in 50 of the 90 patients (56%) postoperatively. The postoperative MVP group had higher pulmonary-to-systemic flow ratios (3.6 +/- 1.9 vs 2.8 +/- 1.1, p less than 0.05) and higher mean pulmonary arterial pressures (21 +/- 11 vs 13 +/- 5 mmHg, p less than 0.01) at the time of surgery. Between the two groups with or without MVP postoperatively, there was no difference (p less than 0.05) in age at surgery, the postoperative duration and left ventricular (LV) deformity index both in pre- and postoperative states. A mitral regurgitant (MR) murmur was recorded in seven patients postoperatively. However, only two had clinically severe MR. It was concluded that MVP is frequently detected in patients with closure of ASD and it is related neither to degree of the LV deformity nor to age at operation; rather, it is related to the severity of the preoperative hemodynamic state. Clinically significant MR is rare in the postoperative period.

[Venous hum and innominate vein flow velocity in chronic anemia: a pulsed Doppler echocardiographic study]

To assess the hemodynamic correlates of the cervical venous hum in patients with chronic anemia, 14 patients (mean age; 49 years, mean hemoglobin (Hb); 7.3 g/dl) and 14 control subjects (mean age; 50 years, mean Hb; 14 g/dl) without cardiac disease were studied by auscultation, phonocardiography and Doppler echocardiography in two positions (supine and sitting). Venous hum was detected in the sitting position in 11 of the 14 anemic patients whose Hb was less than 9 g/dl, and in six anemic patients in the supine position, while venous hum was absent in the control subjects in both positions. Pulsed Doppler echocardiography with the transducer in the supraclavicular fossa revealed significantly (p less than 0.01) higher peak velocity in the innominate vein in the 11 anemic patients with venous hum (supine; 71 +/- 12, sitting; 111 +/- 24 cm/sec, mean +/- SD) than in the control subjects (supine; 46 +/- 15 sitting; 76 +/- 27 cm/sec) in both positions. Intensity of venous hum increased concomitantly with increased innominate vein flow velocity when the body position was changed from supine to sitting. Peak velocity in the innominate vein correlated significantly with Hb in all study subjects (r = 0.65, p less than 0.01). In conclusion, the cervical venous hum in patients with chronic anemia is related to the hemoglobin concentration and flow velocity in the innominate vein.

Aortic regurgitation associated with hypertrophic cardiomyopathy: a colour Doppler echocardiographic study

The frequency, severity, and cause of aortic regurgitation were assessed by colour Doppler and cross sectional echocardiography in 87 patients (mean SD) age 57 (12) years) with hypertrophic cardiomyopathy, and 48 age matched controls (57 (8) years). Aortic regurgitant murmurs were recorded in only three of 87 patients and in none of the controls. Colour Doppler echocardiography showed an aortic regurgitant signal in 20 (23%) of the patients and three (6%) of the 48 controls. The colour Doppler signals typical of aortic regurgitation were limited to the left ventricular outflow tract. There were no significant differences between patients with hypertrophic cardiomyopathy with and without aortic regurgitation in terms of age (59 years v 56 years), blood pressure (140/84 mm Hg v 136/80 mm Hg), aortic diameter (34 mm v 33 mm), or frequency of calcification of the aortic valve (15% v 10%) and of systolic anterior motion of the mitral valve with mitral-septal contact (25% v 16%). On cross sectional echocardiograms, the degree of septal protrusion into the left ventricular outflow tract during systole was significantly more prominent (15 v 10 mm), and the portion of the basal septum that protruded most deeply into the left ventricular outflow tract was significantly closer to the aortic annulus in patients with aortic regurgitation than in those without it (11 v 14 mm). Mild aortic regurgitation was found in almost a quarter of patients with hypertrophic cardiomyopathy. The regurgitation was related to the morphological abnormality of the left ventricular outflow tract.

[Prevalence of mitral valve prolapse in patients with premature ventricular contractions and the relationship between the prolapse and the types of premature contractions]

To assess the prevalence of mitral valve prolapse (MVP) in patients with premature ventricular contractions (PVCs), 109 patients with PVCs (M: 69, F: 40, 42 +/- 20 years; mean +/- SD) and 50 control subjects (M: 38, F: 12, 47 +/- 10 years) were studied by echocardiography. MVP was diagnosed by two-dimensional echocardiography. The criterion for mitral valve prolapse by two-dimensional echocardiography is extension of the mitral leaflet to the left atrial side beyond the plane of the mitral annulus. In addition, 60 patients with PVCs were examined by 24-hour Holter ECG and scored by the Lown's classification. Results were as follows: 1) MVP was detected more frequently in patients with PVCs than in the control subjects (22/109, 20% vs 3/50, 6%, p less than 0.05) by echocardiography. 2) PVC patients with MVP were significantly younger than patients without MVP (34 +/- 14 vs 47 +/- 21 yrs, p less than 0.05), but there were no significant differences between these two groups as to sex, left atrial diameter and left ventricular dimension. 3) The 24-hour Holter ECG revealed that the high grade PVCs (Lown grade III & IV) was more closely related to the absence of MVP (20/45, 44% vs 4/11, 36%), though this trend did not reach statistical significance. It was suggested that MVP is not a major determinant of PVC, and life-threatening arrhythmias are more likely related to cases without MVP.