Prognostic significance of lymph node metastasis and clear cell histology in ovarian carcinoma limited to the pelvis (pT1M0 and pT2M0)

BACKGROUND

The prognostic significance of lymph node (LN) metastasis in clinically early-stage (pT1M0 or pT2M0) ovarian carcinoma has not yet been fully elucidated.

METHODS

From 1988 to 1997, 94 patients with ovarian carcinoma of pT1M0 (n = 78) or pT2M0 (n = 16) classification underwent surgery including systematic pelvic and paraaortic LN dissection. We investigated the prognostic factors of intraperitoneally determined early-stage ovarian carcinoma focusing on LN metastasis.

RESULTS

LN metastasis was seen in 5.1% of pT1M0 and in 31.3% of pT2M0 tumors. Univariate analysis of grade, histology (clear cell vs others), size of primary tumor, peritoneal cytology, and LN metastasis revealed that histology (P < 0.01), size of tumor (P < 0.05), and LN metastasis (P < 0.0005) were related to patient survival of early-stage ovarian carcinoma. Peritoneal cytology (P = 0.053) and grade (P = 0.059) had marginal statistical significance. A multivariate Cox regression analysis showed that clear cell histology (P < 0.05) and LN metastasis (P < 0. 005) are significant independent prognosticators of patient survival. Three (two with clear cell adenocarcinoma and one with mucinous adenocarcinoma) of nine patients with LN metastasis had died of the disease by the time of the present analysis. Two of the three deceased patients had recurrent tumors in distant organs (bone and brain/liver), one had pleural and peritoneal carcinomatosis, and no patients had retroperitoneal recurrence. This suggests that LN metastasis indicates that tumor cells may have already spread systemically at the time of treatment and, at the same time, retroperitoneal lymph node dissection (RPLND) may be effective in eradicating retroperitoneal metastasis in some instances of ovarian carcinoma.

CONCLUSION

Clear cell histology and LN metastasis are indicators of poor prognosis for patients with tumors limited to the pelvis. Therapeutic significance of systematic RPLND for pT1M0/pT2M0 ovarian carcinomas needs to be further investigated by randomized studies.

Clinical study of cefpirome sulphate in obstetric and gynaecological infections

Cefpirome sulphate is a fourth-generation cephem antibiotic, which has a broad spectrum of antibacterial activity against Gram-positive and -negative bacteria, and is highly stable to beta-lactamase. Cefpirome sulphate was administered to 166 patients with obstetric or gynaecological infections, and its clinical and antibacterial effect was evaluable in 139. Excluding seven patients who violated the study protocol by receiving concomitant drugs, the safety of cefpirome sulphate was assessed in 159 patients. In the 139 patients in whom efficacy was evaluated, the improvement rate was 80.6% (112/139) and the eradication rate 72.6% (45/62). The eradication rate for bacteria isolated from the patients at the start of the study was 84.7% (111/131). No resistance to cefpirome sulphate was observed in Enterococcus faecalis or Bacteroides species. Systemic erythema and nausea each occurred in one patient, and nine patients showed abnormal hepatic function test results. These results suggest that cefpirome sulphate is effective in the treatment of obstetric and gynaecological infections and has a good side-effect profile.

Two cases of endometrial cancer meeting new clinical criteria for hereditary nonpolyposis colorectal cancer

BACKGROUND

New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC) that includes extracolonic cancers were recently proposed. We present 2 endometrial cancer patients who met the new criteria of 161 endometrial cancer patients.

CASE REPORTS

Case 1: A 55-year-old female was operated on for synchronous double primary cancers of the endometrium and rectum. She had also undergone an operation for metachronous ascending colon cancer at the age of 44. She had five relatives with a history of colorectal cancer. The rectal cancer tissue revealed no microsatellite instability (MSI). Case 2: A 48-year-old female underwent a radical operation for synchronous double primary cancers of the endometrium and ovaries. She had three relatives with a history of colorectal cancer. The endometrial cancer tissue showed high MSI.

CONCLUSIONS

The frequency of endometrial cancer patients meeting the new HNPCC criteria was 1.2% (2/161). These are the first case reports selected from consecutive endometrial cancer patients.

Factors influencing pulmonary surfactant protein A levels in cord blood, maternal blood and amniotic fluid

The purpose of this study was to evaluate factors that influence pulmonary surfactant protein A (SP-A) levels in cord blood, maternal blood and amniotic fluid, as well as to establish the normal range of serum SP-A. Labor significantly influenced cord blood SP-A levels. The SP-A levels in maternal blood after delivery were correlated with, but higher than those before delivery. There was a correlation between SP-A levels in amniotic fluid and cord blood. Neonatal serum SP-A was not correlated with maternal SP-A levels. The normal range of SP-A in cord blood was 2.7-21.7 ng/ml following cesarean section without labor, 4.8-50.2 ng/ml after labor at gestational weeks 36-38, and 12.2-44.6 ng/ml at gestational weeks 39-41. SP-A levels in maternal blood before and after delivery and amniotic fluid were 6. 0-74.0, 9.6-73.6 and 403.4-24,540 ng/ml, respectively.

Effects of inflammatory cytokines on prostaglandin E(2) production from human amnion cells cultured in serum-free condition

The effects of five inflammatory cytokines, i.e. interleukin(IL)-1alpha, IL-1beta, IL-6, IL-8 and tumor necrosis factor-alpha (TNF-alpha) on prostaglandin E(2) (PGE(2)) production from amnion cells cultured in a serum-free condition was evaluated. After human amnion cells obtained from term placenta were incubated with the inflammatory cytokines at various concentrations, PGE(2) production in the culture supernatant was determined using an enzyme immunoassay method. Under a serum-free culture condition, an increase in PGE(2) production by IL-1alpha and IL-1beta was observed at concentrations of 10 and 100 ng/ml compared to control cultures. However, the increases in PGE(2) production by IL-6 and IL-8 were found at relatively high concentrations, i.e. at 100 and 200 ng/ml. TNF-alpha induced a significant increase in PGE(2) production at 50 and 100 ng/ml, but not at 200 ng/ml. These data suggest that these inflammatory cytokines directly stimulate PGE(2) production from amnion cells and may initiate premature labor if amniotic inflammatory cytokines are elevated, e.g. following intrauterine infection.

Retention versatility of silica-supported comb-shaped crystalline and non-crystalline phases in high-performance liquid chromatography

Silica-supported comb-shaped polymer (Sil-ODA18) provided a specific selectivity towards aromatic and non-aromatic solutes. Selectivity of Sil-ODA18 and ODS (polymeric and monomeric) columns towards polycyclic aromatic hydrocarbons and geometric isomers have been discussed in respect of molecular shapes and sizes. The retention versatility of this phase arises from the orientation change on transition from the ordered crystalline to the less ordered non-crystalline state. Selectivity in the crystalline and non-crystalline regions of Sil-ODA18 is similar to that of polymeric and monomeric ODS phases, respectively. Sil-ODA18 column also exhibited the characteristic temperature dependency of liquid-crystalline phases, i.e., an increase in retention with increasing temperature on transition from crystalline to isotropic state.

Novel mutation (E113X) of antithrombin III gene (AT3) in a woman with gestational recurrent thrombosis

A 35-year-old Japanese woman with a low level (42-54%) of blood antithrombin (AT) III, experienced two induced abortions due to deep venous thrombosis at 8 weeks of gestation (GW) and cerebral thrombosis at 10 GW. The present pregnancy was successfully managed with intravenous administration of AT III (6,000-8,000 U/wk). Analysis of polymerase chain reaction (PCR)-single strand conformation polymorphism (SSCP) for exons 3A and 4 of the AT III gene (AT3) using her DNA revealed extra expansion bands with altered migration. The DNA sequencing demonstrated novel mutations in exon 3A of AT3: a G to T substitution at nucleotide position 5333 in codon GAG for Glu 113, causing a stop codon (E113X), and an A to T substitution at position 5338 in codon AAA for Lys 114, forming Asn (K114N). These novel mutations, especially E113X, in AT3 may be related to recurrent thrombosis in the pregnancy.

Prognostic significance of serous and clear cell adenocarcinoma in surgically staged endometrial carcinoma

BACKGROUND

The serous adenocarcinoma (SA) and clear cell adenocarcinoma (CCA) of endometrium have been shown to be associated with high relapse rate and poor survival. It is not clear whether prognostic significance of these specific cell types of tumor is independent of retroperitoneal lymph node metastasis and other histopathologic prognostic factors in endometrial carcinoma.

METHODS

We examined 240 consecutive patients with clinical stage I to stage III endometrial carcinoma who were treated prospectively with radical surgery and/or platinum-based chemotherapy. Surgery included extended hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic and paraaortic lymph node dissection. Prognostic significance of various histopathologic factors was determined by Cox regression analysis.

RESULTS

SA/CCA were more frequently associated with deep myometrial invasion, high nuclear grade (G3), lymph-vascular space invasion (LVSI), and pelvic lymph node metastasis when compared to endometrioid adenocarcinoma (EMA). Of 216 clinically staged stage I or II disease, seven of 12 cases of SA/CCA had extrauterine disease. This incidence was much higher than that for EMA (46/204) (p<0.01). A multivariate Cox regression analysis revealed that cell type, grade, LVSI, and paraaortic node metastasis (PANM) were independent prognosticators.

CONCLUSIONS

Prognosis of patients with endometrial carcinoma depends on cell type, grade, LVSI, and PANM. Poor prognosis for patients with SA/CCA is independent of lymph node metastasis and other histopathologic prognostic factors. The SA/CCA should be strictly discriminated from EMA.

Efficacy of maternal serum screening in the prenatal detection of fetal chromosome abnormalities in Japanese women

OBJECTIVE

This prospective study assesses the efficacy of maternal serum screening for use in prenatal diagnosis of fetal anomaly and chromosome imbalance in Japanese women.

METHODS

Maternal serum alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol were measured in 1,055 singleton pregnant women between 14 and 20 weeks of gestation. A calculated risk for trisomy 21 of >/=1/299 or alpha-fetoprotein >/=2.5 multiples of the median was adopted as positive.

RESULTS

Three hundred and seventy-eight of the 1, 055 women screened (35.8%) were identified as positive. Sensitivity, false-positive rate, and positive predictive value in women aged <35 years were 60.0, 10.6, and 6.8%, respectively, and these values were 87.5, 49.3, and 4.2%, respectively, in women aged >/=35 years. The false-positive rate in women aged <35 years was significantly lower than that for women aged >/=35 years (p < 0.001). Chromosomal abnormalities were identified in 21 cases, including 10 with trisomy 21, 5 with trisomy 18, 2 with trisomy 13, and 4 with other chromosomal disorders. Seventeen of the 21 cases (81.0%) showed screen-positive results, and among these all 10 cases with trisomy 21 were detectable. Two cases with trisomy 18, 1 with trisomy 13 and 1 with isochromosome X showed extremely low human chorionic gonadotropin levels (0.4 +/- 0.1 multiples of the median, mean +/- SE), although they were screen negative. Of the 264 women who did not undergo amniocentesis, none had any clinical findings consistent with aneuploidy after birth.

CONCLUSIONS

Our results suggest that the evaluation of each serum marker, as well as of the calculated risk, was significantly important in the prenatal detection of fetal aneuploidy.

Prediction of respiratory distress syndrome by the level of pulmonary surfactant protein A in cord blood sera

The purpose of this study was to determine the utility of measuring the level of pulmonary surfactant protein A (SP-A) in cord blood sera to predict for respiratory distress syndrome (RDS). SP-A levels in cord blood sera from 48 infants born at gestational ages < 32 weeks were measured by a sandwich ELISA system. Mean value of SP-A in cord blood was 5.8 ng/ml in cases with RDS and 15.1 ng/ml in those without RDS (p = 0.002). The best cut-off point of cord blood SP-A to predict RDS was determined as 10 ng/ml. The sensitivity and the specificity of the cut-off point for predicting RDS were 81 and 76%, respectively. Multivariate regression analysis showed that high SP-A level in cord blood, premature rupture of the membranes longer than 24 h and heavy birth weight were all significantly related to the non-RDS outcome.

Selectivities of dihydropyridine derivatives in blocking Ca(2+) channel subtypes expressed in Xenopus oocytes

Some dihydropyridines (DHPs), such as amlodipine and cilnidipine, have been shown to block not only L-type but also N-type Ca(2+) channels; therefore, DHPs are no longer considered as L-type-specific Ca(2+) channel blockers. However, selectivity of DHPs for Ca(2+) channel subtypes including N-, P/Q-, and R-types are poorly understood. To address this issue at the molecular level, blocking effects of 10 DHPs (nifedipine, nilvadipine, barnidipine, nimodipine, nitrendipine, amlodipine, nicardipine, benidipine, felodipine, and cilnidipine) on four subtypes of Ca(2+) channels (L-, N-, P/Q-, and R-types) were investigated in the Xenopus oocyte expression system with the use of the two-microelectrode voltage-clamp technique. L-type Ca(2+) channels expressed as alpha(1C)alpha(2)beta(1a) combination were profoundly blocked by all DHPs examined, whereas blocking actions of these DHPs on R-type (alpha(1E)alpha(2)beta(1a)) channels were equally weak. In contrast, 5 of the 10 DHPs (amlodipine, benidipine, cilnidipine, nicardipine, and barnidipine) significantly blocked N-type (alpha(1B)alpha(2)beta(1a)) and P/Q-type (alpha(1A)alpha(2)beta(1a)) Ca(2+) channels. These selectivities of DHPs in blocking Ca(2+) channel subtypes would provide useful pharmacological and clinical information on the mode of action of the drugs including side effects and adverse effects.

BRCA1 mutation testing for Japanese patients with ovarian cancer in breast cancer screening

From February 1996 to April 1998, 2967 women received screening for breast cancer in the gynecologic ambulatory practice of the Hokkaido University Hospital. In 116 Japanese women with epithelial ovarian cancer, mutation analysis of BRCA1 exon 11 in genomic DNA was performed by the stop codon (SC) assay and DNA sequence analysis. Clinicopathological factors were also investigated in these patients. The aim of this study was to examine the advantages of performing BRCA1 mutation testing for ovarian cancer patients during breast cancer screening. We achieved a high detection rate (6.0%) of patients with germline mutations in BRCA1. The high frequencies of breast ovarian cancer syndrome, serous adenocarcinoma, high histological grades, advanced FIGO stages, and breast cancer as double cancer were found to be characteristic of ovarian cancer with germline mutations in BRCA1. These characteristics may assist physicians in selecting BRCA1 mutation testing for ovarian cancer patients. The mean age at diagnosis of ovarian cancer was 51.0 and 51.2 years in the groups with and without mutation, respectively, and no difference was found in age at diagnosis. All of the nine living female mutation carriers were offered the options of increased surveillance or prophylactic surgery, and all chose the former. We have performed breast cancer screening and/or ovarian cancer screening every 6 months for these carriers. This may allow another advantage in establishing a relationship of mutual trust with a patient from a series of responsible follow-ups.

Clinicopathological comparisons of familial and sporadic cases in 219 consecutive Japanese epithelial ovarian cancer patients

BACKGROUND

It is estimated that approximately 5-10% of epithelial ovarian cancer patients in Western countries are associated with an autosomal dominant inheritance with variable penetrance. There are a few reports of familial ovarian cancer in Japan and considerable uncertainties remain regarding Japanese familial ovarian cancer. The aim of this study was to clarify the clinicopathological features of Japanese familial ovarian cancer.

METHODS

We studied clinicopathological findings for 219 consecutive epithelial ovarian cancer patients treated at our institution from April 1987 to September 1997.

RESULTS

Eleven patients in nine families were diagnosed as familial ovarian cancer and the incidence of familial cases was 5.0%. Most women (90.9%) with familial cases were diagnosed as the breast ovarian cancer syndrome, whereas ovarian cancer associated with hereditary nonpolyposis colorectal cancer was relatively rare (9.1%). Serous adenocarcinoma, high histological grade, advanced FIGO stage and breast cancer as multiple primary cancer were significantly more common in familial cases compared with sporadic cases (p < 0.001, p < 0.05, p < 0.005 and p < 0.005, respectively). Earlier age of onset was thought to be a characteristic of familial ovarian cancer in Western countries; however, we did not find any difference in age at diagnosis between familial and sporadic cases (53.4 vs 51.3 years). The prognosis of familial ovarian cancer remains controversial and our data did not show a significant difference (p = 0.45) in prognosis between these two groups.

CONCLUSION

These findings, except for age at diagnosis, in Japanese familial ovarian cancer are in accordance with the features of familial ovarian cancer in Western countries.

Morphological aspects of ectopia cordis: four case reports and a review of the literature

Ectopia cordis is a rare congenital anomaly. We present 4 cases of ectopia cordis, 1 of which is the first report of an affected fetus in a triplet pregnancy. The morphological relationship between the types of ectopia cordis and their outcomes were investigated in all 4 cases. In addition, the literature on ectopia cordis in Japan was reviewed and discussed.

Tubal pregnancy in a unicornuate uterus with rudimentary horn: a case report

OBJECTIVE

To report a case of tubal pregnancy in a unicornuate uterus with rudimentary horn on the side of the rudiment and its pathology.

DESIGN

Case report.

SETTING

University hospital.

PATIENT

An 18-year-old woman, primigravida, with tubal pregnancy.

INTERVENTION(S)

Systemic administration of methotrexate, salpingectomy by laparotomy, and laparoscopic surgery for resection of rudimentary horn.

MAIN OUTCOME MEASURE(S)

Emergent laparotomy revealed that the intraperitoneal hemorrhage was caused by the rupture of the tubal pregnancy on the same side as the rudimentary horn of the unicornuate uterus. A corpus luteum was found at the ipsilateral ovary of the rudimentary horn.

RESULT(S)

Image diagnosis and pathological examination of the rudimentary horn revealed that this uterine malformation was a unicornuate uterus with a noncommunicated, noncavitary rudimentary horn, corresponding to class IIc of the American Fertility Society classification of müllerian anomalies.

CONCLUSION(S)

This is the first report of a tubal pregnancy on the side of the noncommunicating rudimentary horn with the ipsilateral ovary carrying a corpus luteum in a unicornuate uterus.

Recent trends in the prevalence of Down syndrome in Japan, 1980-1997

The aims of the present study were to determine recent trends in the prevalence of Down syndrome (DS) in Japan, and to determine whether recent changes in demographic and social habits and access to prenatal diagnosis have influenced the livebirth rates of DS. Livebirth statistics indicate that the birth rate in Japan has decreased for women in their 20s and has increased for those in their 30s and 40s. During an 18-year period between 1980 and 1997, 1,299 consecutive DS infants were born among a total of 2,232,694 births, a rate corresponding to approximately 10% of all births in Japan over the same period. The increasing risk of DS with advancing maternal age was confirmed. The overall prevalence was 5.82 DS births per 10,000 livebirths (8.3-9.7 per 10,000 after correction according to the estimated ascertainment ratio: 60-70%). The prevalence rate by year of child birth represents a statistically significant increase (P = 0.001). In conclusion, recent trends in the prevalence of DS in Japan from 1980 to 1997 failed to show a consistent tendency to decrease, probably because of the concomitant increase in pregnancy in advanced maternal age.

Coagulation and fibrinolytic activity in rats with naturally occurring gingivitis

It is well known that there are several coagulation factors and fibrinolysis factors, and these inhibitors are also present in blood and tissues. Normally, these factors balance each other. We measured antithrombin III (AT III), an important inhibitor of coagulation and alpha 2-plasmin inhibitor (alpha 2-PI), a factor inhibiting fibrinolysis in blood and gingival tissue of naturally occurring gingivitis rats (ODUS/Odu) and control rats (Res). Blood plasma and supernatants of gingival homogenate from ODUS/Odu and Res were used as samples. And concentrations of alpha 2-PI and AT III were measured by colorimetric assay using commercially available reagents. We found no difference in blood concentrations of alpha 2-PI or AT III between ODUS/Odu and Res groups. However, AT III in the gingiva showed a significantly higher value in the ODUS/Odu group versus that in the controls (p < 0.001). There was a high positive correlation between AT III in gingival tissue and pocket probing depth. Moreover, the fibrinolytic activity in saliva and the gingiva from ODUS/Odu increased with each passing month. Results suggest that both the decrease in blood coagulability and systemic enhancement of fibrinolytic activity due to increased AT III in gingival tissue are associated with the bleeding tendency and inflammatory response in the gingiva of ODUS/Odu.

Use of PCR serum in diagnosing and monitoring cytomegalovirus reactivation in bone marrow transplant recipients

We previously reported that the use of polymerase chain reaction (PCR) in detecting cytomegalovirus (CMV) DNA in serum (sPCR) enables the detection of CMV viremia, which has not been possible with other methods. In this study, the clinical usefulness of sPCR was investigated by comparison with the results of three other diagnostic methods, i.e., antigenemia assay (AG), shell vial culture test (shell vial), and complement-fixing (CF) antibody titer. The present study included 26 patients with hematological diseases who had undergone allogeneic bone marrow transplantation (BMT). A total of 347 samples were collected, and the results of the sPCR and AG methods were in agreement in 91.1% of the samples. When a subject was positive in both the sPCR and AG tests, and the other two tests (shell vial and CF) were also positive, CMV reactivation was surmised as definite. When only the result of the shell vial test or the CF test was positive, these results were taken as false-positives. The time at which the samples became positive in each of these four tests was 7.5 weeks post-BMT for sPCR, 7.0 weeks post-BMT for the AG test, 7.4 weeks post-BMT for the shell vial test, and 9.7 weeks post-BMT for the CF test. Thus, it was found that samples became positive at almost the same time for the sPCR, AG, and shell vial tests. Interstitial pneumonitis (IP) due to CMV developed in 3 subjects. These cases were positive in the sPCR, AG, and shell vial tests prior to the manifestation of symptoms of IP. The CF test did not become positive until after the onset of the disease. As the IP due to CMV was controlled with treatment, the sPCR and AG tests became negative. With the shell vial and CF tests, on the other hand, the test results continued to be positive even after the IP was cured. These findings demonstrate that the sPCR test method--like the AG test--yields few false-positive results. Therefore, the sPCR method is useful in early diagnosis of reactivation of CMV and for evaluation of the efficacy of therapy administered for IP. In addition, sPCR can be performed simultaneously on a large number of samples, and the evaluation of the test results is simple. We conclude that the sPCR test may be superior to the three other diagnostic methods for evaluation of serum samples from multiple institutions.

Prenatal identification of mos 45,X/46,X,+mar in a normal male baby by cytogenetic and molecular analysis

We report a case of mos 45,X/46,X,+mar, diagnosed prenatally by amniocentesis, whose physical examination, including external and internal organs, along with serum testosterone values were normal five years after delivery. The mosaic karyotype was seen in 146 of 240 cells examined (amniotic fluid cells, 110/65; placental chorionic villi: 5/4; cord blood, 21/81; cultured skin fibroblasts, 10/90) from 386 metaphases, and the marker chromosome appeared as a small non-fluorescent acrocentric chromosome. All autosomes appeared normal, and no normal Y chromosome could be demonstrated. Analysis of 26 Y-chromosome loci by molecular techniques such as PCR, Southern analysis using multiple Y-specific DNA probes, and Hae III restriction endonuclease assessment of male-specific repeated DNA in the heterochromatic region of the Y chromosome, and fluorescence in situ hybridization (FISH), revealed the marker was derived from a Y chromosome including p terminal to q11.23, and paracentric inversion in the remaining Y long arm. The formation of testes can be considered as existence of SRY (sex-determining region of Y) as a testis-determining factor. The present report illustrates the importance of FISH and molecular techniques as a complement to cytogenetic methods for accurate identification and characterization of chromosome rearrangements in prenatal diagnosis.

Expression of telomerase activity in human endometrium is localized to epithelial glandular cells and regulated in a menstrual phase-dependent manner correlated with cell proliferation

Telomerase activity is observed in most malignant tumors and germ cells, whereas normal somatic cells usually do not express it. Human endometrium is composed of glandular and stromal components and exhibits dramatic changes in proliferative activity during the menstrual cycle, which is exquisitely regulated by estrogen function. We previously reported that normal human endometrium expresses telomerase activity. However, it remains unclear which of the above components are the major sources of telomerase activity and how levels of telomerase activity are regulated over the menstrual cycle. Quantitative analysis of telomerase activity revealed that it changes dramatically over the course of the menstrual cycle and is strictly regulated in a menstrual-phase-dependent manner. Maximal activity equivalent to that in endometrial cancer was present in late proliferative phase, and minimal activity in late secretory phase. Postmenopausal endometrium and endometrium treated with anti-estrogen drugs exhibited decreased telomerase activity. Testing isolated epithelial glandular cells and stromal cells, we found that telomerase activity was localized to epithelial glandular cells. In situ RNA hybridization analysis also revealed epithelial-specific expression of human telomerase RNA. In vitro analysis of cultured epithelial cells demonstrated that telomerase activity is correlated with epithelial proliferation but not affected by estrogen treatment. These findings suggest that expression of telomerase activity is specific to epithelial cells and linked to cell proliferative status. The involvement of estrogen in telomerase regulation remains to be elucidated.

Concentration-dependent block of sodium current in guinea pig ventricular myocytes by a class III antiarrhythmic agent, MS-551

Although MS-551 is classified as a class III antiarrhythmic agent (K+ channel blocker), its effect on the Na+ channel has not been fully characterized. We investigated the effect of MS-551 on the Na+ current (I(Na)) in isolated guinea pig ventricular myocytes. MS-551 blocked I(Na) in a concentration-dependent manner at a holding potential of -140 mV. The concentration-response curve revealed that the median inhibitory concentration (IC50) for the block of resting channel was 292 +/- 20 microM with a Hill coefficient of 1 (n = 11). Although MS-551, 300 microM, did not show a use-dependent block, it shifted the steady-state inactivation curve in a hyperpolarizing direction by 6.3 +/- 0.8 mV and delayed the recovery process from long depolarization. This delay was considered to be related to the drug unbinding and was expressed by a triple exponential function. The slowest component had a time constant of 409 +/- 35 ms, and the proportion of the amplitude of this component to the total current amplitude was 14 +/- 3% (n = 6). The IC50 for the inactivated Na+ channel was thus estimated to be 169 microM at maximum. These results suggest that MS-551 has a low affinity for both the resting and inactivated Na+ channel.

Intraperitoneal administration of cytomegalovirus hyperimmunoglobulin to the cytomegalovirus-infected fetus

Twenty-five percent of cytomegalovirus (CMV)-infected fetuses had sequelae and 8% of those in the recurrent-infected group had sequelae. There is no report yet on the fetal therapy for CMV infections. A Japanese pregnant woman with intrauterine fetal CMV infection diagnosed at 26 weeks of pregnancy is presented. CMV culture of amniotic fluid was positive. A CMV DNA assay using the polymerase chain reaction method of the cord blood and the amniotic fluid was positive during the pregnancy; however, testing for fetal serum CMV-specific IgM was negative. The CMV IgG titer of fetal serum at 27 weeks of pregnancy was a third of that of the maternal serum. CMV hyperimmunoglobulin was injected into the fetal abdominal cavity at 28 and 29 weeks of pregnancy. A second administration of CMV hyperimmunoglobulin increased the titer of CMV IgG in the fetal circulation. At birth, the urine culture was positive for CMV. However, CMV DNA of the ascites became negative. A brain CT scan performed 2 weeks after birth revealed some small calcifications beside the right ventricle. CMV hyperimmunoglobulin injection to the fetal abdominal cavity has been shown to increase the IgG in the fetal serum. This is the first report of fetal therapy of congenital CMV infection.