Prevalence of antibody to hepatitis C virus in pregnant Taiwanese

To assess the prevalence of an antibody to hepatitis C virus (anti-HCV) in pregnant women in Taiwan, and elucidate whether or not there is superinfection of the hepatitis B virus (HBV) in such cases, we investigated two independent groups of pregnant women. Group A included 294 without serum alanine aminotranferase (ALT) screening, and group B included 171 pregnant women with an abnormal ALT level (greater than 45 IU/L) who were recruited from 9,523 pregnant women screened for ALT. Blood samplings were taken at early gestation and each serum sample was tested with an HCV EIA kit for anti-HCV. The results showed that 1 woman in group A (0.34%) and 4 women in group B (2.3%) were anti-HCV-positive. However, all 5 cases showed positive antibodies to both the hepatitis B surface and core antigens, but were negative for the hepatitis B surface antigen. Therefore, the prevalence of anti-HCV in pregnant women by current assay in Taiwan is 0.34% without ALT screening, but increases to 2.3% among abnormal ALT cases. The prevalence rate is less than the rates reported in other countries. If confirmed by subsequent study, the results suggest that infection with HCV is low among healthy young females in Taiwan today.

Molecular characterization of rat multigene family encoding proline-rich proteins

Three members of the rat proline-rich protein multigene family have been characterized. Each of these genes, RP4, RP13, and RP15, contains three exons and they are approximately 4.8, 5.7, and 5.4 kb, respectively. The DAN sequences of RP4 and RP13 are greater than 93% homologous in the 3.1-kb segment extending from the 5'-upstream region (approximately nucleotide -930) to 238 nucleotides after the second exon/intron junction; however, regions further downstream, intron II and exon III, share less than 43% identity. In contrast, exon III from RP15, RP13, and the previously sequenced mouse PRP gene MP2 are more than 73% conserved. These analyses suggest that the duplication of the ancestral genes to RP13 and RP4 occurred prior to the divergence of the rat PRP genes. The results also indicate that in the past 21.5 million years, multiple recombination events have resulted in a very high degree of divergence among intron II and exon III of RP4 and RP13. This divergence is due in part to the insertion of members of the rat long interspersed repeat DNA family at -930 bp upstream from the transcription initiation site and within intron II of RP13. Comparisons of the nucleotide sequences and organization of exon I with the genomic organization of PRP and glutamic acid/glutamine-rich protein genes in this and previous studies reveal striking resemblance among these genes. These observations are consistent with the notion that this super multigene family arose from duplication of progenitor genes via unequal crossing over events. In addition, the results suggest that concerted evolution has occurred within the tandemly repeated motif of exon II.

Blood content in guinea-pig tissues: correction for the study of drug tissue distribution

The blood content in different organs or tissues of guinea-pigs was determined by means of [125I]bovine serum albumin. The blood distribution expressed as percentage of total body blood for various organs or tissues ranged from 0.35 (adipose) to 17.5 (muscle)%. The blood content in tissue preparations expressed as the blood background correction factor, F (ml blood/g wet tissue) depended on the extent of bleeding during experiment; that factor can cause a considerable difference in the results of a tissue distribution study of a drug. Blood content was high in the lung (0.36 ml/g), heart, liver, kidney and spleen, but low in adipose and brain tissues (0.021 ml/g). The distribution of valproic acid in various tissues of guinea-pigs after intravenous injection was determined from the homogenates of isolated organs. The results showed that blood contamination can greatly alter the data of tissue distribution of a drug to as much as 25%. This study proposed a maximum (non-bled) and a minimum (extreme-bled) blood background correction factor for respective tissues of guinea-pigs, as well as equations for correcting the blood contamination in tissue during the drug distribution study. The results suggest that to obtain an exact analysis of drug concentrations in specific tissues, a correction for the blood of that specific tissue is necessary.

Is preoperative ultrasound cancer survey necessary in patients with normal liver function tests?

Abdominal ultrasound examination is so easy that it may be overused. To reduce medical costs, we investigated whether preoperative ultrasonic abdominal survey was necessary for oncologic patients with normal liver function tests. We used the ultrasound diagnosis as the final standard to test the value of liver function tests for the prediction of liver metastases. Five hundred forty-four patients with various primary malignancies were referred for preoperative ultrasonic survey of the abdomen. The results showed that for a single test, serum albumin was most sensitive (87.2%) but least specific (29.4%), and serum bilirubin was least sensitive (13.0%) but most specific (97.2%), for the prediction of liver metastases. For a combination of five tests or more, the sensitivity was 95.9% and the specificity 29.5%. In patients with normal liver function tests, liver metastases were detected by ultrasound in two of 106 (1.9%) patients. One hundred of 544 (18.4%) patients having major abnormalities that may influence clinical management were also detected during the ultrasound examination. We conclude that ultrasound is convenient, cheap, and without side effects. It can provide additional information affecting patient management, even in the presence of normal liver function tests.

Comparison of two screening methods, modified Hb H preparation and the osmotic fragility test, for alpha-thalassemic traits on the basis of gene mapping

We evaluated 61 patients with two screening tests for alpha-thalassemia traits on the basis of endonuclease gene mapping. Comparing these two methods--the osmotic fragility test of the red cell and modified hemoglobin H inclusion staining for the sensitivity--we found that the latter was much superior to the former with 100% sensitivity in detecting heterozygous alpha-1 thalassemia and it was also specific as a confirmatory test for thalassemia traits. Red cell indices are still the basic screening tool and can be used together with modified Hb H inclusion staining. The osmotic fragility test was not better than the red cell indices and was not confirmatory. Besides the MCV, RBC, and discrimination functions, we found that RBC distribution width-standard deviation (RDW-SD) was consistently low in heterozygous alpha-1 thalassemia but not in heterozygous alpha-2 thalassemia. None of the above tests was shown to be really helpful in screening in the latter situation. We conclude that the modified Hb H inclusion staining is superior to the osmotic fragility test in screening of alpha-1 thalassemia.

Prevalence of antibodies to hepatitis C virus in the hemodialysis unit

An enzyme immunoassay was used to detect antibodies to hepatitis C virus (anti-HCV) in 261 patients and 69 staff members of a hemodialysis unit. The prevalence of anti-HCV was 46.7% in patients and 2.9% in staff members (p less than 0.001). The prevalence of anti-HCV increased significantly with increasing duration of hemodialysis (p less than 0.001), but was not related to age, sex, history of blood transfusion, status of hepatitis B or hepatitis A virus infection, or serum ALT. Patients with hepatitis episode increased with increasing duration of hemodialysis and showed a significantly higher prevalence of anti-HCV than those without (63.1 vs. 34.7%, p less than 0.001). The prevalence of anti-HCV in patients with hepatitis also increased with increasing duration of hemodialysis (p = 0.05). Thus, HCV appears to be the major cause of hepatitis in hemodialysis patients. Besides strict infection control measures, further studies are needed to determine the mode of HCV infection and its prevention in the hemodialysis unit.

DNA measurements in chronic hepatitis, cirrhosis and hepatocellular carcinoma

It has been documented that chronic hepatitis may progress to cirrhosis and then develop hepatocellular carcinoma (HCC). To test whether abnormal cellular DNA increases along this line of development, liver tissues from 48 patients with chronic hepatitis, 17 with cirrhosis, and 8 with HCC were investigated for cellular DNA content with a scanning microdensitometer. Seven of 8 HCCs and 2 cirrhotic livers adjacent to HCC had abnormally increased cellular DNA content. Only 4 livers from patients with chronic liver diseases other than HCC had abnormal cellular DNA content. The cellular DNA content in livers not accompanying HCC was not related to the patient's age, histological diagnosis, and hepatitis inflammatory activity. The results confirmed the increase of cellular DNA content in HCC, but did not provide evidence of a progressively increasing DNA content from chronic hepatitis to liver cirrhosis. However, cirrhotic livers with abnormal hepatocytic DNA content deserve careful follow-up for the early detection of HCC.

Duodenal ulcer hemorrhage with and without dyspepsia

To clarify the clinical significance of dyspepsia in patients with bleeding duodenal ulcer, we studied 298 patients prospectively. Ages of patients ranged from 16 to 81 yr (mean 45.9). There were 244 (82%) dyspeptic and 54 (18%) nondyspeptic patients. In the dyspeptic group, significantly more patients were taking nonsteroidal anti-inflammatory drugs. In the nondyspeptic group, there was a higher percentage of patients with duodenal bulb deformity (p less than 0.005), which deformity was related to previous peptic ulcer disease. The age, sex, past history of dyspepsia or bleeding, consumption of alcohol and cigarettes, and the hospital course of the two groups of patients did not differ significantly. Our results show that the clinical course of duodenal ulcer hemorrhage is not significantly different in patients with or without dyspepsia, and indicate that bleeding and dyspepsia probably are two independent presentations in the natural course of the disease. The significance of the correlation between dyspepsia and duodenal bulb deformity is discussed.

Fungemia: analysis of 43 cases

This report reviews the cases of 43 patients with 48 episodes of fungemia, and examines the clinical significance of fungemia and the results of treatment. All episodes were nosocomial infections. Candida albicans (60.4%), Candida parapsilosis (16.7%), and Candida tropicals (14.6%) were the most common fungal pathogens isolated from blood cultures. Patients with Candida albicans had a better survival rate than those with other species (p = 0.011). Polymicrobial fungemia was noted in 5 patients (11.6%). Most patients had underlying diseases and predisposing factors. Intravascular catheters (100%), broad-spectrum antibiotics administration (100%), surgical procedures (46.5%) and total parental alimentation (41.9%) were the most common predisposing factors. The clinical manifestations were not characteristic and consisted of nonspecific signs of sepsis. The overall mortality rate was 79%. We did not find any improvement in the mortality rate of our patients treated with amphotericin B. Early recognization, immediate removal of predisposing factors, and correction of underlying conditions is most important for patients with fungemia. We also suggest that fungal infection should be considered early when a febrile patient at high risk dose not improve with broad-spectrum antibacterial therapy.

Transferrin expression in myelinated and non-myelinated peripheral nerves

Transferrin and its receptor are involved in the delivery of iron to most cells. Previous studies have demonstrated that transferrin is associated with oligodendrocytes, the myelin-producing cells in the central nervous system. In the peripheral nervous system, the Schwann cell produces myelin. This study used immunohistochemistry and immunoblot analysis to determine whether expression of transferrin is unique to myelinated peripheral nerves. Immunohistochemical examination demonstrated cytoplasmic accumulation of transferrin in Schwann cells of the myelinated sciatic nerve, but not in the unmyelinated cervical sympathetic trunk. Immunoblot analysis revealed there is 10 X the amount of transferrin in the sciatic nerve compared to the cervical sympathetic trunk. These results are consistent with the hypothesis that transferrin may play a role in myelination.

[Etiology of intestinal obstruction--4 years' experience]

In order to find out the etiological patterns of intestinal obstruction, we reviewed 1205 cases diagnosed as intestinal obstruction at our hospital. The operative findings, locations of obstruction and pathological results were analyzed among 707 cases who were operated on. The most common cause of colon obstruction was tumor (78.7%). The etiologies of small intestinal obstruction were: adhesions, 47.4%; hernia, 22.1%; tumor, 11.8%; intussusception, 8.8%; foreign bodies, 3.7%; and miscellaneous causes, 6.2%. In the patients older than 40 years, the most common causes of intestinal obstruction were adhesion and malignancy, in contrast to hernia and intussusception that were commonly found in children. The mean age of the patients with colon obstruction was older than those with small bowel obstruction, 55.7 +/- 21. vs 39.4 +/- 17.3 (P less than 0.001). Of the patients with previous abdominal surgery, adhesions caused the obstruction in up to 60.5%. Among the 102 cases who had been operated for abdominal malignancy, the cause of intestinal obstruction was due to recurrent tumor in 78 patients (76.4%). Of patients without previous abdominal surgery, the etiologies of intestinal obstruction were: incarcerated hernia, 36.7%; tumor, 21.1%; intussusception, 15.6%; and adhesion, 13.8%. The incidence of strangulation obstruction was 25.7%, of which the major causes were adhesions, 51.7%; and hernia. 43.0%. We concluded that the most common cause of colon obstruction was tumor. The two most common causes of small intestinal obstruction were adhesions and hernia. Age and past history of abdominal surgery can much help for the differential diagnosis.

Hepatocellular carcinoma presenting as acute spontaneous haemothorax

Hepatocellular carcinoma may present in various ways, but only a few instances present with symptoms of distant metastases. This report describes a case of hepatocellular carcinoma presenting with acute haemothorax and haemorrhagic shock secondary to spontaneous rupture of chest wall metastasis. Hepatocellular carcinoma is a frequent malignancy in Asia and should be considered in the list of differential diagnosis of spontaneous haemothorax.

[Intraocular lens implantation at Kaohsiung Medical College]

Between March 1984 and December 1987, 993 cataractous eyes in 884 patients (462 males, 422 females) were operated on using intraocular lens implantation at the Kaohsiung Medical College Hospital. The age of the patients ranged from half year to 93 years, with an average of 61.9 years. Primary lens implantation was performed in 98.4% of the cases, secondary implantation in 1.6% of the cases. There were 6 cases were done by using the triple procedure (combined keratoplasty with cataract extraction and intraocular lens implantation). Among these 742 eyes followed-up for from one to 43 months, final vision could be corrected to 6/12 or better in 63.5% of the cases. While 64.4% of the cases of post-operation cylinder were less than 2 diopters, the final refraction showed that the spherical equivalent diopters were within 2 diopters in 61.7% of the cases. Complications in the anterior chamber lens group included pupillary changes (21.2%), pseudophakic bullous keratopathy or decompensation (13.5%), lens subluxation or dislocation (13.5%) and cystoid macular edema (5.8%). Complications in the posterior chamber lens group included pupillary changes (16.2%), posterior capsular thickening (3.2%), anterior or posterior synechiae (2.7%) and lens subluxation or dislocation (2.8%).

Acute hepatitis delta virus superinfection in patients with liver cirrhosis

A clinicopathologic study in a total of 164 patients with acute hepatitis delta virus (HDV) infection showed that nine male patients (5.5%) had evidence of liver cirrhosis prior to or during the episode of acute hepatitis. All nine patients had typical clinical presentations and laboratory findings of acute viral hepatitis. Four of them had prolonged prothrombin time, three developed ascites and one finally died of hepatic failure. Clinical ascites occurred more frequently in cirrhotic patients with severe but non-fulminant hepatitis than their non-cirrhotic counterparts (p less than 0.05). In addition, histologic studies in five patients with cirrhosis disclosed diffuse lobular necrotizing inflammatory activity, with four showing bridging hepatic necrosis, which also occurs more frequently in cirrhotic than in non-cirrhotic patients (p less than 0.05). The data suggest that HBsAg positive patients with cirrhosis are susceptible to acute HDV infection which may lead to extensive necrosis or even decompensation and failure, simulating decompensation of the underlying liver disease. Therefore, careful clinicopathologic work-ups are required for accurate diagnosis and correct assessment of their outcomes.

Amniotic rupture sequence: report of five cases

Amniotic rupture sequence or amniotic band syndrome is a rare, non-recurrent disease complex. We preferred the former term because its wide spectra of fetal malformation appear to depend on the timing and the consequent changes following a single event of amniotic rupture. However, the exact etiology and pathogenesis still remain obscure; and the disease is often mis- or under-diagnosed, thus leading to inappropriate genetic counselling. Prenatal diagnosis is sometimes possible with the aid of ultrasound. We reported our experience of 5 cases of amniotic rupture sequence with special emphasis on different clinical pictures, possible pathogenesis and pathologic findings. Hopefully this will aid in the recognition of this disorder, thus offer appropriate genetic counselling to the patients.

[Clinico-etiological observation of 13 cases of mycobacterial keratitis]

We report a series of 13 cases of atypical mycobacterial keratitis encountered in 1986 and 1987. The ratio of mycobacterial keratitis to the total number of corneal ulcer cases increased recently from 1% in 1984 to 8% in 1988 at our clinic. The diagnosis was established by a positive acid-fast stain of smear and a Löwenstein-Jensen media culture. Of the 13 cases, 12 were diagnosed within one week after the first presentation. All cases had a history of corneal trauma; there was foreign body injury in 10 cases, pterygium surgery in 2 cases and penetrating keratoplasty in one case. The clinical pictures of mycobacterial keratitis mostly included anterior stromal infiltrate (100%), necrotic abscess (69.2%), migration lesion (69.2%) and Descemet's folding (61.5%), showing resemblances to fungal keratitis in their characteristics. Species identification showed 11 cases of Mycobacterium fortuitum and 2 cases of Mycobacterium chelonei. On the sensitivity test Rifampin (12 cases, mean 19 mm), Kanamycin (11 cases, mean 29 mm), Ethambutol (11 cases, mean 28 mm), Amikacin (11 cases, mean 19 mm), Netilmicin (9 cases, mean 20 mm) and Tobramycin (8 cases, mean 20 mm) were more effective. Ten of the 13 cases completely healed after treatment and remained quiet during the follow up period of more than one year. In the other 3 cases there was no follow up. We emphasize that the recognition of the clinical features of the corneal findings will facilitate an early diagnosis of this disease and is of essential importance for the salvage of the eye.

The development of the transferrin-transferrin receptor system in relation to astrocytes, MBP and galactocerebroside in normal and myelin-deficient rat optic nerves

The factor(s) which control the onset of myelination are unknown. It is now accepted that transferrin (Tf), the major iron transport protein in vertebrates, is found in oligodendrocytes in the adult brain. Because of the importance of iron in basic cell metabolism we have hypothesized that iron (mobilized by Tf) may be a permissive agent in the process of myelination. The present study was designed to determine with immunohistochemistry the relationship of Tf receptor expression, Tf accumulation, and the expression of myelin components myelin basic protein (MBP) and galactocerebroside (GAlC)) in the developing rat optic nerve. In addition to Tf and its receptor, the developmental pattern for GalC reported in this study has not been examined in the rat optic nerve. Furthermore, a myelin mutant strain of rats was used to determine if a lack of myelin production affects the Tf-Tf receptor system. Our study found that Tf receptor was expressed from birth on blood vessels and was first seen in the parenchyma of the nerve at 8 days of age. The expression of the Tf receptor preceded that of Tf, MBP or GalC. The accumulation of Tf by oligodendrocytes occurred about the same time as the intracellular appearance of MBP and GalC which was shortly after the onset of myelination. Tf-positive cells as well as MBP- and GalC-positive cells increased in number and staining intensity with age whereas the expression of the Tf receptor declined after reaching a peak at 15 days of age. In the optic nerves of myelin-deficient rats, the Tf receptor expression and Tf accumulation was confined to the vasculature. The results of this study suggest that the expression of the Tf receptor is an early event in oligodendrocytic maturation and is followed by the intracellular accumulation of myelin components and Tf. The temporal association of Tf and myelin production suggests that further study is warranted regarding the possibility that the Tf-iron system supports or perhaps even permits the initiation of the process of myelination.

Postpartum subsidence of hepatitis B viral replication in HBeAg-positive carrier mothers

To elucidate the effects of pregnancy and delivery on hepatitis B e antigen (HBeAg)-positive carrier mothers, 31 HBeAg-positive carrier mothers were followed-up postpartum 1 year, with 30 HBeAg-positive nonpregnant female carriers as controls. Serum hepatitis B surface antigen (HBsAg), HBeAg titer, and hepatitis B virus (HBV)-DNA concentration were studied at defined intervals. The results revealed that in the control group HBeAg titers and HBV-DNA concentrations fluctuated, whereas the HBsAg titers showed little change, but HBeAg clearance or seroconversion to anti-HBe were not noted on follow-up. In contrast, one carrier mother seroconverted to anti-HBe during pregnancy and the antibody persisted thereafter. Five of the remaining 30 carrier mothers cleared HBeAg postpartum, and among these five cases, one also seroconverted to anti-HBe. In addition, in another five of the 30 cases, the HBV-DNA fell to undetectable level (less than 0.04 ng/ml). All these ten cases had a common tendency of showing a decrease in HBeAg titers and/or HBV-DNA concentrations 1-2 months after delivery. The HBeAg titers and HBV-DNA concentrations in the other 11 cases remained unchanged, whereas the remaining nine cases had increased levels. It is concluded that subsidence of HBV replication is precipitated by delivery in one-third of HBeAg-positive carrier mothers in Taiwan, and this occurs most frequently 1-2 months postpartum.

Tubal cyst following tubal sterilization: a delayed complication

Clinical pictures and histopathological findings in 15 patients of tubal cyst following tubal sterilization were analyzed. The interval between tubal sterilization and occurrence of tubal cyst was 10 years (ranged from 4 to 21 years). Clinically 8 cases (53%) suffered from lower abdominal pain, 5 cases (33%) from hypermenorrhea coexistent with uterine myoma and 2 cases (13%) from irregular menstruation. Five out of 9 patients with ultrasound examination were suspected to have tubal cyst before operation. The size of tubal cyst ranged from 1.5 to 9.0 cm in diameter with mean 3.4 cm. Eleven were unilateral and 4 were bilateral. Histologically they showed flattened mucosal epithelial cells with absence of epithelial plica, compression atrophy of muscular layer, suture stitch or granuloma and intact fimbria with clear serous fluid. Thus, the differential diagnosis of adnexal cyst in patients with a past history of tubal sterilization should include tubal cyst.

Hepatic parenchymal calcifications--differentiation from intrahepatic stones

Intrahepatic hyperechoic lesions with acoustic shadows could be stones or nonspecific calcifications. To verify this, 9 patients with hepatic parenchymal calcifications were compared with 40 patients with intrahepatic stones. A set of criteria are proposed for the diagnosis of intrahepatic stones: (A) dilated intrahepatic duct; (B) pneumobilia; or (C) 2 or more of the following: (1) common hepatic duct more than 6 mm in diameter, (2) multiple lesions in one lobe, (3) left lobe involvement, and (4) elevated serum alkaline phosphatase. The sensitivity, specificity, and overall accuracy were 97.5%, 88.9%, and 95.9, respectively. The criteria help in the selection of patients for evaluation of intrahepatic stones.

Natural course of patients with chronic type B hepatitis following acute hepatitis delta virus superinfection

A 6-96-month prospective follow-up study on the natural course of chronic type B hepatitis after contracting acute hepatitis delta virus (HDV) superinfection was conducted in 30 patients with clear-cut onset of acute HDV superinfection (HDV group). Thirty patients with acute exacerbation without evidence of HDV infection, and well matched in terms of age, sex and hepatitis B e antigen/antibody status, served as the control group. The clinical and biochemical presentations tended to be more severe in the HDV group. More patients in the HDV group had persistent abnormal liver biochemical tests (69% vs 47%) and progressed to chronic active hepatitis (46% vs 20%) or cirrhosis (9.4%/year vs 5.2%/year), but the differences were not significant statistically. The results suggest that HDV superinfection induces slow progression of liver disease. However, in the early stage, the impact of HDV superinfection is not particularly different from that of the acute exacerbation unrelated to HDV in patients with chronic type B hepatitis.

Transplacental leakage of HBeAg-positive maternal blood as the most likely route in causing intrauterine infection with hepatitis B virus

Thirty-two HBeAg-positive carrier mothers and their 32 babies were investigated to elucidate the mechanism involved in intrauterine infection with HBV. Five mothers had symptoms and signs of threatened abortion and/or threatened preterm labor. Three mothers gave birth more than 6 weeks after the episodes, and their babies were those infected in utero. The other two gave birth within 1 week after the episodes, and the two babies were treated with HBIG immediately after birth; HBV infection was successfully prevented. Therefore we suggest that transplacental leakage of HBeAg-positive maternal blood, which is induced by uterine contractions during pregnancy and the disruption of placental barriers, is the most likely route to cause HBV intrauterine infection.

Differential influences of different stressors upon midbrain raphe neurons in rats

Various types of stressors were given to different groups of animals to examine their effects on the mesostriatal and mesolimbic serotonergic pathways. Results indicate that shock-induced fighting experience preferentially decreased serotonin (5-HT) levels in the dorsal raphe and striatum, while air puff stimulation selectively lowered 5-HT and 5-hydroxyindoleacetic acid (5-HIAA) contents in the median raphe and hippocampus. Both immobilization and light footshock stress have a more consistent effect on both serotonergic systems. These results suggest that different stressors have differential influences upon central 5-HT neurons and, other than anatomical differentiation, these serotonergic neurons are not homogeneous with respect to their responses to stress either.

Intrauterine transmission of hepatitis B virus is closely related to placental leakage

Hepatitis B virus (HBV), transmitted by hepatitis B e antigen (HBeAg)-positive mothers by intrauterine infection, infecting newborns, is closely related to signs and symptoms associated with miscarriage. However, no correlation was observed between intrauterine infection of infants and the presence of antibodies of immunoglobulin M (IgM) class antibodies against hepatitis B core antigen (anti-HBc) in maternal blood, nor was HBeAg found in maternal or cord sera. These results indicate that contamination by the mother's blood, through placental leakage, plays an important role in HBV infection in utero. Without placental leakage, maternal blood could not pass through the placenta and enter fetal circulation, and so intrauterine infection would not occur, even if very high titers of hepatitis B surface antigen (HBsAg) and HBeAg were present in maternal blood.

A hormone-producing thecoma of broad ligament

A very rare extraovarian hormone-producing thecoma, originated from the broad ligament, is described. Its preoperative diagnostic difficulty, clinical significance, differential diagnosis and histogenesis are discussed.

[Histopathological changes in endometrial cancer treated with tamoxifen]

Eight cases of endometrial adenocarcinoma, including 7 well differentiated cases (stage Ia three, stage Ib three, stage II one) and I poorly differentiated case (stage IVb), were treated with Tamoxifen (20 mg/day) for 7-14 days. The average age of these patients was 59.1 +/- 10.9 years old and they were all postmenopausal for between 6 months and 30 years. The endometrial tissue was biopsied before Tamoxifen administration and half of it was investigated for progestin receptor (PR) and estrogen receptor (ER) while the remainder was used for histopathological examination. After surgical treatment, some tissue fragments of the endometrium were taken for investigation of PR and ER. The effect of Tamoxifen was then studied for the amount of PR, ER and histopathology. The result was that the amount of PR was increased in well differentiated cases whereas it was unchanged in poorly differentiated ones, and the amount of ER was decreased in all cases. Meanwhile, obvious histopathological changes were noted as follows decrease of glandular epithelial stratification, increased secretory activity, increased epithelial cell size with columnar cell type, increase of transparent, vacuolated cytoplasm, increase of nuclear size with variable shape and prominent nucleoli with marginal aggregation of chromatin. However, no stromal change was noted. Furthermore, the greater the increase in the amount of PR, the more conspicuous histopathological change was noted. It was concluded that Tamoxifen could produce both functional (PR, ER) and morphological (histopathology) changes in endometrial cancers.

Studies on the risk factors of intrauterine infection of hepatitis B virus

In order to elucidate the mechanism involved in HBV intrauterine infection, some risk factors were checked among 22 HBsAg and HBeAg positive carrier mothers. It was found that the HBV intrauterine infection had no correlation with (1) abnormal maternal liver functions, (2) high HBsAg and HBeAg titers or high concentration of HBV-DNA in the maternal serum or (3) HBeAg titer in the cord serum. Four babies were born to mothers with positive symptoms and signs of threatened abortion and/or threatened premature labor during pregnancy. Among them, two babies born at full term were HBV infected cases in utero, whereas the other two babies born within one week after the occurrence of threatened premature labor showed negative HBsAg antigenemia at birth and HBIG was immediately administered and prevented HBV infection. We therefore inferred that placental leakage caused by uterine contraction during pregnancy could cause maternal blood to enter the fetal circulation and cause HBV intrauterine infection. Moreover, even if placental leakage occurs, HBV infection might be prevented by administering HBIG within a week.

Detection of Mold in Processed Foods by High Performance Liquid Chromatography 1

A high-performance liquid chromatographic (HPLC) method was developed to analyze for the degree of mold contamination in processed fruit and vegetable products. The method is based on detection of glucosamine, a breakdown product of chitin which is one of the major constituents of fungal cell walls Food samples were hydrolyzed at 121°C for 2 h to release glucosamine from fungal chitin. The hydrolysates were partially purified by passing them through a Dowex-50 cation exchanger. Effluents were derivatized by o-phthalaldehyde and the fluorogenic reaction products were separated by reversed-phase HPLC and detected by a spectroflurometer. Six species of mold, Alternaria alternata , Alternaria solani , Colletotrichum coccodes , Fusarium oxysporum , Geotrichum candidum and Rhizopus stolonifer , which are commonly associated with fruit and vegetable products, were used in this study and different levels (0.1 to 2.5 mg/g of sample) of mold mycelium were added to rot-free tomato products. A linear relationship between concentration and glucosamine was observed. However, different species of mold gave different amounts of glucosamine. The effect of insect contamination on the assay was negligible unless high levels were present. Results obtained by the HPLC method were compared with those obtained with an amino acid analyzer and reasonable correlation between the two methods was evident.

Activation analysis of mercury in urine samples of electrolysis cell workers

The activation method of determination of trace amounts of Hg in human urine has been studied by introducing a simple amalgam deposition method. Human urine samples were obtained from the alkali chloride, electrolysis plant equipped with Hg cells. The capacity of Cu powder for Hg quantity, the pH conditions, and the shaking time were described. The results showed that the Hg contents in workers' urine samples varied from 33 ppb to 60 ppb depending on working conditions.

Thermal regulation of the immune response in South American toads (Bufo marinus)

Thermal regulation of the immune response was studied in toads following single injections of bacteriophage f2. The immune response was markedly inhibited in animals kept at 15° as compared to the controls (25°). The appearance of serum antibodies was delayed in animals kept at 15° for the first post-immunization week but their peak antibody levels were similar to those in toads maintained at 25° throughout. Transfer of animals from 25° to 15° 2 weeks after immunization only temporarily depressed the serum antibody levels but caused a marked delay in conversion from heavy to light antibodies.

Our results are in keeping with the hypothesis that lowered environmental temperatures inhibit a variety of metabolic processes which may be concerned with the utilization of antigen and/or the synthesis of antibodies.

Primary and secondary immune responses of the marine toad (Bufo marinus) to bacteriophage f2

The primary and secondary immune responses of toads (Bufo marinus) were studied using the bacteriophage f2 as antigen. Antibodies were identified in the serum 2 weeks after primary immunization and peak antibody levels were reached at 6 weeks. Although both IgM and IgG antibodies can be found in toad serum, most of the antibody activity in our animals persisted in the IgM fraction until 8 weeks after immunization. When a second injection of antigen was given 4 weeks after primary immunization, there was a marked increase in the total serum antibody activity and IgG antibodies were found as early as 4 weeks after the second injection of antigen. These observations suggest that the toad, B. marinus, is capable of a true secondary response to the bacteriophage f2.

Renal allografts in HL-A matched recipients. Light, immunofluorescence and electron microscopic studies

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