A comparison between ultrasonography and mammography, computed tomography and digital subtraction angiography for the detection of breast cancers

Ultrasound (US) was compared with mammography (MMG), computed tomography (CT), and digital subtraction angiography (DSA) in its effectiveness to detect breast cancer masses and metastatic axillary nodes. Forty-seven breast cancer patients who all underwent MMG, US, CT, and DSA preoperatively in our institution between 1986 and 1990 were studied. US was able to detect tumors in all cases regardless of tumor size, whereas DSA detected T1-size tumors and MMG detected T2-size tumors in 40% and 64.7% of cases, respectively, being specifically inferior to US. It was found that MMG was least likely to detect papillotubular carcinoma, although microcalcification alone without a tumor mass on MMG improved detectability from 46.2% to 76.9%, according to the histological type. CT was found to be most sensitive to axillary node metastases (81.8%), followed by US (72.7%), but DSA was significantly unfavorable (42.9%). Thus, we concluded that US was superior to MMG, CT, and DSA for detecting breast cancer masses, but that CT was more advantageous than US, while DSA was of little value for evaluating axillary nodal status.

The characteristics of alcoholics with HCV infection: histopathologic comparison with alcoholics without HCV infection and chronic type C hepatitis

Out of 71 patients admitted to the National Kurihama Hospital and a related hospital for alcoholics or hepatic dysfunction, we studied the histopathology of alcoholics with HCV infection. Liver biopsies were divided into three groups depending on whether or not the patient was an alcoholic and anti-HCV antibody positive. The three groups were: (1) 30 HCV-antibody negative alcoholics, (2) 17 HCV-Ab positive alcoholics, and (3) 24 HCV-Ab positive non-alcoholics. Alcoholics developed specific hepatic fibrosis with a solid appearance, and the HCV-Ab negative alcoholics had relatively less lymphocytic infiltration. In contrast, patients with type C virus developed fibrosis with a loose appearance with more lymphocytic infiltrates including lymphfollicular accumulation. HCV-Ab positive alcoholics showed mixed features such as more fibrosis and less piecemeal necrosis and lymphocytic infiltration, especially in follicle formation, than HCV-Ab positive non-alcoholics. Changes of hepatocytes, such as hydropic swelling, fatty change and acidophilic body, increased in severity in the alcoholics compared with the non-alcoholics with viral hepatitis. These findings suggest that the combined exposure to both alcohol and HCV enhances hepatocellular damage, but suppresses inflammatory reactions such as lymphocyte infiltration and follicle formation seen in type C hepatitis.

Crystal structure of methyl 3-O-beta-D-glucopyranosyl-beta-D-glucopyranoside (methyl beta-D-laminarabioside) monohydrate

Crystals of methyl 3-O-beta-D-glucopyranosyl-beta-D-glucopyranoside (methyl beta-D-laminarabioside) belong to the orthorhombic system, space group P2(1)2(1)2, with a = 14.548(2), b = 24.252(7), c = 4.938(1) A, and Z = 4. The crystal structure was solved by the direct method and refined by the full-matrix least-squares procedure to an R-value of 0.062 for 1099 observed reflections in the X-ray data. The molecular structure is similar to that of beta-D-laminarabiose. The torsional angles around the glycosidic bonds are influenced by both the existence of an intramolecular hydrogen bond at O-4'... O-5 and the exo-anomeric effect. In the nonreducing residue, the exocyclic O-5-C-5-C-6-O-6 and C-4-C-5-C-6-O-6 torsional angles are (+)gauche and trans, respectively, whereas the corresponding torsional angles in the reducing residue are (-)gauche and (+)gauche. One water molecule cocrystallizes with each disaccharide, and the crystal structure is stabilized mainly by intra- and inter-molecular hydrogen bonds involving water molecules.

Postnatal growth curves of very low birthweight Japanese infants

To construct standard growth curves for Japanese infants of very low birthweight, longitudinal data provided by 47 neonatal centers in Japan were reviewed. Data were collected on the growth of infants admitted to those units during 1986 and 1987 and who survived beyond 3 years of age. A total of 379 singleton infants, who were free of neurological sequelae and appropriate for gestational age, were enrolled. Those whose birthweights were more than 600 g and less than 1,500 g were grouped into nine weight categories separated by increments of 100 g. Data on the increase in weight and head circumference were compiled and analyzed until more than half the infants in each weight category had been discharged from each site. Growth curves of bodyweight and head circumference in the nine groups were constructed using polynomial regression analysis to define the curve of best fit. With increasing prematurity, significant trends of greater weight loss (P < 0.05), longer time to reach the lowest weight (P < 0.01) and a longer time to regain birthweight (P < 0.01) were observed. In addition, there was a significantly higher incidence of chronic lung disease in such groups (P < 0.0001). Growth curves were characterized by the average clinical profiles in each of the nine groups. We believe that these data will be useful in evaluating the growth of very low birthweight infants being cared for in modern neonatal intensive care units in Japan.

Effect of mean airway pressure on bronchial mucosal blood flow in rabbits with oleic acid-induced injury

The effects of mean airway pressure (MAP) on bronchial mucosal blood flow at the carina in nine anesthetized adult rabbits undergoing high frequency ventilation were studied. The animals were given oleic acid to diminish lung compliance and to exclude the influences of increasing MAP on systemic venous return. Mucosal blood flow decreased significantly when MAP exceeded 14 cmH2O. Mucosal blood velocity tended to decrease as higher levels of MAP were applied. Mucosal blood volume decreased significantly when MAP exceeded 20 cmH2O. Hemodynamics, arterial blood gas values and pH were not changed significantly. Our data demonstrate that bronchial mucosal blood flow decreases at high levels of MAP even if cardiac output remains constant. Hence this decrease of bronchial mucosal blood flow may be due to the transmission of pressure to submucosal bronchial capillaries.

[Signification of liver metastases of colorectal cancer with special reference to recurrence in the residual liver after hepatic resection]

In the patients with liver metastases of colorectal cancer, pre-and post operative intra-arterial infusion chemotherapy was evaluated for prevention of recurrence in the residual liver after hepatic resection. Materials are sixty-five hepatectomized patients from May 1981 to 1992. Therapies were subdivided into five groups. I: pre-and postoperative non-therapy (n = 3); II: postoperative chemotherapy (n = 22); III: postoperative intra-arterial infusion chemotherapy (n = 12); IV: pre-operative intra-arterial infusion chemotherapy + postoperative chemotherapy (n = 15); and V: pre-and postoperative intra-arterial infusion chemotherapy (n = 13). In recurrence rate in the residual liver, I to IV groups showed as high as 50-100%. However, the disease-free survival rate was 100% in V group, revealing a significant difference between the other four groups. Accordingly, in order to prevent recurrence in the residual liver of hepatectomized patients with liver metastases of colorectal cancer and prolong the disease-free interval, we consider that pre-and post-operative intra-arterial infusion chemotherapy can be effective, compared to pre-or postoperative intra-arterial infusion chemotherapy alone.

[Complications and their management in intraarterial infusion chemotherapy]

Complications and its management were evaluated in intraarterial infusion chemotherapy for 188 patients with advanced carcinoma of the digestive organs from 1975 to Sept. 1991. Subjects were divided into four groups: Group I was 62 patients in whom the tip of the catheter without knots was established in the abdominal aorta via celiac axis, Group II consisted of 72 patients with the tip of the catheter without knots in the common hepatic artery. Group III had 35 patients with the tip of the catheter with knots (Anthron catheter) in the common hepatic artery. Group IV was 19 patients with the tip of the anthron catheter connected to the Infuse A-Port in the common hepatic artery. The most frequent complications seen among Group I, II and III were caused by catheter thrombosis (11.3%) in Group I, spontaneous dislodgement of catheter (26.4%) in Group II and extravasation (20%) in Group III. By using 16 gauge Toray Anthron catheter with Heparin coating on its inner and outer surfaces, the number of complications in Group I and II was kept smaller. Extravasation, on the other hand, has been less frequently seen in Group III by establishing the tip of the catheter at the branching site of the gastroduodenal artery from the common hepatic artery. Complications in Group IV (19 patients) were noted only in 3 patients, i.e., extravasation, subcutaneous necrosis and subcutaneous abscess, respectively. Therefore, we concluded that Group IV showed the most favorable intraarterial infusion chemotherapy with the most infrequent complications.

Fortified preterm human milk for very low birth weight infants

We studied the nutritional effects of two types of human milk fortifiers for very low birth weight infants. These studies suggest that fortified human milk provides nutritional advantages for very low birth weight infants. However, providing calcium and phosphorus with supplementation is necessary for the improvement of bone density.

[Clinicobacteriological study of Pasteurella multocida infection as a zoonosis. (2)--Comparisons of P. multocida separated from patients and their pet dogs and cats]

A total of 17 strains of Pasteurella multocida, of which 13 were isolated from patients treated at Nihon University Itabashi Hospital or Nihon University Surugadai Hospital between April, 1984 and March, 1991 and 4 from 1 dog and 3 cats kept by the patients, were evaluated with respect to their biochemical properties, sensitivity to drugs, and serotype. The isolated strains were all considered to be Pasteurella multocida subsp. multocida because of the agreement of their responses to indole, sorbitol and dulcitol with those of this subspecies, except for 1 sorbitol-negative strain of Pasteurella multocida subsp. septica isolated from 1 patient who had been bitten by a cat. All the isolated strains showed high sensitivities to various drugs. The serotype was capsular type A, which is often observed in cats and dogs, in 7 strains, which consisted of 6 of the 7 strains derived from the airway of the patients and 1 of the 6 strains derived from bit or scratch wound. The remaining strains could not be classified. Five morphological types, namely 1, 3, 3.8, 6, and 8 were observed. In 2 patients, Pasteurella multocida subsp. multocida of the same serotype was also isolated from their cats. One of these patients had intimate contact with the cat including kissing. Our findings suggest that: 1) Pasteurella multocida subsp. multocida has been responsible for most conventional cases of Pasteurella multocida infection. 2) Strains isolated from patients differ in the capsular type according to the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Color Doppler flow imaging of CSF flow in an infant with intraventricular hemorrhage

Evaluation of CSF flow was performed by means of the color Doppler flow imaging (CDFI) technique. The motion of CSF was examined in an infant with intraventricular hemorrhage (IVH). With the aid of CDFI, CSF flow in the aqueduct, 3rd ventricle and foramen of Monro could be demonstrated. CSF flow in both upward and downward directions was clearly visualized, primarily reflecting cardiac pulsation and respiration. When he was subjected with intermittent positive pressure ventilation, during inspiration there was upward flow in the aqueduct, while during expiration there was downward flow. Our experience indicates that CDFI is a useful technique for examining the CSF circulation in infants with IVH.

[Pathogenetic analysis of the dynamics involved in prevention of fetal and neonatal brain damage]

This symposium was focused on pathogenetic analysis on dynamic changes of intracranial pathology in the perinatal period and prevention of fetal and neonatal brain damage. New and valuable results were reported in topics of cerebral blood flow dynamics in the fetus and neonate, imaging modalities in the fetus and neonate, metabolic parameters, neurophysiological function, and pathological analysis.

[Measurement of serum type III procollagen aminopeptide with RIA-gnost PIIIP coated tube: changes in patients with various alcoholic liver diseases after abstinence]

In 55 patients with various alcoholic liver diseases, serum type III procollagen aminopeptide (PIIIP) was measured on admission, on biopsy (2-4 weeks after admission) and on discharge from hospital (3 months after admission) using RIA-gnost PIIIP Coated Tube, an assay kit recently launched by Hoechst Japan Limited. Serum PIIIP on admission showed a good correlation with the degree of hepatic fibrosis and was significantly higher in any disease group than in healthy controls, suggesting its usefulness as an indicator of hepatic fibrosis. After abstinence, however, serum PIIIP level exhibited an increasing tendency in all the disease groups except alcoholic hepatitis, and the number of laboratory tests showing a significant correlation with PIIIP decreased as compared with that on admission. The mechanism of serum PIIIP elevations seen after abstinence is yet to be elucidated in detail, considering their possible association with factors other than collagen synthesis in the liver.

[Clinicobacteriological study of Pasteurella multocida as a zoonosis (1). Condition of dog and cat carriers of Pasteurella, and the influence for human carrier rate by kiss with the pets]

Pasteurella multocida is a gram-negative short rod-shaped bacteria, which is a part of the indigenous flora of the oral cavity of many animals other than man. The number of reports on cases of infections with this bacterium due to animal bites and/or scratches, bacterial infections of the respiratory tract, sepsis due to this organism and death caused by the bacteria have been increasing in recent years. We investigated P. multocida in the hair and oral cavity of 3 dogs and 29 cats according to the classification of Mutters et al.. We also studied the relationship between the carrier rate for Pasteurella in the oral cavity and kissing of pets in 24 pet owners (3 dogs and 11 cats). No P. multocida was isolated from the hair of neither dogs nor cats. One strain of P. multocida subsp. multocida and two strains of P. stomatis, were isolated from the oral cavity of dogs, and 35 strains of Pasteurella were isolated from the oral cavity of cats. Two strains of P. multocida subsp. multocida, whose biochemical properties were different, were detected in the oral cavity of one cat. In three cats, Pasteurella other than P. multocida subsp. multocida was isolated from the same oral cavity. No Pasteurella was detected in the oral cavity of 19 pet owners who had not kissed their cats, whereas P. stomatis was isolated from the oral cavity of one of 2 pet owners who had kissed their cats and in 2 of 3 pet owners who had kissed their dogs (the same bacteria was isolated from a dog that was being kept by some of these positive pet owners).(ABSTRACT TRUNCATED AT 250 WORDS)

[The first report of human chronic sinusitis by Pasteurella multocida subsp. multocida in Japan]

A 53-year-old male visited our hospital due to nasal obstruction persisting for 6 months and constant rhinorrhea. Pasteurella multocida subsp. multocida was isolated from his nasal discharge and lavage fluid of the maxillary sinus, and also from the oral cavity of the dog he kept. The bacterial strains isolated from the patient and dog were identical in terms of biochemical properties, and drug sensitivity. Although serotype was different, the strain from the patient showed (A:6) and that from his dog showed (A:5). The microorganism is not present in the general environment. The patient had contact with his dog such as he kissed it frequently, gave it food with his chopsticks et al.. From the mouth of the people who kiss one's dog, we detected Pasteurella of the same character of bacteria as from the mouth of the dog. We detected two Pasteurella multocida of different character from only one mouth of a cat. Pasteurella multocida was checked in only one colony for sero type. Sero type A is the popular type for dogs and cats. The above suggest that their was a high possibility that the Pasteurella multocida subsp. multocida found in the patient was from his dog. In Japan, the incidence of Pasteurella multocida subsp. multocida infection has been increasing. In 1969, the Japanese Ministry of Health and Welfare officially communicated this infection as a zoonosis to related institutions. At both medical and surgical departments, wither the patient keeps a pet should be confirmed during interview, and guidance of pet keeping methods is important in some cases from the aspect of clinical bacteriology.(ABSTRACT TRUNCATED AT 250 WORDS)

Monitoring of immature rabbit brain during hypoxia with near-infrared spectroscopy

Continuous monitoring of the cerebral blood flow, oxyhemoglobin, deoxyhemoglobin, total hemoglobin, oxidized cytochrome a, a3, and tissue pH during prolonged CO2 or N2 loading in 2-week-old rabbits was performed by near-infrared spectroscopy, the thermocouple method, and a tissue pH meter. Near-infrared spectroscopy demonstrated decreases in oxyhemoglobin and oxidized cytochrome a, a3 and increases in deoxyhemoglobin and total hemoglobin in the early stage within 5 min, which gradually lessened with time on both 10% concentration of inspired O2 with CO2 and N2. CBF increased with venous retention in the early stage and then slowly decreased in parallel with blood pressure and oxidized cytochrome a, a3 on abolition of autoregulation. These changes were more remarkable during the 10% concentration of inspired O2 with CO2 than N2 which may be caused by marked acidosis and hypotension associated with hypercarbia. Oxidized cytochrome a, a3, however, demonstrated a gradual decrease in 10% concentration of inspired O2 with N2 rather than CO2; therefore, the continuous monitorings demonstrated hemodynamic and oxygenation changes despite the same extent of prolonged hypoxic loading. These changes in prolonged hypoxic conditions may occur in human intrapartum asphyxia which develops into postnatal hypoxic-ischemic encephalopathy.

Radiolucent bone cysts and the type of dialysis membrane used in patients undergoing long-term hemodialysis

The relationship between the types of dialysis membrane used and the prevalence and severity of radiolucent bone cysts (which are a main radiological feature of dialysis amyloidosis) was studied in 30 patients on hemodialysis for more than 10 years. One of them was treated exclusively with cuprophane; the other 29 were dialyzed with cuprophane, and then treated with polyacrylonitrile AN 69. In 12 of the 30 patients, radiolucent bone cysts (at least 5 mm in diameter in the wrists and at least 10 mm in the shoulders or hips) were observed. The patients with bone cysts spent significantly more time on cuprophane dialysis and significantly less time on AN 69 dialysis than the group of patients without bone cysts. Nine of the 14 patients who had been treated with cuprophane for more than 8 years had bone cysts; whereas bone cysts were observed in only 2 of the 12 patients dialyzed for more than 8 years with AN 69. The frequency of bone cysts was significantly different for each of the two groups. There was, however, no significant difference in the total duration of dialysis between the two groups. The severity of the cystic bone lesions correlated positively with the duration of dialysis using cuprophane and negatively with the duration of dialysis using AN 69. These findings suggest that the development of osteoarticular amyloidosis may be related to the type of dialysis membrane used. Hemodialysis using AN 69 membranes may prevent, or at least postpone the development of dialysis amyloidosis.

[Elevated Clq-bearing immune complexes in hemophiliacs with viral infections]

One hundred hemophilia A and 30 hemophilia B patients who had been treated with non-heated and heated factor VIII or prothrombin complex concentrates were examined by immunological tests including Clq-bearing immune complexes assay. Antibodies to human immunodeficiency virus type 1 (HIV-1), hepatitis B virus (HBV), hepatitis C virus (HCV) and human parvovirus B19 (B19) were analyzed by Western blotting, enzyme immunoassay, passive hemagglutination or radio-immunoassay. Clq-bearing immune complexes were assayed by a monoclonal anti-Clq ELISA system (Immunomedics). Seropositivity to HIV-1, HBV, HCV, and B19 was 56.9%, 87.7%, 79.2% and 100% respectively. Clq-bearing immune complexes were positive in 109 of the 130 patients (83.8%). The positivity and the levels were extremely higher than those in normal individuals. Clq-bearing immune complex levels in patient positive for HIV-1, HCV, or HBV were higher than those in the negative group (HIV: P less than 0.001, HCV: P less than 0.005, HBV: P less than 0.05). When the patients were divided into four groups according to seropositivity to HIV-1 and/or HCV, Clq-bearing immune complex levels were the highest in the group positive for both antibodies, and the lowest in the group negative for both antibodies. These results suggested that each viral infection influences the formation of immune complexes and repeated viral infection increased the level of Clq-bearing immune complexes in these patients.

Continuous comparison of cerebral blood flow velocity and volume on hypoxia

Cerebral blood flow velocity (CBFV) in the basilar artery, monitored by Doppler sonography, and cerebral blood flow (CBF) in the parietal cortex, monitored by Laser Doppler flowmetry, were continuously recorded and compared during and after hypoxic loading with nitrogen (N2) or carbon dioxide (CO2). On severe hypoxic loading (10% O2) of N2, CBFV and CBF increased with an increase in blood pressure (BP). On the other hand, with 18% and 15% O2 with CO2, CBFV and CBF increased with BP. However, there was a difference between CBF and CBFV in the recovery stage. CBF continued to be elevated for a long time, while CBFV rapidly normalized after loading. With 10% O2 with CO2, CBFV, CBF and BP decreased at first, and then increased during loading. Also, the difference between CBF and CBFV in the recovery stage being more definite. Thus, on continuous measurement, CBFV shows similar changes to CBF in response to hypoxia. However, CBFV shows different changes from CBF in association with dilatation or constriction of cerebral vessels. Resistance index (RI) shows different changes and have a different significance from CBF and CBFV.

Granular cell tumor of the esophagus--report of a case and review of the literature

We report herein a case of a 46 year old man presenting with a gastric ulcer in whom an endoscopy happened to detect an elevated lesion in the lower esophagus. Endoscopic biopsy proved sufficient for determining the diagnosis of a granular cell tumor (GCT). Electron and microscopic studies suggest that GCT are derived from Schwann cells. Although commonly found in the tongue and skin, GCT are rarely seen in the gastrointestinal tract, especially in the esophagus. However, advances in endoscopic techniques will increase the opportunity of detecting GCT of the esophagus.

Molecular and crystal structures of Aib-containing oligopeptides Boc-Leu4-Aib-Leu4-OBzl and Boc-(Leu4-Aib)2-OBzl

Sample peptides Boc-Leu4-Aib-Leu4-OBzl and Boc-(Leu4-Aib)2-OBzl, were crystallized by the solvent-evaporation method. Both crystals are monoclinic, with space group of P2(1) and Z = 2. The cell parameters are a = 16.580 (7), b = 21.105 (7), c = 11.583 (4) A, and beta = 104.90 (3) degrees (Boc-Leu4-Aib-Leu4-OBzl), and a = 15.247 (9), b = 19.04 (1), c = 16.311 (9) A, and beta = 117.10 (1) degrees [Boc-(Leu4-Aib)2-OBzl]. Crystal structures were solved by the direct method and refined to R values of 0.096 (the former peptide) and 0.112 (the latter). Peptide backbones fold into a right-handed alpha-helix, except for the C-terminal Aib residue in Boc-(Leu4-Aib)2-OBzl. Both peptide molecules are stabilized by six (the former) or seven (the latter) intramolecular (5----1) hydrogen bonds, and arranged in the head-to-tail fashion, which makes an infinite column. In this column, one (the former) or two (the latter) intermolecular hydrogen bonds link the neighboring molecules. In the case of Boc-Leu4-Aib-Leu4-OBzl, the solvent molecule N,N-dimethylformamide was found in the difference Fourier map. There was a hydrogen bond between peptide and solvent molecule. Along the lateral direction, only hydrophobic contacts were observed between adjacent peptide molecules.

Assessment of brain death in children by means of P-31 MR spectroscopy: preliminary note. Work in progress

The authors examined the possibility of assessing cerebral damage with phosphorus-31 magnetic resonance (MR) spectroscopy in 24 patients (three infants, four children older than age 5 years, and 17 adults) who met the adult criteria for brain death. In all patients except patient 3 (an infant 8 months old), inorganic phosphate with phosphodiester was observed, and adenosine triphosphate (ATP) and phosphocreatine (PCr), which are detectable in healthy brains, were not detected. In 22 of these 23 patients, cardiac death occurred within 7 days after clinical brain death, and in one infant 14 months old, cardiac death occurred 38 days after clinical brain death. In patient 3, ATP and PCr were detected with P-31 MR spectroscopy, and now, more than 20 months after brain death, cardiac death has not yet occurred. In children younger than age 5 years, P-31 MR spectroscopic findings were predictive of the patient's clinical outcome. These findings may help establish criteria for the diagnosis of brain death in children younger than age 5 years.

[Changes in serum levels of gynecological tumor markers throughout the period from early gestation to puerperium]

The aim of this study is to elucidate the change in serum levels of gynecological tumor markers throughout the period from the early gestational stage to puerperium. We measured eight tumor markers of--CA 125, TPA, SCC, AFP, haptoglobin, ferritin, CA19-9 and CEA--in 17 healthy women with a normal course of pregnancy, delivery and puerperium, and obtained the following results: 1) Profiles of change in serum levels of CA125, SCC, haptoglobin and ferritin were similar during pregnancy, with those levels being the highest at 4-15 weeks of gestation and declining gradually from 16 to 27 weeks. Serum levels of these four markers decreased significantly (p less than 0.01) at 16-27 and 28-40 weeks of gestation, respectively. 2) A significant (p less than 0.01) increase in CA125 and SCC was observed 2 hours after delivery compared with the levels in the first stage of delivery. However, these two markers decreased to the normal range after the fifth day postpartum. 3) Serum TPA decreased significantly (p less than 0.05) in 16-27 weeks of gestation, comparing with those of 4-15 weeks. Serum CA19-9 and CEA remained almost unchanged within the normal range throughout the period from pregnancy to puerperium. 4) Tumor markers of CA125, TPA, SCC, haptoglobin, ferritin and CEA of which serum levels decreased during the course of pregnancy and puerperium might be a clue to judge whether gynecological tumors in pregnant women are malignant or benign.

[Evaluation of modalities for recurrent breast cancer patients]

Of 342 breast cancer patients radically operated on in the Second Department of Surgery, School of Medicine, Chiba University during 1965-1988, treatment for 75 recurrent patients were evaluated by the initial modes of recurrence. The modes of recurrence were classified into distant metastases, local lymph node recurrence (axillary, parasternal and supraclavicular nodes) and chest wall recurrence according to the General Rules for Clinical and Pathological Recording of Breast Cancer. Of 75 recurrent patients, distant metastases were seen as common as 77.3%, followed by recurrences of local lymph nodes (14.7%) and chest wall (8.0%). The number of patients in each mode of recurrence increased in relation to increase in the size of tumor and the number of metastatic lymph nodes at the time of the first operation. Histologically, scirrhous carcinoma was most common in chest wall recurrence. 2-year disease-free survival rates of distant metastases, local lymph node recurrence and chest wall recurrence were 44.6%, 24.2% and 16.7%, respectively. 5-year survival of bone metastasis with chemo-endocrine therapy was as significantly favorable as 60%, compared to chemo- or radiotherapy alone (p less than 0.01). However, 5-year survival of lung metastasis with or without endocrine therapy revealed no significant difference. Local lymph node recurrence with the combination of resection, radio- and/or chemotherapy produced a trend toward showing more favorable survival than that without resection.

Isolation and characterization of renin-expressing cell lines from transgenic mice containing a renin-promoter viral oncogene fusion construct

We constructed transgenic mice containing a renin-promoter SV40 T antigen fusion transgene with the intention of inducing neoplasia in renin-expressing cells and isolating renin-expressing cell lines in vitro. We examined six kidney tumors from mice representing three different transgenic lines and found they expressed their endogenous renin gene. Initially, five nonclonal kidney tumor-derived cell lines were established which expressed their endogenous renin gene in addition to the transgene. They retained active renin intracellularly and constitutively secreted an inactive form of renin (prorenin). One of these cell lines was cloned to homogeneity. This line maintained high level expression of renin mRNA throughout 3 months of continuous culture. Although the cells contained an equal proportion of active and inactive renin, the species constitutively secreted into the media was predominantly (95%) prorenin. However, active renin secretion was stimulated 2.3- and 4.6-fold by treatment with 8-bromo-cAMP after 4 and 15 h, respectively. In addition, the presence of multiple secretory granules was confirmed by ultrastructural analysis. These cells, which express renin mRNA and can regulate secretion of active renin, should provide an excellent tool for studying renin gene regulation and secretion. Furthermore, these mice should provide a useful source for the establishment of renin-expressing cell lines from a variety of renin-expressing tissues.

Surfactant replacement therapy with a single postventilatory dose of a reconstituted bovine surfactant in preterm neonates with respiratory distress syndrome: final analysis of a multicenter, double-blind, randomized trial and comparison with similar trials. The Surfactant-TA Study Group

The effects of a single dose of surfactant TA were assessed in premature neonates (birth weight 750 to 1749 g) with respiratory distress syndrome (RDS) in a multicenter, double-blind, randomized clinical trial. Only neonates with surfactant deficiency and without ultrasonographic evidence of intracranial hemorrhage greater than or equal to grade II were enrolled. Fifty-four patients received surfactant (100 mg of phospholipid per kilogram of body weight) and 46 patients received an air placebo within 8 hours of life. Treatment with this surfactant resulted in a significant reduction in the severity of RDS with a concomitant increase in the proportion of neonates with mild disease. The frequency of pulmonary interstitial emphysema and of pneumothorax was significantly lower in treated neonates compared with control neonates (2% vs 26%, P = .0008, and 7% vs 39%, P = .0004, respectively). The frequency of intracranial hemorrhage was significantly lower in the surfactant group compared with the control group (20% vs 54%, P = .0008) and was also reduced for the smallest neonates in the surfactant group (13% vs 73%, P = .00008). When categorized according to severity of intracranial hemorrhage and severity of bronchopulmonary dysplasia, the surfactant group was at a significant advantage (adjusted Cochran-Mantel-Haenszel X2 = 10.72, P less than .001 and X2 = 4.43, P = .036, respectively). The proportion of neonates surviving without intracranial hemorrhage and/or bronchopulmonary dysplasia was 63% in the surfactant group vs 26% in the control group (P = .0004); as for the smallest neonates, it was 58% in the surfactant group vs 4% in the control group (P = .0002). There were no differences between the groups with respect to the frequency of patent ductus arteriosus (46% vs 37%), pulmonary hemorrhage (6% vs 7%), necrotizing enterocolitis (0% vs 2%), sepsis (4% vs 2%), retinopathy of prematurity (13% vs 22%), or death (15% vs 22%). It is concluded that treatment with the single-dose surfactant regimen used in this study reduces the severity of respiratory distress during the 48 hours after treatment and decreases the major pulmonary morbidity and intracranial hemorrhage in premature neonates with RDS. Further studies are needed to determine whether (1) treatment at birth or as soon as after RDS is diagnosed and (2) the use of multiple dose of this surfactant would result in any additional benefits.

[Human respiratory tract infection by Pasteurella multocida subsp. multocida presumably derived from the cat]

Pasteurella multocida is a Gram-negative short rod-shaped bacteria that has been recognized as a pathogen of hemorrhagic septicemia and fowl cholera in the veterinary medicine. Infections by this microorganism as seen in the foreign literature vary widely from local infections due to bites and scratches by animals to general infections such as infections of the respiratory tract, sepsis, and meningitis. In Japan, reported cases of P. multocida infections are predominantly local infections, followed by respiratory infection. Recently, death of diabetic patients due to septicemia by this pathogen has also been reported. In this study, we experienced a case of respiratory tract infection in which the pathogen P. multocida subsp. multocida was suggested to have been transmitted from a pet cat by the agreement of the serotype of the bacterial isolates between the patient and the cat. This case was evaluated from the zoonotic viewpoint. The patient was a 68-year-old male who had been followed up since 1982 with a diagnosis of bronchiectasis. After his referral to our hospital, P. multocida subsp. multocida was isolated from his bloody sputum and, then, from the cat kept by the patient. The tow isolates were identical in terms of the biochemical properties, drug susceptibility profile, and serotype (-:1), and the derivation of P. multocida subsp. multocida infection from cat was established for the first time in this report. The incidence of P. multocida infections is increasing in Japan, and particular attention is considered to be needed about these conditions as zoonoses as indicated in "Preventive Measures against Zoonoses Derived from Pet Animals (Dog, Cat)", an official communication from the Ministry of Health and Welfare to related institutions in 1989. Also, to check whether the patient keeps any pet at the clinical inquiry is a practice of bacteriological importance in all fields of medicine.

Use of a HpaII-polymerase chain reaction assay to study DNA methylation in the Pgk-1 CpG island of mouse embryos at the time of X-chromosome inactivation

A HpaII-PCR assay was used to study DNA methylation in individual mouse embryos. It was found that HpaII site H-7 in the CpG island of the X-chromosome-linked Pgk-1 gene is less than or equal to 10% methylated in oocytes and male embryos but becomes 40% methylated in female embryos at 6.5 days; about the time of X-chromosome inactivation of the inner cell mass.

[A case of fatal graft-versus-host disease following blood transfusion in esophageal cancer documented by homozygous changes of HLA typing]

A 72 year-old Japanese male with esophageal cancer underwent esophagectomy. After seemingly uneventful recovery, he developed high fever on 11 post-operative day (POD), rashes over the whole body on 13 POD and leukopenia on 15 POD. On 22 POD, thrombopenia and parenchymal bleeding of lungs were noted. He died on 26 POD after progressive hypoxia and hypotension. HLA type of peripheral lymphocytes on him changed homozygously to that of the transfused fresh blood. Skin biopsy showed mild leukocyte infiltration in the epidermis and the dyskeratotic keratinocytes were associated with a contiguous lymphocyte, the so-called satellite cell necrosis. In the findings of autopsy, aplastic bone marrow and atrophied spleen, whose weight was 14g, were noted. Based on the clinical picture, skin biopsy and HLA study findings, we diagnosed this case as post-transfusion GVHD. We think that high age, operative injury and preoperative irradiation might be inducement to reveal post-transfusion GVHD in this case.

[Cerebral blood flow in infants: comparison of carotid blood flow and cerebral blood velocity]

Carotid blood was measured with a ultrasonic volume flow meter in 38 infants. The carotid blood flow was 1.50 +/- 0.55 ml/sec. At the same time peak systolic flow velocity, mean blood velocity, end diastolic velocity, pulsatility index (PI) and resistance index (RI) in the middle and anterior cerebral arteries were measured by duplex Doppler scanning. There was a correlation between the carotid blood flow and the mean blood velocity in middle and anterior cerebral arteries. However, PI and RI were not well correlated with carotid blood flow.

[Cerebrospinal fluid transfer of cefbuperazone in the blood-brain barrier lesions of neurosurgical patients]

Cefbuperazone (CBPZ) was given in 15 patients after surgery. There was no infections except for 1 case in which signs of infections were suspected. As side effects, slight elevations in hepatic transaminase levels were observed in 3 patients during the CBPZ chemotherapy. CBPZ concentrations in 7 patients were studied. The subjects were divided into 3 groups according to CT finding during the chemotherapy to correlate CBPZ concentrations to degrees of blood-brain barrier lesions; Group I: no enhancement, Group II: mild or focal enhancement, Group III: diffuse and marked enhancement. It was interesting to note that the more marked enhancement were obtained, the higher levels of CSF concentration of CBPZ.

[Immunotherapy and quality of life]

In order to examine the quality of life with immunotherapy, a survey was conducted on 17 advanced gastric or colon cancer patients receiving LAK immunotherapy and on 10 patients receiving EAP chemotherapy as a control. Performance status of patients at the time of treatment was similar between the groups. Many patients on EAP therapy complained of severe side effects, such as loss of hair, nausea and vomiting, and appetite loss. None of the patients on LAK therapy complained of such effects on the contrary, favorable effects were found. Appetite increased in some patients and tenderness of the liver disappeared in others. As for the continuance of the treatment, two thirds of EAP patients declined, and all LAK patients replied in the affirmative. The data suggest that LAK immunotherapy is better than EAP chemotherapy from the standpoint of the quality of life.

The treatment of lymph node metastasis from esophageal cancer by extensive lymphadenectomy

During the period between 1965 and the end of 1988, 560 patients with esophageal cancer were surgically treated in our University hospital. In an attempt to improve patient survival, three-field lymphadenectomy of the bilateral neck, mediastinum and abdomen was performed in 117 patients treated since 1983. The present study was undertaken to reveal the substantial rate of lymph node metastasis in esophageal cancer and to decide if three-field lymphadenectomy is mandatory or not for surgery of esophageal cancer. Despite the increased radicality of the operation, the mortality and morbidity rates decreased in the 1980's compared to the earlier periods, the operative death being 12.5 per cent in the 1960's, vs. 2.0 per cent in the 1980's. Moreover, the mortality rate of the patients receiving the three-field lymphadenectomy was as low as 2.6 per cent. The metastatic rate of cervical nodes in the patients receiving three-field lymphadenectomy was 32.5 per cent, while that of mediastinal and abdominal nodes was 47.0 per cent and 46.0 per cent respectively. The metastatic rate in the mediastinum was high in the bilateral recurrent nerve lymph nodes, bifurcation nodes and paraesophageal nodes, while in the abdomen, it was high in the bilateral paracardial nodes. Recurrent nerve paralysis, which had been rarely seen was observed in 12.0 per cent of the patients. Metastasis from esophageal cancer is often seen in the cervical nodes, however, the clinical importance of three-field lymphadenectomy will be decided by the data of patient survival in the near future.

[Studies on the giardiasis as the zoonosis]

To obtain basic data on the route of Giardia infection as zoonosis, we examined feces from 80 dogs and 16 cats for Giardia cysts and evaluated the detection rates. In addition, familial infection was studied in 3 family members of the patient with giardiasis. Giardia cysts were detected in 10 of the 80 dogs (12.5%) but none of the cats. Of the 10 dogs from which Giardia cysts were isolated, 6 had been maintained by the breeders. Tow other dogs were for examination in the research institutions. None of the family members of the patient with giardiasis had this infection. Since the detection rates of Giardia cysts in the dogs and cats were low, the possibility that human infection is acquired from dogs or cats seemed to be low. However, some of patients with giardiasis we encountered had never been abroad. This fact together with the presence of Giardia cysts in the dogs despite the low detection rates suggest that attention should be paid to the possible association between human giardiasis and pets since the number of people keeping pets is increasing.

[Study of risk factors for postoperative pulmonary complications following esophageal cancer surgery--multivariate statistical analysis]

In 91 patients undergoing resection and reconstruction of the esophagus for esophageal cancer, risk factors for postoperative pulmonary complications were studied. In order to investigate these factors, multivariate statistical analysis was applied. The incidence of postoperative pulmonary complications was significantly higher in patients over 70 years of age who had poor renal function (PSP15' less than 25%) and had prolonged thoracotomy time (greater than 3 h) by Student's t test. In preoperative pulmonary functions, obstructive respiratory dysfunction (MMF, FEV1.0) correlated well with postoperative pulmonary complications. The analysis of each factor was, however, not enough to predict the risk of pulmonary complications following operation. Meanwhile, risk score (= 2.0 (age) + 1.0 (FVC) + 0.7 (MMF) + 1.5 (PSP15') + 1.8 (thoracotomy time) + 1.7 (postoperative RI] was obtained by multivariate statistical analysis. High incidence (greater than 80%) of pulmonary complications was observed in patients with risk score more than 5.0. It is suggested that using this risk score will be helpful for postoperative pulmonary care.

A selective signaling defect in helper T cells induced by antigen-presenting cells from mice with murine acquired immunodeficiency syndrome

APC activity of spleen cells from C57BL/10 (B10) mice infected with LP-BM5 murine leukemia virus (MuLV), which is known as a murine acquired immunodeficiency syndrome (MAIDS) virus, was investigated. The ability of splenic APC from LP-BM5 MuLV-inoculated B10 mice to induce soluble Ag-specific proliferation of cloned Th cells was decreased progressively during the infection. The APC defect was found to be due neither to the decreased expression of Ia Ag nor to the insufficient production of IL-1. It was demonstrated that cloned Th stimulated with virus-infected splenic APC displayed the increased [Ca2+]i with severely decreased inositol phospholipid metabolism, which probably led to the defect of Th proliferative responses. These results suggested that the failure of Th to respond to soluble Ag in MAIDS is at least in part due to a selective defect in signal transduction caused by abnormal APC.

A selective signaling defect in helper T cells induced by antigen-presenting cells from mice with murine acquired immunodeficiency syndrome

APC activity of spleen cells from C57BL/10 (B10) mice infected with LP-BM5 murine leukemia virus (MuLV), which is known as a murine acquired immunodeficiency syndrome (MAIDS) virus, was investigated. The ability of splenic APC from LP-BM5 MuLV-inoculated B10 mice to induce soluble Ag-specific proliferation of cloned Th cells was decreased progressively during the infection. The APC defect was found to be due neither to the decreased expression of Ia Ag nor to the insufficient production of IL-1. It was demonstrated that cloned Th stimulated with virus-infected splenic APC displayed the increased [Ca2+]i with severely decreased inositol phospholipid metabolism, which probably led to the defect of Th proliferative responses. These results suggested that the failure of Th to respond to soluble Ag in MAIDS is at least in part due to a selective defect in signal transduction caused by abnormal APC.

[Benefits and risks associated with dissection of three regional lymph nodes (bilateral cervical, thoracic and abdominal) in thoracic esophageal carcinoma]

To obtain curability safely, we have employed dissection of three regional lymph nodes (the bilateral cervical, thoracic and abdominal lymph nodes) since 1983. The subjects were 111 (three regional group) of 158 patients with thoracic esophageal carcinoma operated on our department till 1988. When compared to 207 patients treated during the period from 1973 to 1982 (control group), the background factors of the subjects revealed that the three regional group included more patients with advanced carcinoma and more elderly patients over 70 years of age. Operative results were more favourable in the three regional group (5.3% vs 2.7%), although mean operative time was longer (5 hrs and 2 min vs 8 hrs and 38 min) and mean blood loss was higher (1,098ml vs 1,407ml). Moreover, the incidence of recurrent nerve paralysis was higher. Overall 5-year survival was 20.4% vs 22.3%, showing no significant difference. However, when stage distribution is taken into consideration, results in the three regional group may be regarded as improved. After dissection of the three regional lymphnodes, the pattern of lymph node metastasis of thoracic esophageal carcinoma has been made clearer to give useful information on the site in which further dissection of lymph node is required.

[Effects of combined therapy with irradiation, cisplatin and vindesine in lymph node recurrence of esophageal cancer]

The effects of combined therapy with irradiation, cisplatin and vindesine for lymph node recurrence of esophageal cancer was studied. The subjects were 95 patients with lymph node recurrence, who were divided into the following four treatment groups: Group I: Radiotherapy alone (R) (n = 31); Group II: cisplatin (CDDP) alone (n = 18); Group III: R + CDDP(n = 9); Group IV: R + CDDP + VDS (n = 10). The response rate (CR + PR) of Groups III and IV was 66.7% and 100%, respectively, which was significantly more favorable than 11.1% of Group II. The survival duration after recurrence was prolonged in the order of Group IV, Group III, Group II and Group I. In conclusion, combination therapy using R, CDDP and VDS will be effective for lymph node recurrence of esophageal cancer.

[Over two years survival of intra-arterial infusion chemotherapy in gastric cancer with liver metastases]

Between 1977 and April in 1989, long-term survivors (over two years) by intra-arterial infusion chemotherapy in gastric cancer patients with liver metastases were examined. The materials were 5 patients (4 synchronous, 1 metachronous metastases) among 21 P0H (+) gastric cancers. The extent of liver metastases shows 1 H1 and 4 H2. Reduction surgery was performed in 4 H2 patients (2 S2 + 3, 1 S4, 1 S6) and postoperative intra-arterial infusion chemotherapy via the catheter in the common hepatic artery was done to control the residual liver metastases. Continuous intra-arterial infusion chemotherapy with the regimen of FML (5-FU, MMC, Lentinan) revealed 100% response rate (3 CR, 1 PR). In a patient with metachronous metastases, PR was obtained with MA (MMC, ADM) + one-shot intra-arterial infusion of LAK cells. Among 5 patients, one with synchronous metastases has survived 35 months, followed by a patient who died after 32 months and two patients who died after 27 months. A patient with metachronous metastases has survived for 24 months.