[Diagnosis of ovarian tumor by measuring tumor markers]

Values of CA125, CA19-9, TPA, CA72-4, BFP and LDH in sera were detected in 148 malignant ovarian tumors, 41 borderline malignant ovarian tumors, 71 benign ovarian tumors and 64 benign uterine diseases. A new cut-off value was determined by ROC graph for distinguishing malignant and borderline ovarian tumors from benign ovarian tumors. CA125 (cut off: 30 U/ml) was a highly sensitive marker for malignant and borderline malignant ovarian tumors, the value being 88.1% (52/59) and 81.8% (9/11), respectively. On the other hand, in 37 benign ovarian tumors, the positive rate was 21.6% and in 21 benign uterine diseases it was 52.4%. CA19-9 (cut off: 150 U/ml) was inferior to CA125, but it was an effective marker for mucinous ovarian tumors. TPA (cut off: 40 U/ml) was also a sensitive (84.7%, 50/59) marker of malignant ovarian tumors. CA72-4 (cut off: 4 U/ml) was a highly specific (87.0%, 60/69) marker of malignant ovarian tumors. Combination assays of CA125/CA19-9, CA125/TPA and CA125/CA72-4 were not effective. Usefulness of BFP for early malignant ovarian tumors was suggested. Seven cases of dysgerminoma showed extremely elevated LDH levels (1,248 +/- 886 IU/1/37 degrees C). Malignancy and histological type of ovarian tumors could be decided by combination assay of these tumor markers, before surgical operation.

Effect of thrombocytopenia on the onset of immune complex glomerulonephritis

The effect of platelets on the development of immune complex glomerulonephritis (GN) was examined using bovine serum albumin (BSA) GN with platelet depletion. To clarify the role of platelets in the initial stage of BSA GN, thrombocytopenia was induced before BSA infusion. In 18 New Zealand white rabbits, BSA was intravenously injected twice after the presensitization. Eight of these BSA GN rabbits were injected daily with goat anti-rabbit platelet antiserum to induce thrombocytopenia, and platelet counts were maintained below 5 x 10(4)/microliters throughout the experiment. In the thrombocytopenic group, the degree of proteinuria was significantly decreased compared to the control group. Glomerular polymorphonuclear leukocyte infiltration, mononuclear cell proliferation, exudation and glomerular enlargement were significantly suppressed in the thrombocytopenic group. The results suggest that platelets may be quite important in the initiation and development of immune complex GN.

Genomic DNA fingerprinting by pulsed-field gel electrophoresis as an epidemiological marker for study of nosocomial infections caused by methicillin-resistant Staphylococcus aureus

In this study, we have compared genomic DNA fingerprintings among isolates of methicillin-resistant Staphylococcus aureus (MRSA) by using pulsed-field gel electrophoresis (PFGE). Chromosomal fragments digested with SmaI were most suitable for the PFGE separation. SmaI cut genomic DNA into 15 to 20 fragments whose sizes ranged from about 30 to 1,500 kb. Thirty-one distinctive fragment patterns were identified in 111 infecting and colonizing MRSA isolates from six different hospitals in Japan. On the basis of the genomic typing by PFGE, we performed an epidemiological investigation of an outbreak of nosocomial MRSA infections among inpatients in Nagoya University Hospital. Ten types of chromosomal digestion were identified in the 20 strains isolated from 18 infected patients and 1 from colonized hospital personnel. According to the restriction patterns, we found that four types of these strains had caused epidemic infections among 13 patients in the outbreak. Two types (types 1 and 4) of the strains were involved in the death of five patients. The other infections were sporadic. The clarity and polymorphism of the chromosomal digestion patterns enabled us to discriminate between isolates which could not be differentiated by antibiogram or plasmid analysis. Classification of the genomic DNA fingerprinting patterns by PFGE is therefore proposed as a useful method for investigating the source, transmission, and spread of nosocomial MRSA infections.

[Clinical features of enterococcal septicemia and antimicrobial susceptibilities for clinical isolates of enterococci in Nagoya University Hospital]

Enterococci are important causative organisms of nosocomial infections as well as methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa. Enterococcal bacteremia has been increased in Nagoya University Hospital from April 1983 to March 1990. We analyzed the clinical backgrounds, portal of entry and mortality for the patients with Enterococcal septicemia. Thirty-four cases with enterococcal septicemia (24 Enterococcus faecalis, 10 Enterococcus faecium) were subjected in this study. Twenty-seven cases were monomicrobial septicemia and 7 cases were polymicrobial septicemia. As to the portal of entry, intra-abdominal infections in 21 cases, urinary tract infections in 4 cases, respiratory tract infections or chest tubes in 2 cases, decbitus infection in 1 case, intravascular catheter in 1 case, and unknown sources in 5 cases. Total mortality of the septicemia was 44.1%. E. faecium and Enterococcus avium were much more resistant to antimicrobial agents than E. faecalis. Enterococci with high-level resistance to gentamicin (minimal inhibitory concentration, greater than 2000 micrograms/ml) accounted for 35% of the 26 clinical isolates of enterococci.

Circadian rhythms of somatostatin-immunoreactivity in the suprachiasmatic nucleus of the rat

Twenty-four hour patterns in somatostatin (SS)-like immunoreactivity (LI) within the suprachiasmatic nucleus (SCN) were determined by enzyme immunoassay in rats blinded by bilateral orbital enucleation or kept sighted under light-dark conditions. A remarkable circadian rhythm was found in the concentration of SS-LI in the SCN under blinded conditions. The peak time appeared at about circadian time (CT) 4 in the early subjective day and the trough at around CT 16 or 20 in the subjective night. Light-dark cycles did not alter the circadian patterns of SS-LI observed in the blinded rat SCN. These results indicate the presence of an endogenous circadian rhythm in SS-LI in the rat SCN, independent of environmental lightning cycles.

Immunohistochemical characterisation of extracellular matrix components of salivary gland tumours

Proteoglycans (PGs) were localised immunohistochemically in 52 salivary gland tumours including pleomorphic adenoma, adenoid cystic carcinoma, acinic cell carcinoma, oncocytoma, mucoepidermoid carcinoma, clear cell tumour and Warthin tumour, using antibodies raised against large PG, small PG, chondroitin 4-sulphate PG, chondroitin 6-sulphate PG, heparan sulphate PG and keratan sulphate PG. Large PGs were mainly observed in mucinous materials of extracellular matrix (ECM) and interstitial fibrous element of tumour tissues, while small PGs were located only in hyaline matrix and surrounding fibrous (capsular) connective tissues. Chondroitin 6-sulphate PG was detected in the ECM of pleomorphic adenomas and clear cell carcinomas and in pseudocystic spaces of adenoid cystic carcinomas, but only in vessel walls in non-neoplastic tissues. Keratan sulphate PG was observed to locate in mucinous material of pleomorphic adenomas, acinic cell carcinomas and clear cell carcinomas, but not in the adenoid cystic carcinomas examined, and it was also unobservable in non-neoplastic salivary gland tissues. Heparan sulphate PG was observed on the inner surfaces of true ductal spaces of adenoid cystic carcinomas and on cell surfaces of oncocytoma cells. By HPLC analysis, individual glycosaminoglycans contained in tumour tissues were compared. Chondroitin 6-sulphate PG was very rich in ECM of pleomorphic adenomas and adenoid cystic carcinomas. Pleomorphic adenomas contained relatively more low-sulphated chondroitin sulphate than adenoid cystic carcinomas and other tumours.

[Histological differences between sternal and iliac bone marrow in various hematological diseases]

Even in normal state, hematopoietic activity is different in terms of the site of bone marrow as well as age. The activity may also differ with bone marrow site in various hematological diseases. We chose 32 cases with various hematological diseases and examined their bone marrow histologically at two different sites (sternum and posterior iliac crest) at almost the same time. We studied the histological differences in 5 cases of malignant lymphoma, 15 cases of aplastic anemia, 8 cases of myelodysplastic syndrome, 2 cases of myeloproliferative syndrome and 2 cases of acute leukemia. In malignant lymphoma, the iliac marrow was slightly hypoplastic compared with sternal marrow but there were no differences in the components of hematopoietic cells, that were thought to reflect normal hematopoietic activity for their respective ages. In 5 among 15 cases of aplastic anemia, nodular hyperplastic areas were observed in sternal marrow even though iliac marrow was severely hypoplastic. The presence of a nodular hyperplastic area is useful for differential diagnosis between aplastic anemia and refractory anemia, because such a histological change was not observed in the cases of refractory anemia. In myeloproliferative syndrome and acute leukemia, there were no differences between sternal and iliac marrow. They were hyperplastic and had almost the same hematopoietic components.

[Immunohistochemical localization of proteoglycans in interstitial elements of human bladder cancer]

The immunohistochemical localization of glycosaminoglycan side chains and core protein of proteoglycan was observed, using monoclonal antibodies, on 8 specimens of non-tumor bladder tissues and 26 specimens of bladder tumors obtained from total cystectomy or transurethral resection of bladder tumor (TUR-Bt). In non-tumor tissues of human bladder examined, the surface of urothelial epithelium consisted of heparan sulfate as revealed with antibody HepSS-1, and submucosal interstitial elements consisted mainly of small proteoglycan having chondroitin 4-sulfate side chains as revealed with antibodies 6B6 and 9A2, respectively. On the other hand, in bladder tumors examined, the interstitial fibrous elements, the so-called "specific stroma" in cancer cell nests, consisted mainly of large proteoglycans having chondroitin 4-sulfate or 6-sulfate side chains as revealed with antibodies 2B1, 9A2 and 3B3, respectively. Antibodies 2B1 and 3B3 are considered to be useful to demonstrate the involvement by invasive growth of bladder tumor cells.

Dynamic exercise-induced elevation in plasma levels of atrial natriuretic peptide in patients with effort angina pectoris

We investigated the relationship between plasma atrial natriuretic polypeptide (ANP) levels and hemodynamic indices during dynamic exercise testing in 15 patients with effort angina pectoris. Patients exercised on an angina-limited, supine, multistage bicycle ergometer, and plasma ANP levels and hemodynamic indices were measured at rest, at peak exercise, and 6 minutes after exercise. Plasma ANP levels increased significantly at peak exercise. Pulmonary artery wedge pressure (PAWP) and coronary sinus blood flow (CSBF) were significantly correlated with plasma ANP levels before and at peak exercise (PAWP: r = 0.69, p less than 0.001; CSBF; r = 0.45, p less than 0.05). In six of eight patients whose PAWP exceeded 20 mm Hg at peak exercise, plasma ANP levels were increased at 6 minutes after exercise, whereas PAWP had decreased relative to the values obtained at peak exercise. Plasma ANP concentrations at 6 minutes after exercise were not correlated with PAWP at the same time. However, PAWP at peak exercise was correlated with the plasma ANP levels at 6 minutes after exercise (r = 0.80, p less than 0.001). These results suggest that in patients with effort angina pectoris left ventricular dysfunction resulting from exercise-induced myocardial ischemia may increase preload excessively and may contribute to the excess secretion of ANP after dynamic exercise.

[Myxomatous stromal changes in bone marrow following chemotherapy of acute leukemia--immunohistochemical characteristics of matrix components]

Although fibrosis and gelatinous transformation of bone marrow stroma are well known, there have been few histopathological descriptions in the literature. We studied 16 cases of acute leukemia, and describe the myxomatous changes of bone marrow stroma observed at 2 or 3 weeks following chemotherapy. We analyzed the extracellular matrix components immunohistochemically, using monoclonal or polyclonal antibodies raised against collagens, proteoglycans (PG), fibronectin and laminin. We found that the major components of the myxomatous matrix were chondroitin 6-sulfate PG and large PG. The stainability resembles that of extracellular matrix components in long-term bone marrow culture. We suppose that the myxomatous matrix provides favorable conditions for hematopoiesis, because hematopoietic cells proliferate and differentiate as soon as such stromal changes occur.

Clinical significance of simple heart rate-adjusted ST segment depression in supine leg exercise in the diagnosis of coronary artery disease

To evaluate the clinical significance of simple heart rate-adjusted ST segment depression (delta ST/delta HR) in the diagnosis of coronary artery disease, 42 patients with stable exertional angina underwent supine leg exercise testing and cardiac catheterization. During exercise, heart rate, a multilead electrocardiogram, and pulmonary artery wedge pressure were recorded. The sensitivity and accuracy of the delta ST/delta HR criteria (greater than or equal to 3.0 microV/beat/min) were significantly greater than the conventional analysis of ST segment depression criteria (greater than or equal to 0.2 mV) for detecting three-vessel coronary artery disease at a matched specificity of 72% (100% versus 46%, 81% versus 64%, p less than 0.01). A significant linear correlation was found between maximum pulmonary artery wedge pressure increments during exercise (delta PAWP) or Gensini score and the delta ST/delta HR (delta PAWP: r = 0.51, p less than 0.001; Gensini score: r = 0.47, p less than 0.001). There were no statistically significant differences in the delta PAWP or Gensini score between patients with three-vessel disease who had delta ST/delta HR greater than or equal to 3.0 microV/beat/min and those with one- or two-vessel disease who had delta ST/delta HR greater than or equal to 3.0 microV/beat/min (delta PAWP: 18.1 +/- 2.0 versus 21.9 +/- 3.3, p = NS; Gensini score: 68.5 +/- 6.6 versus 66.3 +/- 11.3, p = NS). These findings demonstrate that delta ST/delta HR is more useful than a conventional analysis of ST segment depression for identifying not only anatomically severe coronary artery disease but also functionally severe coronary artery disease.

Multiple intracranial xanthogranulomas--case report

A 58-year-old female was admitted to our hospital with nausea, vomiting, and gait disturbance of 1 year duration. Postcontrast computed tomographic scans demonstrated enhanced lesions in the left cerebellopontine angle (CPA), the retrosellar region, the right parasellar region, and the left parietooccipital convexity. The left parieto-occipital tumor was totally removed in the first operation and the left CPA tumor was partially removed in the second. The histological diagnosis of both tumors was xanthogranuloma. She also had cutaneous lesions (subcutaneous nodules without tenderness) and an ureteral stenosis possibly due to the retroperitoneal involvement. A skin biopsy demonstrated infiltration of xanthoma cells and foamy cells in the dermis. A gallium scintigram demonstrated an abnormal uptake in the thoracic cavity, liver, and bones. From these findings, systemic Weber-Christian disease was diagnosed. Another unique aspect was that the serum IgE levels were increased during postoperative hospitalization. This suggests that abnormal immunological conditions are related to this disease and that intracranial xanthogranulomas are a manifestation of systemic Weber-Christian disease.

[Nosocomial infection by new quinolone resistant Enterobacter cloacae]

For the past two years, five strains of new quinolone resistant Enterobacter cloacae have been isolated from three patients in our hospital; strain A was isolated from patient A, strain B from patient B, and strains C1, C2, C3 from patient C. These five strains were resistant to new quinolones and other antimicrobial agents including ampicillin, piperacillin, methicillin, cefotaxime, cefoperazone, kanamycin, gentamicin, tetracycline, minocycline, and chloramphenicol. Plasmid DNA profiles on agarose gel indicated that strain B and C3 carried completely the same plasmid pattern, but strain A gave a different plasmid pattern. Furthermore chromosomal DNAs extracted from strains A, B and C3 were digested with restriction endonucleases EcoR I, BamH I and Sma I. They were separated by pulsefield gel electrophoresis. The banding profiles of strains B and C3 showed the same pattern. It is, therefore, highly suggested that strains B and C3 are the same E. cloacae strain, although isolated from different patients at different time. The possible route of nosocomial infection between these two patients who were hospitalized in the same room after an interval of 4 months was discussed.

[Heart rate changes in sleep apnea syndrome]

Sleep apnea syndrome (SAS) is often associated with arrhythmias. The study was performed to clarify the characteristics and mechanisms of the heart rate (HR) changes during and after sleep induced apneas. Thirty-one patients with SAS without definitive heart disease, aged 17-78 years (mean 54.2 years), were examined by electroencephalograms, electrocardiograms, electrooculograms, nasal and oral breathing, thoracic and abdominal respiratory movements and arterial oxygen saturation (SaO2). [Results and Discussion] At the onset of sleep apnea, some showed progressive reductions in HR, followed by abrupt tachycardia on the resumption of breathing. Thirty-one patients with SAS were classified into three Groups (A, B, C). Group A demonstrated that HR changes occurred associated with apnea both in stage REM and in stage non-REM. Group B demonstrated that HR changes occurred associated with apnea only in stage REM. Group C demonstrated that HR changes did not occur associated with apnea. In Group A, apnea frequency and apnea index were higher than those of Group C. In Group A, the lowest SaO2 was lower than that of Group C, total time under 90% of arterial oxygen saturation (SaO2) was longer than that of Group C. There was a good negative correlation between oxygen saturation and HR changes. Further, HR changes were augmented by arousal response. This might be related to the arousal response as well as to the cardiostimulatory effects of hypoxia associated with increased ventilation. The arousability in response to apneas might be important in HR changes. In SAS, the degree of HR changes was related to apnea frequency, apnea index, apnea length and sleep stage.(ABSTRACT TRUNCATED AT 250 WORDS)

[An erythremia with acquired HbH disease and chromosomal abnormality]

A 56-year-old male was admitted to the Nihon University Hospital because of general fatigue and anemia on September 21st, 1985. He had mild hepato-splenomegaly. Hematological findings showed RBC 286 x 10(4)/microliters, Hb 6.0/dl, reticulocyte count 2.5%, platelet count 9.3 x 10(4)/microliters and WBC 2,400/microliters. An erythroblast per 100 leukocytes counted in a blood film was found. Bone marrow was erythroid hyperplasia with megaloblasts. The erythroblasts were PAS positive but not ringed sideroblasts. Other laboratory data including hemolysis were all negative. This case seemed to be diagnosed as refractory anemia (RA) according to the FAB classification. Chromosomal analysis of marrow cells, however, all revealed 46, XY, 20q- at diagnosis and 46, XY, 7q- 20q- after 22 months. Furthermore, Hb electrophoresis ahd family study indicated the presence of acquired HbH disease. Neither erythroid bursts (BFU-e) nor late erythroid progenitors (CFU-e) were detected. He has had progressive anemia without proliferation of blasts for over 2 years. From these findings, we postulate that the entity of erythremia should be distinguished from RA including many heterogeneous diseases.

Ovarian epithelial tumors of borderline malignancy in Japan

Seventy-one cases of ovarian epithelial tumor of borderline malignancy have been surveyed from a clinicopathologic viewpoint. The majority of the borderline tumors (73.2%) were of the mucinous type, versus only 16.9% of the serous type. The other types--endometrioid (2.8%), Brenner (1.4%), and mixed type (5.6%)--were much rarer. Patients with mucinous tumors were significantly younger (mean age 42.6) than those with serous tumors (mean age 57.5) (P less than 0.01). Of patients with mucinous tumors, 64.2% were of reproductive age (15-45 years), compared with 17% of patients with serous tumors. Some 78.8% of mucinous and 83.3% of serous borderline tumors were FIGO stage I. Serous tumors were more frequently bilateral (66.7%) than mucinous tumors (9.8%). In mucinous borderline tumors, the extent of tumor spread at the first laparotomy had an intimate relationship to the prognosis, but in serous borderline tumors, it was insignificant. The survival rate of patients with mucinous borderline tumors was 69.3% at 5 years and 62.4% at 10 years (Kaplan-Meier method). Most patients with pseudomyxoma peritonei classified as borderline at the time of discovery died within 5 years of the operation. The prognosis of the serous type was extremely favorable. Criteria for borderline tumors of various cell types and differences in the clinicopathologic data of ovarian borderline tumors between Japan and other countries were discussed.

[Acute myeloblastic leukemia associated with 46, XY, del(5)(q22)]

A 38-year-old male admitted to the Internal Medicine of Surugadai Nihon University Hospital, complaining of general fatigue and throat pain. The laboratory examinations revealed leukocytosis (83, 900/microliters) and an appearance of myeloblasts (90.2%) in the peripheral blood. The nucleated cell count was 56 x 10(4)/microliters with 85.5% myeloblasts in bone marrow. He was diagnosed as acute myeloblastic leukemia (AML). Though he received two courses of combination chemotherapy with daunorubicin, BH-AC, 6 MP and prednisone, one course of combination with mitoxantrone, etoposide and cytosine arabinoside and one course of combination with aclarubicin cytosine arabinoside and prednisone, he could not achieved remission. A chromosome analysis revealed 46, XY del(5)(q22). The amount of DNA fragments hybridized to 4.5 Kb v-fms probe in blastoid cells was approximately a half amount of normal persons. It is not defined the relationship between the decrease of fms and leukemia in this case. He was diagnosed de novo AML, since he had not been received the therapy with potential mutagenic and carcinogenic agents and had not been exposed the irradiation on his works.

[Acute lymphocytic leukemia having surface phenotype of CD 2 and NKH-1 with rapid clinical course]

Abnormal expansion of large granular lymphocytes (LGLs) was observed in peripheral blood and bone marrow in a 28-year-old man. He had general lymphadenopathy and splenomegaly. Surface phenotypical analysis of LGLs showed that these LGLs express CD 2, Ia and NKH-1 but not express CD 3, CD 4, CD 8 and Leu 7. Cytochemical analysis of these LGLs revealed positive acid phosphatase and beta-glucuronidase reaction but negative alpha-naphthyl acetate esterase reaction. These LGLs showed very weak NK activity against only MOLT-4 but showed no cytotoxic activity against K 562. An beta-receptor gene rearrangement of human T-cell receptor was not found by Southern blot analysis. Rapid and fetal clinical course with the results of theses analytical studies showed that this case is highly suggestive of acute leukemia of LGLs which is committed to NK cell lineage.

Mechanism of abnormal postexercise systolic blood pressure response and its diagnostic value in patients with coronary artery disease

To define the factors that affect an abnormal postexercise systolic blood pressure (SBP) response and to verify the diagnostic value of that response in patients with coronary artery disease (CAD), we studied 33 normal subjects, eight patients with hypertension who had no CAD, and 42 patients with documented CAD who underwent supine leg exercise testing. SBP recovery ratios were derived by dividing the values obtained 1 and 3 minutes after exercise by the peak value. The upper normal limit of the SBP ratio was defined by two standard deviations from the mean for 33 normal subjects. The specificity of this criterion for identifying patients with CAD was 97% and the sensitivity was 60%. None of the eight patients with hypertension showed an abnormal postexercise SBP response. At peak exercise the pulmonary artery wedge pressure was significantly greater in the patients with CAD having an abnormal response. In multiple regression analysis the exercise pulmonary artery wedge pressure, the exercise SBP, and the systemic vascular resistance after exercise were determining factors for an abnormal SBP response. Three-vessel disease was more common in patients with an abnormal response. Results of this study indicate that an abnormal postexercise SBP response appears to be determined by (1) the extent of exercise-induced impairment of left ventricular function and (2) peripheral vascular tone during recovery. This study also suggests that this criterion can increase the specificity of supine exercise testing in patients with CAD including those with hypertension and might provide a marker for the severity of impaired left ventricular function by exercise in CAD.

Hemodynamic mechanisms of antianginal action of calcium channel blocker nisoldipine in dynamic exercise-induced angina

To investigate the mechanism of antianginal action of the calcium channel blocker nisoldipine and to determine the reproducibility of the clinical and hemodynamic events induced by supine leg exercise, 30 patients with stable effort angina pectoris were studied. They were divided into two groups; one group of 19 patients received a single 10-mg dose of nisoldipine orally, and the other group of 11 patients received a single dose of placebo orally. Chest pain was induced in all of 30 patients during the control exercise test. After nisoldipine administration, chest pain was not induced in 13 of 19 patients and was of lessened severity in five patients with the same work load as those performing control exercise. ST segment at peak exercise showed less severe depression after nisoldipine. Systemic vascular resistance was reduced by 38% (p less than 0.001) at rest and 22% (p less than 0.001) at peak exercise, and coronary vascular resistance was reduced by 31% (p less than 0.01) at rest and 18% (p less than 0.01) at peak exercise. Pulmonary artery wedge pressure fell from 6 +/- 1 to 3 +/- 1 mm Hg (p less than 0.001) at rest and from 28 +/- 3 to 11 +/- 2 mm Hg (p less than 0.001) at peak exercise. Coronary sinus flow at rest and myocardial oxygen uptake both at rest and during exercise was not modified by nisoldipine. However, coronary sinus flow at peak exercise increased significantly from 219 +/- 24 to 249 +/- 31 ml/min (p less than 0.01) after nisoldipine, and myocardial oxygen uptake was not significantly changed despite decreased coronary vascular resistance. The clinical and hemodynamic events induced by the exercise during invasive studies (except pulmonary artery wedge pressure at rest) were reproducible after placebo administration. Our data demonstrate that increased coronary blood flow could be the major mechanism of the antianginal action of nisoldipine in supine leg exercise-induced angina.

[Morphological and immunological classification and response to chemotherapy in adult patients with acute leukemias]

Three hundred forty four adult patients with acute leukemia were classified according to the FAB classification, and revealed 109 patients were ALL and 235 were AML. Surface marker analysis were done in 52 cases with ALL and 51 with AML. Patients with ALL were treated with VP or LVP therapy and those with AML were treated with DC(M)P, BH-AC DMP, DCMP-85 or DBMP-85. L 1 was 56% of ALL patients and L 2 was 44%. Complete remission (CR) rate of L 1 was 78.8% and that of L 2 was 62.5%, however 5 year survival rate was less than 20% in both groups. c-ALL was 62% of ALL, T-ALL and N-ALL were 15% and 13% respectively. L + M ALL was 8% and B + T ALL was 2%. CR rate was almost same among each groups, however disease free survival (DFS) was better in T-ALL and worse in c-ALL. M 1 was 23.4% of AML, M 2, M 3, M 4, M 5 and M 6 were 42.6%, 15.7%, 11.9%, 5.1% and 1.3% respectively. CR rate of all AML was 71.9% and that of M 3, M 5 and M 6 was worse than the average. Five years continued complete remission (CCR) rate of M 2, M 3 and M 4 were 20-25%, while that of M 1 and M 5 were worse than the former. Myeloid-AML was 67% of AML, L + M-AML and lymphoid-AML were 27% and 6% respectively. CR and CCR rate of L + M-AML and lymphoid-AML were seemed to be better than those of myeloid-AML. Thus, the patients with AML, even though they have the blasts which express lymphoid markers, can be treated with AML directed therapy.

[Working ability between air and trimix breathing gas under 8 ATA air condition]

Pneumatic caisson work in Japan has come into operation since 1924. Afterward, this technique of compressed air work has been widely utilized in the construction of foundation basements, shafts of the bottom tunnel shields for subway and so forth. While using this technique of compressed air work means that workers have to be exposed to hyperbaric environment, this technique has risks of not only decompression sickness (DCS) but also toxicity of poisonous gas and/or oxygen deficiency. However, this technique is independent of city construction work and the operation of compressed air work higher than 5ATA (4.0 kg/cm2G) is actually been planning recently. Accordingly unmanned caisson work is considered as a better technique for such higher pressurized work, even though workers must enter into hyperbaric working fields for maintenance or repair of unmanned operated machinery and materials. This research is to establish the safe work under hyperbaric air environment at 8ATA.

Study of ovarian tumors treated at Nagoya University Hospital, 1965-1988

The relative frequency and the age distribution of ovarian tumors (873 primary and 47 secondary tumors) encountered over 23 years at Nagoya University Hospital were examined with respect to histological type and grade of malignancy. Of the primary neoplasms, common epithelial tumors accounted for 56.6%, sex cord-stromal tumors for 7.3%, and germ cell tumors for 39.5%. Among 296 cases with primary malignant neoplasms, common epithelial type accounted for 75.6%, sex cord-stromal tumors for 4.7%, and germ cell tumors for 19.6%. A review of the literature from Western countries indicated that in Japan, the relative frequency of common epithelial tumors is lower but that of germ cell tumors, especially malignant germ cell tumors, is higher. The difference in the incidence of germ cell tumors between Japan and Western countries is not considered significant, and the incidence of common epithelial tumors is considered to be much lower in Japan.