Squamous cell carcinoma of the ovary--a case report

A 68-year-old woman presented a one-month history of lower abdominal pain and weight loss, and was admitted to our hospital. On physical examination, a large hard mass was palpated in her right lower abdomen. An ultrasonograph and computed tomographic (CT) scan revealed a right ovarian tumor that measured 6.9 x 4.9 cm in size. A total hysterectomy and bilateral salpingo-oophorectomy were performed. The postoperative diagnosis of the tumor was squamous cell carcinoma (SCC) of the ovary. She died of infection and disseminated intravascular coagulation 5 months after surgery. The clinical and autopsy examinations did not show the primary lesions of SCC except in the right ovary. Mature cystic teratoma, Brenner tumor and endometriosis, which are ordinary regarded as the histogenesis of ovarian SCC, were not found, but a few surface epithelial inclusion cysts with squamous metaplasia were observed in non-cancerous area of the right ovary, and the contiguous transition from the metaplastic cyst wall to SCC was confirmed by stepwise serial sections. The present case suggests that the surface epithelium of ovary could be the fourth possibility in the histogenesis of the ovarian SCC.

A carcinoma in situ arising in an endocervical polyp--a case report

A rare case of a carcinoma in situ arising from an endocervical polyp is described. The covering epithelium of the polyp transformed gradually into a carcinoma in situ via squamous metaplasia and dysplasia, spreading horizontally with glandular involvement, and colliding with the surface columnar cells. The lack of tumor tissue in the pedicle and adjacent cervical region confirms the case was a carcinoma in situ originating from the surface epithelium of the endocervical polyp.

Serum manganese superoxide dismutase (MnSOD) and histological virulence of ovarian cancer

The serum level of a scavenging enzyme, manganese superoxide dismutase (MnSOD), was examined in 78 patients with ovarian cancer. Tumors included 27 stage I, 6 stage II, 37 stage III and 8 stage IV diseases. They were classified as 43 serous, 18 mucinous, 10 clear cell and 7 endometrioid neoplasms, and grouped into 25 grade I, 27 grade II and 26 grade III cancers. Factors affecting the MnSOD level were estimated by analysis of variance and Bonferroni t-test. From these, both the stage and histology were less-effectively affected by the level, while the histological grade was estimated as effective with p < 0.05. The MnSOD value increased significantly in accordance with the escalation of the tumor grade with p = 0.02 for grade I vs II, 0.005 for II vs III, and 0.0001 for I vs III respectively. MnSOD determination may be unique as a predictor of the histological virulence of ovarian carcinoma.

[Myelopathy associated with HTLV-1: clinical electrophysiologic study]

Clinical and electrophysiological studies have been performed in 9 cases of HTLV-I associated myelopathy (7 female, 2 male). Spastic paraparesis and neurogenic bladder were present in 8; sensory disturbances were detected only in 4. The conduction velocities of the posterior tibial and sural nerves were reduced in 2 cases. Median nerve SSEP revealed a delay of N11, N13, N14, N20 peak latencies and an increase of N9-N20, N13-N14 and N13-N20 interpeak latencies. The electrophysiological studies are the most accurate indicators of the diffuse involvement not only of central motor and sensory pathways but also of the peripheral nervous system.

Intermittent high-dose vitamin C therapy in patients with HTLV-I associated myelopathy

The efficacy of intermittent high-dose vitamin C therapy was evaluated in seven patients with HTLV-I-associated myelopathy (HAM). All HAM patients responded well to this therapy without serious side effects. Grade of disability score improved at 9.7 (SD 5.8) months after the therapy from 7.1 (3.3) to 3.6 (2.0) (p < 0.01). Serum immunosuppressive acidic protein was elevated before and decreased after the therapy from 747 (316) to 398 (86) micrograms/ml (p < 0.05), suggesting favourable immunomodulatory action of vitamin C therapy in HAM patients.

[A study on cervical cerclage for a dilated cervix or bulging membranes without rupture of membranes]

During the period January 1, 1989 through December 31, 1991, one hundred thirty-six pregnant women with an effaced and widely dilated cervix or with bulging membranes were treated by emergent cervical cerclage. Suturing was carried out in 16 women before 20 weeks gestation, in 86 women between 20 and 28 weeks and in 34 women after 28 weeks. 16 patients in group A were those whose pregnancy was terminated with 3 days after operation and their tocolysis index was significantly higher than that of 69 patients in group D, whose pregnancy was prolonged move than two weeks. Clinical chorioamnionitis (WBC > 15,000/mm3 and CRP > 2mg/dl) was occurring in 43.7% of patients in group A, compared with 8.7% in group D at the time of operation. Vaginal delivery was accomplished in 38 patients at between 24 and 36 weeks gestation in our hospital, while 41 cesarean sections were performed. On the basis of these results, we conclude that the emergency cerclage operation may improve the outcome of pregnancy but we have to pay special attention to premature rupture of membranes and chorioamnionitis.

[Estimation of asbestos exposure among workers repairing asbestos cement pipes used for conduits]

Asbestos cement pipes (ACPs) containing 15 to 20% chrysotile or crocidolite have been used for underground conduits. Even today 16.2% of all conduits in Japan are ACPs, though the production of ACPs was suspended in 1985. When such a conduit is accidentally damaged the workers belonging to the Waterworks Bureau of a local government cut off the damaged conduit using a high-speed disk cutter and replace it with a new conduit. This operation develops a cloud of dust and the workers involved run the risk of asbestos exposure. It was the aim of the present study to estimate asbestos exposure levels among these workers. First, in the experiment, we established the typical working conditions and requested an experienced worker to cut an ACP using a high-speed disc cutter in a hole dug in the ground as he routinely does. The experiment was repeated three times. During a bout of each experiment, dust was sampled at several points both inside and outside the hole. Second, a self-administered questionnaire survey was conducted to obtain information from the workers regarding their working conditions in cutting ACPs. The subjects of the survey were 1,048 men belonging to conduit repair sections of the Waterworks Bureau of 119 local governments. The results obtained can be summarized as follows. 1) Each bout of cutting ACPs required about five minutes. The concentration of asbestos fibers longer than 5 microns with 3:1 aspect ratio ranged from 48 to 170 fibers/ml (92 fibers/ml on an average) inside and 1.7 to 15 fibers/ml outside the hole. The concentration inside the hole exceeded the ceiling limit (10 fibers/ml) recommended for asbestos by the Japanese Association of Industrial Health. A concentration of 92 fibers/ml is equivalent to 0.96 fibers/ml as 8-h time-weighted average. 2) The number of subjects with experience of cutting ACPs was 849 (81.0%). The average length of service in conduit repair section was 14.2 yr. Based on the information obtained from each subject regarding the average working days per yr for each decade from 1946, the cumulative days to date expended in cutting ACPs was estimated to average 235 d, that is, 17 d per yr. Only 18.1% of the subjects used a protective respiratory device.(ABSTRACT TRUNCATED AT 400 WORDS)

[Intermittent high-dose vitamin C therapy in patients with HTLV-I-associated myelopathy]

The aim of this study was to determine the efficacy and safety of intermittent high-dose vitamin C therapy in patients with HTLV-I associated myelopathy (HAM). Seven HAM patients (4 men and 3 women, aged 36 to 81 years), who were repeatedly given a daily oral dose of 1.5 to 3.0 g of vitamin C (40 mg/kg/day) for 3 to 5 successive days followed by a two-day withdrawal period, were followed for a mean period of 9.7 +/- 5.8 months after the therapy. The therapeutic efficacy was evaluated by a 10-grade disability scoring (DS) system, short somatosensory evoked potentials (SSEP) elicited by tibial nerve stimulation and several immunological parameters before and at 2.0 to 14 months after the therapy. All HAM patients responded well to intermittent high-dose vitamin C therapy, 6 being excellent responders (DS improvement > or = 2 grades) and one being a good responder (DS improvement of one grade). The grade of DS was decreased at 9.7 +/- 5.8 months after the therapy from 5.9 +/- 1.6 (baseline) to 3.0 +/- 1.5 (p < 0.01), indicating an excellent clinical outcome. SSEPs were obtained before and after the therapy in 4 of the patients. On SSEP before therapy, all the patients showed abnormally prolonged P37 peak latency. N20 was not recorded in 2 patients. After the therapy, N20 appeared and prolonged P37 peak latency improved in 2 patients. Immunoglobulin concentrations, T-B lymphocyte subsets and HTLV-I antibody titer in serum did not change.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mutational activation of H-ras and K-ras (Codon 12,61) genes in 7,12 dimethylbenz(a)anthracene induced rat ovarian tumors]

We had studied the histogenesis and p21 expression in ovarian tumor induced by 7,12-dimethylbenz(a)anthracene (DMBA). The present study was done to elucidate point mutation of the ras gene in tumors. Cases with immunohistological p21 expression; 3 adenomas, 5 adenocarcinomas and 2 sarcomas were examined by polymerase chain reaction (PCR). 1) The products of PCR were confirmed the presence of amplified sequences by electrophoresis. 2) No point mutation of H-ras (Codon 12,61) or K-ras (Codon 12,61) genes was found in the ovarian tumors induced by DMBA. 3) These results suggested that the mutational activation of ras genes in tumorigenesis was dependent on another mechanism.

Laparoscopic treatment of ectopic pregnancies--reports of two cases

Two cases with ectopic pregnancy were successfully treated by laparoscopic injection of methotrexate (MTX). Case 1: A 29 year-old housewife was laparoscopically treated with a 15 mg MTX injection to the left Fallopian tube. After the laparoscopy, the human chorionic gonadotropin (HCG) was reduced to the normal range. Case 2: A 34 year-old housewife was also laparoscopically treated with a 35 mg MTX injection to the right Fallopian tube. After the laparoscopy, the HCG was quickly reduced to the normal range. The endoscopic approach can be used as the surgical treatment of choice for ectopic pregnancies.

Strumal carcinoid of the ovary

A strumal carcinoid arising in a benign cystic teratoma of the left ovary was reported in a 41 year-old woman. The solid tumor was histologically a trabecular carcinoid tumor associated intimately with thyroid follicle-like structures. By Grimelius staining, argyrophil granules were found in the cytoplasm of the tumor cells. The final diagnosis of strumal carcinoid, however, was established by the confirmation of thyroid tissue.

[A study of urinary tegafur, 5-fluorouracil (5-FU) and uracil concentrations in the cases of gastric carcinoma for the confirmation of drug-taking compliance after UFT oral administration]

We have measured urinary tegafur (FT), 5-FU and uracil concentrations after UFT oral administration (300 mg daily for 7 days) to confirm drug-taking compliance in the 17 cases undergone gastrectomy. Urinary FT and 5-FU concentrations reached to the plateau 2 and 3 days after administration, respectively, and were maintained until the day after termination of administration. Subsequently, FT and 5-FU concentrations also decreased about 50% at 2 day, 20% at 3 day, 10% of the plateau values at 4 day after termination, respectively. The mean plateau value of urinary FT was 12.9 +/- 6.8 micrograms/dl, and that of urinary 5-FU was 0.67 +/- 0.50 microgram/dl. On the other hand, uracil concentration, was not different before and after administration because of the uracil being present endogenously. Therefore, it was suggested that measurement of urinary FT and 5-FU concentrations is useful for confirmation of UFT-taking compliance.

[Immunohistochemical studies of recessive oncogene p53 and N-myc oncogene expression in 7, 12 dimethylbenz (a) anthracene-induced rat ovarian tumors]

In the present study, the expressions of p53 and N-myc gene were analyzed immunohistochemically in rat ovarian tumors induced by 7,12 dimethylbenz (a) anthracene (DMBA). 1) p53 could be seen in the nucleolei of tumor cells. The positive rates were: adenomas 17%, adenocarcinomas 37%, sarcomas 0%, mixed müllerian tumor 0% and epidermal cysts 100%. Neither the serial-allografted tumor nor DMBA-OC-1 was positive. 2) N-myc could be seen in the cytoplasm and perinuclear cytoplasm of tumor cells. The positive rates were: adenomas 33%, adenocarcinomas 77%, sarcomas 100%, mixed müllerian tumors 100% and epidermal cysts 100%. Both the serial-allografted tumor and DMBA-OC-1 were positive. 3) The positive rates in both p53 and p21 were: adenocarcinoma 20% and epidermal cysts 100%. The positive rates in both N-myc and p21 at the were: adenoma 17%, adenocarcinoma 50%, sarcoma 33%. Both the serial-allografted tumor and DMBA-OC-1 were positive. Only two cases were positive for p53, N-myc and p21. p53 was detected in most of the adenomas. 4) The positive rate for both N-myc and p21 was higher than that for both p53 and p21. This was similar to other reports. The results suggested that p53 plays a role in precancerous tumor as a recessive oncogene. It was supposed that tumors with N-myc gene expression were had malignant growth characteristics.

Detection of human papillomavirus (HPV) using dot blot and Southern blot, hybridizing with a mixture of seven probes

A previously presented method for the detection and typing of human papillomavirus (HPV) DNA has been modified for the simultaneous analysis of HPV types 6, 11, 16, 18, 31, 33 and 35. The method has two steps, where a dot blot test is used to exclude cases that do not hybridize with HPV-DNA. The remaining cases are then analysed by a Southern blot procedure, using a mixture of subgenomic probes for the simple and accurate analysis of HPV types. When the procedure was used for the analysis of clinical samples, patient groups at varying risk were found to differ with regard to the prevalence of HPV infections. Thus, the virus was detected in only 8.8% of otherwise healthy young women - i.e. women without clinical signs of HPV-related disease - as compared to 48% of women who also had cervical intraepithelial neoplasia (CIN). A similarly high prevalence was found in patients in whom CIN persisted (42%) as compared to those in whom the morphological lesion regressed to normal (8%).

[Renal pseudoaneurysm successfully treated by superselective embolization as a complication of percutaneous nephrolithotomy: report of a case]

A case of renal pseudoaneurysm which occurred as a complication of percutaneous nephrolithotomy (PNL) for right renal staghorn calculi is presented. A 59-year-old man, who previously had left nephrectomy due to renal staghorn calculi and right pyelolithotomy due to renal calculi, was admitted to our hospital for treatment of recurrent right renal staghorn calculi on March 29, 1990. Laboratory data on admission revealed no significant abnormality except for a mild elevation on blood glucose (116 mg/dl). Pseudomonas aeruginosa (10(6) CFU/ml) was cultured from urine. Preoperative plain abdominal film showed right partial staghorn calculi extending to the lower calyx and pelvis. Three sessions of PNL were performed. Two nephrostomy tubes were placed in the upper and middle calyces at the first session. Although all calculi were removed completely, massive renal bleeding with bladder tamponade occurred several times postoperatively and blood transfusion was necessary. Renal angiography was performed, and it was demonstrated renal pseudoaneurysm at the upper nephrostomy tract. At the same time the pseudoaneurysm was treated by superselective embolization with an absorbable gelatin sponge. We reviewed the related literature on complications of PNL. Etiology and treatment of a renal vascular injury associated with PNL are also discussed.

[Characterization of oncogenes (K, N-ras and N, c-myc) in subcloned cell lines (KCC-1a and 1b) derived from same endometrial carcinoma presenting well differentiated adenocarcinoma and clear cell carcinoma]

Human endometrial adenocarcinoma cell lines (KCC-1a and KCC-1b) were established from the same endometrial carcinoma. 1) Amplification of the N-ras gene was not able to be observed in Southern blot hybridization. K-ras gene amplification of KCC-1b was more than 10 fold that of KCC-1a and the control. N-myc gene amplification of KCC-1b was more than 3-5 fold that of KCC-1a. c-myc gene amplifications of KCC-1a and KCC-1b were more than 5-7 fold that of the control DNA. 2) p21 was observed in tubular adenocarcinoma but not in clear cell carcinoma. p21 was detected in KCC-1b cells but not in KCC-1a cells. 3) KCC-1a and KCC-1b cells had quite different characteristics in molecular biology.

[Immunohistochemical studies of ras oncogene product p21 in 7,12 dimethylbenz (a) anthracene-induced rat ovarian tumors]

In the present study, ras oncogene product p21 was analyzed immunohistochemically in rat ovarian tumors induced by 7,12 dimethylbenz (a) anthracene (DMBA). 1) After 28-38 (average 35.6) weeks, the tumors -6 adenomas, 30 adenocarcinomas, 3 sarcomas, one mixed müllerian tumor and 2 epidermal cysts--were produced in the rat ovaries. 2) The p21 positive reactions could be seen in the cytoplasm of the tumor cells. The positive rates were as follows: adenomas 83%, adenocarcinomas 57%, sarcomas 67%, mixed müllerian tumors 0%, epidermal cysts 100%, in which the positive reactions were obtained in squamous cells. Both of the serial-allografted tumor and DMBA-OC-1 were positive. 3) The present study showed that the ras oncogene is not a specific gene in ovarian sarcoma or in other tumors. 4) The present study has suggested that the ras oncogene plays a role in tumor genesis including benign tumors, by showing p21 positive in adenomas and epidermal cysts.

Establishment and characterization of unique cell lines (KCC-1a and KCC-1b) from endometrial adenocarcinoma with clear cell carcinoma presenting unusual karyotypes and estrogen secretion

Human endometrial adenocarcinoma cell lines (KCC-1a and KCC-1b) were established from a resected endometrial carcinoma of a 67-year-old woman. The original tumor showed the bimorphic patterns of tubular adenocarcinoma and clear cell carcinoma. The cell lines have been maintained for 50 months through 100 passages. The doubling time of KCC-1a was 87 hours, whereas that of KCC-1b was 144 hours. The number of chromosomes of KCC-1a distributed in a range from 33 to 79, whereas that of KCC-1b distributed in a range from 64 to 82 (mode, 76). Functionally, both KCC-1a and KCC-1b cells showed the productions of estrone (E1) and estradiol (E2) but not estriol (E3) or progesterone (P). These cells grown in a serum-free medium secreted E1 (KCC-1a, 13.6 pg/ml; KCC-1b, 9.5 pg/ml) and E2 (10.5 pg/ml, 9.5 pg/ml) at passage 40. Neither KCC-1a nor KCC-1b cells contained estrogen or progesterone receptors. Tumor markers--alpha-fetoprotein, carcinoembryonic antigen, CA 125, and CA 19-9--were not detected. Both KCC-1a and KCC-1b cells produced tumors in nude mice xenografts. Histologically, the tumors of KCC-1a cells were clear cell carcinoma, whereas those of KCC-1b cells were tubular adenocarcinoma. These findings suggest that KCC-1a and KCC-1b cells will provide useful information to clarify the histogenesis of endometrial carcinoma combined with clear cell carcinoma.

Human papillomavirus infection of the male diagnosed by Southern-blot hybridization and polymerase chain reaction: comparison between urethra samples and penile biopsy samples

A group of 108 healthy men aged 18 to 23 years underwent penoscopy after application of acetic acid. In 39 (37%) aceto-white lesions were found and a biopsy was taken. From 105 patients a urethra sample was collected with a brush. The prevalence of HPV-DNA by dot-blot and Southern-blot hybridizations (DBH/SBH) and polymerase chain reaction (PCR) as well as the correlation between results from urethra samples and penile aceto-white epithelium were examined. In urethra, HPV-DNA was detected in four of the 66 patients (6%) with normal epithelium and in three of the 39 (8%) with aceto-white epithelium by using DBH/SBH. By PCR the corresponding findings were eight (12%) and 10 (26%) HPV-DNA-positive patients, respectively. Out of the 39 biopsy samples HPV-DNA was detected in six (15%) by DBH/SBH and in 17 (44%) by PCR. Twenty-two (56%) of the patients with aceto-white lesions were by PCR positive in either the urethra sample or biopsy. All samples positive by DBH/SBH were also positive by PCR except for one biopsy with HPV 35, a type not tested for by PCR. HPV 11 was the most common finding in urethra and HPV 6 and 16 in aceto-white epithelium.

[Work load of nursery teachers in a nursery school. Relationship between age of children and work load]

Time study of six nursery teachers of children aged 0 to 5 was conducted at a public nursery school to ascertain their work load, and the results obtained were examined from the following two viewpoints. First, comparison was made between the results obtained by the following two methods of analysis; 1) An observer recorded the work contents and the working postures of a nursery teacher at place of work in one-minute units. 2) The nursery teacher was recorded on video tape and the analysis of the work contents and the working postures was made in one-second units. Second, comparison was made between the work loads (work content, working posture, walking, lifting children and recess) of nursery teachers of children of different age group. The results could be summarized as follows: 1. The results of analysis made by the two methods of the work contents and the working postures were in good agreement. 2. The higher the age of children in the class, the longer was the cumulative time for "indoor group nurture" and the shorter was the cumulative time for "help and care for feeding", "help and care for afternoon nap" and "help and care for excretion". 3. The higher the age of children in the class, the longer was the cumulative time of "standing" in a nursery teacher and the shorter was the cumulative time of "sitting on the floor". The total time of "bending forward", "squatting" and "rising on the knee" occupied 20% of the working hours on an average and was not related clearly to the age of children. 4. The frequency of walking was not found to be related to the age of children. 5. The nursery teachers of children aged 0 and 1 lifted children much more frequently among all nursery teachers. 6. The recess away from children was rarely observed throughout the day.

[A study of amplifications of myc gene (c-myc and N-myc) in human ovarian cancer]

Amplifications of myc oncogenes (c-myc, N-myc) were studied by Southern blot hybridization methods in ovarian cancers. Fourteen cases were primary ovarian cancers and one case was metastatic ovarian cancer. Primary and metastatic foci of three primary ovarian cancers were compared. A serous adenocarcinoma had a c-myc gene amplification more than 10 fold without N-myc gene amplification. This case also had an amplification in other c-myc probes with upper and down streams of the second exon. The results suggested that this case had c-myc gene expression. One of these cases had 5 fold amplification of the metastatic focus compared with the primary focus. The amplified c-myc gene did not show relations among clinical courses, prognosis and histologies.

[A study of localizations and serum data; four tumor markers (CA125, CA19-9, CEA and TPA) in ovarian cancers]

Four tumor markers (CA125, CA19-9, CEA, TPA) were analysed between the localizations and the serum data in the 36 ovarian cancers. The positive rates of each tumor markers were; 23 cases (63.9%) on CA125, 15 cases (41.7%) on CA19-9, 12 cases (33.3%) on CEA, and 27 cases (75.0%) on TPA. CA125 and CA19-9 were observed in the luminar borders and cellular membranes on serous adenocarcinomas and in the cytoplasms on mucinous adenocarcinomas. Both CEA and TPA were stained in cytoplasms. The correlation in the localization was observed between CA19-9s and CEAs (Kendall's rank correlation = 0.5303 greater than 0.5). The correlations between the localization and the serum data were observed on CA19-9 and CA125.

Detection and typing of human papillomavirus infection of uterine cervix in young women by non-isotopic subgenomic probes on Southern blot--a report of studies in Sweden

Human papillomavirus (HPV) was detected by non-isotopic subgenomic probes on Southern blot hybridization (Oncor Inc., Gaithenberg, MD). The 108 samples which were obtained from patients below the age of 30 (mean age 19.0 +/- 2.8 yrs). All samples were collected from the ectocervical mucosa by Cytobrush (Medscand, Malmö, Sweden) as previously described. HPV-DNA was detected in 16 cases (15%). In 36 cases (33%) the patients presented clinical findings of condyloma or cervical intra-epithelial neoplasia (CIN) at simultaneous vaginal ectocervical smears. HPV-DNA was detected in 12 out of 36 cases. On the other hand, in the patients without subclinical findings HPV-DNA were detected in only 4 out of 70 cases (6%). HPV-DNA was detected in one of the 4 patients with accuminate condyloma of the cervix and in 4 out of 16 cases with similar lesions in the vulva. The only HPV type found in these patients was type 6. Papillomavirus was also detected in 5 out of 16 cases (31%) with flat condylomas, most studied types being represented here. CIN was only reported two patients both of them carrying HPV-DNA (types 16 and 18 respectively). The most common type of virus was HPV 6. Combined infections with two or three types were seen in 5 out of 16 HPV-positive cases (31%). Such cases are readily detected and typed with the present Southern blot procedure, where the use of subgenomic probes enables the distinction of all types, even when present in the same sample.