[Clinical experience of norfloxacin (Baccidal) in the urological field]

The clinical effectiveness of a new synthetic pyridoncarboxylic acid derivative, norfloxacin (NFLX: Baccidal) was studied in the urological field. NFLX was given clinically to 50 patients with urogenital tract infections; 40 cases were acute simple cystitis and 10 cases were complicated UTI satisfied the criteria of the UTI committee. Thirty two bacterial strains were isolated from the group of acute simple cystitis and 10 bacterial strains were isolated from the group of complicated UTI. Susceptibility of NFLX by the method of distribution and disk sensitivity was 97% in the former group and 89% in the latter group. The overall clinical efficacy rate estimated by the criteria of the UTI committee in 32 cases with acute simple cystitis was 97% and in 10 cases with complicated UTI was 60%. The incidence of side effect was 8.0% (4/50). All of these side effects which were nausea, abdominal fullness and headache may be attributable to the administration of NFLX. No abnormal laboratory findings were observed except for elevation in GOT and GPT values in 1 case (4.0%), which returned to normal after NFLX treatment. Therefore NFLX is suggested to be a clinically useful and safe drug in the treatment of UTI.

[Relief of experimental cerebral vasospasm by the intrathecal administration of a calcium antagonist (diltiazem)--in comparison with intra-arterial administration]

The effect of an intra-arterial administration of diltiazem on experimental cerebral vasospasm was previously reported by us. In the present study, the effect of diltiazem on cerebral vasospasm, intracranial pressure and systemic blood pressure were investigated using dogs. Cerebral vasospasm was induced by an injection of 5 ml of autologous blood into the cisterna magna. Diltiazem (10(-6) M) was administrated into the cisterna magna and the dilating effect of the drug on the basilar artery was monitored angiographically. The intrathecal administration of diltiazem relieved the vasospasm for more than 30 minutes, same as that of the intra-arterial administration. However, the intracranial and blood pressures remained unchanged. The changes of concentration of the drug in CSF and plasma following the intracisternal administration of 14C-diltiazem were measured using rabbits. The concentration of an administered diltiazem in CSF and plasma was quickly decreased and reduced to 2% of its initial value after one hour (t1/2 = 8 min). Our results show that even the concentration of diltiazem is very low in CSF, the vasodilating effect continues for more than 30 min. This suggests that the intrathecal administration of diltiazem may be useful for the prevention and treatment of the cerebral vasospasm following subarachnoid hemorrhage.

Primary signet-ring cell carcinoma of the urinary bladder. Report of two cases with histochemical studies

Two cases of primary signet-ring cell carcinoma of the urinary bladder are presented with histochemical studies. The signet-ring cell carcinoma of the bladder is a rare variant of mucus-producing vesical adenocarcinoma: sixteen cases have been reported in the Occidental and two other cases in Japanese literature. Most of the cases were discovered in the advanced stage and the prognosis was poor: necessity of early detection by cytological examination and treatment with surgery is stressed. The histochemical evidence for the similarity of the neoplasm to colonic epithelium in mucus production is illustrated and the grade of malignancy is discussed from the view of mucus production by the neoplasms.

[A case of ovarian carcinoma preceded by intracranial metastasis]

A 28-year-old woman with primary ovarian carcinoma which was found with intracranial metastasis is reported. The patient was operated on because of metastatic brain tumor with unknown primary lesion. Subsequently, left ovarian tumor was found, and left salpingo-oophorectomy was performed. The histological diagnosis was endometrioid carcinoma. A review of the literature shows that intracranial metastasis by ovarian carcinoma is very rare. The incidence is lower than 2.1%. The present case in which intracranial metastasis manifested itself before primary ovarian carcinoma seems to be extremely rare.

[A case of renal adenoma associated with staghorn calculus]

A case of renal adenoma associated with staghorn calculus is reported. The patient was a 52-year-old man. In 1973, he underwent an ileal conduit because of tuberculous contracted bladder and impediment in renal function. At that time, small calculi were already present in the right kidney. Later, in the left kidney, calculi developed into staghorn calculus. An ureteral calculus was also present in the right side and contracted kidney was observed. In 1983, he suffered from continuous left abdominal pain and macroscopic hematuria. Left nephrolithotomy was performed on August 23, 1983. During surgery, a yellow subcapsular flat mass the size of the tip of an index finger was found in the upper pole of the left kidney and was easily excised. An 11 cm incision was made in the renal parenchyma and the calculi were completely removed. At the center of the incised region, biopsy was performed. The wound was closed by the one-layer interrupted parenchymal suture method designed by Taguchi. Pedicle clamp time was 37 minutes and postoperative macroscopic hematuria was seen for only two days. The postoperative course was uneventful. The resected tumor was 18 X 16 X 10 mm in size. Histological examination revealed presence of fibrous capsules and papillary or tubular proliferation of cells which were suspected to have originated in the renal tubule. Also, there were scattered nests of foam cells. On the basis of these histological findings, the mass was diagnosed as renal adenoma. In addition, examination of the biopsied parenchyma also revealed small multiple adenomas, which were supposed to be remaining in the left kidney.

[A case of papillary adenocarcinoma of the prostate]

A relatively rare case of papillary adenocarcinoma of prostate is reported. The patient was a 49-year-old male. He presented with the chief complaints of micturition frequency, a feeling of residual urine and a burning sensation in urethra. There was no palpable abnormality in the prostate. Endoscopic examination revealed papillary tumors in the prostatic urethra and the anterior urethra, but no evidence of abnormality in the utricle. Both hematological examination and blood chemistry revealed no abnormalities; ACP, PACP and PAP were normal. The tumors were resected by TUR on March 8, 1982. Histopathological findings indicated papillary proliferation of single layer of columnar epithelium, with clear cytoplasm and nuclei with atypism distributed in the base. The tumors in the anterior urethra gave the same findings, and the diagnosis made was papillary adenocarcinoma which seemed to have originated from the prostatic duct. After operation, hormone therapy and chemotherapy with peplomycin were conducted. Eleven months after the operation, the remaining prostatic tissues including surgical capsule were resected as completely as possible. Histopathological findings revealed only atrophic prostatic tissues without any remaining tumor. The hormone therapy was discontinued. Presently, 19 months has elapsed since the first TUR. His micturition condition is good without evidence of recurrence or metastasis.

The beta subunit of human chorionic gonadotropin is encoded by multiple genes

Two recombinant phage clones bearing sequences corresponding to the beta subunit of human chorionic gonadotropin (hCG beta) were isolated from a human genomic library. The beta sequences were mapped by blot hybridization of restriction digests of these phage DNAs and the nonoverlapping inserts were subcloned in pBR322 and sequenced. The nucleotide-sequencing data show that the hCG beta subunit is encoded by at least three nonallelic genes. Moreover, based on restriction analyses of human placental DNA, these genes may be linked in a single cluster with four other hCG beta-like genes. The sequenced genes all differ in their 5' flanking regions, and none of them is completely homologous in sequence to either of two hCG beta cDNA clones used here. In the translated region of one of these genes, three base substitutions result in two changes from the reported amino acid sequence. In the family of beta-containing glycoprotein hormones, the hCG beta subunit is unique in that it contains an extension of 29 amino acids at its COOH end. The DNA sequence corresponding to this region in the sequenced genes is part of a larger exon. These data show that the COOH-terminal extension does not result from splicing of the primary RNA transcript.

[Effect of diltiazem on experimental cerebral vasospasm incomparison with effects of cinnarizine, verapamil and nifedipine]

The contractile activity of arterial muscle cells is controlled by the intercellular free Ca2+ concentration. The membrane systems of both the cell surface and internal organs, seem to be responsible for controlling the myoplasmic Ca2+ level. The mechanism of action of Ca2+ antagonists, typified by verapamil and nifedipine, has been postulated to be a blockade of transmembrane calcium influx. In this study, the vasodilating effect of diltiazem on experimental cerebral vasospasm in vivo was examined using dogs and was compared with those of cinnarizine, verapamil and nifedipine which have already been reported by us. Cerebral vasospasms were induced in adult dogs by injecting 5 ml of fresh arterial blood into the cisterna magna. 10(-6)M diltiazem was injected by one shot into the vertebral artery with cerebral vasospasm. Dilatation of the cerebral arteries were monitored by angiography after administration of diltiazem. Blood pressure, intracranial pressure and pulse rate were measured during intravenous application of the drug in normal animals. Administration of diltiazem released the vasospasm for 30 minutes comparable to the times of the other Ca2+ antagonists. Diltiazem had cerebral vasodilator actions similar to cinnarizine at doses that did not decrease systemic blood pressure, while the other drugs decreased intracranial pressure slightly and nifedipine decreased pulse rate slightly. Therefore, we consider diltiazem to be satisfactory for the treatment of experimental cerebral vasospasm.

[Experimental and clinical studies of cefmenoxime in the field of obstetrics and gynecology]

The study group was organized to evaluate the usefulness of cefmenoxime (CMX) injection, a new synthetic cephalosporin, for the treatment of infections in the field of obstetrics and gynecology. Fundamental and clinical studies were made by the society and the following results were obtained. 1. The peak distribution of CMX's MIC for E. coli, Klebsiella sp., Enterobacter sp., Bacteroides sp. and Peptococcus sp. isolated from obstetrical and gynecological infections with relatively high frequencies area 0.1, less than or equal to 0.05, 0.2, 3.13, 1.56 micrograms/ml, respectively, with an inoculation of 10(6) cells/ml. 2. When 1 g of CMX is administered by intravenous drip infusion for 1 hour, the maximum concentrations in various tissues of female genital organs were as follows: 14.2 and 13.2 micrograms/g in ovary and oviduct, respectively, at 1.20 hours after the start of administration, and 16.9 and 26.3 micrograms/g in corpus uteri and cervix uteri, respectively, after 1 hour. As for the transfer to the exudate in the pelvic dead cavity, the peak concentration was 15.6 micrograms/ml after 2.13 hours. 3. In the clinical studies, CMX was given to 258 cases with female genital organ infections and others. As for the clinical effects, with exclusion of 3 cases in which other antibiotics are concomitantly used, responses were excellent in 76 cases, good in 162 cases and poor in 17 cases, among 255 cases in total. The efficacy rate was 93.3%. The efficacy rates by diseases were 97.1% (68/70) for intrauterine infections, 88.8% (79/89) for intrapelvic infections, 98.4% (62/63) for adnexitis, and 100% (23/23) for infections of external genital organs. As for the clinical effects on causative bacteria, the efficacy rates were 100% (19/19) for single infections due to Gram-positive bacteria, 94.8% (55/58) for single infections due to Gram-negative bacteria, and 88.2% (15/17) for single infections due to anaerobic bacteria. And its efficacy rates were 89.6% (69/77) for mixed infection cases. Side effects were observed in 2 cases (0.8%); 1 case with eruption, and 1 case with diarrhea and vomiting. As for abnormal laboratory findings, lower white blood cell count was observed in 2 cases and elevation of the values regarding hepatic functions in 9 cases. All cases were returned to the normal after the completion of the administration. Cefmenoxime showed a satisfactory clinical efficacy and a potent bacteriological effect in treatment of the infections in the field of obstetrics and gynecology, and it has been concluded that cefmenoxime will be useful addition to the antibiotics for the therapy of these infections.

Sex steroid receptors in diverse human tumors

The estrogen receptor was assayed in 8 intracranial meningiomas, 14 lung cancers, 3 thymomas and 2 malignant lymphomas using the dextran-charcoal method. Progesterone and androgen receptors were also assayed in all the cases of lung cancer. The estrogen receptor assay was positive in 3 meningiomas, 2 lung cancers, and all thymomas and malignant lymphomas. The androgen receptor assay was positive in one case of lung cancer but the progesterone receptor was negative in all assayed cases. No cases showed multiple receptor positivity. An antiestrogen (tamoxifen) was administered to one case each of intracranial meningioma and lung cancer with positive estrogen receptor. The receptor content was decreased to an undetectable level in the former after 4 months of administration. This finding suggests the estrogen dependency of the tumor. The lung cancer patient, however, died 2 weeks later without any evidence of hormone dependency.

[Characterization of the three calcium binding proteins in the human placenta (author's transl)]

Calcium binding protein (CaBP) has been reported to be involved in absorbing calcium in the duodenum. There is some evidence to show that active transport of calcium ions occurs from mother to fetus in the human placenta. The presence of CaBP in the human placenta was examined according to Taylor and Wasserman's method, extracting the vitamin D-dependent CaBP in the duodenum, and the character of CaBP was then studied. 38,000 X g supernatant of the villous homogenate of the human placenta was heated at 60 degrees C for 5 mins to neutralize the calcium binding activity resulting from the blood. The fractions containing CaBP were separated and partially purified on Sephadex G-100 and DEAE cellulose columns. The CaBP fractions were further purified by preparative agar electrophoresis. The Chelex-100-resin method was used for the detection of calcium binding activity in the eluates and for calculation of Kd values and of calcium binding sites. The molecular weights were determined by electrophoresis of SDS-polyacrylamide gel. Three CaBPs were found in the human placenta. The molecular weight, Kd (micro M) and the binding activity (Ca mol/CaBP mol) of the three placental CaBPs were CaBP-Peak I: 82,000, 0.64, 0.52; Peak II: 12,000, 0.67, 1.10; Peak III: 8,500, 0.75, 2.08, respectively. The tyrosine residue of CaBP has been shown to act as an important binding site in that removal of calcium ions from CaBP generates a blue-shifted phenomenon in the ultraviolet difference spectrum between 270 and 300 nm. However no difference spectrum was observed with the placental CaBPs. This result was further confirmed by amino acid analysis which showed that none of the placental CaBPs contained tyrosine, tryptophan, half-cystine and proline, which are usually found in most proteins. The circular dichronism (CD) spectrum of CaBP-Peak I in the far ultraviolet range showed two negative bands at 222 and 207 nm (alpha-helix structure), and removal of calcium ions caused no difference spectrum. CD spectra of CaBP Peak II and III in the far ultraviolet range revealed random coil structures in the presence and absence of bound calcium ions. These findings indicate that the calcium binding mechanism of the placental CaBPs should be different from that of the others. In this study, three kinds of human placental CaBP newly isolated were characterized according to molecular weights, Kd values and binding activities and clarified as having an amino acid composition quite different from the CaBPs already reported.

Posterior fossa subdural hemorrhage in the newborn as a result of birth trauma

During the past 19 years, 229 autopsies of intracranial hemmorrhages were performed at the Department of Pathology, and 23 cases of posterior fossa subdural hemorrhages were discovered (10.0%). 25 cases of posterior fossa subdural hemorrhages (2 of our own treated surgically and 23 untreated found at autopsy) are described in detail. 2 cases treated surgically responded favorably to surgical treatment. The mechanism of hemorrhage into posterior fossa subdural spaces is investigated and reconsidered following a review of the literature. The necessity for CT is emphasized for early diagnosis of posterior fossa subdural hemorrhage.

Inhibition of superovulation in immature female rats by the antiserum to cyclooxygenase

In order to investigate involvement of prostaglandins (PGs) in ovulation, we examined whether the antiserum to cyclooxygenase was able to inhibit superovulation in immature female rats as indomethacin did. The antiserum to cyclooxygenase was raised in rabbits using as antigen the solubilized cyclooxygenase extracted and purified from bovine seminal vesicles. The in vivo administration of the antiserum inhibited superovulation in female rats dose-dependently at doses of 0.1, 0.2 and 0.4 ml but did not affect production of progesterone. Inhibition of cyclooxygenase in the follicular cells due to the antiserum causing no effect on steroidogenesis was observed in organ cultures of the follicles excised from rats primed with PMS-hCG and the antiserum. In contrast to this, no inhibition of cyclooxygenase was detected upon adding the antiserum to the culture medium. The present study showed PG is as indispensable a factor in ovulation as are the steroids.

Alterations of amygdaloid kindling phenomenon following repeated electroconvulsive shocks in rats

In this study we investigated the effect of the electroconvulsive shock (ECS) soon after each amygdaloid stimulation (KS) upon the development of a kindling phenomenon. Thirty male Wistar albino rats were used in this study. Once daily stimulation of 200 microA, 1 msec, 60 Hz, 2 sec train by the right amygdaloid stimulation electrodes and the recording of the EEG were done. Rats of the Kindling + ECS group received the ECS through the clipped ears for five minutes after the KS. Behavioral manifestations, the duration of afterdischarge and the numbers of spikes were counted for five minutes at the time of every stimulation. The numbers of times the KS required to develop each stage were stage 1:4.8, stage 2:8, stage 3:8.6, stage 4:9.6, stage 5:12.6, respectively, on the kindling group. On the ECS-treated group, those were stage 1:8, stage 2:17, stage 3:18, stage 4: more than 20. The ECS soon after the amygdaloid stimulation retarded the process of kindling significantly. This result is consistent with the hypothesis that the electroconvulsive shocks disturb the information of the synaptic pathway before the consolidation of a central neuroplastic change underlying kindling.