Sensation in the anal region and rectum after surgery for anorectal malformations

Sensation of the anal region and rectum after surgery for anorectal malformations was investigated in 32 patients (17 with high type, 6 with intermediate type and 9 with low type anomaly), aged 5 to 16 years. All patients were examined as to whether or not they could appreciate sensations of touch, pain, heat and cold in the circumanal skin and in the anal canal. Rectal sensation and compliance were also examined by anorectal manometry. All patients had normal sensation in the circumanal skin, but less than half of them had normal sensation in the anal canal. Patients with normal bowel control showed a significantly higher incidence of touch sensation in the anal canal than those with fecal incontinence or constipation. It was suggested that a sensation defect of the anal canal is related to a disturbance of discrimination between flatus and feces. The results of rectal sensation and compliance showed that reduced elasticity of the neorectum and low rectal compliance were important factors of fecal incontinence after surgery for anorectal malformations.

Genes up-regulated in hypertrophied ventricle

We isolated 8 genes whose expression is modulated during cardiac development. The expressions of 6 of these eight genes were modulated during the development of cardiac hypertrophy and/or during the transition to heart failure. In particular, the expression levels of the pro alpha-1 collagen, tissue type II transglutaminase, and vimentin genes were markedly increased during the transition to heart failure. Up-regulation of the pro alpha-1 collagen and vimentin genes may reflect activation of interstitial cells during the transition to heart failure. Up-regulation of the tissue type II transglutaminase gene during the transition to heart failure is intriguing, since this enzyme has been suggested to be involved in the activation of latent TGF-beta.

Intestinal obstruction in an infant due to magnet ingestion

A case of intestinal obstruction in an infant due to magnet ingestion is reported. The 17-month-old female swallowed seven small magnets, and developed an acute intestinal obstruction. At laparotomy, a fistula between the jejunum and the ileum which contained the seven magnets was found and resected. The patient's postoperative recovery was uneventful. Accidental magnet ingestion mandates careful observation for the development of intestinal obstruction.

Angiotensinogen gene and blood pressure in the Japanese population

A molecular variant of the angiotensinogen gene with threonine instead of methionine at position 235 (ie, with M235T polymorphism) has been shown to be associated with essential hypertension in Caucasian populations. The purpose of the present study was to assess whether the M235T polymorphism was associated with essential hypertension in the Japanese population. The study population consisted of 347 subjects selected in our outpatient clinic. The clinical data included in the analyses were sex, age, body mass index, cholesterol level, genotype of the angiotensinogen gene, genotype of the angiotensin-converting enzyme gene, and systolic and diastolic blood pressure. Multiple regression analysis revealed that only body mass index was a predictor of both diastolic and systolic blood pressure in these 347 subjects, but the genotype of the angiotensinogen gene was identified as a predictor of both diastolic and systolic blood pressure in a subpopulation less than 50 years of age. However, in a subpopulation more than 50 years of age, body mass index was the only predictor of both systolic and diastolic blood pressure. Of the 347 subjects, 189 had a technically excellent echocardiogram at the initial observation period. Multiple regression analysis revealed that sex, body mass index, diastolic blood pressure, and genotype of the angiotensin-converting enzyme gene were predictors of left ventricular mass. Although subjects with the TT angiotensinogen genotype had significantly greater left ventricular mass than those with either the TM or the MM genotype, the effects of the genotype of the angiotensinogen gene on left ventricular mass were mainly due to effects on blood pressure.

Regulation of neuronal nitric oxide synthase in rat adrenal medulla

Neuronal nitric oxide synthase (nNOS) has been suggested to be involved in cardiovascular homeostasis. We studied the regulation of nNOS expression, determining nNOS mRNA expression levels in various tissues in spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY). We also investigated the effects of antihypertensive treatment with the angiotensin II antagonist hydralazine or reserpine on nNOS mRNA expression. The expression levels of nNOS mRNA and nNOS protein were determined by Northern and Western blot analysis, respectively. NADPH-diaphorase histochemistry was used to identify cells in the adrenal medulla that expressed nNOS. No significant differences in expression levels in SHR and WKY were observed in the cerebellum and brain stem. nNOS mRNA expression levels in the decapsular portion of the adrenal gland were developmentally modulated and in a 24-week-old WKY were 2.5 times higher than in an age-matched SHR. This reduced expression of nNOS mRNA in the decapsular portion of the adrenal gland of SHR seemed to be a result of hypertension in the SHR, because administration of either an angiotensin II antagonist (TCV-116) or hydralazine upregulated nNOS mRNA expression in both SHR and WKY. Marked augmentation of nNOS mRNA expression in the decapsular portion of the adrenal gland by reserpine treatment suggested an intimate relation between nNOS in the decapsular portion of the adrenal gland and the sympathoadrenal system. Reserpine treatment also increased the expression of nNOS protein; however, reserpine treatment did not affect the distribution pattern of nNOS-positive cells (NADPH-diaphorase-positive cells) in the adrenal medulla.(ABSTRACT TRUNCATED AT 250 WORDS)

Impaired proliferative activity of mesenchymal cells affects the migratory pathway for neural crest cells in the developing gut of mutant murine embryos

The developmental expression of neural and cell proliferation-related antigens in guts from mutant murine embryos (Is, lethal spotted) as a model for Hirschsprung's disease was studied. The expression was examined immunohistochemically using antibodies specific for neural cell adhesion molecule (NCAM), the L1 molecule, and proliferative cell-related nuclear antigen (PCNA). Cells immunoreactive for neural components proceeded from the esophagus to the anorectum showing a one-way migratory wave between embryonal day 10 (E10) and E14 in control specimens (Is/+, +/+). The patterns of NCAM and L1 immunoreactivity in Is/Is mutant specimens was the same as in controls on E10. However, from E10.5 to E13.5, the immunoreactivity in the mutants decreased and remained in the more oral side as compared with controls. No migration of immunoreactivity was found after E14.0. Therefore, the terminal portion of the colon remained aganglionic in Is/Is mutant embryos. PCNA immunoreactivity of mesenchymal cells preceded the migratory wave of the neural specific immunoreactivity, but the PCNA-positive cells were meager and poorly organized in the mutant embryos. Deficient PCNA staining patterns were found in mesenchymal tissue rather than in the migrating cells themselves. This impaired PCNA expression may reflect a deficient microenvironment for migration such that neural crest cells cannot colonize properly.

[Laboratory and clinical studies on SY5555 in pediatrics]

Laboratory and clinical studies were performed on SY5555, the first penem oral antibiotic developed in Japan, in the pediatric field. The following results were obtained. 1. Antibacterial activities of the drug against 42 strains of Streptococcus pneumoniae clinically isolated in 1993 were compared to those of 13 other drugs mainly composed of beta-lactam preparations. Minimum inhibitory concentration (MIC) values of SY5555 were below 0.39 micrograms/ml for all strains examined, thus the drug showed an excellent activities against benzylpenicillin (PCG)-resistant strains as well. When the antibacterial effects of individual drugs were compared using MIC50 and MIC90 as indices, SY5555 was the most effective against PCG-sensitive strains and similar to cefazolin (CEZ), cefotaxime (CTX), cefuzonam (CZON), amoxicillin (AMPC) and imipenem (IPM). It also showed excellent antibacterial effects against moderately PCG-resistant strains, and the activities were similar to IPM. Activities of SY5555 on highly PCG-resistant strains were similar to those of CTX, CZON and IPM. 2. SY5555 at a dose of 5 mg/kg or 10 mg/kg was administered to 16 pediatric patients in the fasting state or after meal to examine its plasma concentration and urinary excretion rate. The fecal excretion was measured in 5 affected children treated with this drug. When the drug at a dose of 5 mg/kg was administered to 11 older children, 5 with ages 5-12 years and 6 with ages 10-13 years in the fasting state and after meal, respectively. Peak plasma levels were reached at 1 hour after administration in the two groups, and they were 0.93 +/- 0.25 and 2.44 +/- 1.25 micrograms/ml, respectively. The plasma levels then decreased gradually with half-lives of 1.95 +/- 1.09 and 0.72 +/- 0.21 hours, respectively. Urinary recovery rates in the first 6 hours after administration were 1.98 +/- 0.82 and 4.13 +/- 1.40%, respectively. In 3 cases (6-9 years) treated with the drug at a dose of 10 mg/kg after meal, a peak of 1.58 +/- 0.81 micrograms/ml appeared 1 hour after administration with a half-life of 1.08 +/- 0.30 hours and with the urinary recovery rate in the first 6 hours after administration of 3.46 +/- 1.03%. When the drug at a dose of 10 mg/kg was administered to 2 infants (2-3 months post partum) after meal, a peak plasma level of 3.74 micrograms/ml appeared 1 hour after administration with a half-life of 1.19 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pharmacokinetic, bacteriological and clinical evaluation of biapenem (L-627) in the pediatric field]

Pharmacokinetic, bacteriological and clinical studies on biapenem (L-627), a newly developed carbapenem antibiotic, were performed in the field of pediatrics. 1. Antibacterial activities of biapenem against 54 strains of Streptococcus pneumoniae isolated in 1993 were compared with those of 13 other antibiotics, consisting primarily of beta-lactam compounds. Minimal inhibitory concentrations (MICs) of biapenem were < or = 0.78 micrograms/ml against all strains, and excellent values were obtained even against benzylpenicillin (PCG)-resistant strains. Based on MIC80 values, biapenem, imipenem, and cefuzonam showed highest antibacterial activities, followed by cefotaxime. 2. Blood concentrations and urinary excretion were studied after intravenous drip infusion of 6.0 mg/kg and 6.1 mg/kg of biapenem, given over 30 min., to two children (ages: 4 years and 11 years). Blood drug concentrations were 14.7 and 37.6 micrograms/ml, respectively (mean: 26.2 micrograms/ml), at 30 min. after starting infusion (at completion of infusion). Blood concentrations then declined gradually with half-lives of 0.66 and 1.16 hrs., respectively (mean: 0.91 hrs.). After 5.5 hrs., blood concentrations were no longer measurable in the former and 0.46 micrograms/ml in the latter. Urinary recovery rates of drug in the first 6 hrs. after starting administration were 65.8% and 60.9%, respectively (mean 63.4%). 3. Penetration of the drug to the cerebrospinal fluid (CSF) was studied in 2 patients with purulent meningitis. Biapenem, 31.6 mg/kg, was administered four times daily by 30-min. intravenous drip infusion. CSF concentration 1 hr. after administration was 8.54 micrograms/ml on the day of the start of treatment (day 0), and 3.00, 2.04, 16.1, 4.16, 3.24, and 1.60 micrograms/ml on days 1-7 of treatment, respectively. In a patient similarly administered with the drug at 33.7 mg/kg four times daily, the CSF concentration at 1.5 hrs. after administration was 2.62 micrograms/ml on the next day of the start of treatment. On days 2-7 of treatment, CSF concentrations at 0.5-1 hr. after administration were 4.60, 12.9, 20.6, and 1.32 micrograms/ml, respectively. 4. Clinical efficacy was evaluated in 27 patients with pediatric infections. The dose administered per dosage was 5.2-33.7 mg/kg. Three or four dosages were given daily. The duration of therapy ranged from 3 1/3 to 11 days. Total administered doses were between 0.675 and 20.475 g. Clinical efficacy was evaluated in a total of 24 patients (purulent meningitis 1, acute otitis media 1, acute bronchitis 2, acute pneumonia 19, acute urinary tract infection 1). Responses to treatment were excellent in 14 patients and good in 10 patients.(ABSTRACT TRUNCATED AT 400 WORDS)

DD genotype of the angiotensin-converting enzyme gene is a risk factor for left ventricular hypertrophy

BACKGROUND

The cardiac renin-angiotensin system has been suggested to be involved in the development of left ventricular hypertrophy. In humans, a strong correlation has been found between plasma angiotensin I-converting enzyme (ACE) activity and the insertion/deletion (I/D) polymorphism of the ACE gene, which has been reported to be associated with myocardial infarction, ischemic and idiopathic dilated cardiomyopathy, sudden death in hypertrophic cardiomyopathy, and restenosis after percutaneous transluminal coronary angioplasty. In the present study, we examined the possibility that the genotype of the ACE gene might influence the development of left ventricular hypertrophy.

METHODS AND RESULTS

The study population consisted of 268 subjects randomly selected from our outpatient clinic. In 142 subjects, left ventricular mass (LVM) was determined by echocardiogram. The genotype of the ACE gene was determined by the polymerase chain reaction. ANCOVA revealed that the genotype of the ACE gene had no effect on blood pressure. The percentage of the explained variance of LVM with variables including diastolic blood pressure (DBP, P = .0001), body mass index (BMI, P = .0001), sex (P = .0009), and the genotype of the ACE gene (P = .0017) was 34.61%. Significant differences in the effects of the genotype of the ACE gene on LVM were observed between the II and DD (P = .0004) and between the ID and DD (P = .0077) genotypes. The percentage of the explained variance of the LVM/ht ratio with variables including sex (P = .134), age (P = .3655), the genotype of the ACE gene (P = .0014), BMI (P = .0001), and DBP (P = .0001) was 31.25%. Significant differences in the effects of the genotype of the ACE gene on LVM/ht were observed between the II and DD genotypes (P = .0003) and between the ID and DD genotypes (P = .0091).

CONCLUSIONS

In addition to BMI and DBP, the genotype of the ACE gene was a significant predictor of LVM and LVM/ht in our study population.

Cloning, expression and regulation of angiotensin II receptors

Angiotensin II isoform 1 (AT1) receptor cDNAs were cloned by expression cloning from bovine adrenal and rat vascular smooth muscles. Human AT1 receptor was also cloned. Seven transmembrane structures emerged. A single type of receptor seems to interact with more than one type of G-protein. AT1 consists of subtypes AT1A and AT1B, and the regulation of the receptors occurs at many stages. The isoform AT2 was also expression cloned from rat pheochromocytoma cells. Although its ligand binding is not affected by GTP analogs, it is a seven transmembrane domain receptor. It mediates the inhibition of phosphotyrosine phosphatase by angiotensin II and AT2 specific CGP42112A; the inhibition was abolished by pertussis toxin. Thus, AT2 belongs to a new class of angiotensin receptors with unique signalling and regulatory mechanisms.

Molecular genetics of the SA gene

1. We have recently identified a candidate gene for rat genetic hypertension, termed SA, by identifying an mRNA species that shows markedly higher expression in the kidneys of spontaneously hypertensive rats (SHR) than in those of Wistar-Kyoto rats (WKY). 2. Subsequent genetic co-segregation analyses by ourselves and others indicated that the SA gene locus did indeed influence blood pressure. Moreover, in a preliminary association study, we found an association of a polymorphism of the human SA gene with essential hypertension. 3. Further studies to identify functions of the SA gene products are required before reaching a definite conclusion.

[Pharmacokinetic and clinical evaluation of cefozopran in the pediatric field]

We conducted a pharmacokinetic and clinical studies on cefozopran (CZOP), a new cephem antibiotic for injection. 1. Changes in serum levels of the agent after intravenous bolus injection at a dose of 20 mg/kg to 4 pediatric patients (age: 5-10 years) were observed. The levels at 30 minutes after injection were 32.9-73.4 micrograms/ml average: 55.4 +/- 18.1 micrograms/ml), then the levels gradually decreased with half-lives of 1.67-2.24 hours (average: 1.85 +/- 0.27 hours) to 0.8-1.8 micrograms/ml (average: 1.2 +/- 0.4 micrograms/ml) at 8 hours after injections. Urinary levels reached at the maximum as, 1,773-3,450 micrograms/ml (average: 2,693 +/- 698 micrograms/ml) within 0-2 hours or 2-4 hours after injection, and recovery rates from urine in the first 8 hours after injection were 55.4-91.1% (average: 71.6 +/- 16.8%). 2. Transition to cerebrospinal fluid was examined in cases with purulent meningitis and aseptic meningoencephalitis. In the meningitis case, the level in cerebrospinal fluid 1 hour after administration was 8.8 micrograms/ml in the second day after the start of 4 times a day intravenous bolus injections with 42.5 mg/kg at each dose; The ratio of the drug level in cerebrospinal fluid to that in serum was 24.0%. In the meningoencephalitis, the levels in cerebrospinal fluid 1 hour after administrations were 1.1 micrograms/ml and 1.5 micrograms/ml in the second and the sixth days respectively, after the start of 4 times a day intravenous bolus injections with 50 mg/kg at each dose; the ratio of the levels in cerebrospinal fluid to those in sera were 0.93% and 2.41% respectively, at the second and the sixth day. 3. CZOP was clinically evaluated in 29 cases (ages: 2 months to 15 years) of pediatric infectious diseases. The agent was administered 3-4 times daily with 17-50 mg/kg at each dose, continued for 5-13 days. Total doses were 1.95-24.05 g. Clinical efficacy was evaluated in a total of 28 cases (1 case of purulent meningitis, 2 cases of acute purulent tonsillitis, 20 cases of acute pneumonia, 3 cases of urinary tract infections, 1 case of purulent lymphadenitis in cervical part and 1 case of cellulitis in face); The efficacies were "excellent" in 22 cases and "good" in 6 cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Increased numbers of argyrophilic nucleolar organizer regions between primary and metastatic sites predict tumor progression in stage IV and IV-S neuroblastoma

BACKGROUND

A silver colloid technique to determine nucleolar organizer region (AgNOR) number was used to study the proliferative activity of Stage IV-S neuroblastoma in which a spontaneous tumor regression is often observed.

METHODS

Primary regional lymph nodes and hepatic lesions from five children with Stage IV-S and five with Stage IV neuroblastoma were examined.

RESULTS

Average AgNOR counts per tumor cell nucleus from all five children with Stage IV neuroblastoma were lowest in the primary lesions, intermediate in the metastatic regional lymph nodes, and highest in the distant metastases. However, in four Stage IV-S patients whose metastases later disappeared and showed no sign of recurrence, the average AgNOR number was similar in primary tumors and metastatic lesions. In the other patient with progressive metastases initially diagnosed as Stage IV-S, the data showed the same pattern as in Stage IV neuroblastoma.

CONCLUSIONS

The unique AgNOR staining pattern may reflect the proliferative activity of Stage IV-S neuroblastoma. This method may provide further information to differentiate a subtype of metastatic neuroblastoma showing spontaneous tumor regression and/or favorable prognosis.

OK-432 therapy in 64 patients with lymphangioma

Intralesional injection of OK-432 was employed to treat 64 lymphangiomas between 1986 and 1992. This was used as primary therapy for 46 lesions (group A), as treatment following incomplete surgical removal in 14 (group B), and as therapy after failure of bleomycin in 4 (group C). In group A (n = 46), total shrinkage of the lesion, without serious complications, was noted in 23; there was marked shrinkage in 8, slight shrinkage in 12, and no response in 3. Of the cystic lesions (n = 24), significant shrinkage occurred in 22; of the cavernous lesions (n = 22), only 9 improved after treatment. In groups B (n = 14) and C (n = 4) there was significant clinical improvement occurred in 5 and 2, respectively. No recurrence was noted during follow-up (6 to 87 months). The only side effects were fever lasting 2 to 4 days and a local inflammatory reaction of 3 to 7 days' duration. The local inflammation did not cause any damage to the overlying skin and did not lead to scar formation. These data suggest that intralesional injection of OK-432 is effective treatment for lymphangiomas and should be considered as the primary method of treatment.

[Estimated prevalence of presenile dementia in Tottori prefecture]

A questionnaire study of dementia in the age group of 40-64 years old was performed among all hospitals and clinics in Tottori prefecture. Response rate was 52.9% (hospitals 53.2%, clinics 52.4%). A total of 100 patients (from April 1992 to March 1993) were reported. The estimated prevalence rate of all dementia in the age group of 40-64 years old was 81.4 per 100,000 population. Cerebrovascular dementia accounted for half and Alzheimer's disease, intoxication and trauma accounted for 14.0%, 11.5%, and 10.8% of dementia in the age group of 40-64 years old, respectively. There were several other types of dementia but numbers were very few. The estimated prevalence rates of cerebrovascular dementia in the age groups of 40-49, 50-59, and 60-64 years old were 0, 47.9 (male 66.0, female 31.5) and 113.2 (male 184.5, female 51.5), respectively. Those of Alzheimer's disease in the age groups of 40-49, 50-59, and 60-64 years old were 0, 5.6 (male 4.2, female 6.9) and 47.5 (male 50.3, female 45.0), respectively.

Human SA gene locus as a candidate locus for essential hypertension

We have recently identified a candidate gene for rat genetic hypertension by identifying an mRNA species that shows markedly higher expression in the kidneys of spontaneously hypertensive rats than in those of Wistar-Kyoto rats. By using a restriction fragment length polymorphism, we carried out cosegregation analyses between the genotype of the SA gene and blood pressure in three F2 cohorts and observed significant effects of the SA gene on blood pressure in all of those cohorts. In the present study, we have isolated a human counterpart of the rat SA gene to investigate the possible association between the human SA gene and human essential hypertension. The deduced amino acid sequence from the isolated human SA cDNA consisted of 578 amino acid residues and had slight homology to a bacterial enzyme, acetyl-coenzyme A synthase. The human gene was mapped to the human chromosome 16 with the use of a rodent/human somatic hybrid cell panel. A restriction fragment length polymorphism was found with the restriction enzyme Pst I, and the allele frequencies were compared between hypertensive and control groups. The hypertensive group consisted of 89 individuals, and the Pst I rare allele (A2 allele) frequency in this group was 0.270. The control group consisted of 81 healthy normotensive individuals whose precise clinical data were available; the A2 allele frequency in this group was 0.09. Significant differences in the frequency of the A2 allele were observed between the hypertensive and control groups (P = .0001). The present findings provide favorable evidence that the SA gene is a candidate gene for human essential hypertension and also provide a starting point for future studies.

[Pharmacokinetic, bacteriological and clinical evaluation of cefditoren pivoxil in pediatrics]

Pharmacokinetic, bacteriological, and clinical studies were performed in pediatrics on cefditoren pivoxil (CDTR-PI, ME1207) in granules. 1. Serum concentrations and urinary excretions of CDTR after administration of CDTR-PI to children (ages between 1 and 10) were investigated. Five cases were administrated with CDTR-PI at a dose level of 3 mg/kg 30 minutes after meal. Serum concentrations in these cases reached their peaks at 2 hours after administration with an average level of 1.23 +/- 0.34 micrograms/ml and diminished to 0.04 +/- 0.04 micrograms/ml at 8 hours after administration with a half-life of 1.60 +/- 0.38 hours. Urinary recovery rates of CDTR in the first 8 hours after administration of CDTR-PI averaged 14.9 +/- 0.9%. Five cases were administered with CDTR-PI at a dose level of 6 mg/kg 30 minutes after meal. Serum concentrations with the drug after meal reached their peaks at 1 hour after administration with an average level of 2.62 +/- 0.42 micrograms/ml and diminished to 0.21 +/- 0.11 micrograms/ml at 8 hours after administration with a half-life of 1.58 +/- 0.31 hours. Urinary recovery rates of CDTR in the first 8 hours after administration of CDTR-PI averaged 17.0 +/- 0.7%. These data also showed that serum and urinary concentrations of the drug depended on dose levels. 2. CDTR-PI was administered to 31 pediatric patients (their ages ranged between 1 year and 10 years) with various infections, and clinical and bacteriological effects and adverse reactions were investigated. Clinical effects were evaluable in 24 cases including 2 cases of scarlet fever, 1 case of acute pharyngitis, 12 cases of acute purulent tonsillitis, 4 cases of acute bronchitis, 5 cases of acute pneumonia. Clinical responses were excellent in 16 cases, effective in 8 cases, with an efficacy rate of 100%. Antimicrobial effects against a total of 16 strains identified or assumed to be pathogenic bacteria were evaluated. The 16 strains of bacteria included 4 strains of Staphylococcus aureus, 6 strains of Streptococcus pyogenes, 2 strains of beta-Streptococcus, 4 strains of Haemophilus influenzae. All the bacteria listed here were judged to have been eradicated except 2 strains of H. influenzae (1 was decreased and 1 was unchanged) thus, the eradication rate was 87.5%. Two strains of bacteria replaced infection causing bacteria. Streptococcus pneumoniae replaced S. pyogenes and S. aureus replaced H. influenzae. No adverse side reactions were observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Viability of one-cell bovine embryos cultured in vitro: comparison of cell-free culture with co-culture

In this study, the quality (number of cells) and pregnancy rates of bovine blastocysts produced by in vitro maturation/in vitro fertilization (IVM/IVF) following cultivation in either cell-free culture or co-culture were compared. Bovine one-cell IVM/IVF embryos obtained 6 h after insemination were stripped of cumulus cells and assigned to either cell-free culture or co-culture with granulosa cell monolayers for 9 days (Expt 1) or 10 days (Expts 2 and 3). In Expt 3, day-7 (day 0 = day of insemination) blastocysts, day-8 expanded blastocysts and day-9 hatched blastocysts were air-dried, fixed and stained to determine the number of cells. Expanded blastocysts obtained in Expt 1 were cryopreserved using propylene glycol as a cryoprotectant and were used later for embryo transfer. There were no significant differences between cell-free culture and co-culture in the percentage of one-cell embryos that developed to 2- to 16-cells (66.7% versus 72.4% for Expt 1, 71.0% versus 78.2% for Expt 2). However, significantly more (P < 0.05) of the one-cell embryos co-cultured with granulosa cell monolayers developed to morula, blastocyst and expanded blastocyst stages compared with those in cell-free culture (35.0 versus 27.1%, 25.1 versus 14.2%, 15.6 versus 5.4% for Expt 1; 37.6 versus 24.0%, 25.7 versus 11.0%, 16.8 versus 3.0% for Expt 2). Only embryos co-cultured with granulosa cell monolayers hatched (Expt 2). Embryos co-cultured with granulosa cell monolayers also had higher (P < 0.01) numbers of cells (92 +/- 42 versus 56 +/- 21 for blastocysts, 149 +/- 53 versus 81 +/- 29 for expanded blastocysts).(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonic Doppler measurements of visceral blood flow in the repair of giant omphalocele

An ultrasonic Doppler device was used for visceral perfusion monitoring in the repair of a giant omphalocele. A full-term newborn, antenatally diagnosed as having middle celosomia involving the entire liver, stomach, spleen and small intestine, underwent a staged repair following the method of Gross after visceral compression induced by periodically squeezing a Dacron membrane silo. The hilum of the omphalocele was semicircular and measured 70 mm in diameter; the membrane was kept intact. The blood flow of the abdominal inferior vena cava (IVC), hepatic vein (HV) and portal vein (PV) was serially examined. During the 11-day process of repair, the data consistently showed an IVC flow of over 60 ml/min, a PV flow of over 100 ml/min, and an IVC pressure of under 15 mmHg in this patient, whose birth weight was 3024 g. These values were closely correlated with the clinical status and the ultrasonographic findings showing angulation and decompression of the IVC and HV by visceral contents. Ultrasonic Doppler blood flow measurement provides a sensitive, noninvasive indicator of visceral organ viability during omphalocele repair.

Pulmonary hypertension as a fatal complication of extrahepatic portal hypertension

Pulmonary hypertension is an uncommon complication of portal hypertension seen in cirrhotic as well as noncirrhotic patients. We report a 10-year-old girl who presented with extrahepatic portal hypertension and pulmonary hypertension in the absence of intrinsic liver disease. Further investigations revealed high serum concentrations of prostaglandin F2 alpha, thromboxane B2 in the inferior vena cava, and angiotensin I in the inferior vena cava and right ventricle. The increased levels of these vasoconstrictive substances strongly suggest that the possible mechanism for the pulmonary hypertension in such patients with extrahepatic portal hypertension include shunting of vasoactive agents from the splanchnic circulation to the pulmonary vascular bed.

[Laboratory and clinical evaluation of S-1108 in pediatric field]

We performed laboratory and clinical evaluation of S-1108 granules, a new oral cephalosporin antibiotic, in the pediatric field. 1. Pharmacokinetics of S-1108 was examined with 6 patients, at a dose of 4 mg/kg that was orally ingested 30 minutes after meal. Mean plasma concentrations at 30 minutes, 1, 2, 4, 6 and 8 hours after dose were 0.35, 0.63, 0.86, 0.75, 0.37 and 0.09 microgram/ml, respectively, with a half life of 1.14 hours. The urinary recovery rate in the first 8 hours was 25.5%. 2. The clinical efficacy of S-1108 was evaluated in 31 patients with various infectious diseases. S-1108 was administered at doses ranging 2 to 4.2 mg/kg/dosage, 3 times a day for 1/3 to 10 days. Clinical effects were excellent in 19, good in 12, with an efficacy rate of 100%. Bacteriologically, all causative organisms except two of Staphylococcus aureus and Haemophilus influenzae were eradicated, with an eradication rate of 80%. As an adverse reaction, mild diarrhea was noted in 2 patients. Slight elevations of GOT and/or GPT were noted in 2 patients. Only 1 child had difficulty ingesting the antibiotic preparation. From the above results, we have concluded that S-1108 is a highly effective and safe for patients with various infectious diseases in the pediatric fields.