Albumin therapy and intrauterine growth retardation in gestosis

Intravenous administrations of albumin, 8-16 g for 5-46 days, to the total doses of 56-736 g (averaged 198 g) were given for 10 patients suffered from both EPH gestosis and hypoalbuminemia averaged 2.4 g/dl. Plasma albumin level, total proteins and A/G ratio were elevated from 2.4 to 3.3 g/dl, from 4.9 to 5.8 g/dl, and from 0.97 to 1.28, respectively in average, following the albumin therapies. Slight decreases in hematocrit, urinary protein, SGOT and SGPT were observed, while BUN increased slightly. Pregnancies were maintained until 36.7 weeks in average. Fourteen newborn infants were delivered in good conditions, mean birth weight being 2,475 g. Four infants (28.6%) were SFDs, while ten (71.4%) were AFDs. Intravenous albumin therapies appear to be safe and effective for those who have both EPH gestosis and hypoalbuminemia.

Prenatal diagnosis and treatment of intrauterine growth retardation

Prenatal treatment consisting of daytime bedrest, high protein diet and oral administration of allylestrenol was assessed in a prospective study of 30 patients with IUGR infants whose ultrasonically estimated body weight was less than the 10th percentile. In these pregnancies, the gestational age was confirmed in the first trimester, and the fetal weight was estimated from the BPD and AC measurements in the third trimester (Fig. 1). Following treatment, ultrasonic and biochemical determinations were performed. As results: The estimated fetal weight of 1,362 g at 32.9 g gestational weeks increased to 2,678 g at 39.2 weeks on average. The average weekly weight gain was significantly higher than the standard, and 16 cases (53.3%) were more than 10th percentile at birth (Tab. I, Fig. 2). A significant correlation (r = 0.94) between the estimated fetal weight and the birth weight was found. Following prenatal treatments, maternal plasma and urinary estriol, plasma HPL and progesterone increased significantly (Tab. II).

[Laboratory and clinical studies on latamoxef in the field of obstetrics and gynecology]

Latamoxef (LMOX) is a new antibiotic synthesized by Shionogi Research Laboratory. Chemically LMOX is especially unique with a sulfur atom replacing the oxygen atom in the 1 position of the conventional cephalosporin nucleus, and in addition, this antibiotic has a cephamycin-like structure. The antibacterial activity of LMOX shows high potency against Gram-negative bacteria, but tends to be weak against Gram-positive bacteria. The tissue levels of LMOX in humans after intravenous injection of 1 g were examined. The levels in uterine and adnexa uteri tissue at 1 hour after administration were 25.4 and 27.4 micrograms/g respectively. LMOX was administered to 147 cases in infections of obstetric and gynecological field. The clinical effect according to disease was 94.6% for intrauterine infections, 95.0% for adnexitis, 87.0% intrapelvic infections, and 100% for external genital organ infections, making a total of 92.5%. The rate of occurrence of side effects or abnormal laboratory findings was similar to or slightly less than that seen with other beta-lactam antibiotics.

[Prenatal diagnosis and treatments of intrauterine growth retardation (author's transl)]

Prenatal management consisting of bed rest, high protein diet and oral administration of allylestrenol was assessed in prospective studies of 22 IUGR pregnancies, in which ultrasonographically determined fetal body weight was less than 10th percentile of Japanese population. In these cases, the gestational age was ascertained and corrected in the first trimester of pregnancy by the routine sonar measurements of CRL and BPD. Early in the third trimester, the fetal body weight was estimated by BPD and AC using the method of Warsof et al. Following the prenatal treatment, sonar measurements and biochemical determinations of maternal plasma and urinary E3, plasma HPL and progesterone, and serum HSAP and LAP were made biweekly. As results: (1) The fetal estimated body weight, averaging initially 1431 +/- 284 g at 33.8 +/- 2.1 weeks of gestation, increased finally up to 2612 +/- 451 g at 39.5 +/- 1.8 weeks. (2) Average delta/week weight gain, being 212 +/- 67 g in these cases, exceeded significantly that, being 162 +/- 43 g, of normal 50th percentile level. (3) Fifty percent of the newborn was larger than 10th percentile of normal population, at the delivery. (4) Neonatal birth weight correlated significantly with finally estimated fetal body weight (r = 0.82, Y = 1.01 X + 17.5). (5) Maternal plasma E3, which was initially low in 20 out of 22 cases (91%), being 2.1 +/- 1.5 ng/ml, elevated to 4.1 +/- 3.6 ng/ml following 2 weeks treatment. Urinary E3 increased significantly from 14.0 +/- 6.9 mg/day to 23.7 +/- 11.2 mg/day. Plasma progesterone raised significantly from 110 +/- 14 ng/ml to 133 +/- 31 ng/ml. Those results suggested that maternal increases in steroid levels were at least partly due to a stimulation of placental function by allylestrenol.

Myoclonus epilepsy associated with ragged-red fibres (mitochondrial abnormalities ): disease entity or a syndrome? Light-and electron-microscopic studies of two cases and review of literature

A report is given of an association of dyssynergia cerebellaris myoclonica associated with Friedreich's ataxia and mitochondrial myopathy in 2 patients. They had suffered from gradually increasing bursts of myoclonus since the wage of 14 and childhood, respectively. The other striking clinical features included generalized convulsions, mental deterioration, intention tremor, ataxia, muscular atrophy and deformity of feet. Muscle biopsies revealed ragged-red fibres in both cases. On electron microscopy these fibres contained subsarcolemnal aggregations of abundant abnormal mitochondria with proliferation of inner membranes or paracrystalline inclusions. One of these patients showed elevated blood lactate and pyruvate with an increased lactate/pyruvate ration, apparently of primary origin. These 2 cases resemble those reported briefly by Tsairis et al. (1974). An association of dyssynergia cerebellaris myoclonica associated with Friedreich's ataxia and mitochondrial myopathy in these 2 patients is unlikely to be coincidental but may represent one nosological entity. This myoclonus epilepsy syndrome associated with ragged-red fibres is compared with other possibly related mitochondrial encephalomyopathies.

[Ultrasonic and biochemical detection and prenatal treatments of intra-uterine fetal growth retardation (author's transl)]

Efficacy of three ultrasonographic and six biochemical methods for the detection of intrauterine growth retardation were assessed in prospective studies of 40 cases associated with short uterine fundal height less than -1.5 SD and/or small ultrasonographically determined total intrauterine volume (TIUV) less than -1 SD of normal populations. Prenatal treatments, consisting of bed rest, high protein diet, intravenous drip infusion of 10% maltose, 500 ml per day, for more than 12 days, etc., were administered on them. Fifteen cases (37.5%) delivered small-for-date infants, 9 of which complicated by toxemia of pregnancy. At the final determinations, small TIUV were found in all small-for-date cases (100%), short biparietal diameter 80.0%, and short longitudinal intracavital uterine length 53.3% of 15 small-for-date cases. In biochemical parameters, low maternal plasma estriol levels were found in 73.3%, low plasma human placental lactogen levels 66.7%, low urinary estriol excretion 53.3%, abnormal plasma alpha-fetoprotein levels 33.3%, and low plasma progesterone levels 20.0% of 15 small-for-date cases. Nineteen cases (47.5%) demonstrated remarkable increases in TIUV following prenatal treatments, and delivered appropriate-for-date infants. Despite of marked growth in biophysical parameters, abnormal biochemical values were mostly not improved by these treatments.

[Experience with CS-1170 in gynecological infections (author's transl)]

CS-1170 was used in gynecological cases of infection, and the following satisfactory results were obtained. 1. The drug was markedly effective in 3 of 12 cases, effective in 7, and ineffective in 2, being the efficacy rate 83.3%. 2. It was highly effective even in the cases in which cefazolin (CEZ) and sulbenicillin (SBPC) were ineffective. 3. The results of the bacteriological examinations turned to negative in 7 cases, but continued to be positive in 2, being the bacteriological efficacy rate 77.7%. It is noteworthy that E. coli completely disappeared by the administration of CS-1170 in 2 cases in which CEZ was ineffective. 4. No side effect attributable to CS-1170 administration was observed.

Fusiform aneurysm of basilar artery associated with bilateral choroidal cysts

A case of large fusiform aneurysm of the basilar artery and bilateral choroidal cysts in the lateral ventricles is reported. The pathogenesis of the choroidal cysts is briefly discussed.

Medical data base system with an ability of automated diagnosis

We carried out an experiment on a medical information system in which a clinical data base is combined organically with computer programs for automated diagnosis. In this system, the parameters for automated diagnosis are devised to be renewed as the contents of the data base (patient's information) increase. This system can be regarded as a data base possessing a kind of diagnosing ability which grows up with time. We have named this system "Intelligent Data Base". The algorithm for computer diagnosis used in this study is based on maximum likelihood method, and each likelihood is weighted with a prior probability of each disease. The discrimination efficiency of this method is logically equal to that of the Bayes rule. First 27 cases were learnt by the system and correct diagnosis was obtained in 78% of the cases. When cases for learning increased to 82, the percentage of correct diagnosis was improved to 95%.