P3121Cancer therapeutics-related heart failure from a cohort study using big data of electronic health record in Japan

Background

The prognosis of cancer patients has been improved partly because of the progress in cancer therapy, which increases the cancer survivors in the society. It may raise a concern regarding the development of heart failure (HF), because the anticancer agents have some serious side effects on cardiovascular system, especially in the aging society including Japan. However, the epidemiological data for the risk of HF in the cancer survivors is limited due to the lack of comprehensive dataset in the aging society. In this regard, the electronic health record (EHR), a big data, from the National Health Insurance in Japan provides a unique opportunity to obtain the suitable dataset.

Purpose

The purpose of this study was to clarify the prevalence and the risk factors of HF in cancer survivors, focusing on the impact of their age, using EHR in Japan.

Methods

We examined the EHR of 17.8 million patients, covering 14% of the total Japanese population. The EHR includes the diagnoses as coded with International Classification of Diseases, 10th revision (ICD-10), and the information for therapeutics. We extracted 159,380 patients who received anticancer agents between April 2008 to January 2017. HF patients were identified accordingto ICD-10 codes and the record for the use of therapeutic drugs for HF at least once after the HF diagnosis following the treatment with anticancer agents. We excluded the patients if they had other conditions indistinguishable from HF or if they had past history of HF before receiving anticancer agents.

Results

The mean follow-up period was 1.75 years and mean age (standard deviation) was 68.9 (11.6) years. The population over 75 years old were 37%, while males were 59.5%. There were prostate cancer (28.1%), lung cancer (13.4%), and colon cancer (12.6%)in males, and breast cancer (42.8%), colon cancer (11.5%), and lung cancer (8.6%)in females. Among them, 5,529 patients were diagnosed with HF, corresponding to the prevalence of 3.8%. The mean time form the initiation of chemotherapy to the HF onset was 1.03 year. In the Cox's proportional hazard model after the adjustments for comorbidity, HF was more prevalent in males with hazard ratio (HR) 1.07 and 95% C.I. 1.01–1.13 (p<0.05) and in those with obesity (HR 1.18, 95% C.I. 1.09–1.26, p<0.01).We divided the subjects into three age groups (younger; <65 years, intermediate; 65–74 years, older; ≥75 years). HF was more prevalent in older group than younger group (HR 1.72, 95% C.I. 1.60–1.85, p<0.01). Among the anticancer agents, doxorubicin showed HR 2.09 (95% C.I. 1.89–2.3, p<0.01), and trastuzumab showed HR 1.47 (95% C.I 1.25–1.73, p<0.01).

Conclusion

We showed that the average prevalence of HF after anticancer agentwas 3.8%. The independent risk factors for HF were older age, male, obesity, and the use of doxorubicin or trastuzumab. This study also demonstrated the usefulness of EHR in Japan, to investigate the cardiovascular risk associated with the anticancer agents.

Aldo-keto reductase family 1, member B10 in uterine carcinomas: a potential risk factor of recurrence after surgical therapy in cervical cancer

Aldo-keto reductase family 1, member B10 (AKR1B10), an enzyme that converts retinals into retinols is known to detect in non-small cell lung carcinoma (squamous cell- and adeno-carcinomas), but is barely expressed in normal tissues. Since these types of carcinoma occur frequently in the uterus (like in the lung), AKR1B10 may also be overexpressed in two major types of uterine cancer, cervical cancer (CC), and endometrial cancer (EMC). The objective of this study is to investigate AKR1B10 expression in uterine cancer and to analyze its clinical significance. In samples from uterine cancer patients, AKR1B10 was detected in 6 out of 30 (20.0%) CC cases and 6 out of 38 (15.8%) EMC cases. Statistical analysis indicated that AKR1B10 expression was associated with tumor recurrence after surgery and keratinization of squamous cell carcinoma only in CC. Although retinol (a metabolic product by AKR1B10) was observed in the normal epithelium, the molecule was not observed in cancer cells of AKR1B10-positive CC samples suggesting that the recurrence in CC may not depend on the convert of retinals into retinols via AKR1B10, a potential indicator in the management of patients with CC.

Exotic radiation from a photonic crystal excited by an ultrarelativistic electron beam

We report the observation of an exotic radiation (unconventional Smith-Purcell radiation) from a one-dimensional photonic crystal. The physical origin of the exotic radiation is direct excitation of the photonic bands by an ultrarelativistic electron beam. The spectrum of the exotic radiation follows photonic bands of a certain parity, in striking contrast to the conventional Smith-Purcell radiation, which shows solely a linear dispersion. Key ingredients for the observation are the facts that the electron beam is in an ultrarelativistic region and that the photonic crystal is finite. The origin of the radiation was identified by comparison of experimental and theoretical results.

Observation of millimeter-wave radiation generated by the interaction between an electron beam and a photonic crystal

We observed directional light emission in the millimeter-wave region when a high-energy (150 MeV) electron beam passes just above a photonic crystal made of polytetrafluoroethylene beads ( approximately 3.2 mm in diameter). The relation between the momentum and the energy of the emitted photons strongly suggests that the observed light is generated by the umklapp scattering process that changes the evanescent waves emitted by the electron beam into observable ones. By comparing the observed spectra with calculated ones based on the photonic band structure, we found that generated photons excite the photonic band modes making them observable as enhanced fine structures in the emission spectra.

Prevalence of human immunodeficiency virus, hepatitis B and hepatitis C virus antibodies and hepatitis B antigen among commercial sex workers in Japan

OBJECTIVE

To investigate the prevalence of antibodies to human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), and of hepatitis B surface (HBs) antigen in commercial sex workers (CSW) who attended a sexually transmitted disease (STD) clinic in Tokyo.

METHODS

Surveys were conducted on 308 CSW and 384 control subjects for HIV antibody or 241 control subjects for HBs antibody and antigen and HCV antibody.

RESULTS

HIV antibody was not detected in either CSW or control subjects. The positive rates for HBs antigen and antibody were 0.6 and 23.4%, respectively, in the CSW group, and 0.4 and 71.8% in the control group. The HCV antibody positive rate was 3.2% in the CSW group and 0.4% in the control group.

CONCLUSION

A statistically significant difference between the two groups was observed only in HCV antibody positive rate. STD checkup for CSW alone is inadequate--STD health education and screening for the general public are also required.

Observation of coherent cerenkov radiation from a solid dielectric with short bunches of electrons

Short bunches of 150-MeV electrons of a linear accelerator passed along the surface of a crystal quartz or a teflon and coherent Cerenkov radiation from the solid dielectrics has been observed in the wavelength range from 0.5 to 4 mm. Properties of the radiation have been experimentally investigated. The angular distribution of the observed radiation showed a maximum peak in the direction of the Cerenkov angle with several satellite peaks. The intensity increased linearly with increasing the length of the medium and was proportional to the square of the number of electrons in the bunch. The spectral intensity was enhanced by almost five orders of magnitude in comparison with the theoretical calculation of incoherent radiation.

Prevalence of human papillomavirus infection and its correlation with cervical lesions in commercial-sex workers in Japan

OBJECTIVE

To investigate the prevalence of the human papillomavirus (HPV) infection and its correlation with cervical lesions in commercial-sex workers (CSWs) who attended a sexually transmitted disease (STD) clinic in an entertainment area in Tokyo.

METHODS

Surveys were conducted on 546 prostitutes and 233 control subjects. In all subjects, HPV detection was performed by the hybrid capture method. A cervical cytological examination was performed on 247 prostitutes and 233 control subjects.

RESULTS

The HPV-positive rates in the two periods of study were higher (p < 0.01) in CSWs than in the control subjects. When the cytological grades were examined according to HPV-positive rates, the proportion of cytologic Class IIIa to Class IV was significantly higher (p < 0.01) in the HPV-positive CSWs than in the HPV-negative CSWs or in the normal subjects.

CONCLUSION

The high frequencies of HPV infection and cervical dysplasia in the CSWs in the present series might predict a higher risk of cervical cancer in this group of subjects.

Prevalence of human papillomavirus, Chlamydia trachomatis, and Neisseria gonorrhoeae in commercial sex workers in Japan

OBJECTIVE

We used the hybrid capture assays to investigate the prevalence of human papillomavirus (HPV), Chlamydia trachomatis and Neisseria gonorrhoeae among commercial sex workers in Tokyo.

METHODS

Five hundred forty-six consecutive commercial sex workers (CSW) who visited an STD clinic for STD checkup in 1998 and 1999 were studied. A control group consisted of 233 consecutive women who visited a general gynecological clinic for annual checkup. A cervical sample was obtained for hybrid capture assays for HPV-A (low-oncogenic-risk types), HPV-B (intermediate- and high-oncogenic-risk types), C. trachomatis, and N. gonorrhoeae. Fisher's exact test was used for statistical analyses.

RESULTS

The positive rate for HPV-B among the CSW was 48.4%, significantly higher than the 6.0% among the control subjects. The positive rates for HPV-A, C. trachomatis, and N. gonorrhoeae were also significantly higher among the CSW than among the control subjects. Among the microorganisms tested, the positive rate for HPV-B was the highest in both the STD and control groups.

CONCLUSIONS

The high prevalence of HPV, C. trachomatis, and N. gonorrhoeae infection in CSW poses a risk of further transmission of STD to the general public, suggesting the need for further education and screening for CSW and the general public. We found high- and intermediate-oncogenic-type HPV to be the most prevalent infection among both CSW and control subjects. Screening for HPV may be necessary in STD and general clinics to predict the risk of cervical malignancy. Hybrid capture assays, which permit simultaneous detection of HPV and other STD with high sensitivity, may be a useful diagnostic method.

[Relation between human papilloma virus DNA and expressions of p53 and p21 proteins in cervical lesions]

Oncogenic types of human papilloma virus (HPV) are known to be closely associated with cervical carcinoma. On the other hand, the oncogenic process is associated with various abnormalities in the mechanisms of cellular regulation. In this study, we detected the expressions of p53 and p21 proteins in cervical lesions by immunohistochemical techniques, and examined the relationship with HPV infection as well as the clinical usefulness of the results. Cervical biopsy specimens from 107 cases of cervical lesions were studied. HPV-DNA was detected by the hybrid capture method using probe A for low oncogenic types and probe B for high oncogenic types. Anti p21, anti-p53 antibodies were used to perform immunostaining. Point mutation in the p53 gene was analyzed by the DGGE method. High oncogenic HPV types were detected at high frequencies in CIN and SCC. In lesions associated with high oncogenic HPV, p53 protein was detected in 33.4% of the lesions and p21 protein in 36.3%. The p53 gene was analyzed in all cases, and point mutation was not detected. No relation was detected between HPV infection and p53/p21 protein expression. Since mutation was not found in the p53 gene, the p53 protein expressed was considered to be wild-type, which is suspected to play a role in inhibiting disease progression in some cases.

Usefulness of estrogen receptor detection using archival Papanicolaou-stained smears

OBJECTIVE

To examine estrogen receptor (ER) detection using cytologic specimens and to compare the results with those obtained by the dextran-coated charcoal (DCC) method and enzyme immunoassay (EIA).

STUDY DESIGN

Immunocytochemical staining was conducted on 60 cases of breast cancer resected at our hospital between April 1993 and November 1997 in which ER had been measured by DCC or EIA. Specimens for immunocytochemical staining were prepared by a cell transfer method using archival Papanicolaou-stained imprint smears, and ER staining was performed by the labeled streptavidin method using an anti-ER monoclonal antibody. These results were compared with those obtained by DCC or EIA.

RESULTS

In immunocytochemical staining for ER, positive staining was observed in the nuclei of tumor cells. A good correlation was obtained between the immunocytochemical staining results and biochemical results. Five cases were positive in anti-ER staining but negative in biochemical tests, and two cases were negative in anti-ER staining and positive in biochemical tests.

CONCLUSION

Unlike biochemical assays, the immunocytochemical method does not necessitate use of fresh frozen materials and can be performed even using archival Papanicolaou-stained smears. Immunocytochemical study is a highly useful method for routine ER determination.

Prevalence of human papillomavirus infection in women attending a sexually transmitted disease clinic

The purpose of this study was to determine the prevalence of infection due to human papillomavirus (HPV) types of high and intermediate oncogenic risk, which was most frequently associated with uterine cervical neoplasia. The subjects were 236 prostitutes who visited a sexually transmitted diseases (STD) clinic in a metropolitan area in 1998. Another 95 women who visited a university hospital were selected as a normal control group. A swab sample collected from the uterine cervix and external os was subjected to hybrid capture assays for low-oncogenic-risk HPV types (HPV A; including types 6, 11, 42, 43 and 44) and high- and intermediate-oncogenic-risk HPV types (HPV B; including 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68). Chlamydia trachomatis and Neisseria gonorrhoeae. Fisher's exact test was used for statistical analyses. Among the microorganisms tested, the positive rate for HPV B was the highest both in the women attending the STD clinic (STD group) and in the control group. The positive rate for HPV B in the STD group was 47.5% (112 of 236), and this was significantly higher than the 5.3% (5 of 95) in the control group (p < 0.0001). These findings suggest that HPV examination is recommended for women who visit an STD clinic to assess the future risk of cervical neoplasia.

Intra-abdominal angiosarcomatosis after radiotherapy

BACKGROUND

We report a case of a 61-year-old Japanese woman who developed intra-abdominal angiosarcomatosis 20 years after receiving radiotherapy for squamous cell carcinoma of the cervix.

METHODS AND RESULTS

The surgically resected portion of the ileum showed diffuse proliferating angiosarcoma, with irregular channels lined by atypical vascular endothelial cells. Immunohistochemical studies showed that the tumour cells were positive for Factor VIII-related antigen and ulex europaeus agglutinin 1. At autopsy, the tumour had disseminated to the peritoneum and invaded into the right thoracic cavity.

CONCLUSIONS

These findings were compatible with radiation-induced angiosarcomatosis.

[A 40-year-old woman with progressive dementia and abnormal behavior]

We report a 40-year-old Japanese woman who died after 12 years history of progressive dementia and abnormal behaviors. She was well until 1985 at her age of 28 years old, when she had an onset of behavioral change in which she drank much, neglected house-keeping works, and her life style became sloppy. At age 30, she became unable to understand written sentences, and paced up- and down in and out of her house. She was admitted to other hospital where marked dementia with disorientation and memory loss were noted. Slight increase in CSF protein and decrease in the peripheral nerve conduction velocity were also noted at that time. In the next year, she started to have convulsions. These symptoms had progressively become worse and was admitted to Tokyo Metropolital Matsuzawa Hospital in June of 1991 when she was 34 years of age. Despite marked dementia, she was able to walk normally, no motor paralysis, cerebellar ataxia, nor dyskinesia were noted. Deep tendon reflexes were diminished. MRI revealed T-2 high signal intensity lesions involving the white matter of the cerebrum predominantly in the frontal region. In about one year, she started to show difficulty in gait, and she became bed-ridden in July of 1994. She was discharged to home for a while, but required admission again. She expired on February 5, 1998. Her younger brother had an essentially similar dementing disease and he expired at the age of 35 years. The parents were of first cousins. The patient was discussed in a neurological CPC, and the chief discussant arrived at the conclusion that the patient had adult form of metachromatic leukodystrophy, because of white matter change in the frontal lobe, decrease in nerve conduction velocity, convulsion, marked dementia, and consanguineous marriage with a similarly affected brother. Most of the audience agreed with this conclusion, but the differential diagnosis from globoid cell leukodystrophy was felt difficult from the clinical findings alone. Post-mortem examination revealed marked atrophy in the frontal lobe. Cerebellum appeared to be smaller than normal. In the coronal sections, marked atrophy of the white matter with brown discoloration was noted. The lateral ventricles were dilated. Klüver-Barrera staining revealed marked demyelination with relative preservation of the U-fibers. PAS-positive materials were deposited in some astrocytes as well as neurons. Metachromatic deposits were noted not only in the cerebrum but also cerebllum after staining with acid cresyl violet. Pathologic diagnosis was consistent with adult type of metachromatic leukodystrophy.

Usefulness of hybrid capture HPV DNA assay as a diagnostic tool for human papillomavirus infection

The purpose of this study was to determine the usefulness of the hybrid capture HPV DNA assay, a new nonradioactive solution hybridization assay, as a diagnostic tool for human papillomavirus infection. In a total of 234 women, samples for the hybrid capture assay and polymerase chain reaction (PCR) assay were obtained by wiping a swab across the cervix and external os (either a Dacron swab or a cotton swab was used). The papanicolaou smear test (Pap smear) was carried out on all 234 women. Tissue samples for biopsy were obtained by colposcopy from 118 of the women. Fisher exact test was used for statistical analyses. Using the hybrid capture assay, HPV DNA of high- and intermediate-oncogenic-risk type was detected in 23 (13.9%) of 166 samples from women with Pap smear Class I or II, and 48 (70.6%) of 68 with Pap smear Class III, IV or V (p < 0.0001). The HPV DNA type was detected in 18 (29.0%) of 62 samples from those with no evidence of cervical intraepithelial neoplasia and 44 (78.6%) of 56 with cervical intraepithelial neoplasia or squamous cell carcinoma (p < 0.0001). Correlation of the test results between the hybrid capture test and PCR was determined by using the 217 samples in which both test results were available (PCR test results were not obtainable in 17 samples. When PCR is set as a gold standard, the hybrid capture test has high sensitivity (74.6%) and specificity (92.7%). These findings suggest that the hybrid capture HPV DNA assay is a useful method for diagnosing HPV infection in the clinic.

Cytodiagnosis of malignant melanoma of soft tissue: report of a case with diagnosis by intraoperative cytology

BACKGROUND

Malignant melanoma of soft tissue (MMST) is a rare tumor and consists of < 1% of all soft tissue neoplasms. There are few reports on its cytodiagnosis.

CASE

A 14-year-old male attended the Department of Orthopedics, Juntendo University Urayasu Hospital, in August 1994 because of a painless tumor in the distal portion of the left thigh. Intraoperative imprint smear examination led to a diagnosis of malignant melanoma, and wide resection of the tumor, including the surrounding normal tissue, was performed. On cytologic examination, the background was relatively clean, with tumor cells distributing individually or in clusters. Under high magnification, the tumor cells were seen to contain a slightly enlarged, conspicuous nucleolus and large cell body. The cells varied in shape from polygonal to spindle shaped, with a few multinuclear giant cells. Melanin and glycogen were observed in varying degrees in the tumor cells.

CONCLUSION

MMST can be diagnosed easily if melanin is observed in the cytoplasm. Even in the absence of melanin, the tumor has relatively characteristic cytomorphology. Intraoperative cytology is useful for an accurate diagnosis of the tumor.

[The intratumoral levels of thymidylate synthetase and folate in gastric and colon cancer]

Currently, biochemical modulation for 5-fluorouracil (5-FU) is one of the most successful chemotherapy for both colo-rectal and gastric cancer. The purpose of this study is to evaluate the significance of measuring intratumoral thymidylate synthetase (TS) and folate (FH4) levels as predictive parameters for the successful treatment. Samples were collected from 16 advanced colo-rectal and 21 advanced gastric cancer. TS and tetrahydrofolate levels in the specimens were measured by binding assay. Results showed that there were no significant difference in TS levels between the different pathologic types of carcinoma. On the other hand, well (3.94 +/- 1.75 p mol/g) and moderately (5.95 +/- 2.69 p mol/g) differentiated carcinoma showed lower FH4 levels compared to poorly differentiated carcinoma (9.58 +/- 5.27 p mol/g). In conclusion, biochemical modulation by cisplatin or leucovorin, which elevates intratumoral folate levels, is more needed for well and moderately differentiated carcinoma. Finally, measuring TS levels can also be important because two cases who responded to cisplatin/5-FU chemotherapy showed low TS levels compared to the others who had lower response.

[Long-term results of operation for acute type A aortic dissection]

We report results of surgical treatment in 30 patients with acute type A aortic dissection. The average age of the 25 patients without the Marfan syndrome was 59.2 (range 51-76), and male/female ratio was 11/14. The average age of the five patients with the Marfan syndrome was 36.8 (range 27-48), and male/female ratio was 2/3. As an adjunct, we used deep hypothermic circulatory arrest during ascending aortic replacement, while selective cerebral perfusion was employed during aortic arch replacement. Operative procedures for the non-Marfan patients included 14 ascending aortic replacement and 11 ascending and aortic arch replacement, while the Marfan patients underwent extensive aortic replacement that included three aortic arch replacement combined with the Bentall operation, one extensive replacement from the ascending aorta to the descending thoracic aorta and one ascending and aortic arch replacement. One patient died early after the operation and the early mortality rate was 3.3%. No patient developed new brain complication related to the operation. During the follow-up period, three patients died and two patients required a total of three subsequent distal operations. Cumulative survival rate was 89% at one year, 85% at three years, 85% at five years. Cumulative cardiovascular event-free rate was 89% at one year, 85% at three years, 77% at five years. Early and long-term results of surgical treatment for acute type A aortic dissection was satisfactory. This seems to result from the use of deep hypothermic circulatory arrest and selective cerebral perfusion as an adjunct and application of aortic arch replacement when the aortic arch is dilated or intimal tear is located in the aortic arch or more distally.

Cytodiagnosis of placental site trophoblastic tumor. A report of two cases

BACKGROUND

Placental site trophoblastic tumor (PSTT) is a rare form of trophoblastic neoplasm. Approximately 100 cases of PSTT have been reported, but we found no report on its cytodiagnosis.

CASES

Case 1, a 39-year-old female, came to the hospital because of abnormal genital bleeding. Case 2, a 36-year-old female came because of amenorrhea for a year. In both cases, endometrial smear and intrauterine curettage suggested trophoblastic disease, and hysterectomy was performed. Laboratory data revealed a mild increase in human chorionic gonadotropin (hCG) and beta-hCG but normal human placental lactogen (hPL). In the cytologic examination, the background contained some hemorrhagic and fibrinous areas but no necrosis. Most tumor cells stained light green, were round or polygonal, and contained abundant cytoplasm. Some were palely stained and had vacuoles. Some cells showed hyperchromatism, an irregular nucleus, fine-to-coarse chromatin granules and markedly different sizes. Most of the cells were hPL positive, and a few were hCG positive.

CONCLUSION

Both cases were considered benign because of rare mitoses despite cellular pleomorphism. However, careful follow-up is required. The differential diagnosis of PSTT is difficult from cytologic and biopsy specimens alone but may be achieved with additional magnetic resonance imaging findings and positive staining of hPL and hCG.

Cytodiagnosis of vaginal endodermal sinus tumor. A case report

BACKGROUND

Endodermal sinus tumor (EST) of vaginal origin is extremely rare, and few previously published reports have described the cytology of this tumor.

CASE

A high serum alpha-fetoprotein (AFP) level and magnetic resonance imaging findings in a 10-year-old female suggested EST of the lower genital tract. Laparotomy revealed EST occupying the pelvic cavity. The patient died on the 17th postoperative day due to complications from disseminated intravascular coagulation. Autopsy was performed immediately after death. The tumor originated in the posterior vaginal wall directly below the ectocervical area. Both ovaries were involved, and the tumor proliferated to occupy the cavity of the pelvis minor. A vaginal smear, obtained on two occasions, revealed severe necrosis with few cells, and a diagnosis could not be made. An imprint smear of the tumor obtained during surgery showed relatively characteristic cytologic findings of EST. Immunocytochemical and immunohistochemical studies revealed staining positive for AFP.

CONCLUSION

Vaginal EST usually occurs in patients under 3 years of age. This 10-year-old patient was the oldest among the reported cases. Vaginal EST is clinically similar to sarcoma botryoides and clear cell carcinoma, and a differential diagnosis is necessary. Immunocytostaining for AFP is essential for a definitive cytologic diagnosis of EST.

[Obstructive sleep apnea in children with cerebral palsy]

To determine the etiology of obstructive sleep apnea (OSA) in children with cerebral palsy (CP), a survey using a questionnaire was conducted on parents of 233 CP children (1-5 years old, mean age: 2.7) and on those of 343 control children during a routine medical check-up at the age of three. The prevalence of habitual snoring and nasal obstruction was 63 and 20% in CP children, which were significantly higher than in control children. Sleep apnea episodes and stridor were noted in 19.7 and 15.4% of CP children. A screening sleep study was performed using Apnomonitor II and a pulseoximeter (Pulsox 5) in 48 CP children whose questionnaires revealed habitual snoring and sleep apnea, and it was found that 27 and 58% of the children had on apnea-hypopnea index (AHI) of greater than 5 and a low level of SaO2 (LSaO2) of less than 85%, respectively. When another 10 CP children visited our hospital for treatment of severe OSA, precise evaluations including pharyngeal pressure and fiberscopic examination during sleep as well as a sleep study using an inductive prezysmograph (Respigraph) were performed. Adenoid and/or tonsillar hypertrophy were noted in only 4 children, and the main cause of sleep apnea in the other 6 children was pharyngeal collapse at the lingual base. Their OSA was successfully treated by adenotonsillectomy in 2 children, adenotomy in 2 children, UPPP and lingualplasty in 1 child, tracheostomy in 2 children, and nasal CPAP in 1 child. Before treatment of OSA in CP children, precise evaluation is recommended in order to perform appropriate treatment.

[Cytopathology and histopathology of human papilloma virus]

Human papilloma viruses (HPV) have been regarded seriously not only as an important agent causing sexually transmitted disease, but also because of its association with malignant transformation. Over 70 types of HPV are known, of which 30 types have been detected in specimens from the cervix. These have been classified into a low risk group, a high risk group and an intermediate group according to their association with malignant transformation. Therefore, diagnosis of cervical HPV infection and to a certain extent the HPV type are extremely important. Diagnostic methods of HPV infection include morphological methods such as cytological, pathological and electron microscopical diagnoses; DNA hybridization methods such as Southern blot hybridization (SBH) and Dot blot hybridization (DBH); and a combination of the two methods such as in situ hybridization (ISH), in situ polymerase chain reaction (in situ PCR) and polymerase chain reaction-in situ hybridization (PCR-ISH). Morphological methods using koilocytosis as an indicator have a low detection rate for HPV. Although ISH, in situ PCR and PCR-ISH have lower sensitivity that SBH and DBH, they enable visual localization of the detected DNA in cells or tissues. These methods are therefore important for cytopathologists and histopathologists. In this study, we report the morphological characteristics of HPV, as well as the advantages, disadvantages and detection rates of the various diagnostic methods.

A study of tubo-ovarian and ovarian abscesses, with a focus on cases with endometrioma

OBJECTIVE

To determine the incidence and causes of endometrioma-associated tubo-ovarian abscesses (TOAs) and ovarian abscesses.

METHODS

The medical records of 6,557 gynecologic inpatients were reviewed, and the data were analyzed using the median test and chi 2 test.

RESULTS

The incidence of TOAs was 2.3% (5/218) in patients with endometrioma, and 0.2% (11/6,339) in patients without endometrioma (p = 0.0001). Among the TOA cases (n = 16), no significant differences in age, parity, history of pelvic surgery, or isolated organisms were observed between the subgroups with (n = 5) and without endometrioma (n = 11). There were only 2 cases of ovarian abscess, and both were associated with endometrioma. The causes of the abscesses in the 7 cases with endometrioma were contamination during surgery (1 case), contamination during a transvaginal endometrioma aspiration (1 case), and ascending infection (1 case), and unknown in 4 cases.

CONCLUSIONS

The presence of endometrioma is a risk factor for the development of a TOA or an ovarian abscess.

[Detection of HPV-DNA in the various uterocervical lesion by the in situ polymerase chain reaction]

The causal association of human papilloma virus(HPV) with cervical cancer has been supported by multiple lines of evidence. Therefore, in the case of dysplasia, the presence of HPV-DNA should be detected and its subtypes identified. This is important in the determination of the prognosis for cervical disease. We reported a study in which the localization and types of HPV in cervical diseases was identified by in situ polymerase chain reaction(PCR), using biotin-labelled DNA probes. The in situ PCR, used by us was modified of Nuovo's method. We used biopsy materials of 18 CIN and 9 SCC cases(total 27 cases), all of which had been detected HPV-DNA by Southern blot hybridization, but not detected by in situ hybridization. A positive intranuclear reaction was detected in 13 of 18 CIN cases and 6 of 9 SCC cases(total 19 positive cases). Molecular biological techniques are the most reliable methods for detecting specific tumor genes and virus DNA. In situ hybridization has the advantage of enabling recognition of the cellular localization of the DNA in histologic specimens, but its sensitivity in inferior to the other techniques such as Southern blot, Dot blot and PCR. In situ PCR method possesses the advantages of both PCR and in situ hybridization in being highly sensitive and enabling visualization of the cellular localization of the DNA. In our present study, we succeeded to detect HPV-DNA in cervical biopsies of CIN and SCC cases by the in situ PCR.

Inverted transitional cell carcinoma of the ureter

An inverted urothelial tumor (transitional cell carcinoma, inverted type, grade 1), consisting of a large (3.5 x 1.2 x 1.2 cm) tumor with stalk (0.3 cm in diameter) and surrounding broad base polypoid foci (0.5 x 0.6 x 0.5 cm altogether), was found in the lower segment of the left ureter of a 59-year-old man. He has taken oral anticancer drugs and kanpo medicine as a follow-up for 61 months, and is now free of disease. Differential diagnosis, inverted urothelial papilloma and carcinoma, and adequate treatment are discussed.

[Changes in folate levels after cisplatin treatment of gastric cancer]

Currently, biochemical modulation for 5-fluorouracil (5-FU) by cisplatin (CDDP) is one of the most successful forms of chemotherapy for gastric cancer. Although the mechanism of this modulation is thought to increase intracellular folate levels, it is still unknown how much CDDP is needed to elevate folate levels. The purpose of this study is to determine the appropriate volume of CDDP as a modulator for 5-FU. Either 5, 20, 100 mg/body of CDDP was administered intravenously to advanced gastric cancer patients just before operation. Four hrs later, the stomach was resected and folate levels were measured in the tumor and normal mucosa by thymidylate synthase binding assay. The results showed folate elevation only after administration of 100 mg/body of CDDP, both in the tumor and mucosa (p < 0.01). In conclusion, if CDDP is infused as a bolus, a relatively large amount is needed to modulate the intratumor folate level.

Changes in lymphoproliferation and DTH responses after vaccination immediately before surgery in puppies

To clarify the effects of the presurgical vaccination canine parvovirus vaccine (CPV) on immunological responses to surgery in puppies, we assessed it by measuring the blastogenic responses of lymphocytes and delayed type hypersensitivity (DTH) responses after laparotomy in the non- and vaccinated puppies. The inhalation anesthetic used was isoflurane or halothane. In post-surgery, the blastogenic responses of lymphocytes in the non-vaccinated puppies decreased, especially, those in these puppies with halothane anesthesia (GOF) did significantly, and the duration of this decrease prolonged more than that in the non-vaccinated puppies with isoflurane anesthesia (GOI). However, the responses in the vaccinated puppies with each anesthesia didn't almost decrease below the presurgical levels. In GOI groups, the DTH responses in vaccinated puppies increased significantly over those in non-vaccinated ones, but in GOF groups, there were few differences between the DTH responses in the non- and vaccinated puppies. These results suggest that the CPV vaccination immediately before surgery possibly prevents the postsurgical immunosuppression, and that GOI may depress the immunocompetence less than GOF.

[HPV infection of the uterine cervix by cytodiagnosis, histodiagnosis and dot blot hybridization method]

Human papilloma virus (HPV) infection is diagnosed by morphological methods (including cytodiagnosis, histodiagnosis and electron microscopy) and DNA diagnostic methods. One of the DNA diagnostic methods, Dot blot hybridization (DBH), is generally regarded to be superior to the morphological methods in terms of specificity and sensitivity. There have recently been reports showing that such morphological methods as cytodiagnosis [for koilocytotic atypia (KC) or koilocytosis] and histodiagnosis are best for HPV detection in laboratories because they have better sensitivity, and are cheaper, and procedurally simpler than the DBH method. We compared detection rates by morphological methods (cytodiagnosis and histodiagnosis) and the DBH method. (Materials and Methods) The subjects were 377 patients who came to the Department of Obstetrics and Gynecology of Juntendo University Urayasu Hospital and had abnormal findings in the uterine cervix by cytodiagnosis of colposcopy. Uterine cervix swabs were scraped during colposcopic examination, and specimens for Papanicolaou and Giemsa staining were prepared on 2 slides. Scraping was again performed for the DBH (Vira pap. and type, Toray Industries, Inc.) method using swabs specified for the kit, and cells were obtained in a collection kit. At the same time, at least 3 sites including, possible atypical conversion zones, were biopsied, followed by paraffin embedding and hematoxylin-eosin staining of the specimens. (Results) 1) Comparison of detection rates by cytodiagnosis and the DBH method The positive rates by the DBH method were determined according to cytodiagnostic category in 377 patients. HPV-DNA was detected in every category and in 86 (22.8%) of all of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Detection of HPV infection in CIN and invasive cancers by in situ hybridization method--comparison with histopathology]

The causal association of human papilloma virus (HPV) with cervical cancer has been supported by multiple lines of evidence. Therefore, in the case of dysplasia, the presence of HPV-DNA should be detected and its subtypes identified. This is important in the determination of the prognosis for cervical disease. We reported a study in which the localization and types of HPV in cervical diseases was identified by in situ hybridization using biotin-labelled DNA probes. Seven types (3 basic forms) of HPV were used as DNA probes. HPV types used were following: 6/11, 16/18, 31/33/35. In this study, we introduced 7 new types (3 forms) of probes for a total of 14 types (6 forms). The new probes introduced were 42/43/45, 45/56, 51/52. Using these probes, the rate of detection HPV according to types was examined. In addition, localization of HPV infection and its relationship with histopathological findings of cervical disease were evaluated. 1) Types 6/11 and 45/56 were found in the lesions with less important histological findings (CIN I). Types 16/18, 31/33/35, 51/52 were found in the all lesions. Type 42/43/44 were not detected in this study. 2) The addition of 7 new types (3 new forms) of probes resulted in a 17% increase (16 cases) in the rate of detection of HPV compared to our previous study. 3) Localization and distribution pattern of the HPV is not, as has been reported so far, dependent on HPV type but rather on the histological characteristics, such as the degree of dysplasia.

Effects of apraclonidine on intraocular pressure and blood-aqueous barrier permeability after phacoemulsification and intraocular lens implantation

To evaluate the effect of topical apraclonidine on early postoperative intraocular pressure and blood-aqueous barrier permeability, we conducted a double-masked clinical trial in which 37 patients undergoing uncomplicated phacoemulsification and posterior chamber intraocular lens implantation were randomly assigned to treatment with 1% apraclonidine or its vehicle. One drop of 1% apraclonidine or its vehicle was instilled 1/2 hour preoperatively and immediately postoperatively. In addition to intraocular pressure, aqueous flare intensity was also determined before and after the operation by using a laser flare-cell meter. In the apraclonidine group, intraocular pressure showed no significant postoperative increase, whereas it showed a significant increase at six hours in the vehicle group (P < .01). Difference between intraocular pressure recorded at the end of the operation with the Tono-Pen II and that measured postoperatively was significantly greater in the vehicle group by 3.5 to 7.0 mm Hg (P < .05 to .01). In the apraclonidine group, the aqueous flare intensity was about half that in the vehicle group with significant differences at six (P < .05) and 24 (P < .01) hours.

[Comparison of different methods for anti-HTLV-I assay]

In 130 patients, who were considered to be anti-HTLV-I positive or negative by the PA method, we compared the anti-HTLV-I detection rates and the specificity of the following three EIA methods: the Ei-test ATL and two new EIA methods using different recombinant antigens which recognize different sites. The results from the three EIA methods were consistent with the results from the PA method at a rate over 96.9%. The specificity and sensitivity of the three methods were excellent. In 8 (0.6%) of the 130 cases, however, the results from the four methods were not in agreement. All of these 8 cases had been classified (by the PA method) as weakly positive (low antibody titer). The use of the Ei-test ATL produced some false positive cases and some false negative cases (no false negative cases have been reported in tests for anti-HTLV-I antibody before). In 3 patients, the results of the two new EIA methods were not in agreement. Because all of these three patients had a low antibody titer, the discrepancy was difficult to explain based on the difference in the antigens used. Although the four methods had similar anti-HTLV-I detection rates, the results indicate a need to carefully evaluate the data in patients with low antibody titers. Therefore, it is recommended that a combination of multiple tests be used or that the results from one test be checked against those from another test.

[Significance of determination of the blood antibody level in Chlamydia trachomatis infection of the uterine cervix]

Kits for measurement of C. trachomatis specific antibody are not commercially available, but of the significance of determination of the serum antibody level has not been clarified. In this study, we first determined the C. trachomatis antibody level in patients considered to be free of C. trachomatis infection. Then, we evaluated the relationship between the presence or absence of antigen with the antibody level in patients at our department who were available for antigen examination. Anti-C. trachomatis IgA and IgG antibodies were detected in all age groups with a peak frequency in the 20's expect that IgA antibody was absent in the umbilical blood (IgG antibody was detected also in the umbilical blood). Concerning the relationship between the presence or absence of C. trachomatis antigen and the serum antibody levels, both IgA and IgG antibodies were significantly different (chi 2 test, p less than 0.01) between the antigen-positive group and the antigen-negative group. Because females infected by C. trachomatis were more often asymptomatic than infected males, and because antigen tests may produce false negative results, determination of the antibody level must be included in the clinical tests. Determination of the antibody level is considered to be valuable also in screening for mother-child infection and asymptomatic infection.

[An autopsy case of primary lung leiomyosarcoma]

We report autopsy findings for a case of leiomyosarcoma originating in the right lung in an 86-year-old man. We surveyed current literatures and compared the immunohistochemical results in the present case with those reported previously in Japan. The solid tumor measured 6 x 7 x 7 cm sized and was located in the right lung. Its cut-surface appeared grayish to yellowish and contained areas of hemorrhage and necrosis. The lungs contained scattered nodular lesions less than 2 cm in diameter. Metastatic lesions were also confirmed in other tissues such as the heart, pericardium, liver, spleen, left adrenal gland and thyroid. Microscopically, 14 mitoses were detected in every 10 high-power fields. An immunohistochemical study revealed positivity for smooth muscle myosin and actin, and negativity for CEA, and appeared to be important in differential diagnosis and determination of histogenetic type.

[Positive rate of Chlamydia trachomatis antigen detected by the simultaneous sampling of the uterine cervix, uterine cavity and urinary tract and its relation to serum antibody titers]

The presence or absence of Chlamydia trachomatis antigen in the uterine cervix, uterine cavity and urinary tract was investigated by EIA (Chlamydiazyme) in 159 patients, in addition to the measurement of serum antibody titers in 120 of them by indirect enzyme immunoassay (IPAzyme). The results obtained were as follows. 1. The antigen was detected from one of the 3 sites in 13.8%. Patients in their twenties or younger had the highest positive rate (22.2%) and also the highest incidence of multiple lesions. 2. Patients with irregular hemorrhage from the uterine cavity had a high detection rate. 3. Detection rates for the uterine cervix, uterine cavity and urinary tract were 11.9%, 6.9% and 9.4% respectively. 4. As for overlap infection, the antigen was detected from 1, 2 and 3 sites in 7, 7 and 8 of 22 patients, respectively. 5. The incidence of active infection was significantly higher in antigen-positive patients than in antigen-negative patients, while no difference was observed in antibody titers by the increasing number of antigen-positive sites. These results suggested that the examination of the Chlamydia trachomatis antigen in the uterine cervix alone is insufficient, to determine the true actual prevalence of the organism.

[Comparison of transvaginal sonographic appearance and endometrial histology]

Transvaginal sonograms were performed randomly in 51 patients in order to study the changes that occur in the normal endometrium. A total of 68 sonograms were performed. The accuracy of sonographic estimates of the endometrium was evaluated in 51 patients who underwent endometrial biopsy. Sonographic patterns were classified into six types. In the menstrual phase, the endometrial pattern showed hyper-echogenicity and an irregular border, then the pattern became thin and linear. The pattern assumed a leaf shape with hypo-echogenicity in the mid proliferative phase and hyper-echogenicity in the late phase. The enhancement of endometrial hyper-echogenicity and the disappearance of the midline were observed in the early secretory phase. A hyperechoic lumpy pattern was seen by the next menstruation. In all of the individuals studied, sonography was able to depict changes in the endometrium which corresponded to various phases of its histology.