Consecutive Serious Medical Concomitants Associated With Extremely Severe Anorexia Nervosa in a Patient With Body Mass Index of 10.2 Kilograms per Square Meter: A Case Report

Anorexia nervosa (AN) is often accompanied by numerous medical complications and mental disorders. There are few specialized AN facilities in Japan, resulting in the unmet medical needs of patients with AN. A 37-year-old Japanese woman was admitted to the hospital after experiencing a disturbance of consciousness. Her body mass index was 10.2 kg/m2. She developed the following serious medical concomitants associated with extremely severe AN: hypothermia, shock liver, refractory hypoglycemia, acute gastric mucosal bleeding, gelatinous marrow transformation, catheter-related bloodstream infection and infective endocarditis due to β-lactamase-negative Staphylococcus aureus, aspiration pneumonia, intracranial hemorrhage, candidemia, and osmotic demyelination syndrome in the pons, which led to a fatal condition that quickly worsened after we started treatment. The patient was able to overcome several serious concomitants and be discharged from the hospital after multidisciplinary treatment team care. AN is associated with increased rates of all-cause mortality. It is important to take an interdisciplinary approach with emergency physicians, intensivists, hematologists, gastroenterologists, psychiatrists, clinical psychologists, a nutrition support team with a nationally registered nutritionist and hospitalists, and hospitalization as required based on appropriate medical evaluation with good patient and family rapport. Furthermore, social and educational efforts aimed at preventing the development of AN are necessary.

Acute respiratory failure developing in a patient with lymphomatoid granulomatosis

Lymphomatoid granulomatosis (LYG) is a rare B cell lymphoproliferative disorder associated with Epstein-Barr virus infection. LYG diagnosis is often difficult because of non-specific and varied radiological and pathological findings. The lung is the most common organ of LYG occurrence, but extrapulmonary lesions involving the central nervous system, skin, kidneys and liver are observed. A surgical biopsy is often inevitable for LYG diagnosis.We encountered a man in his 50s who presented with progressive dyspnoea. Extrapulmonary lesions were not observed. Although he developed respiratory failure within a short period, a low dose of corticosteroid relieved his symptoms. Video-assisted thoracoscopic lung biopsy revealed grade 1 LYG. The patient was successfully treated with chemotherapy, including rituximab. Only a few cases of LYG with progressive respiratory failure are reported, and most have been diagnosed via autopsy. Our case highlights the importance of performing a surgical lung biopsy at the appropriate time to diagnose LYG.

Hyperprogressive disease in lung metastases without target lesion progression after durvalumab consolidation therapy: A case report

Hyperprogressive disease (HPD) is a novel progressive pattern that occurs after immune checkpoint inhibitor (ICI) administration. Here, a 74-year-old woman who had undergone right lower lobectomy for lung cancer received curative chemoradiotherapy followed by consolidation therapy with durvalumab for metastatic recurrence confined to the mediastinal lymph nodes. Three weeks later, multiple randomly distributed nodular shadows appeared on chest CT, and thoracoscopic lung biopsy led to the diagnosis of multiple pulmonary metastases. HPD may be suspected when multiple metastases appear in new organs early after the administration of ICIs. This phenomenon may occur not only with ICI monotherapy but also with the administration of ICIs after chemoradiotherapy. Therefore, patients who have received radiation therapy should also be given similar attention early after the administration of ICIs.

[A Case of Left Renal Cell Carcinoma with Renal Arteriovenous Fistula and Multiple Vascular Malformation Undergoing Nephrectomy]

A 69-year-old woman was referred to our hospital for the treatment of a left renal tumor found by computed tomography (CT) during examination for microscopic hematuria. Contrast-enhanced CT showed a 5 cm tumor in the inferior pole of the left kidney. Left renal cell carcinoma (RCC) (cT1bN0M0) was suspected. In addition, the left renal and gonadal veins were dilated and enhanced in an arterial phase; renal arteriovenous fistula (RAVF) was suspected. Moreover, there were multiple focal arterial dilatations, suggesting the presence of multiple vascular malformation. Hereditary aortic disease, including vascular Ehlers-Danlos syndrome (vEDS), was a concern. In general, surgery is not recommended for patients with vEDS, due to vascular fragility. As such, a panel analysis of genes for hereditary aortic diseases, including vEDS, was performed; no pathogenic variants in candidate genes including COL3A1 were identified. After detailed discussions with the patient, she underwent a left nephrectomy, following transcatheter arterial embolization (TAE) of the left renal artery. We prepared a balloon catheter for aortic occlusion as a preventative measure for massive bleeding; this was not the case, as only a small amount of intraoperative bleeding occurred. Thus, the nephrectomy was performed successfully without using the balloon catheter. The patient recovered uneventfully and was discharged on day 8. Pathological examination showed clear-cell RCC (pT1a) and a RAVF near the tumor. Herein we report this case of left RCC with RAVF and multiple arterial malformation, which was successfully managed by evaluating preoperative risks with a genetic test, followed by TAE of the renal artery and open nephrectomy.

Verification of the Usefulness of an Assessment and Risk Control Sheet that Promotes Management of Cancer Drug Therapy

Background: Proper management of adverse events is crucial for the safe and effective implementation of anticancer drug treatment. Showa University Hospital uses our interview sheet (assessment and risk control [ARC] sheet) for the accurate evaluation of adverse events. On the day of anticancer drug treatment, a nurse conducts a face-to-face interview. As a feature of the ARC sheet, by separately describing the symptoms the day before treatment and the day of treatment and sharing the information on the medical record, it is possible to clearly determine the status of adverse events. In this study, we hypothesized that the usefulness and points for improvement of the ARC sheet would be clarified by using and evaluating a patient questionnaire.

Methods: This study included 174 patients (144 at Showa University Hospital (Hatanodai Hospital) and 30 at Showa University Koto Toyosu Hospital (Toyosu Hospital) who underwent pre-examination interviews by nurses and received cancer chemotherapy at the outpatient center of Hatanodai and Toyosu Hospital. In the questionnaire survey, the ARC sheet’s content and quality, respondents’ satisfaction, structural strengths, and points for improvement were evaluated on a five-point scale.

Results: The patient questionnaire received responses from 160 participants, including the ARC sheet use group (132 people) and the non-use group (28 people). Unlike the ARC sheet non-use group, the ARC sheet use group recognized that the sheet was useful to understand the adverse events of aphthous ulcers (p = 0.017) and dysgeusia (p = 0.006). In the satisfaction survey questionnaire, there was a high sense of security in the pre-examination interviews by nurses using the ARC sheet.

Conclusions: The ARC sheet is considered an effective tool for comprehensively evaluating adverse events. Pre-examination interviews by nurses using ARC sheets accurately determined the adverse events experienced by patients with anxiety and tension due to confrontation with physicians.

Cytological detection of metastatic chordoma cells in pleural effusions: A case report

Cytological detection of chordoma cells in the serosal cavity is challenging because of its rare presentation. Herein, we report a case of chordoma showing malignant pleural effusion accompanied by pleuropulmonary metastases in a 68-year-old woman. Cytological analysis was performed using pleural fluid obtained following thoracentesis. Conventional cytological staining demonstrated few clusters of large, atypical cells characterized by epithelial cell-like connectivity and rich cytoplasm with foamy and/or multivacuolar changes. The nuclei of these atypical cells were large and either round or oval with no conspicuous irregularities in the nuclear membrane. Periodic acid-Schiff staining of these atypical cells revealed fine granules in the cytoplasm. Giemsa staining showed foamy and/or multivacuolar cytoplasm in these cells, with metachromatic mucoid stroma in the surroundings. Immunocytochemistry analysis using cellblock showed these cells to be positive for broad cytokeratins, epithelial membrane antigen, S100 protein, vimentin, and Brachyury. To the best of our knowledge, this is the first case report in which chordoma cells were cytologically detected in pleural effusions. Our findings also suggest that conventional cytology combined with cellblock immunocytochemistry can increase the accuracy of chordoma cell detection in the serosal cavity.

Combining the Tumor Contact Length and Apparent Diffusion Coefficient Better Predicts Extraprostatic Extension of Prostate Cancer with Capsular Abutment: A 3 Tesla MR Imaging Study

Purpose: To assess the diagnostic performance of the tumor contact length (TCL) and apparent diffusion coefficient (ADC) for predicting extraprostatic extension (EPE) of prostate cancer with capsular abutment (CA).

Methods: Ninety-three patients with biopsy-proven prostate cancer underwent 3-Tesla MRI, including diffusion-weighted imaging (b value = 0, 2000 s/mm²) and radical prostatectomy. Two experienced radiologists, blinded to the clinicopathological data, retrospectively assessed the presence of CA on T2-weighted imaging (T2WI). TCL on T2WI and ADC values were measured on detecting CA in prostate cancer. We used the receiver operating characteristic curves to assess the diagnostic performance of TCL and ADC values for predicting EPE.

Results: CA was present in 58 prostate cancers among 93 patients. The cut-off value for TCL was 6.9 mm, which yielded an area under the curve (AUC) of 0.75. This corresponded to a sensitivity, specificity, and accuracy of 84.2%, 61.5%, and 69.0%, respectively. The cut-off value for ADC was 0.63 × 10^–3 mm²/s, which yielded an AUC of 0.76. This, in turn, corresponded to a sensitivity, specificity, and accuracy of 84.2%, 59.0%, and 67.2%, respectively. The combined cut-off value of TCL and ADC yielded an AUC of 0.82. The specificity (84.6%) and accuracy (81.0%) of the combined value were superior to their individual values (P < 0.05).

Conclusion: A combination of TCL and ADC values provided high specificity and accuracy for detecting EPE of prostatic cancer with CA.

Steroid resistance in organizing pneumonia caused by pulmonary cryptococcosis

Cryptogenic organizing pneumonia (COP) usually responds well to steroid therapy; however, recurrence is commonly observed when the steroid dose is tapered. A 74-year-old man suspected of having steroid-resistant COP presented to our hospital. Chest computed tomography (CT) revealed new consolidations of the left inferior lobe despite administration of a moderate dose of oral steroids. Repeated transbronchial lung biopsy showed pulmonary cryptococcosis. The left interior consolidations shrank gradually after antifungal therapy was initiated. Immunocompromised patients with pulmonary cryptococcosis show various CT findings, and consolidation is frequently observed. Superimposed pulmonary cryptococcosis infection should be considered in cases of steroid-refractory COP.

Pulmonary mucoepidermoid carcinoma arising in a patient with Kartagener syndrome

Background

Kartagener syndrome, an autosomal recessive disorder with a triad of chronic sinusitis, bronchiectasis, and situs inversus, is characterized by recurrent respiratory tract infections and chronic inflammation of the lung. Information on comorbidities other than infections in patients with Kartagener syndrome is currently limited.

Case presentation

A 39-year-old, non-smoking female was diagnosed with Kartagener syndrome and admitted to Saitama Medical Center, Jichi Medical University, Japan. Computed tomography revealed an endobronchial massive shadow at the ostial site of the right upper lobe bronchus with atelectasis of the right upper lobe. The mass was surgically resected and pathologically diagnosed as mucoepidermoid carcinoma. The lesion had no vascular invasions and no metastases to the lungs or lymph nodes. The surgical margin was negative for carcinoma. Following surgery, the patient has been in good condition.

Conclusions

The present case showed different clinicopathological characteristics from those previously reported in cases of Kartagener syndrome complicated by carcinoma. To the best of our knowledge, this is the first reported case of a young, non-smoking female with comorbid Kartagener syndrome and pulmonary mucoepidermoid carcinoma. This case report may provide a new perspective on the complications of Kartagener syndrome.

Proteinase 3-antineutrophil cytoplasmic antibody-positive necrotizing crescentic glomerulonephritis complicated by infectious endocarditis: a case report

Background

Proteinase 3-antineutrophil cytoplasmic antibody has been reported to be positive in 5–10% of cases of renal injury complicated by infective endocarditis; however, histological findings have rarely been reported for these cases.

Case presentation

A 71-year-old Japanese man with a history of aortic valve replacement developed rapidly progressive renal dysfunction with gross hematuria and proteinuria. Blood analysis showed a high proteinase 3-antineutrophil cytoplasmic antibody (163 IU/ml) titer. Streptococcus species was detected from two separate blood culture bottles. Transesophageal echocardiography detected mitral valve vegetation. Histological evaluation of renal biopsy specimens showed necrosis and cellular crescents in glomeruli without immune complex deposition. The patient met the modified Duke criteria for definitive infective endocarditis. On the basis of these findings, the patient was diagnosed with proteinase 3-antineutrophil cytoplasmic antibody-positive necrotizing crescentic glomerulonephritis complicated by Streptococcus infective endocarditis. His renal disease improved, and his proteinase 3-antineutrophil cytoplasmic antibody titer normalized with antibiotic monotherapy.

Conclusion

Few case reports have described histological findings of proteinase 3-antineutrophil cytoplasmic antibody-positive renal injury complicated with infective endocarditis. We believe that an accumulation of histological findings and treatments is mandatory for establishment of optimal management for proteinase 3-antineutrophil cytoplasmic antibody-positive renal injury complicated with infective endocarditis.

Measurement and comparison of individual external doses of high-school students living in Japan, France, Poland and Belarus-the 'D-shuttle' project

Twelve high schools in Japan (of which six are in Fukushima Prefecture), four in France, eight in Poland and two in Belarus cooperated in the measurement and comparison of individual external doses in 2014. In total 216 high-school students and teachers participated in the study. Each participant wore an electronic personal dosimeter 'D-shuttle' for two weeks, and kept a journal of his/her whereabouts and activities. The distributions of annual external doses estimated for each region overlap with each other, demonstrating that the personal external individual doses in locations where residence is currently allowed in Fukushima Prefecture and in Belarus are well within the range of estimated annual doses due to the terrestrial background radiation level of other regions/countries.

[Nasal endotracheal intubation using GlideScope]

We describe the performance of GlideScope in 34 consecutive patients who required nasal endotracheal intubation for surgical convenience. In the 34 patients, nasal endotracheal intubation was achieved in 52 +/- 22 (mean +/- SD) sec by unexperienced clinicians, and in 50 +/- 17 sec by anesthetists in the department. Margill forceps were not needed for any patient during nasotracheal intubation. The improved coordination afforded by an image on a video monitor seen by both the assistant providing laryngeal manipulation and the anesthetist handling the laryngoscope resulted in a significant advantage over the conventional laryngoscope technique. GlideScope seems to be a novel useful device for nasal endotracheal intubation.

VASOPRESSIN MAY BE USEFUL IN THE TREATMENT OF SYSTEMIC ANAPHYLAXIS IN RABBITS

Recent studies demonstrate that vasopressin is useful when treating hemorrhagic and septic shock. The effect of vasopressin on systemic anaphylaxis has not been investigated except in clinical case reports. Vasopressin increases blood pressure because of vasoconstriction through the V1 receptor. Thus, we evaluated the effect of vasopressin on circulatory depression and bronchoconstriction provoked by systemic anaphylaxis and survival rates in rabbits. In the first set of experiments, 15 nonsensitized rabbits received normal saline (control) and vasopressin at 0.8 or 0.08 U/kg. In the second set, 40 sensitized rabbits received horse serum to induce anaphylaxis, and then received the same drugs as in the first set. In the first set, mean arterial pressure (MAP) in vasopressin groups increased by 18% to 24% compared with the control. Vasopressin at 0.8 U/kg decreased MAP insignificantly before the increases of MAP occurred. In the second set, vasopressin at 0.08 U/kg improved the survival rate. At 45 min after antigen challenge, 69% of the rabbits that received vasopressin at 0.08 U/kg were alive, whereas 29% of the control rabbits and 23% of the rabbits that received vasopressin at 0.8 U/kg were alive. Vasopressin increased MAP by 36% to 109% compared with the control within 5 min, however, at 2 min, vasopressin at 0.8 U/kg had no effect on MAP. Pulmonary dynamics were similar. In conclusion, vasopressin at 0.08 U/kg improved survival rates and severe hypotension provoked by systemic anaphylaxis, suggesting that this agent may be useful in the treatment of systemic anaphylaxis.

Hypotension associated with systemic aggregated anaphylaxis is not attenuated by a selective endothelin-A receptor antagonist, BQ 610, in rabbits in vivo

PURPOSE

The present study was done to investigate the role of endothelin-1 (ET-1) in hypotension and bronchospasm provoked by anaphylaxis in rabbits in vivo.

METHODS

Forty-five rabbits sensitized to horse serum were randomly allocated to five groups: Group 1 (n = 10) received 0.5 nmol x kg(-1) of ET-1; Group 2 (n = 10) received 0.5 nmol x kg(-1) of ET-1 and 200 nmol x kg(-1) of a selective ETA receptor antagonist, BQ 610, without anaphylaxis; Group 3 (n = 5) received 200nmol x kg(-1) of BQ 610 alone without anaphylaxis, Group 4 (n = 10) received normal saline alone before being antigen challenged to induce anaphylaxis; Group 5 (n = 10) received 200 nmol x kg(-1) of BQ 610 before antigen challenge.

RESULTS

Mean arterial pressure (MAP) values were significantly different between Groups 1 and 2. Heart rate (HR), central venous pressure (CVP), dynamic pulmonary compliance (C(dyn)), and pulmonary airway resistance (R(L)) did not differ significantly between Groups 1 and 2. MAP values were significantly decreased compared with baseline in both Groups 4 and 5; however, the values were not significantly different between two groups. CVP values were significantly different between Groups 4 and 5 only at the 15-min time point following antigen challenge. HR, R(L), and C(dyn) values were not significantly different between Groups 4 and 5, nor were the survival rates.

CONCLUSION

BQ 610 does not improve hypotension or survival rates in systemic aggregated anaphylactic rabbits in vivo, implying that circulating ET-1 may not play an important role in anaphylaxis, although direct proof of production of circulating ET-1 or activation of ETA receptors is lacking in this study.

[Heparin resistance during cardiopulmonary bypass]

A 74-year-old man was scheduled for coronary artery bypass graft surgery with cardiopulmonary bypass. After intravenous heparin (200 U.kg-1), the activated clotting time (ACT) increased from 124 to 436 sec. However, it decreased to 128 sec immediately after cardiopulmonary bypass. The bypass was discontinued because the addition of heparin (200 U.kg-1) proved heparin resistance. The coronary artery bypass procedure was completed uneventfully without cardiopulmonary bypass. Several recent articles have reported that heparin resistance was corrected with antithrombin III concentrates, fresh frozen plasma, or argatroban. In this case, these drugs could not be used because the mechanism of heparin resistance remains uncertain. Thus, the off-pump technique is useful for unknown heparin resistance.

[Anesthetic management of caesarean section in a parturient with ankylosing spondylitis complicated with severe cervical myelitis]

A 28-year-old patient with ankylosing spondylitis and cervical myelitis was scheduled for caesarean section. We selected general anesthesia because of her cervical myelitis. Her trachea was intubated using a flexible fiberscope. The patient and the infant had no complications on their discharge.

[Emergency cesarean section in a patient with acute cortical blindness and eclampsia]

A 28-year-old parturient with acute cortical blindness and eclampsia was scheduled for an emergency cesarean section. Computed tomography (CT) of the head revealed low-density areas suggesting cerebral edema in posterior regions. The operation was performed under general anesthesia with sevoflurane. The brain edema was managed by concentrated-glycerin and steroid. The operation was performed uneventfully. Her consciousness returned to normal by the following day and visual recovery was complete within 72 hr postpartum. The patient and the infant showed no complication on their discharge.

[Diphenhydramine is useful in a parturient with hypersensitivity to local anesthetics to manage her delivery]

We did an obstetric management of a parturient, aged 32 years, with a history of local anesthetic hypersensitivity. The results of histamine release test, and cellular antigen stimulation test with lidocaine, mepivacaine, bupivacaine and preservative-free lidocaine during her pregnancy showed that all local anesthetics studied were positive. We used diphenhydramine as an alternative local anesthetic for episiotomy to the parturient during the delivery. Infiltration with diphenhydramine provided adequate analgesia without noticeable adverse reaction. One month after the delivery, we performed provocative challenge test with local anesthetics, and confirmed she had positive tests to lidocaine, mepivacaine and preservative-free lidocaine, and negative test to bupivacaine. Diphenhydramine is an adequate alternative of local anesthetics in patients with history of hypersensitivity to local anesthetics.

Effects of lightwand (Trachlight) compared with direct laryngoscopy on circulatory responses to tracheal intubation

We compared the effects of the lightwand technique on circulatory responses to tracheal intubation with those of direct-vision laryngoscopy. Forty adult patients received propofol and vecuronium, and their lungs were ventilated for 2 min via a mask with 5% sevoflurane in oxygen, after which the trachea was intubated orally using either the lightwand (Trachlight, n = 20) or the Macintosh laryngoscope (n = 20). Maximum mean arterial pressure changes did not differ between groups during (lightwand group, 25 (SD 21) mm Hg vs laryngoscopy group, 23 (19) mm Hg) and after (21 (24) mm Hg vs 21 (16) mm Hg) tracheal intubation. Maximum heart rate changes were similar for groups during (16 (14) beat min-1 vs 16 (15) beat min-1) and after (2 (11) beat min-1 vs 7 (19) beat min-1) tracheal intubation. There were no differences between the lightwand technique and direct-vision laryngoscopy in changes in mean arterial pressure and heart rate during and after tracheal intubation. We conclude that the effects of the lightwand technique on circulatory responses to tracheal intubation were similar to those of direct-vision laryngoscopy.

[Cesarean section in a morbidly obese parturient under epidural anesthesia]

A 26-yr-old morbidly obese parturient with a body mass index of 62 kg.m-2 underwent elective cesarean section for preeclampsia under epidural anesthesia. The distance between the skin and the epidural space was about 9 cm at the L3-4 interspace via mid approach. Epidural catheter was inserted 5 cm cephalad in the sitting position and a bolus of 17 ml of mepivacaine 1.5% was given in the supine position. The T5 level of analgesia was obtained 10 min later. Forty minutes after the start of the surgery, a female newborn weighing 3,206 g was delivered with an Apgar score 8 at 1 min and 9 at 5 min. Throughout the surgery, sufficient analgesia was obtained and any complications such as severe hypotension and respiratory depression did not develop. Postoperative pain was relieved sufficiently with a continuous epidural infusion of 0.25% bupivacaine at a rate of 0.5 ml.h-1 for two days. Both maternal and neonatal postpartum courses were uneventful. In conclusion, elective cesarean section in a morbidly obese parturient was successfully managed with epidural anesthesia. This indicates that an elective cesarean section under epidural anesthesia reduce the risk of perioperative complications in a morbidly obese parturient.

Spectral analysis of body weight, food and water consumption and spontaneous motor activity in male Sprague-Dawley rats

Spectral analyses by maximum entropy method were performed on the time-series data of body weight, food and water consumption and spontaneous motor activity in Sprague-Dawley rats. These parameters were recorded by a monitoring system collected every 30 min for 10 days. All the parameters had circadian (24 +/- 4 hr) and ultradian (less than 20 hr) rhythms. From the logarithmic transformation of spectral frequencies and their power spectral densities, the characteristics of the spectrum of body weight showed 1/f fluctuation and those of food and water consumption were white noises. The spectrum of the spontaneous motor activity showed complex characters. The range of frequencies lower than 0.1 Hz showed white noise while the range of those higher than 0.1 Hz were 1/f or 1/f2 fluctuations, especially in the range between 0.5 and 1.0 Hz (1-2 hours cycle). The auto-correlation coefficients of body weight did not declined suggesting that 24 hours cycle is only periodic phenomenon in body weight changes. Though the auto-correlation coefficients of food and water consumption also did not declined, they had not enough auto-correlations. This was consistent with the appearance of white noise in spectral analyses. The auto-correlation coefficients of spontaneous motor activity declined remarkably, and this suggests that there are various periodic changes in spontaneous motor activity including one to two hours cycles. These results suggest that the possibility of further extension of research is expected by using rhythmicity. It is also indicated that the time of measurement of body weight must be taken into consideration in experiments because of the presence of the circadian rhythmic changes.

Correlation of body weight gain with food and water consumption and spontaneous activity in rats

We developed a data acquisition system which measure the body weight, food and water consumption and spontaneous activity of a rat automatically. The correlation of body weight gain with other parameters obtained by this system were analysed. Each parameter showed rhythmic circadian changes. The multiple regression analysis with stepwise method brought the high coefficiency on the body weight gain with water consumption in the dark period, whereas only low correlation was observed among the body weight gain, food consumption and spontaneous activity in the light period. Since the body weight is affected by various factors, food and water consumption, spontaneous activity and/or other parameter(s) with body weight should be monitored simultaneously.

Automatic monitoring system for the measurement of body weight, food and water consumption and spontaneous activity of a mouse

The simultaneous recording system for body weight, food and water consumption and behavior (spontaneous motor activity and drinking and feeding behavior) of a mouse was developed. The body weight and food consumption were measured by force transducers. Food and water consumption and drinking and feeding behavior were measured by an infrared luminous diode and a phototransistor. Spontaneous motor activity was measured by photosensors. The system control and data acquisition were performed by using a personal computer. Every parameter could be monitored with a desired time interval. All the data collected by this system revealed apparent circadian rhythm. In conclusion, this system would be a powerful tool for pharmacological and/or toxicological research.

Effects of intrastriatal injections of selective dopamine D-1 and D-2 agonists and antagonists on jaw movements of rats

The effects of bilateral intrastriatal injections of the selective D-1 and D-2 antagonists, SCH23390 and sulpiride on apomorphine-induced jaw movements were studied in ketamine-anaesthetized rats after C1 spinal transection. A photo-transducer attached to the lower mandible automatically detected jaw movements. Apomorphine (0.2, 0.5 and 1.0 mg/kg i.v.) dose dependently increased jaw movements, an effect prevented by prior administration into the ventral striatum of either SCH23390 (0.1, 0.5 and 1 microgram) or sulpiride (125 ng). To be effective, SCH23390 had to be given less than 30 min before apomorphine whereas sulpiride had to be given earlier. Sulpiride injected into the dorsal striatum potentiated the effects of apomorphine, an action prevented by administering the sulpiride with SCH23390. Local application of the selective D-1 and D-2 agonists, SKF38393 (5 micrograms) and quinpirole (10 micrograms) into sites within the ventral striatum from which repeated jaw movements could be obtained by electrical stimulation, also evoked jaw movements; the effects of combining the two drugs were much greater than the effects of either drug alone.

Serum cortisol levels in pregnancy induced hypertension patients

We measured the serum cortisol levels in 15 normal and 8 pregnancy induced hypertension (PIH) primigravidas. The normal pregnancy had a significant (p less than 0.05) higher cortisol level than that of PIH patient. Especially, 4 severe PIH patients had a significantly (p less than 0.05) lower cortisol level. The lower maternal cortisol level of PIH patients became more significant with the severity of clinical symptoms of PIH. After the onset of labor, the cortisol levels of PIH patients did not elevate compared with normal pregnancy. These data suggest that in the PIH patient the reactivity of the adrenal cortex to adrenocorticotropic hormone (ACTH) may be blunted or the cortisol production in the adrenal cortex may be decreased by the tissue circulation insufficiency due to PIH.

[Urinary kallikrein quantity and activity of normal pregnant women and toxemia patients in third trimester]

In this study, urinary kallikrein quantity and activity were measured by the kallikrein direct RIA and kininogenase activity with human low molecular weight kininogen in 32 non pregnant healthy women, 20 normal 3rd trimester pregnant women and 18 3rd trimester hypertension type toxemia patients. There was no significant difference in urinary kallikrein quantity between non pregnant women (n = 32, 64.0 +/- 6.3 micrograms/day, mean +/- SE) and normal pregnant women (n = 20, 68.1 +/- 10.1 micrograms/day). There was a significant difference (p less than 0.001) between non pregnant women and toxemia patients (n = 18, 22.5 +/- 3.3 micrograms/day). There was a significant difference (p less than 0.001) between toxemia patients and normal pregnant women. There was a significant difference (p less than 0.05) in urinary kallikrein activity between non pregnant women (n = 32, 496.2 +/- 57.2 micrograms kinin/day) and normal pregnant women (n = 20, 319.5 +/- 48.1 micrograms kinin/day). There was a significant difference (p less than 0.0001) between non pregnant women and toxemia patients (n = 18, 82.6 +/- 13.6 micrograms kinin/day). There was a significant difference (p less than 0.01) between normal pregnant women and toxemia patients. There were no correlation in both urinary kallikrein quantity and activity between severe type toxemia patients (systolic blood pressure greater than or equal to 160mmHg or diastolic blood pressure greater than or equal to 110mmHg) and mild type toxemia patients (160mmHg greater than systolic blood pressure greater than or equal to 140mmHg and 110mmHg greater than diastolic blood pressure greater than or equal to 90mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in active and inactive renin throughout pregnancy]

There have been few reports about the changes in active and inactive renin throughout pregnancy. In this study, the changes in total and active renin concentrations during pregnancy were measured and their physiological roles are discussed. The present method employed radioimmunoassay of angiotensin I generated during incubation of plasma in an excess of sheep renin substrate. For determination of total renin concentration, inactive renin was activated by exposing plasma to trypsin. Concurrent with the progress of pregnancy, active renin increased gradually and reached its maximum during the third trimester, then fell sharply to first trimester levels by the fifth day of the puerperium. Total renin levels during pregnancy were about twice as high as puerperal levels. We found no difference in total renin levels between trimesters but a marked difference in individual women was observed. In the first trimester of pregnancy, inactive renin in plasma rapidly increased (to 4 times the average concentration in plasma of puerperal women), then declined slowly throughout pregnancy, and fell quickly after delivery. These results suggest that in pregnancy total renin levels are consistently elevated, 67% of which is inactive renin in the first trimester and active renin increases gradually with advancing gestation. After delivery, both active and inactive renin fall to normal levels within a few days.

[Urinary kallikrein quantity and activity in normal pregnant women in the third trimester]

In this study, urinary kallikrein quantity and activity were measured by the kallikrein direct RIA and kininogenase activity with human low molecular weight kininogen in 32 non pregnant healthy women and 20 normal 3rd trimester pregnant women. There was no significant difference in urinary kallikrein quantity between non pregnant healthy women (n=32, 64.0 +/- 6.3 micrograms/day, mean +/- S.E.) and normal pregnant women (n=20, 68.1 +/- 10.1 micrograms/day). There was a significant difference (p less than 0.05) in urinary kallikrein activity between non pregnant healthy women (n=32, 496.2 +/- 57.2 micrograms kinin/day) and normal pregnant women (n=20, 319.5 +/- 48.1 micrograms kinin/day). The reason for no significant difference in the urinary kallikrein quantity may be that neither non pregnant women nor normal pregnant women have renal damage. And, one of the reasons for significant low urinary kallikrein activity in normal pregnant women may be that the sensitivity of blood vessels to angiotensin II in normal pregnancy is less than in non pregnancy.

[Amniotic fluid 3,3',5'-triiodothyronine (reverse T3)]

RT3(3,3',5'-triiodothyronine) levels in amniotic fluid and T4(thyroxine), T3(triiodothyronine), rT3 and TSH(thyroid-stimulating hormone) levels in maternal and cord serum were determined simultaneously by RIA. We also determined the activities of the monodeiodination of thyroxine to rT3 in placentas. Amniotic fluid rT3 and cord serum rT3 levels decreased, but T4, T3 and TSH levels increased with advancing gestational age. The activities of the monodeiodination in placentas decreased rapidly from midgestation, preterm to term. In maternal hyperthyroidism, amniotic fluid rT3 levels were markedly elevated. Moreover, there were significant positive correlations between amniotic fluid rT3 and maternal serum rT3 (r = 0.756, p less than 0.001, n = 26) and T4(r = 0.509, p less than 0.01, n = 26) in the normal 3rd trimester. We found significant correlations between amniotic fluid rT3 and fetal thyroid function as well as the activity of the monodeiodination in placenta after 17 weeks' gestation. But we couldn't find any such correlations in the 3rd trimester. These data suggest that the amniotic fluid rT3 in the 3rd trimester was affected by maternal thyroid function as well as fetal thyroid function and the activity of the monodeiodination in placenta.

Effects of caffeine ingestion during pregnancy

We studied the effects of caffeine ingestion during pregnancy. A total number of 9,921 healthy pregnant women with a gestational age after 24 weeks were subjected to the study. The women who drank more than 5 cups of coffee per day had a high incidence of impending abortion, premature labor, and fetuses small for gestational age. The heavy coffee drinkers among the pregnant women had high rates of spontaneous abortion, chromosomal abnormality and congenital multi-anomalies. However, we would like to stress that the multiple socioeconomic variables might be more important than any direct effect of caffeine.

Simultaneous and serial measurement of serum levels of human placental lactogen, beta-human chorionic gonadotropin and unconjugated estriol levels in pregnant women

Serum levels of human placental lactogen (hPL), beta-human chorionic gonadotropin (beta-hCG) and unconjugated estriol (E3) were measured simultaneously and serially in regular menstrual late pregnant women (155 samples) by radioimmunoassay. The peak of beta-hCG level was shown at 37 weeks' gestation. After that, there was a moderate decline of the beta-hCG level. Serum hPL showed the peak at 30 weeks' gestation. The level of unconjugated E3 rose toward 41 weeks' gestation. In the 155 samples, there were significant positive correlations among these hormone levels. Also, there were highly significant positive correlations between placental weight and these three hormone levels. Only unconjugated E3 level which was obtained within a week before the onset of labor had a significant positive correlation with birth weight. These data suggest that even in late pregnancy, maternal beta-hCG makes a peak and may change parallel with hPL and unconjugated E3. Only the unconjugated E3 level may be affected by fetal growth.

Chemical synthesis of the 5'-terminal part bearing cap structure of messenger RNA of cytoplasmic polyhedrosis virus (CPV): m7G5'pppAmpG and m7G5'pppAmpGpU

The 5'-terminal structures of mRNA bearing the so-called 'cap' from cytoplasmic polyhedrosis virus (CPV), m7G5' pppAmpG and m7G5' pppAmpGpU, were first chemically synthesized. S,S-Di(4-methoxyphenyl) N6-benzoyl-2'-O-methyladenosine 5'-phosphorodithioate ((ArS) 2pAbmz) was prepared by phosphorylation of the 5'-hydroxyl group of N6-benzoyl-2'-O-methyladenosine with S,S-di(4-methoxyphenyl) phosphorodithioate by TPS. By the triester approach using (ArS) 2pAbmz as starting material, the protected dinucleotide and trinucleotide bearing 5'-phosphate group were synthesized. The protective groups of the dinucleotide and trinucleotide were removed to obtain pAmpG and pAmpGpU, respectively. By the reaction of a capping agent ((PhS) ppm7G) with pAmpG and pAmpGpU in the presence of silver nitrate or iodine. The 5'-terminal structure of the messenger RNA strand of CPV which was labelled isotopically, was confirmed completely as m7G5' pppAmGpU by cochromatography with the materials chemically synthesized here.

Retrograde time-scale analysis of human placental lactogen, beta human chorionic gonadotropin, and unconjugated estriol levels in human maternal serum from the onset of spontaneous labor

We analyzed on a retrograde time scale which calculated in maternal serum, from the onset of spontaneous labor, human placental lactogen (hPL), beta human chorionic gonadotropin (beta-hCG), unconjugated estriol (E3) levels, and the ratios among these hormones in the normal late pregnancy. Maternal serum hPL, beta-hCG, and unconjugated E3 levels were measured simultaneously and serially in regular menstrual sera from 27 women in late pregnancy (total 155 samples) by radioimmunoassay. The peak level of hPL was found at 2 weeks before labor, and the peak of beta-hCG was found during 2-4 weeks before the onset of spontaneous labor. On the other hand, the mean level of E3 rose slightly with advancing gestational age. The hormonal ratios of hPL to E3 and beta-hCG to E3 decreased gradually toward the onset of labor, but the ratios of hPL to beta-hCG did not change. From these data, it is possible to conclude that the onset of spontaneous labor can be predicted by measuring the levels of hPL and unconjugated E3 in maternal peripheral serum.

Clinical background of preeclampsia in Japanese women

In Japan, the maternal mortality rate from preeclampsia is still high. In this study, we analyzed the clinical background of 70(1.5%) cases of severe preeclampsia in 4,633 deliveries in our clinic. The main family history was hypertension (34.2%). The medical complication of this pregnancy were nephritis (11.4%), hypertension (5.7%) and diabetes mellitus (4.3%). In previous obstetrical complication, preeclampsia was found very high frequency (44.4%). In this pregnancy, the cesarean section was done for 15 (21.4%) cases. There was a significant high frequency of low birth weight infant in preeclampsia (2,400 +/- 925 gr, mean +/- S.D.). The stillbirth was found in 12 (17.1%) cases. The perinatal mortality rate was 169/1,000 deliveries, this was a significantly higher than total rate (15/1,000 deliveries). These data suggest that it is important to control medical complications before to be pregnant to prevent preeclampsia.