Anterior inferior cerebellar artery aneurysm with proximal parent artery stenosis: A case report

Hemodynamic factors are associated with the progression of cerebral aneurysms. We report a 78-year-old woman with an anterior inferior cerebellar artery aneurysm and proximal stenosis of the anterior inferior cerebellar and basilar arteries. The aneurysm exhibited growth on annual follow-up imaging. Aneurysmal rupture occurred 4 years after diagnosis. Coil embolization resulted in aneurysm occlusion with parent artery preservation. Aneurysms adjacent to a more proximal region of severe stenosis in the parent vessel should be considered at high risk for growth or rupture. Such aneurysms require careful monitoring. Particular attention should be paid to posterior circulation aneurysms that occur at anatomically vulnerable sites.

Cerebral Vasospasm After Burr Hole Evacuation of Chronic Subdural Hematoma

Cerebral vasospasm is a frequent complication of subarachnoid hemorrhage. We report a case of chronic subdural hematoma complicated by cerebral vasospasm after burr hole evacuation. A 74-year-old woman underwent burr hole evacuation of a chronic subdural hematoma. She developed left hemiparesis and disturbance of consciousness on postoperative day 3. Magnetic resonance imaging showed a right parietal infarct and decreased cerebral blood flow signal in the right middle cerebral artery territory. Digital subtraction angiography showed multiple segmental narrowings of the right middle cerebral artery. Her neurological symptoms recovered with conservative treatment. Follow-up angiography showed improvement in the arterial narrowing, which finally led to a diagnosis of cerebral vasospasm. Cerebral vasospasm can occur after burr hole evacuation of chronic subdural hematoma. Magnetic resonance angiography is useful for determining the cause of postoperative neurological worsening in chronic subdural hematoma patients.

A case of high-grade endometrial stromal sarcoma arising from endometriosis in the cul-de-sac

This report describes a rare case of high-grade endometrial stromal sarcoma (ESS) arising from pathologically confirmed endometriosis in the cul-de-sac. A 37-year-old woman presented with irregular menstruation, pelvic pain, and diarrhea. Magnetic resonance imaging and colon biopsy suggested endometriotic nodule of the cul-de-sac. The tumor size was reduced with hormonal therapy, and the residual tumor was excised, resulting in the pathologic diagnosis of endometriosis. Two years later, a soft mass reappeared with rapid growth. Tumor extraction was performed, and the histopathologic diagnosis was high-grade ESS. Neither hormonal therapy nor chemotherapy was effective, and the patient died 6 months postoperatively. ESS should be included in the differential diagnosis of malignant transformation of endometriosis.

Clear cell ependymoma of the fourth ventricle

Two cases of clear cell ependymoma (CCE) of the fourth ventricle are reported in a 49-year-old woman with dysphagia and a 59-year-old woman with dizziness and gait disturbance. CCE is a relatively new variant of ependymoma added to the WHO classification of tumors in 1993. Tumor cells display an oligodendroglioma-like appearance with a clear perinuclear halo. Most infratentorial CCE tumors are located in the cerebellum. There are only three cases, including the present two cases, that have been reported to affect the fourth ventricle.

[Effect of paclitaxel on cisplatin resistant head and neck squamous multicellular tumor spheroids]

Paclitaxel has been reported to be effective for the treatment of CDDP resistant tumors. Thus, the efficacy of paclitaxel on CDDP resistant HEp-2 and KB head and neck squamous carcinoma cell lines was evaluated in monolayer and multicellular tumor spheroids (MTS). Cell lines with a tenfold resistance to CDDP were used in this study (Tanaka, K. et al, Keio J Med, 70. 1993). MTS were developed using the liquid overlay culture technique. After exposure to graded concentrations of drugs and different exposure time, the cells were subjected to a clonogenic assay. The effect of paclitaxel on both monolayer and MTS was dependent on the drug concentration and related to the exposure time. For HEp-2 MTS, 10(-7) M/L of paclitaxel resulted in a cell death rate of approximately 90% in both parent and resistant cells. For KB MTS, the cells were more resistant to paclitaxel than the HEp-2 cells, and a 72 hour exposure time was needed to achieve a cell death rate of approximately 90%. These data suggest that paclitaxel may be effective for treating CDDP resistant head and neck cancer.

[A case of collapsing variant of FSGS]

We report a case of collapsing variant of FSGS. An 82-year-old man without HIV-1 infection or a history of intravenous drug abuse was admitted to our hospital with the chief complaints of acute onset of generalized edema and loss of appetite. Laboratory findings were consistent with nephrotic syndrome. He developed acute renal insufficiency. Initially, we suspected minimal change nephrotic syndrome and started steroid pulse therapy but the nephrotic syndrome was refractory and a renal biopsy was performed. The pathologic findings were judged to be consistent with a collapsing variant of focal segmental glomerulosclerosis (FSGS). This form was described by Weiss et al. in 1986 as a clinically and pathologically distinct variant of FSGS. Valeri et al. further reported that the incidence of this idiopathic collapsing type of FSGS which is devoid of evidence of HIV-1 infection or intravenous drug abuse has progressively increased over the past two decades. They reported that cyclosporin is effective for the treatment of this type of FSGS with a remission rate of about 30%. The present case also had a nearly complete remission after 2 month-cyclosporin treatment. In Japan, no adult case of this type of FSGS has been reported according to our review of the literature.

Leiomyoma with atypical cells (atypical leiomyoma) in the larynx

AIMS

To report and confirm the identity of laryngeal leiomyoma with many atypical cells, which has not been described previously.

CASE DETAILS

A 53-year-old man was found to have a polypoid tumour in the larynx. The tumour was excised and the patient has shown no evidence of recurrence over a 5-year period. The tumour tissue comprised intersecting fascicles of spindle-shaped tumour cells with blunt-ended nuclei. Many of the tumour cells showed marked atypia. Mitotic activity in the tumour cells was low, and no atypical mitoses were found. Immunohistochemically, the tumour cells were positive for smooth muscle actin and desmin. p53 overexpression was identified in many tumour cells; the p53 labelling index of the tumour cells was 45%. DNA from tumour cells showed loss of heterozygosity on chromosomes 3p, 5q, 8p, 9p, 10q, 17p and 18q. We diagnosed this case as leiomyoma with atypical cells (atypical leiomyoma) based on the clinical course and pathological and genetic findings.

CONCLUSION

This is the first report of atypical leiomyoma in the larynx. The clinical course and pathological findings indicate that although laryngeal atypical leiomyoma contains numerous atypical cells, it is a benign neoplasm.

Cox multivariate regression models for estimating prognosis of patients with endometrioid adenocarcinoma of the uterine corpus who underwent thorough surgical staging

The International Federation of Gynecology and Obstetrics (FIGO) adopted surgical staging criteria in 1988. Many studies have shown that histologic grade, nuclear grade, lymph-vascular space invasion and cell type are also important predictors of survival. It has not been clarified, however, how to integrate these histopathologic variables into the process of estimating individual prognosis. We performed Cox multivariate regression analysis to create models that incorporate various histopathologic factors for estimating the prognoses of patients with endometrioid adenocarcinoma of the uterine corpus. Our study was based on data from 206 patients who underwent complete surgical staging, including systematic pelvic and para-aortic lymph node dissection. Two models resulted: one included depth of myometrial invasion, para-aortic node metastasis and the number of sites involved by the tumor among the cervix, ovary and pelvic lymph nodes (which we designated as extracorporeal spread score, ECS) and the other incorporated nuclear grade and lymph-vascular space invasion as variables. These 2 models enabled the prognosis for patients with endometrioid adenocarcinoma to be stratified into several levels according to hazard ratio. Comprehensive integration of the histopathologic prognostic factors, categorized into those relating to tumor extent and those relating to tumor virulence, should facilitate the estimation of individual prognosis more accurately than FIGO staging alone.

[MR diagnosis of internal derangement of the knee by SE T1 and GRE T2* weighted images: evaluation of 300 arthroscopically proven knees]

To evaluate whether or not the combination of sagittal and coronal spin-echo (SE) T1 and sagittal gradient echo (GRE) T2* weighted imaging is adequate to diagnose internal derangement of the knee, a study was done in 300 knees of 293 consecutive patients who underwent both MR imaging of the knee and arthroscopy. In prospective analysis, the MR imaging had an accuracy, sensitivity and specificity of more than 90% in the evaluation of medial meniscus (MM) and of 97% in the evaluation of anterior cruciate ligament (ACL). In the evaluation of lateral meniscus (LM), accuracy was 83%, sensitivity 76%, and specificity 88%. In a review of false-negative MR diagnoses (n = 42) of menisci, the most significant lesion was not in the meniscus but in the ACL in 32 knees (76%). Conservative treatment was selected in 25 knees (60%), rather than partial meniscectomy (n = 13) or meniscoresis (n = 4). There were 21 false-positive MR diagnoses of menisci even in retrospective analysis, and 17 of them (81%) had findings of tear in the posterior zone, which is known to be a difficult area for arthroscopic examination. The results were similar to those of other authors' with SE T1 and/or proton density and T2 weighted images. The combination of sagittal and coronal SE T1 and sagittal GRE T2* weighted images could be sufficient as a routine MR protocol for diagnosing the internal derangement of the knee.

A clinical and pathologic study on para-aortic lymph node metastasis in endometrial carcinoma

BACKGROUND

Recent studies have shown that poor survival for patients with early endometrial cancer was related to the extrapelvic spread of the cancer. The purpose of this study was to evaluate the correlation between para-aortic lymph node (PAN) metastasis and histopathologic findings and to assess the clinical utility of identifying PAN metastasis of endometrial carcinoma.

METHODS

The correlation of para-aortic lymph node metastasis to the clinical stages of endometrial carcinoma (FIGO, 1982), histopathologic findings, and prognosis were investigated in 200 patients with endometrial carcinoma, who were treated by radical operations, including systematic retroperitoneal lymphadenectomies, between July 1982 and February 1996.

RESULTS

Of these, para-aortic lymph node (PAN) metastasis was seen in 18 (9.0%) and pelvic lymph node (PLN) metastasis in 40 (20.0%). The incidence of PAN metastasis according to clinical stages Ia, Ib, II, and III were 2.5%, 8.5%, 15.7%, and 33.3%, respectively. The incidence of metastasis was significantly higher in stage II than in stage Ia (P < 0.05), and in stage III than in stage Ia (P < 0.01). PAN metastasis occurred significantly more frequently in the first of each of the following groups: invasion of > 1/2 of the myometrium (15.7%) vs. invasion of < 1/2 of the myometrium (3.6%) (P < 0.01), the group with cervical invasion (23.5%) vs. the group without (4.0%) (P < 0.0001), the group with lymph-vascular space involvement (17.2%) vs. the group without (1.0%) (P < 0.0005), and PLN-metastasis-positive group (40.0%) vs. the negative group (1.3%) (P < 0.0001). Multivariate analysis showed a significant correlation between PAN and PLN metastases (P < 0.0005). Positive PAN metastasis is not related to multiple PLN metastasis (bilateral PLN metastasis and the number of PLN metastatic groups). However, a correlation was seen between PAN metastasis and common iliac node metastasis. The prognosis was significantly poorer (P < 0.05) for patients with both PLN and PAN metastases than for those with PLN metastasis alone.

CONCLUSIONS

The results of the present study suggest that PAN metastasis may occur as a consequence of PLN metastasis or the two may occur simultaneously as PLN metastasis and also that careful examination of PAN metastasis is necessary to determine the prognosis.

Perineal cystoprostatectomy and ureterosigmoidostomy for invasive bladder cancer

PURPOSE

A technique for perineal cystoprostatectomy with ureterosigmoidostomy is described as a minimally invasive method to treat muscle invasive bladder cancer.

MATERIALS AND METHODS

We performed 7 perineal cystoprostatectomies. In the most recent case ureterosigmoidostomy performed via the perineal approach was the definitive method of urinary diversion.

RESULTS

The operation was well tolerated and minimally invasive.

CONCLUSIONS

Perineal cystoprostatectomy and ureterosigmoidostomy are effective and minimally invasive means of definitive therapy for muscle invasive bladder cancer.

Non-grafting method of vaginal construction for patients of vaginal agenesis without functioning uterus (Mayer-Rokitansky-Küster syndrome)

We have treated 18 patients with vaginal agenesis without functioning uterus (MRK syndrome) during the period between January 1984 and December 1995 by Frank's dilatation method followed by the surgical method without grafting. Clinical records were retrospectively examined in regard to the size and functions of the constructed vagina and problems of the treatment procedure. The treatment by non-invasive dilatation was first carried out starting at the age of 21 years 2 months +/- 2 years 9 months (Mean +/- SD) for the duration of 10.9 +/- 9.8 months. It was successful (constructed vaginal length by pressure: 60 mm or more) in 6 patients (35.3%). The non-grafting surgical method was then performed. The operation time was 2:11 +/- 0:37 hours and no complications were observed. The vaginal lengths 1 month after operation and at the latest follow-up were enough to have coitus and no severe complications including shrinkage were observed. Our method to construct a new vagina is simple and useful, since it left no operation scar in contrast to McIndoe's method and other methods with grafting.

[An analysis of pelvic and para-aortic lymph node metastasis in ovarian carcinoma by systematic retroperitoneal lymph node dissection]

We performed a systematic retroperitoneal lymph node dissection (RPLND) on 137 patients with primary ovarian carcinoma, of whom 97 had undergone RPLND during the primary surgery before chemotherapy and 40 had undergone RPLND during the secondary cytoreductive surgery after preoperative chemotherapy. The tentative staging of the ovarian carcinoma used in this study was determined according to the FIGO criteria without considering the pathologic findings of retroperitoneal lymph nodes. Nodal metastasis was seen in 21.9% (30/137) of them. Thirteen had positive pelvic lymph nodes (PLN) but no positive para-aortic nodes (PAN). Eleven had both positive PLN and positive PAN. Six had positive PAN but no positive PLN. The PAN was the most frequent site of metastasis (17/137). Next were the common iliac, obturator, and lateral group of deep inguinal nodes. Solitary metastasis in the patients who had undergone RPLND during the primary surgery was seen in a PAN and a common iliac node. Among 24 patients with PLN metastasis, there was a significant (p < 0.05) difference in the number of positive PLN between the patients with PAN metastasis (5.27 +/- 3.00) and the patients without PAN metastasis (2.62 +/- 1.66). These results indicate that the PAN and common iliac nodes are the most important site of nodal metastasis in ovarian carcinoma. The metastasis to PLN such as obturator node and internal iliac node seems to occur independently of the PAN metastasis, and the PAN metastasis occurs not only through the direct route but also as a consequence of extension of PLN metastases. Systematic retroperitoneal lymph node exploration therefore seems to be necessary to clarify the lymph node status.

Lasing behavior in a liquid spherical dye laser containing highly scattering nanoparticles

With the addition of scattering nanoparticles to dye-doped spherical droplets, lasing has been observed with well-defined thresholds in input-output data. One-order or more magnitude enhancement of peak intensity from droplet emission has been obtained with certain (optimum) additive scattering particles compared with nonadditive scattering particles (neat dye-doped droplets). Characteristics of input-output intensities, emission spectra (with wavelength shifts), and spectral linewidths are reported experimentally, depending on additive quantities of scattering nanoparticles.

[Chemotherapy of head and neck cancer]

Squamous cell carcinoma of the head and neck is a chemotherapeutically responsive tumor. Methotrexate, cisplatin, 5-fluorouracil and bleomycin in various combinations have achieved tumor regression, with complete or partial response, in 60-90% of previously untreated patients. The response to chemotherapy, however, is often short-lived, and conventional treatment has produced little impact on survival. To date, neo-adjuvant and/or adjuvant chemotherapy have also failed to demonstrate any impact on the survival rate, although subset analysis has indicated a possible survival benefit. Furthermore, larynx preservation and reduction in incidence of metastasis have been demonstrated. Concomitant chemoradiotherapy has some positive results in disease free survival and/or overall survival. In this report, we reviewed the literature on neoadjuvant chemotherapy, adjuvant chemotherapy, salvage chemotherapy and concomitant chemoradiotherapy for advanced head and neck cancer, and analyzed their efficacy.

Induction chemotherapy with cisplatin, etoposide, and mitomycin-C (PEM) regimen in advanced cases with cancer of pharynx and oral cavity

With the aim of improving survival rate in advanced head and neck cancer, we scheduled 26 patients to receive PEM regimen. This regimen consisted of cisplatin (CDDP)(P), etoposide (VP-16)(E), and mitomycin-C (MMC)(M) (CDDP 60 mg/ m2/2 hr infusion on day 1; VP-16 40 mg/m2/1 hr infusion on days 1-3; MMC 7 mg/m2 iv bolus on day 1). Of 25 patients evaluable for response, 8 complete response (CR), 14 partial response (PR) were achieved, with an overall response rate (RR) of 88%. Myelosuppression was major side effect and thrombocytopenia (23% greater than WHO grade) was dose limiting toxicity. Other adverse reactions including mucositis were all mild and transient. Since limited mucosal toxicity, full course of following treatment including radiotherapy and/or surgery could be done satisfactorily. We concluded that this regimen produced beneficial effect as the adjuvant setting in patients with cancer in pharynx and oral cavity because of limited mucosal toxicity.

Prostate specific antigen density in patients with histologically proven prostate carcinoma

BACKGROUND

Prostate specific antigen (PSA) does not appear to have the specificity to distinguish between benign prostate hyperplasia and cancer when the PSA is low. PSA density is thought by many to improve the specificity for cancer; however, this theory remains controversial.

METHODS

The authors retrospectively reviewed 220 carcinomas in radical prostatectomy specimens and examined the relationship of PSA and PSA density to prostate volume, Gleason sum, and pathologic stage.

RESULTS

Prostate specific antigen and PSA density parallel each other and do not appear to correlate statistically with displaced volume of the prostate, Gleason sum, or pathologic stage. However, PSA density in the PSA 4.1-10 ng/ml group may have conferred unique information secondary to increased variation in prostate volume. Furthermore, PSA density was associated more than PSA with carcinoma in the PSA < or = 4.0 ng/ml group. A PSA density cutoff of greater than 0.05 ng/ml/ml was accurate in the diagnosis of 94.9% of the patients with cancer. Finally, carcinomas with a Gleason sum of greater than 6 in patients with a PSA density of greater than 0.3 ng/ml/ml had a high probability of being extra-capsular at the time of surgery.

CONCLUSIONS

Although PSA and PSA density appear to mirror each other in many ways, PSA density confers unique information and may be used as an adjunct to PSA and digital rectal examination in the detection and staging of prostate cancer. If prostate needle biopsy is performed, PSA density and Gleason sum may help identify patients who are at high risk for surgical failure.

A study on the hemostatic effect of sodium alginate on uterocervical hemorrhage

We examined a sodium alginate preparation (Alto) to determine its hemostatic effect, in comparison with other topical drugs, on hemorrhages in the uterocervical area. A total of 149 patients with hemorrhage from cervical erosion or after-treatment bleeding of the cervix uteri were subjects in this trial, and 84 (79%) of 106 patients treated with this preparation experienced a hemostatic effect. A significant positive correlation (p < 0.001) was noted between the degree of tissue adhesiveness and the hemostatic effect in all the drugs tested. As for the tissue adhesiveness, Alto was significantly more favorable (p < 0.001) than both Thrombin and Francetin T powder. Because Alto was softened by tissue moisture, its topical adhesiveness could be increased, which suggested that Alto was superior in hemostasis.

Decreased E-cadherin expression in endometrial carcinoma is associated with tumor dedifferentiation and deep myometrial invasion

Decreased E-cadherin expression in tumor cells has been suggested to promote tumor invasiveness. We examined E-cadherin expression in 30 cases of endometrial carcinoma by immunohistochemistry using a monoclonal antibody to E-cadherin and investigated its correlation with other histopathologic features of the tumor. We observed that: (1) E-cadherin expression decreased with loss of differentiation (P < 0.05); (2) E-cadherin expression was inversely correlated with depth of myometrial invasion (P < 0.05); (3) decreased E-cadherin expression was correlated with paraaortic node metastasis (P < 0.01); and (4) multivariate analysis comparing the depth of myometrial invasion to the pattern of E-cadherin expression, histologic grade, nuclear grade, and lymph-vascular space invasion showed that the depth of myometrial invasion was most strongly correlated with decreased E-cadherin expression (P < 0.005). These findings seem to be consistent with the concept that the dissociation of cancer cells due to decreased expression of E-cadherin facilitates invasion of tumor cells.

[An analysis on prognostic significance of histopathologic risk factor in uterine endometrial carcinoma]

Prognostic risk factors in histopathologic findings were analyzed in the data for one hundred and thirteen patients with uterine endometrial carcinoma who were treated surgically. Univariate survival analysis with Kaplan-Meier methods revealed that the nuclear grade (p less than 0.005), lymph-vascular space invasion (p less than 0.005), histologic grade (p less than 0.01) and histologic type (p less than 0.01) correlated with the patient's prognosis. Among surgical FIGO stages II and III, there was similar significance in the correlations in the nuclear grade (p less than 0.05), lymph-vascular space invasion (p less than 0.0001) and histologic type (p less than 0.05), although there was difference (p less than 0.05) only between grade 1 and grade 3 in the histologic grade. Multivariate survival analysis with a proportional hazard regression model showed that the nuclear grade (p less than 0.005) and lymph-vascular space invasion (p less than 0.01) correlated significantly with the prognosis. The hazard ratios with a 95% confidence interval for each of these factors were 19.2 (3.2-115.7) and 16.9 (2.1-135.3), respectively. The 3-year survival rate was 98% for a hazard ratio less than 64.7, and 45% for one more than 67.4, between which there was a significant difference (p less than 0.0001). And univariate survival analysis of this hazard ratio also revealed strong correlations with the patient's prognosis. These results suggest that it is of great importance to adopt the hazard model including such factors as the nuclear grade and lymph-vascular space invasion in estimating the patient's prognosis and proceeding to adequate post-operative therapy for individual patient.

Extracorporeal spread and its prognostic impact in stages I and II (FIGO) endometrial carcinoma

Prognostic risk factors were statistically analyzed from the histopathologic data obtained from 90 Japanese women with stages I and II endometrial carcinoma treated surgically, including systemic retroperitoneal lymph node dissection, between June 1979 and June 1989. In stage Ia endometrial carcinoma, pelvic and paraaortic nodes metastasis were seen in 13.8(4/29)% and 0.0(0/19)% of patients, respectively. In stage Ib, the incidence of pelvic and paraaortic node metastasis was 25.6(11/43)% and 9.7(3/31)%, respectively. In stage II, the incidence was 38.9(7/18)% and 13.3(2/15)%, respectively. Prognosis of patients even with deep myometrial invasion (greater than or equal to 2/3) or G3 tumor was fairly good (5-year survival rate: 87.5% and 85.7%, respectively) if the disease was histologically confined to the uterine corpus. Once the tumor spread outside the corpus uteri, the survival rate of patients was strongly affected by the grade of the tumor, moderate to marked lymph-vascular space invasion of tumor cells, or tumor invading middle or outer third of myometrium (P less than 0.05 for each factor). In summary, endometrial cancer frequently metastasize to pelvic and paraaortic lymph nodes even in the early stages, and lymph node metastasis and other extracorporeal spread of disease have a serious impact on patient survival. Prognosis of patients with extracorporeal spread of disease seems to be determined by the high grade of tumor and lymph-vascular space invasion. These results suggest that surgical exploration including paraaortic lymph node dissection to accurately evaluate the extent of the disease is essential to estimate the patient's prognostic risk and to individualize the treatment schedule.

[An analysis of prognostic significance of new FIGO staging (1989) of endometrial cancer]

Histopathologic factors were investigated in the data for ninety-one patients with endometrial carcinoma who were treated surgically. Each of these subjects was reclassified according to the new FIGO surgical criteria (1989) for stages and the relationship between the new classifications and the prognosis of patients was analyzed. One third of the patients (24/72) with clinical FIGO stage I (1983) had extracorporeal spread of the disease and these cases were reclassified as surgical stages II and III. Among clinical stage Ib patients there were many more with extracorporeal spread than among those in clinical stage Ia (p less than 0.005) although there was no difference between the histopathological characteristics (histologic grade, myometrial invasion, cervical involvement, adnexal involvement and pelvic lymph node metastasis) of the stage Ia and Ib groups. Univariate survival analysis revealed that the histologic grade (p less than 0.05), myometrial invasion (p less than 0.05), cervical involvement (p less than 0.005) and pelvic lymph node metastasis (p less than 0.005) correlated with the patient's prognosis. Multivariate survival analysis with the proportional hazard regression model showed that cervical involvement (p = 0.05) and the new stage classification (p = 0.03) correlated significantly with the prognosis. The cumulative 5-year survival rate by clinical stage (1983) was 87% for stage I (Ia: 96%, Ib: 80%) and 72% for stage II, between which no significant difference was determined. The survival rate for stage III was not calculated because there was only one case with stage III disease in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

[The incidence and clinical significance of paraaortic lymph node metastases in patients with uterine cervical cancer]

Paraaortic lymph node dissection was performed in the treatment of patients with carcinoma of the cervix who were subjected to radical hysterectomy between June, 1982 and March, 1988 at the Department of Obstetrics and Gynecology, Hokkaido University Hospital, Sapporo, Japan. Thirteen out of 246 (5.3%) patients had metastases in the paraaortic lymph node. Of the patients with stage I carcinoma of the cervix, 1.0 per cent had positive paraaortic lymph node. Of the patients with stage II carcinoma, 4.9 per cent had metastases in the paraaortic lymph nodes, and of the stage III patients, 16.7 per cent had positive paraaortic lymph nodes. The incidence of paraaortic node involvement increased along with the advance of the disease. Of the patients with squamous cell carcinoma of the cervix, 4.6 per cent had paraaortic lymph node metastases. Of the patients with adenocarcinoma of the cervix including mixed carcinoma, 6.8 per cent had positive paraaortic node. All the patients with positive paraaortic lymph nodes had metastatic diseases in the pelvic nodes. In addition, the number of groups of positive pelvic nodes in the patients with positive paraaortic lymph nodes was significantly larger than that in those with negative paraaortic nodes. At the time of reporting, seven out of 13 patients with positive paraaortic lymph node have died of the disease. The mean survival period of those seven patients was 14.9 +/- 12.2 (mean +/- SD) months. Of the remaining six surviving patients, three have been doing well for more than three years.(ABSTRACT TRUNCATED AT 250 WORDS)

[Immunohistochemical study of dysplasia and squamous cell carcinoma of the larynx]

Formalin- or alcohol-fixed, paraffin-embedded laryngeal specimens were stained immunohistochemically with several kinds of monoclonal anti-Keratin antibody (KL-1, PKK-1, PKK-2, PKK-3), polyclonal anti-Keratin antibody, and epithelial membrane antigen. Immunohistochemical technique was used by Avidin-Biotin Complex method with the following subjects; normal epithelium 6 cases, dysplasia 15 cases, inflammation and polyp 12 cases, squamous cell carcinoma 47 cases. 6 specimens of squamous cell carcinoma were totally resected and alcohol-fixed, and other specimens were all biopsied and formalin-fixed. Comparing these two methods, the alcohol-fixed specimen gave superior result to those obtained with formalin-fixed in its staining. Non-staining area was recognized around basal layer by KL-1 stain in the normal epithelium. Enlargement of non-staining area was recognized in the dysplasia. Also, KL-1 staining showed positive staining with the keratinizing squamous cell carcinoma, and weak staining with the non-keratinizing squamous cell carcinoma. And, PKK-3 showed weak staining in the keratinizing squamous cell carcinoma. The results indicate that high molecular weight keratin (56 kilodalton) hardly localize around the basal layer in the squamous epithelium, and also in the non-keratinizing squamous cell carcinoma. The other way, this also suggests that low molecular weight keratin (45 kilodalton) hardly localize in the keratinizing squamous cell carcinoma. It is supposed that intracellular localization of keratin of dysplastic epithelium and squamous cell carcinoma varies from that in the normal squamous epithelium. Accordingly, monoclonal keratin stain is thought to be an useful method for the diagnosis of dysplasia and squamous cell carcinoma.

[Pharmacokinetic and clinical studies of cefuzonam in the field of obstetrics and gynecology]

Pharmacokinetic and clinical studies on cefuzonam (CZON) were performed to evaluate its usefulness in the field of obstetrics and gynecology. A summary of the results is as follows: 1. Concentrations of CZON in female genital organ tissues showed a little variance among organs. Mean concentrations were 3.34-7.83 micrograms/g at 40 minutes, 0.523-1.08 micrograms/g at 2 hours 15 minutes and 0.286 micrograms/g (in the myometrium) at 3 hours 10 minutes after the end of drip infusion. 2. Mean concentrations of CZON in the pelvic dead space exudate were 31.0 micrograms/ml immediately after the end of drip infusion (1 hour after the start of infusion), and 37.2 micrograms/ml 1 hour after the end of infusion, then they gradually decreased to 25.6 micrograms/ml after 3 hours and 21.4 micrograms/ml after 5 hours. Mean serum concentrations of CZON in concurrently collected samples from the peripheral vein were 30.0 micrograms/ml immediately after the end of drip infusion, 14.4 micrograms/ml after 1 hour, 4.00 micrograms/ml after 3 hours and 1.84 micrograms/ml after 5 hours. The T 1/2 beta was 1.03 hours. 3. Clinical trial in 7 patients, with CZON administered at a dose level of 1 g at a time, twice daily, showed "excellent" and "good" efficacy in all the patients. No side effects were noted. From the results of the above studies, CZON seems to be highly useful for infections in the field of obstetrics and gynecology.

Surgical results of intracranial ruptured aneurysms in the acute stage

To evaluate the operative mortality and morbidity of definitive intracranial microsurgical aneurysm obliteration as a function of timing of early operative intervention and as a function of clinical condition at the acute state, we retrospectively review 164 consecutive patients who underwent surgery within 72 hours following haemorrhage. The series was divided into four operation periods (0-6, 6-12, 12-24, 24-72 hours), and patients were graded according to five clinical conditions described by Hunt and Hess. The mortality of the individual clinical condition at each operation period was to great extent independent of the timing of operation, and there was a distinct correlation between the surgical results and the form of bleeding visualized by C.T. In poor condition (grade 3, 4, and 5) patients, satisfactory surgical results were obtained in patients in whom cisternal blood clots, intracerebral haematoma, and subdural haematoma had been shown by C.T. The optimum operation times for each group were suggested.