Change in Contralateral Muscle Blood Volume During Passive Unilateral Muscle Stretching Before and After Surgery

OBJECTIVE

Passive muscle stretching is a common physical therapy for critically ill patients in the intensive care units. This study aimed to evaluate the effects of unilateral passive stretching of the gastrocnemius muscle (GM) before and after surgery on blood volume (BV) in the contralateral (non-stretched) GM in patients who are sedated after surgery.

METHODS

We enrolled eight patients with esophageal cancer. The patients completed two sessions of passive cyclical stretching (20-s hold, 10-s release, 10 cycles) of the right GM: one before surgery (awake) and one after (under sedation). We used near-infrared spectroscopy to measure the BV in the stretched and contralateral GM. BV kinetics were compared between the ipsilateral and contralateral GM.

RESULTS

In seven of the eight patients, BV in the stretched GM decreased during stretching and increased during the stretch-relaxation phase, both before and after surgery. Both before and after surgery, the change in the BV in the contralateral GM was inversely synchronized to the stretching cycle.

CONCLUSIONS

Unilateral passive stretching of the GM influenced the microcirculation of the contralateral GM. The mechanism underlying the synchronous change in the BV in the contralateral GM remains to be clarified.

Multicentre comparison of self-management in patients with COPD

In patients with COPD, self-management plays an important role in disease management. Recently, self-management programmes have expanded patient education practices to include a variety of disease management techniques. We hypothesised that COPD patients have insufficient and/or different self-management needs according to institution. We compared information needs of patients between specialised clinics in Canada (SCC) and Japan and a hospital outpatient clinic in Japan (HCJ), all employing different self-management interventions.  This cross-sectional study evaluated patients' information needs for disease management using the Lung Information Needs Questionnaire (LINQ). Furthermore, we assessed pulmonary function tests, modified Medical Research Council (mMRC) dyspnoea scale and frequencies of hospitalisations and emergency visits.  The total number of patients was 183. Those attending SCC were younger (p=0.047), with lower forced expiratory volume in 1 s % predicted (p<0.0001), and scored higher on the mMRC dyspnoea scale. Total LINQ scores showed differences between institutions (p<0.0001). There was no difference for the smoking domain; however, SCC recorded significantly lower information needs for all other domains (p<0.02). No significant difference in emergency visits was seen between institutions, but HCJ recorded the highest rate of emergency visits, while SCC had significantly higher rates of hospitalisation (p=0.004). Differences were seen for frequency and duration of education between institutions.  These results highlight the differences in information needs by institution and the importance of assessing individual needs. We believe, despite representing only one aspect of self-management, our findings reflect real-world circumstances, adding to the argument that self-management education should be structured, but flexible, to meet the changing needs of COPD patients.

[Effects of Brief Cognitive Behavioral Therapy for insomnia on sleep and usage of hypnotics among community-dwelling older adults: Randomized controlled trial]

Objectives　Chronic insomnia is common in late adulthood. A non-pharmacological approach should take priority in the treatment of insomnia for the elderly. Many studies have shown the efficacy of Cognitive Behavioral Therapy for Insomnia (CBT-I) for elderly diagnosed with insomnia. However the effect of CBT-I on mild insomnia among older adults in community settings has not been ascertained. We conducted a randomized controlled trial to evaluate the effectiveness of a brief CBT-I delivered by nurses, which is feasible in community settings, to improve sleep quality and decrease the dose of hypnotics use for older adults.Methods　Participants aged 60 years and over were enrolled in this study. The participants in the intervention group were administrated the brief CBT-I consisting of a group session (60 min) and an individual session (30 min). The primary outcomes were the score differences in the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). The secondary outcomes were the change in the proportion of people diagnosed with insomnia and the dose of hypnotics used. The follow-up period was 3 months.Results　The score on PSQI in the intervention group (n=41) significantly decreased compared to the control group (n=38). The effect size (Cohen's d) was 0.56 (95% Confidence interval [CI], 0.07 to 1.05). The score on ISI also decreased significantly and Cohen's d was 0.77 (95%CI, 0.27 to 1.26). According to subgroup analysis, Number Needed to Treat (NNT) for improvement of insomnia was 2.8 (95%CI, 1.5-17.2) and NNT for decreasing of dose of hypnotics use was 2.8 (95%CI, 1.5-45.1).Conclusion　The present results have demonstrated that the brief CBT-I significantly improved subjective evaluation of sleep quality and insomnia symptoms among the elderly. In addition, the brief CBT-I decreased the usage of hypnotics. Further studies are needed in terms of the procedure and the effects of brief CBT-I for older adults living in a community.

Deoxygenated hemoglobin/myoglobin kinetics of forearm muscles from rest to exercise in patients with chronic obstructive pulmonary disease

Exercise capacity is frequently decreased in patients with chronic obstructive pulmonary disease (COPD), and muscle dysfunction is one factor in this reduction. Studies using (31)-phosphorus magnetic resonance spectroscopy ((31)P-MRS) have shown that phosphocreatine (PCr) and muscle pH (pHi) are significantly decreased in patients with COPD during mild exercise, suggesting the early activation of anaerobic glycolysis in their muscles. Thus, muscle oxygenation states during exercise might differ between patients with COPD and healthy individuals. We simultaneously measured oxygenation state and pHi in the muscles of patients with COPD during the transition from rest to exercise (on-transition) using near infrared spectroscopy (NIRS) and (31)P-MRS. Sixteen patients with COPD (aged 68.6 +/- 7.5 years) and 7 healthy males (controls; aged 63.3 +/- 7.5 years) performed dynamic handgrip exercise (lifting a weight by gripping at a rate of 20 grips per min for 3 min). Patients were classified based on pHi data at the completion of exercise as having a normal (>or= 6.9; n = 8) or a low (< 6.9; n = 8) pHi. The deoxygenated hemoglobin/myoglobin (deoxy-Hb/Mb) in NIRS recordings remained constant or slightly decreased initially (time delay), then increased to reach a plateau. We calculated the time delay and the time constant of deoxy-Hb/Mb kinetics during the on-transition. The time delay was shorter in the group with a low pHi than in the controls. These findings might reflect a slower increase in O(2) delivery in patients with a low pHi, which might partly account for altered muscle energy metabolism.

Effects of age on muscle energy metabolism and oxygenation in the forearm muscles

PURPOSE

The effects of aging on muscle metabolism and oxygenation have not yet been elucidated. We evaluated the effects of aging on energy metabolism and oxygenation in sedentary healthy subjects by simultaneously measuring 31P-magnetic resonance spectroscopy (MRS) and near-infrared spectroscopy (NIRS).

METHODS

Nine young (28.1 +/- 5.0 yr) and nine older (61.4 +/- 4.6 yr) healthy subjects were studied. The 31P-MR spectrum was obtained every 15 s during and after hand gripping exercise. Intracellular pH (pHi) and PCr/(PCr+Pi) [PCr: phosphocreatine, Pi: inorganic phosphate] were calculated as an index of energy metabolism. The time constant of the PCr/(PCr+Pi) recovery (tau PCr) was calculated. With NIRS, we evaluated the recovery rates of oxygenated (RHbO2) and deoxygenated hemoglobin (RHb) during the initial 10 s of recovery.

RESULTS

The PCr/(PCr+Pi) and pHi at rest and at completion of the exercise and tau PCr did not differ between young and older subjects. However, RHbO2 and RHb were significantly slower in older subjects than in young subjects.

CONCLUSIONS

The results suggest that muscle energy metabolism in the forearm muscle was not affected by aging. The slower RHbO2 and RHb in older subjects suggested impaired O2 supply, which was probably due to impaired peripheral circulation caused by the process of aging.

Dependence of transverse relaxation time T2 of biologic tissues on the interpulse delay time in Carr-Purcell-Meiboom-Gill (CPMG) measurements

To determine the transverse relaxation time (T2) of biological tissues in nuclear magnetic resonance measurements, the Carr-Purcell-Meiboom-Gill (CPMG) method has been recommended to avoid the effect of external magnetic field inhomogeneity on T2 values. However, a dependence of T2 on the interpulse delay time (IPDT) in the CPMG measurements has been shown for biological tissues. The present study examined the dependence of the T2 on IPDT for muscle, lung (passively collapsed or degassed), and brain tissues. It was found that the CPMG T2 of the lung was strongly dependent upon the IPDT, in contrast to muscle and brain tissues. The IPDT dependence of the CPMG T2 for lung tissue, which was lessened by degassing, was affected by the magnetic field inhomogeneity due to air-tissue interfaces, but not by the spin-locking effect, since the T2 measured by the Carr-Purcell-Freeman-Hill (CPFH) method did not show this dependence. These results should aid in the evaluation of T2 values for biological tissues measured under various conditions and by different techniques.

Comparison of carboplatin/etoposide/vincristine with cisplatin/etoposide as combination chemotherapy for small cell lung cancer

We compared the efficacy and toxicity of the CEV regimen (carboplatin at 300 mg/m2 on day 1, etoposide at 100 mg/body on days 1 to 3, and vincristine at 1 mg/m2 on days 1 and 8) with the PVP regimen (cisplatin at 80 mg/m2 on day 1 and etoposide at 100 mg/body on days 1 to 3) in patients with untreated small cell lung cancer (SCLC). Of the 13 patients treated with the PVP regimen, two achieved complete response (CR, 15.4%) and eight partial response (RP, 61.5%). Of the 15 evaluable patients treated with the CEV regimen, one achieved CR (6.7%) and 13 PR (86.7%). Thus, there was no significant difference in response rate between the PVP (76.9%) and CEV (93.3%) regimens. There was also no significant difference in response duration [PVP, 756 +/- 903 (mean +/- SD) days vs. CEV, 318 +/- 159 days] and median survival time (PVP, 472 days, vs. CEV, 471 days). The number of days hospitalized divided by the duration of chemotherapy was shorter with the CEV regimen, but this difference was not statistically significant. Severe leukopenia (< 2,000/microliter) occurred in 15.4% of PVP patients and 31.3% of CEV patients. Severe thrombocytopenia (< 50,000/microliter) occurred in only one patient in this study. In conclusion, the CEV regimen demonstrated a response rate and median survival time comparable to the PVP regimen, although the response time was short. The CEV regimen had the advantage of lower toxicity and ease of outpatient administration. Thus, the CEV regimen is a useful outpatient induction chemotherapy for SCLC.

Muscle energy metabolism and nutritional status in patients with chronic obstructive pulmonary disease. A 31P magnetic resonance study

We investigated the relationship between nutritional status and muscle energy metabolism during exercise in 18 male patients with chronic obstructive pulmonary disease (COPD) and 15 male control subjects using 31P nuclear magnetic resonance spectroscopy (31P-MRS). The patients and control subjects were further categorized as in either a well-nourished (% ideal body weight, % IBW > or = 90) or malnourished (% IBW < 90) state. Muscle energy metabolism was evaluated by determining the ratios PCr/(PCr + Pi) (PCr, phosphocreatine; Pi, inorganic phosphate), and ATP/(PCr + Pi + ATP). The exercise consisted of repetitive hand grips performed against a load. The work rate was normalized for the individual's lean muscle mass by dividing work performed by the forearm fat-free cross-sectional area, which was calculated using 1H-MRS. The PCr/(PCr + Pi) values during exercise did not correlate with the % IBW in any of the groups of control subjects or COPD patients. Furthermore, the PCr/(PCr + Pi) did not correlate with the normalized work rate in either the well-nourished or malnourished subject groups. However, there were correlations within the groups of control subjects and COPD patients. The PCr/(PCr + Pi) values for the normalized work rate were consistently lower in the COPD patients than in the control subjects. These findings suggest that the altered muscle metabolism in COPD patients is not affected by their nutritional status.

[Proton magnetic resonance spectroscopy (1H-MRS) of peripheral blood lymphocytes in patients with sarcoidosis and interstitial pneumonitis]

We recently developed a method of proton magnetic resonance spectroscopy (1H-MRS) to measure the 1H-MR spectra of peripheral blood lymphocytes (PBL) using only 10(7) cells. We investigated the clinical feasibility of this method for evaluating disease activities in sarcoidosis and interstitial pneumonitis. PBL was separated from 10 ml of venous blood by differential centrifugation with Ficoll-Conray. Using a 90 MHz MR spectrometer (EX90, JEOL), the spectrum was obtained with 4000 times accumulation of 1H signals by single 70 degree pulses at 37 degrees C under spinning. Water signal was suppressed with the homo-gated decoupling sequence. The spectra were analyzed with Gaussian curve fitting. The spectra of patients with active disease showed significant increases in peak heights for (CH2)n and CH3 peaks compared with the control. The peak heights decreased after improvement of disease states. The changes in 1H-MR spectra suggested activation of PBL in patients with sarcoidosis and interstitial pneumonitis, since similar changes have been shown for cells activated with mitogens. Our preliminary results indicate that 1H-MRS may be useful to evaluate activation of PBL in sarcoidosis and interstitial pneumonitis.

[A case of angiosarcoma presenting as ill-defined opacities on chest roentgenogram and hemothorax]

A 74-year old male was referred to the Tokai University Hospital for evaluation of abnormal opacities on a chest roentgenogram. Laboratory tests demonstrated leukocytosis, elevated ESR and CRP, elevated LDH, and hypoxemia. The chest roentgenogram demonstrated several ill-defined nodular infiltrates on the bilateral upper lung fields. In addition, a CT scan revealed bilateral pleural effusion which was found bloody on diagnostic thoracocentesis. Administration of antibiotics failed to improve lung infiltration or laboratory data. The patient died of respiratory failure on the 23rd hospital day. At autopsy, multiple ill-defined nodules, which were associated with alveolar hemorrhage, were scattered in the lungs bilaterally. Both hematoxylin-eosin and silver staining showed atypical cells of a vasoformative nature. Factor VIII related-antigen in the tumor cells was confirmed by the peroxidase-antiperoxidase method. These findings were consistent with angiosarcoma. The tumor foci were demonstrated in the lungs, pleura, kidneys, bone marrow, adrenal glands, and the gastrointestinal tract. The primary site of angiosarcoma, however, was not identified. Angiosarcoma, either primary or metastatic to the lungs, should be included in the differential diagnosis of multiple ill-defined nodular opacities associated with hemothorax.

31P-NMR study of skeletal muscle metabolism in patients with chronic respiratory impairment

To evaluate the energy metabolism of peripheral skeletal muscle during exercise in patients with chronic respiratory impairment, the 31P-nuclear magnetic resonance (NMR) spectra of forearm muscle were investigated in nine patients and nine age-matched control subjects. We calculated the phosphocreatine (PCr) to PCr + inorganic phosphate (PI) ratio, the time constant of PCr recovery and the intracellular pH. The exercise consisted of repetitive hand grips against a 2-kg load every 3 s for 6 min (0.33 W). The patients showed a marked decrease in the PCr/(PCr + PI) ratio and pH in the muscle during exercise in contrast to the control subjects whose PCr/(PCr + PI) showed a minor decrease without any change in pH. The relationship between PCr utilization and pH demonstrated that anaerobic glycolysis switched on earlier in patients with chronic respiratory impairment. A split PI peak was observed in five of nine patients during exercise. The PCr/(PCr + PI) ratio during the last minute of exercise correlated significantly with the vital capacity (% predicted), with the FEV1/FVC, with the body weight, with the maximum strength of hand grip, and with the muscle mass. The results indicate impaired oxidative phosphorylation and the early activation of anaerobic glycolysis in the muscles of patients with chronic respiratory impairment. Several factors related to chronic respiratory impairment, such as disuse, malnutrition and dysoxia, would contribute to the metabolic changes observed in the muscles examined.

Multiple pulmonary nodules caused by zygomycosis in a patient without predisposing factors

We report a case of a 61-year-old male without any predisposing factors. His X-ray film showed multiple nodular lesions in bilateral lung fields. Open lung biopsy revealed Zygomycetes in the granuloma. The patient was treated with amphotericin B and miconazole, and remains alive more than 32 months later.

Kinetics of mixed venous oxygen tension during rhythmic contraction of the hindlimb of dogs

Change in mixed venous oxygen tension (PVO2) during transition from rest to exercise induced by rhythmic contractions of the hindlimb of dogs was continuously monitored using intravascular oxygen electrodes. The rapid fall in PVO2, on the average 9.5 sec after the onset of rhythmic contraction, was found. The time course of change in PVO2 was not altered by ligation of the splenic artery and vein. Oxygen tension of venous blood in the superior vena cava and the inferior vena cava was monitored in order to elucidate the mechanism of rapid fall in PVO2 following induced exercise. Oxygen tension of venous blood in the superior vena cava did not fall at the onset of contraction. Oxygen tension of venous blood in the distal and proximal end of the inferior vena cava began to fall at 4.4 sec and at 6.9 sec after the onset of contraction on the average, respectively. There was no significant difference between the hematocrit of mixed venous blood at rest and after 15 sec of exercise. These findings suggest that the rapid fall of PVO2 results from a surge of low oxygenated blood from the exercising hindlimb and that this change in blood gas tensions possibly reaches the lung within 10 sec after the onset of exercise.

Treatment of acute cerebral infarction with a choline precursor in a multicenter double-blind placebo-controlled study

A multicenter double-blind placebo-controlled study of cytidine 5'-diphosphocholine (CDP-choline) was conducted to evaluate possible clinical benefits of the drug in patients with acute, moderate to severe cerebral infarction. The patients included also suffered from moderate to mild disturbances of consciousness, and all were admitted within 14 days of the ictus. Patients were allocated randomly to treatment with either CDP-choline (1,000 mg/day i.v. once daily for 14 days) or with placebo (physiological saline). One hundred thirty-three patients received CDP-choline treatment, and 139 received placebo. The group treated with CDP-choline showed significant improvements in level of consciousness compared with the placebo-treated group, and CDP-choline was an entirely safe treatment.

Clinico-epidemiologic study of stroke in Akita, Japan

An analysis was performed of 2,168 consecutive stroke patients who were examined by computed tomography and entered into a hospital-based stroke registry in Akita Prefecture, Japan. The occurrence of cerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage was 30, 55, and 14%, respectively. Age-specific rates of subarachnoid hemorrhage were higher in women than men; other types of stroke showed a preponderance in men. Total strokes increased in the winter; this seasonal difference was confined to cerebral hemorrhage. Putaminal hemorrhages predominated in the younger age groups; thalamic hemorrhage and cerebellar hemorrhage were predominant in the older age groups. The increased accuracy of the diagnosis of stroke subtypes by the use of computed tomography in this study is in contrast to other community-based epidemiologic studies that have relied solely on clinical diagnosis. This increased accuracy is seen to be the reason that new ratios of stroke subtype incidence have been identified.

[Establishment and characterization of the cell line derived from low differentiated adenocarcinoma of the endometrium]

A new human carcinoma cell line (HEC-1), which was derived from low differentiated adenocarcinoma of the endometrium, has been established. Cells from tumor tissues grown in athymic mice were cultured in minimal essential medium supplemented with 20% fetal calf serum. Contaminated mouse fibroblasts were removed from the culture by the absorption of anti-mouse serum. Continuous cell growth (doubling time: 51.6 hrs) could be observed during 64 passages. The cultured cells appeared monolayer and the cellular arrangement was a pavement-like pattern. The morphology of cells was analogous to the one of adenocarcinoma cells. The modal number of chromosomes of the original tumor cells were 46. The t. dic (1; 16)(p21; q24) marker which had been identified as the clonal abnormality in the original tumor cells, was also observed consistently in cultured cells, though the loss of chromosome 19 was disappeared during the passage. This suggested that the rearrangements of the long arm of chromosome 1 played an important role for the endometrial carcinogenesis.

[Abnormalities of chromosome involving 1q in uterine endometrial carcinomas]

Cytogenetic studies were performed on endometrial specimens from four patients with hyperplasia, six with adenocarcinoma and one with mixed mesodermal tumor. Except for one cell, all 65 cells from the hyperplastic specimens had a normal female karyotype. However, a total of 92 cells from the 5 adenocarcinoma specimens had chromosomal abnormalities, though all 20 cells from a specimen of a well differentiated adenocarcinoma showed a normal karyotype. The chromosome number and morphology of the aneuploid cells had minimal changes. The modal number of chromosomes was pseudodiploid in one case and hyperdiploid in four. Three kinds of structural abnormalities involving chromosomes 1q were identified as of clonal origin: del. 1 (p21) in 2 cases, t. dic (1;16) (p21;q24) in one case and i (1q) markers in 2 cases. Since the carcinoma cells had two chromosomes 1 of normal morphology, the presence of the marker chromosome led to a partial trisomy or tetrasomy of the long arm of a chromosome 1. This involvement of the long arm of chromosome 1, therefore, may be assumed to represent a karyotypic change in the characteristics of adenocarcinoma of the endometrium. Complex karyotypes with many rearranged chromosomes were observed in cells from the mixed mesodermal tumor. The karyotypic differences between endometrial carcinoma and the mixed mesodermal tumor suggest that the genesis (and its mechanism) of the former may differ from that of the latter.

Marker chromosomes of the long arm of chromosome 1 in endometrial carcinoma

Cytogenetic studies were performed on endometrial specimens of four patients with hyperplasia, six with adenocarcinoma, and one with a mixed mesodermal tumor. Except for one cell, all 65 cells from the hyperplastic specimens had a normal female karyotype. However, a total of 92 cells from the five adenocarcinoma specimens had chromosome abnormalities, though all 20 cells from a specimen of a well differentiated adenocarcinoma showed a normal karyotype. The chromosome number and morphology of the aneuploid cells had minimal changes. The modal number of chromosomes was pseudodiploid in one case and hyperdiploid in four cases. Three kinds of structural abnormalities involving chromosomes #1 were identified to be of clonal origin: del(1p21) in two cases, tdic(1;16)(p21;q24) in one case, and i(1q) markers in two cases. Because the carcinoma cells had two chromosomes #1 of normal morphology, the presence of the marker chromosome led to partial trisomy or tetrasomy of the long arm of chromosome #1. This involvement may be assumed to represent a karyotypic change characteristic of some adenocarcinomas of the endometrium. Complex karyotypes with many rearranged chromosomes were observed in cells from the mixed mesodermal tumor. The karyotypic differences between endometrial carcinoma and the mixed medodermal tumor suggest that the genesis (and its mechanism) of the former may differ from that of the latter.

[Fundamental and clinical study on cefpiramide in obstetrics and gynecology. Obstetrics and Gynecology Study Group for Cefpiramide]

Fundamental and clinical studies on a new cephalosporin antibiotic, cefpiramide (CPM), was carried out under a joint study program, in order to evaluate the usefulness of the drug in treating infection of the female genital organs. The results obtained were as follows: CPM was readily transported to female genital organ tissues, and the concentrations of the drug exceeded 35 micrograms/g in various organ tissues in about 1 hour, following intravenous injection of 1 g. A level of more than 2 micrograms/g was maintained even 14 hours after the injection. The transport of CPM to various tissues was also studied following intravenous drip infusion of 1 g for 1 hour. The concentrations in tissues were slightly low but similar to those following intravenous injection. The peak concentration of the drug in the dead space exudate was 3.1-20.4 micrograms/ml, following intravenous injection and intravenous drip infusion of 1 g. The MIC80 of CPM were 3.13-12.5 micrograms/ml against S. aureus, Klebsiella sp., P. mirabilis and P. aeruginosa. Clinical effects of CPM were analyzed in 158 patients, including 56 cases with intrauterine infection, 37 cases with intrapelvic infection, 22 cases with external genital infection, 31 cases with adnexitis, 6 cases with postoperative wound infection and 6 cases with other infections. Excellent response was seen in 28 cases (17.7%), good response in 120 (75.9%) poor response in 10 (6.3%). The rate of response was calculated as 93.7%. Safety of the drug was analyzed in 258 patients, and side effects occurred in 4 (1.6%). Of these 4 patients, rash was in 1 patient, heat sensation in 1 patient, nausea in 1 patient and rash accompanying edema in 1 patient. Abnormal values in clinical laboratory findings were seen in 7 patients. Elevations of transaminase were seen in 5 patients and decrease of platelet was seen in a patient, and then elevations of transaminase with decrease of platelet was seen in a patient, and no other changes of particular note appeared.

[Reevaluation for overlooked signs of cervical smears in cases of uterine cervical adenocarcinoma]

Though the incidence of adenocarcinoma is not high, this cancer has been a matter for discussion on the grounds that mass screening frequently shows "false negative" cases. The purpose of this study was to clarify the factors which had caused a misdiagnosis through the re-investigation of patients' previous cervical smears. In spite of continuous smear tests at various intervals, there was a long delay in the diagnosis, ranging from 6 months to 5 years, in 14 patients out of 51 cases of cervical adenocarcinoma treated in our hospitals during the past 6 years. In 12 of these 14 cases a careful re-examination of previously overlooked smear preparations revealed definite signs of adenocarcinoma in most cases (86%). A cause of the delay in diagnosing adenocarcinoma seems likely to be related to cytological inspections rather than to the process of taking smears. Characteristics overlooked signs in the misdiagnosed smears were either "rosette-like" arrangements or "irregular clusters of sheet-like" arrangements. The rosette-like arrangements a pattern indicative of cervical adenocarcinoma, were found in 10 of the above cases (71%). The findings obtained suggest that for the diagnosis of cervical adenocarcinoma, cytological diagnosis by smear could be made even in the early pre-clinical stage and when cervical adenocarcinoma is suspected on a cytological basis in this stage, conization is also strongly recommended despite the punch biopsy.

Clinical evaluation of two combination chemotherapies for the treatment of small cell carcinoma of the lung

The effects of two different combination chemotherapies, i.e. cyclophosphamide (CPM) + vincristine (VCR) + methotrexate (MTX) and ACNU + VCR, with or without radiotherapy, were studied in twenty patients with untreated small cell carcinoma of the lung. Respective response rates were 66.7% for CVM and 50% for AV. Median survival time was 51 weeks for CVM and 27 weeks for AV. There was no statistically significant difference between the survival probability curves of CVM and AV. Concerning toxicity, two hazardous side effects, myelosuppression and interstitial pneumonitis, were observed although the incidences were low. We concluded that both regimens are useful as chemotherapy of small cell carcinoma.

Influence of temperature and relative humidity on human rotavirus infection in Japan

A climatologic analysis of human rotavirus infection in inpatients with acute diarrhea was conducted over a seven-year period. The infection frequency appeared to be related to temperature, but not to relative humidity. Human rotavirus infection was found to appear abruptly when the mean temperature of any 10-day period became less than 5 C (November or December), reached a peak when it was less than 0 C (January and February), and waned when it became greater than 20 C (June and July) in the city of Yamagata in northern Japan.

Isolation of human rotavirus subgroups 1 and 2 in cell culture

One strain of human rotavirus subgroup 1 (KUN) and one strain of subgroup 2 (MO) were isolated with the MA104 cell line, a fetal rhesus monkey kidney cell line. Their subgroup specificities and RNA patterns were identical to those of rotaviruses present in stools before cultivation. Distinct cytopathic effects consisting of obscure cell boundaries, cell fusion, cell rounding, cell detachment, and lytic foci were recognized at passage 3 of MO and passage 6 of KUN. No differences in cytopathic changes were found between the two isolates.

[Experimental and clinical studies of cefmenoxime in the field of obstetrics and gynecology]

The study group was organized to evaluate the usefulness of cefmenoxime (CMX) injection, a new synthetic cephalosporin, for the treatment of infections in the field of obstetrics and gynecology. Fundamental and clinical studies were made by the society and the following results were obtained. 1. The peak distribution of CMX's MIC for E. coli, Klebsiella sp., Enterobacter sp., Bacteroides sp. and Peptococcus sp. isolated from obstetrical and gynecological infections with relatively high frequencies area 0.1, less than or equal to 0.05, 0.2, 3.13, 1.56 micrograms/ml, respectively, with an inoculation of 10(6) cells/ml. 2. When 1 g of CMX is administered by intravenous drip infusion for 1 hour, the maximum concentrations in various tissues of female genital organs were as follows: 14.2 and 13.2 micrograms/g in ovary and oviduct, respectively, at 1.20 hours after the start of administration, and 16.9 and 26.3 micrograms/g in corpus uteri and cervix uteri, respectively, after 1 hour. As for the transfer to the exudate in the pelvic dead cavity, the peak concentration was 15.6 micrograms/ml after 2.13 hours. 3. In the clinical studies, CMX was given to 258 cases with female genital organ infections and others. As for the clinical effects, with exclusion of 3 cases in which other antibiotics are concomitantly used, responses were excellent in 76 cases, good in 162 cases and poor in 17 cases, among 255 cases in total. The efficacy rate was 93.3%. The efficacy rates by diseases were 97.1% (68/70) for intrauterine infections, 88.8% (79/89) for intrapelvic infections, 98.4% (62/63) for adnexitis, and 100% (23/23) for infections of external genital organs. As for the clinical effects on causative bacteria, the efficacy rates were 100% (19/19) for single infections due to Gram-positive bacteria, 94.8% (55/58) for single infections due to Gram-negative bacteria, and 88.2% (15/17) for single infections due to anaerobic bacteria. And its efficacy rates were 89.6% (69/77) for mixed infection cases. Side effects were observed in 2 cases (0.8%); 1 case with eruption, and 1 case with diarrhea and vomiting. As for abnormal laboratory findings, lower white blood cell count was observed in 2 cases and elevation of the values regarding hepatic functions in 9 cases. All cases were returned to the normal after the completion of the administration. Cefmenoxime showed a satisfactory clinical efficacy and a potent bacteriological effect in treatment of the infections in the field of obstetrics and gynecology, and it has been concluded that cefmenoxime will be useful addition to the antibiotics for the therapy of these infections.

Cyclic AMP concentrations in plasma, cerebrospinal fluid and urine in patients with acute cerebral hemispheric infarction

Plasmas, cerebrospinal fluid and urine were sampled from 22 patients with cerebral hemispheric infarction and analyzed for cyclic AMP. The following observations were made: (1) In mild cases with slight dysarthria and/or hemiparesis but without disturbance of consciousness (Group I), cyclic AMP in peripheral venous plasma (PVP) remained over the normal lowest level more than 10 days after the onset. Patients with apparent neurological deficits could be divided into two groups. In one group, cyclic AMP in PVP decreased to a subnormal level within about 5 days after the onset of stroke (Group II). In another group (Group III), such a decrease was not observed. Brain isotope scintigrams were revealed negative in Group I. The size of brain infarct as judged by isotope uptake was larger in Group III than in Group II, except for a few cases in which the lesion was restricted in the basal ganglionic region. (2) No clinical significance was, however, found in the time course of cyclic AMP levels in internal jugular venous or femoral arterial plasma, or in cerebrospinal fluid, or of the daily amount of cyclic AMP excretion into urine. (3) Cerebral arterio-venous difference of cyclic AMP was negative in most of the cases.

Morphogenesis of human rotavirus type 2 Wa strain in MA 104 cells

Morphogenesis of human rotavirus type 2 Wa strain in MA 104 cells was observed. The virus antigen in the cytoplasm was detected by indirect immunofluorescence twelve hours after infection. The cytopathic effect occurred 24 hours after infection when virus particles were detected by EM in the culture fluid as well as in thin sections of the infected cells. Virus particles were observed in the dilated RER, nuclear envelope (perinuclear space), viroplasm, and a lysosome-like body. Three types of virus particles were noted: double-shelled particles 75-85 nm in diameter, single-shelled particles 64-68 nm in diameter and electron-dense nucleoids or cores 32-40 nm in diameter. The outer shell of virus particles was acquired by budding through the membrane of the dilated RER. Tubular structures, similar in diameter to the single-shelled particles, were found in the cytoplasm and nucleus of infected MA 104 cells. Bundles of filaments or the leaflet-like inclusion bodies of membrane-bounded bundles of filaments were found in the cytoplasm and seemed to be associated with virus particles.

[Changes in plasma dopamine-beta-hydroxylase activity in patients with acute subarachnoid hemorrhage (author's transl)]

In 24 patients with subarachnoid hemorrhage (SAH) who were admitted within 48 hours after the onset, the activity of dopamine-beta-hydroxylase (DBH) in peripheral venous plasma was analyzed applying the method described by Nagatsu and Udenfriend (Clin. Chem., 18: 980-983, 1972) with a minor modification. Plasma samples were serially collected every a few days for three days to four weeks after the onset. DBH activity in peripheral venous plasma increased markedly after the onset, reaching the highest level within 48 hours, and thereafter declined time-dependently for about two weeks. There was no significant difference in the plasma DBH activities on admission between patients with and without cerebrovascular spasm revealed by angiography. The decline of the activity was significantly remarkable in patients with spasm compared with those without spasm. The difference was most prominent around the 7th day after the onset when spasm was shown most frequently. Neurosurgery or administration of analgesics and/or sedatives had little effect on the changes in plasma DBH activity in acute SAH. The activity correlated with the pressure of cerebrospinal fluid (r = 0.587, P less than 0.05), when it was higher than the normal range. With these results we obtained following: 1) The activity of sympathetic nervous system increases following SAH for a week after the onset. 2) The activity declines more rapidly in patients with cerebrovascular spasm than those without spasm, when it was judged from the activity of plasma DBH activity.

The occurrence of calicivirus in infants with acute gastroenteritis

Calicivirus was detected in 8 (1.2%) of 647 hospitalized patients during a survey of acute gastroenteritis in infants and young children, conducted between December 1974 and September 1977. Morphologically calicivirus was approximately 30 nm in diameter with an easily recognizable staining "star of David" configuration. Its buoyant density in cesium chloride was 1.38-1.40 gm/ml. The serologic response to calicivirus by immune electron microscopy (IEM) was demonstrated only in paired sera from patients who shed the virus in their stools. The results suggest that calicivirus might be a cause of acute gastroenteritis in infants and young children.

A long-term survey of rotavirus infection in Japanese children with acute gastroenteritis

Human rotavirus was detected by electron microscopic examination of the stools of 320 (63%) of 506 infants and young children hospitalized with acute gastroenteritis between December 1974 and March 1977. Serologic responses to infection with the rotavirus were revealed by the complement-fixation test in 130 (70%) of 185 patients examined. During the study period three epidemics of human rotavirus infection occurred during the winter months. The peak incidences occurred in January 1975 (88% of patients positive by serologic analysis or electron microscopy of stools), January 1976 (92%), and February 1977 (96%). Rotavirus was detected in the stools of 288 (79%) of 365 patients tested during the cooler months (December to March) and 35 (25%) of 141 during the rest of the year. In the summer (June to August), rotavirus infection occurred rarely. The frequency of human rotavirus infection was highest among patients aged six to 11 months. These results indicate that human rotavirus can be regarded as a major etiologic agent of acute gastroenteritis in infants and young children, of which wintertime epidemics are common in Japan.

Human rotavirus infection in infants and young children with intussusception

Human rotavirus was detected by electron microscopy in 11 of 30 infants and young children with intussusception (37% of subjects under study). Serologic complement fixation tests revealed evidence of infection with the rotavirus in 70% of the patients examined who eliminated the rotavirus in their stools. These results indicate that human rotavirus, in addition to adenovirus, may be an infectious agent causing intussusception in infants and young children.

Cerebrovascular CO2 reactivity in normotensive and hypertensive man

Cerebrovascular reactivity to CO2 inhalation and voluntary hyperventilation was studied in seven normotensive subjects and nine hypertensive patients without clinical or angiographical signs of arteriosclerosis. Cerebral blood flow (CBF) was measured by the intracarotid 133Xe clearance method and calculated as the initial slope index. Three to five CBF measurements were made in each patient in the PaCO2 range of 20 to 55 mm Hg. No difference was observed in reactivity between hypertensive and normotensive patients, either during CO2 inhalation or during hyperventilation. The shape of the CBF:PaCO2 curve suggested a decrease in reactivity below a PaCO2 of 30 to 35 mm Hg in both groups. Above a PaCO2 of 35 mm Hg, exponential regression analysis yielded a mean reactivity of 6 +/- 2%, whereas below a PaCO2 of 30 mm Hg it was about 2%. The rise in CBF during CO2 inhalation was not influenced by the intravenous infusion of a small dose of trimethaphan which blocked the concomitant rise in blood pressure.

Regional cerebral blood flow in patients with hypertensive intracerebral hemorrhage

Regional cerebral blood flow was measured by 133 Xe clearance method in 44 patients with hypertensive intracerebral hemorrhage (HIH) within three weeks from attack. Mean CBF in cases with the more disturbed consciousness was the lower value. There was no definite relationship between mean CBF and the duration from last stroke to measurement. In 44 cases, 35 showed hematoma of so-called "lateral type" and nine showed a "mesial type." There was no difference of mean CBF between these two groups. In the group with lateral-type hematoma, 14 cases were thought to show large space-occupying signs, and their mean CBF was significantly lower than that of the other 21 cases.

In 16 cases, relative hyperemic regions were observed in both the focal and nonfocal areas. In seven cases, relative ischemic regions were frequently in nonfocus rather than focus.

Response of hyperemic region to carbon dioxide was good in seven and poor in three regions in focal area, and was good in eight and poor in one region in nonfocal area. Reactivity of ischemic region to 5% CO 2 inhalation was good in three and poor in zero regions in focus, and was good in three and poor in two regions in nonfocus.

Early venous filling (EVF) was observed in 13 cases and all of them were with lateral-type hematomas.

Only four out of 13 cases showed good correlation between angiographical findings and cerebral circulation.

Lactate in the cerebrospinal fluid and pressure-flow relationships in canine cerebral circulation

In 11 dogs, lactate and pH in the cerebrospinal fluid and in the arterial and the venous blood were measured during stepwise reductions of the arterial blood pressure by controlled bleeding. Increase in lactate and decrease in pH of the cerebrospinal fluid occurred with lowering of the mean arterial blood pressure even within the pressure ranges of 110 to 50 mm Hg, where autoregulation was fairly observed. Reductions of the blood pressure by 20 to 40 mm Hg led to a significant increase in lactate, and reductions by 60 mm Hg led to a significant decrease in pH of the cerebrospinal fluid.

The relation of decrease in pH and increase in lactate was linear, suggesting that lactacidosis occurred. In the arterial and the venous blood, a marked increase in lactate and decrease in pH also were observed. Lactate concentrations of the cerebral venous blood were significantly higher than those of the arterial blood until the arterial blood pressure had been reduced below 70 mm Hg. Therefore, it was suggested that increase in lactate of the cerebrospinal fluid might be attributed solely to increase in lactate of the brain tissue, so far as the blood pressure was not lowered below 70 mm Hg at least. The possibility of participation of the cerebrospinal fluid lactacidosis in autoregulation of the cerebral blood flow was discussed.