POS0794 PREGNANCY AND CHILDBIRTH IN TAKAYASU ARTERITIS IN JAPAN – A NATIONWIDE RETROSPECTIVE STUDY

Background

Takayasu arteritis (TAK), a granulomatous large vessel vasculitis, mainly involves the aorta and its proximal branches and commonly occurs in young females. However, studies of pregnancy in women with TAK are sparse and limited, probably due to the rarity of the disease.

Objectives

The purpose of this study was to understand the status quo of medical treatments of the primary disease and outcomes of pregnancy in patients with TAK, and birth outcomes of the children in Japan.

Methods

Patients with TAK who conceived after the onset of the disease and were managed at medical facilities participating in the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis (JPVAS) were retrospectively enrolled in this study. The following information was collected from patients who had a live-born baby: age at diagnosis of TAK, disease classification, age at delivery, treatments before and during pregnancy, complications during pregnancy, birth outcomes of the children, and changes in disease activity during pregnancy and after delivery.

Results

Fifty-one cases and 69 pregnancies from 19 ethics committee-approved centers were enrolled during the study period 2019–2021. Of these, 49 cases and 66 pregnancies (95.7%) resulted in delivery and live-born babies. The Numano classification of the 49 cases was as follows: type I, 11; type IIa, 15; type IIb,12; type III, 1; type IV, 1; type V, 9; with type IIa being the most common. The age of diagnosis was 22 years (13–37 years, year of diagnosis 1965–2017), the median age of the delivery of 66 pregnancies was 31 years (year of delivery 1969-2021), and the median duration of illness at delivery was nine years. There were 34 planned pregnancies (51.5%, including four pregnancies by artificial insemination/ovulation induction). Preconception therapy included prednisolone (PSL) in 51 pregnancies (77.3%, median dose 7.5 mg (range 4–30 mg)/day), immunosuppressive drugs in 18 pregnancies (27.3%, azathioprine 8, tacrolimus 7, methotrexate 4, cyclosporin A 1, and colchicine 1), biologics in 12 pregnancies (18.1%, infliximab 6, tocilizumab 5, and adalimumab 1), antihypertensive drugs in 5 pregnancies (7.6%). Surgical treatment had been performed before pregnancy in 6 cases (aortic root replacement 2, subclavian artery dilatation 1, subclavian artery bypass 1, subclavian artery stenting 1, and ascending aorta semicircular artery replacement 1). Medications used during the course of pregnancy included PSL in 48 pregnancies (72.7%, median dose 8 mg (range 4–30 mg)/day, increased in 13 pregnancies, decreased in 1 pregnancy), immunosuppressants in 13 pregnancies (19.7%, azathioprine 6, tacrolimus 6, and cyclosporin A 1), biologics 9 pregnancies (13.6%, infliximab 4, tocilizumab 4, and adalimumab 1). Immunosuppressants and biologics were discontinued in five and four pregnancies after conception. Complications during pregnancy were observed in 20 pregnancies (30.3%), with hypertension being the most common. Complications related to TAK or its treatment were severe infections in two pregnancies and aneurysm enlargement due to increased circulating plasma volume in one pregnancy. Aortic arch replacement was performed after delivery for the latter case. Relapse of TAK was observed in 4 pregnancies (6.1%) during pregnancy and in 8 pregnancies (12.1%) after delivery. One pregnancy resulted in restenosis of subclavian artery for which dilatation procedure was performed prior to the pregnancy. There were 13/66 (19.7%) preterm infants and 17/59 (28.8%) low birth weight infants; all but one had a birth weight of more than 2,000 g and no had serious postnatal abnormalities. Forty-three (82.7%) of the 52 confirmed infants were breastfeed fully or mixed.

Conclusion

Most of the pregnancies in patients with TAK were successfully delivered while they had low disease activity at a dose of less than 10 mg/day of PSL. Relapse occurred during pregnancy and after delivery in some cases. The babies tended to have low birth weight, but 82.7% of them were breastfed without serious complications.

Disclosure of Interests

Takako Miyamae: None declared, Yusuke Manabe: None declared, takahiko sugihara Speakers bureau: TS has received honoraria from Abbvie Japan Co., Ltd., AsahiKASEI Co., Ltd., Astellas Pharma Inc., Ayumi Pharmaceutical, Bristol Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., Mitsubishi-Tanabe Pharma Co., Ono Pharmaceutical, Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., and UCB Japan Co., Grant/research support from: TS has received research grants from AsahiKASEI Co., Ltd., Daiichi Sankyo., Chugai Pharmaceutical Co., Ltd., and Ono Pharmaceutical., Natsuka Umezawa: None declared, Hajime Yoshifuji Speakers bureau: HY has received lecture fees from Janssen and Chugai., Naoto Tamura: None declared, Yoshiyuki Abe: None declared, Shunsuke Furuta Speakers bureau: Chugai Pharmaceutical Co.,Ltd.

DaiichiSankyo Co.,Ltd.

Asahi-Kasei Pharma Corporation, Manami Kato: None declared, Takashi Kumagai: None declared, Kaito Nakamura: None declared, Hiroko Nagafuchi: None declared, Jun Ishizaki: None declared, Naoko Nakano: None declared, Tatsuya Atsumi Speakers bureau: Mitsubishi Tanabe Pharma Co., Chugai Pharmaceutical Co., Ltd., Astellas Pharma Inc., Takeda Pharmaceutical Co., Ltd., Pfizer Inc., AbbVie Inc., Eisai Co. Ltd., Daiichi Sankyo Co., Ltd., Bristol-Myers Squibb Co., UCB Japan Co. Ltd., Eli Lilly Japan K.K., Novartis Pharma K.K., Eli Lilly Japan K.K., Kyowa Kirin Co., Ltd.,TAIHO PHARMACEUTICAL CO., LTD., Consultant of: AstraZeneca plc., MEDICAL & BIOLOGICAL LABORATORIES CO., LTD., Pfizer Inc., AbbVie Inc., ONO PHARMACEUTICAL CO. LTD.,

Novartis Pharma K.K., Nippon Boehringer Ingelheim Co., Ltd., Grant/research support from: Astellas Pharma Inc., TAIHO PHARMACEUTICAL CO., LTD.AbbVie Inc., Nippon Boehringer Ingelheim Co., Ltd.,Takeda Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co. Ltd., Otsuka Pharmaceutical Co., Ltd. and Pfizer Inc. Alexion Inc., TEIJIN PHARMA LIMITED., Kohei Karino: None declared, Koichi Amano Speakers bureau: AbbVie GK, Asahi-Kasei Pharma, Astellas, Chugai Pharmaceutical Co.Ltd., Eisai, Eli Lilly, GlaxoSmithKlein, Janssen Pharma, Pfizer Japan, Grant/research support from: Asahi-Kasei Pharma,Chugai Pharmaceutical Co.Ltd., Takahiko Kurasawa: None declared, Shuichi Ito: None declared, Ryusuke Yoshimi: None declared, Noriyoshi Ogawa: None declared, Shogo Banno: None declared, Taio Naniwa Speakers bureau: Chugai, Tanabe, Abbbvie, Eisai, Grant/research support from: Chugai, Tanabe, Abbbvie, Eisai, Satoshi Ito Speakers bureau: SI has received speaker’s fees from pharmaceutical companies., Akinori Hara: None declared, Shinya Hirahara: None declared, Haruhito A. Uchida: None declared, Yasuhiro Onishi: None declared, Yohko Murakawa Speakers bureau: Astellas, UCB, Chugai, AbbVie, Grant/research support from: Chugai, AbbVie, Yoshinori Komagata: None declared, Yoshikazu Nakaoka: None declared, Masayoshi Harigai Speakers bureau: MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Janssen Pharmaceutical K.K., Kissei Pharmaceutical Co., Ltd., Novartis Japan, Pfizer Japan Inc., Mitsubishi Tanabe Pharma Co., Teijin Pharma Ltd and UCB Japan., Consultant of: MH is a consultant for AbbVie, Boehringer-Ingelheim, Kissei Pharmaceutical Co., Ltd., and Teijin Pharma.

Cataract survey in the local area using photographic documentation

An epidemiological survey of cataract was performed in a limited local population. 1,020 individuals over 40 years of age were examined. The crystalline lens findings were documented by both Scheimpflug and retroillumination photography. Cataractous changes were classified into three groups according to early senile changes, incipient cataractous changes and only prominent cataractous changes. Forms of opacification were classified as cortical, subcapsular, nuclear, mixed type and others. The percent prevalence of cataracts including early senile changes was 33.9% in the 40-year-old population, 62.8% in the 50, 76.2% in the 60, 84.0% in the 70 and 100% for those in their 80s. Prominent cataractous opacification was 1.6% in the 40-year-old population, 3.1% for those in their 50s, 19.0% in their 60s, 28.6% in their 70s and 57.1% in their 80s, respectively. Until age 60, the type of opacification was mainly cortical alone; however, after age 70, cortical opacity accompanied by nuclear and/or capsular opacities increased. The pure nuclear type increased in individuals over 70.

Relative importance of the area and intensity of the orange spots of male guppies Poecilia reticulata as mating traits preferred by females

Digitally modified videos of male guppies Poecilia reticulata were used to examine the relative importance of the area and intensity of the orange spots as mating traits preferred by females. The females prioritized the area of the orange spots over intensity for their mate preference.

The influence of sex, line, and fight experience on aggressiveness of the Siamese fighting fish in intrasexual competition

We examined the influence of sex, line, i.e., broods from different parents, and previous fight experience on the aggressiveness of the Siamese fighting fish Betta splendens in intrasexual competition. The innate aggressiveness of the fish against their mirror images was measured on the day prior to the direct fight with other individuals, and it was found to be influenced by the line type but not by the sex. In the direct fight with other individuals, the males invested more effort in the fight than the females. In addition, the individuals of a particular line that exhibited a lower innate aggressiveness spent less time in the direct fight and were often losers when compared with those of other lines. After the direct fight with other individuals, the aggressiveness of the fish against their mirror images was remarkably influenced by the outcome of the direct fight, i.e., the winners exhibited more aggressive behavior, whereas the losers exhibited a lesser degree of aggressive behavior. This influence of the previous fight experience on subsequent aggressiveness was the greatest in the individuals of the line that have exhibited the lowest innate aggressiveness. However, the positive effect of the winning experience or the negative effect of the losing experience on subsequent aggressiveness decreased following several days after the previous fight increased.

[Influence of estrogen replacement therapies such as premarin for the measurement of estradiol]

To investigate problems associated with the measurement of estradiol 17 beta(E2) in hormone replacement therapy(HRT), five commercial immunoassay methods(Coat-A-Count E2 as the conventional method; Immulyze E2, Immuno 1 E2, Vitros E2, and HRT-E2 as the comparative methods) were used to assay E2 concentrations. Samples were obtained from 21 women who had been receiving HRT, 99 nonmedicated women, and 10 healthy men volunteers. No significant difference between the Coat-A-Count E2 and the comparative method was observed in the nonmedicated women. However, we found that the serum E2 concentration from patients taking Premarin showed a large discrepancy between the Coat-A-Count E2 method, which showed considerably higher values, and the other four methods. The reason for our conflicting results from patients with HRT was probably because the Coat-A-Count E2 detected circulating estrogen conjugates. The experimental addition of Premarin for the in vitro cross-reactivity was done. The cross-reactivity was low because a similar E2 steroid exists independently. However, the E2 serum value of the ten male volunteers after taking Premarin was elevated. The reason for this result was due to the high cross-reactivity between anti E2 polyclonal antibody and the various metabolic products of Premarin. In conclusion, the influence of Premarin should be taken into consideration when measuring estradiol concentration to monitor HRT.

Pituitary response to luteinizing hormone-releasing hormone in women with variant luteinizing hormone

OBJECTIVE

To assess the LH response of the pituitary gland to GnRH stimulation in healthy women with a mutant beta-subunit (Trp8 to Arg8 and Ile15 to Thr15).

DESIGN

Clinical study.

PATIENTS

We studied 40 healthy non-pregnant Japanese women of known zygosity for the LH beta-subunit gene (3 homozygotes for the mutant gene, 17 heterozygotes, and 20 homozygotes for the wild type). All women had normal ovulatory cycles.

MEASUREMENTS

Serum LH status was determined by comparing LH immunoassays results using a monoclonal antibody recognizing only wild-type LH with those from a polyclonal antibody assay recognizing both variant and wild-type LH. The ratio of monoclonal to polyclonal immunoassay results determined the serum LH status. LH secretion in response to a GnRH stimulation test was measured.

RESULTS

All women with the wild-type LH showed a normal response of LH to GnRH according to both assays. Over the time course of the response, the ratios in women with wild-type LH showed no remarkable changes. The response curves in women heterozygous for the mutant peaked 15-30min after GnRH injection; their response patterns included a statistically significant decrease in the rates of response at 15min after injection.

CONCLUSIONS

There are the differences in circulatory kinetics between the two LH forms and in regulation of the two types of LHbeta genes. The maximal response of the variant LH to pituitary stimulation with GnRH appears to be greater than that of wild-type LH.

Troponin T in the coronary sinus and percutaneous transluminal coronary angioplasty related myocardial injury

1. Myocardial injury has been shown to be associated with successful percutaneous transluminal coronary angioplasty (PTCA). The present study was designed to determine whether uncomplicated successful PTCA results in myocardial injury by measuring coronary sinus (CS) cardiac troponin T (cTnT). 2. We measured cTnT in the CS and the femoral vein (FV) in 16 patients with stable angina pectoris who underwent uncomplicated PTCA for stenotic lesions of the left anterior descending artery. Blood samples were drawn from both the CS and FV before and immediately after PTCA and every 4 h for the next 12 h. 3. All patients had chest pain and electrocardiographic ST segment elevation or depression during balloon inflation and higher peak elevation of cTnT in the CS than in the FV (0.054 +/- 0.059 vs 0.036 +/- 0.022 ng/mL; P < 0.05). However, all CS cTnT levels were within the normal range over the 12 h period. 4. The fact that CS cTnT measurements showed no evidence of uncomplicated PTCA-related myocardial injury led us to conclude that uncomplicated successful PTCA does not cause myocardial injury.

Estradiol-17beta measurement in women receiving conjugated estrogens. Dissociation between two commercial methods

To investigate problems associated with measurement of estradiol-17beta (E2) in hormone replacement therapy (HRT), two commercial immunometric methods (Coat-A-Count E2 and Immulyze E2) were used to assay E2 concentrations and the two results were expressed as E2 ratios. Samples were obtained from 97 Japanese women receiving HRT and 168 unmedicated women. The largest differences between methods (P < 0.001) occurred in patients receiving oral conjugated estrogen (CE), while the best concordance was found in unmedicated women; like these controls, patients receiving oral estriol or transdermal E2 showed no significant difference between methods. Defining an E2 ratio > or = 2.0 as an abnormal discordance, the mean E2 ratio and the frequency of abnormal discordance in the CE group were 2.15 +/- 1.18 and 43.6%, respectively. No abnormal discordance for E2 occurred in other groups. In serial serum samples from the control group, no significant difference was seen between the mean E2 ratio at first measurement and those at a subsequent measurement. Similarly, no significant difference in the ratio was seen when two serial samples from CE patients were compared. However, E2 ratios after prescription of CE were significantly higher than before treatment in all patients. In conclusion, although measurement of E2 is important in patients receiving HRT, validity of the test methods must be carefully weighed for patients receiving CE.

[Influence of abnormal structure beta chain of luteinizing hormone on endocrinological kinetics of luteinizing hormone and gynecologic diseases]

With recent progress in endocrinology and in procreation physiology, the importance of kinetics of pituitary gonadotropin has been increasing, and the measurement method has been improved. In the present study, however, we found inconsistency in measured LH values between IRMA (SPAC-S LH) as the conventional method and CLEIA (IMMULYZE LH) as the newly developed method. The inconsistency between the SPAC-S LH value and the IMMULYZE LH value was observed in 10.0% of the healthy group and in 12.5% of the patient group. The cause of this discrepancy was due to a reaction of the SPAC-S LH of the intact LH monoclonal antibodies to the LH with the abnormal structure beta chain by two point mutation in the LH beta gene. The response of LH-RH test varied depending on the measurement reagent of LH in patients who had the LH with the abnormal structure beta chain, which made it difficult to determine the lesion and histological grading regarding the ovulation mechanism. Therefore, in patients with abnormal beta chain, an accurate treatment protocol was indeterminate. In this study, although a relationship between various gynecological diseases and the point mutation of LH was not clarified, we suggest that LH of the abnormal structure beta chain may cause excessive secretion in the early stage, and lead to some effect on physical activities.

Increased prevalence of luteinizing hormone beta-subunit variant in Japanese infertility patients

To determine the frequency of a common luteinizing hormone variant in a Japanese population and to evaluate its significance in infertility, serum samples were collected from 169 healthy non-pregnant Japanese women, 105 healthy adult Japanese men and 97 female Japanese infertility patients. The luteinizing hormone variant includes two point mutations in the beta-subunit gene (Trp8 to Arg8 and Ile15 to Thr15). DNA from blood cells was studied in 10 healthy women, 10 men and five patients using polymerase chain reaction and direct sequencing. In immunoassays, results with a monoclonal antibody recognizing only the wild-type hormone and a polyclonal antibody recognizing the variant as well were compared as a ratio; ratios in heterozygotes and in individuals with only wild-type alleles ranged from 0.19 to 0.50 and from 0.56 to 1.21, respectively, and 0.50 was considered a 'cut-off' value for identifying individuals with the variant. For the larger subject groups, the frequency of the variant was 9.5% in normals. The mean ratio (0.80 +/- 0.35) in infertility patients was significantly lower (P < 0.01) than in healthy women (1.09 +/- 0.56), and the variant occurred more frequently in infertility patients (16.5%) than in healthy women (8.3%; P < 0.05). The variant was more frequent in patients with ovulatory disorders (43.8%) than other patients (16.0%; P < 0.05).

Octacosanol affects lipid metabolism in rats fed on a high-fat diet

The effect of dietary octacosanol, a long-chain alcohol, on lipid metabolism was investigated in rats fed on a high-fat diet for 20 d. The addition of octacosanol (10 g/kg diet) to the high-fat diet led to a significant reduction (P < 0.05) in the perirenal adipose tissue weight without decrease of the cell number, suggesting that octacosanol may suppress lipid accumulation in this tissue, whereas no effect was seen in the epididymal adipose tissue weight and in the lipid content in liver. Octacosanol supplementation decreased the serum triacylglycerol concentration, and enhanced the concentration of serum fatty acids, probably through inhibition of hepatic phosphatidate phosphohydrolase (EC 3.1.3.4). Though the activity of hormone-sensitive lipase (EC 3.1.1.3) was not influenced by octacosanol, higher activities of lipoprotein lipase (EC 3.1.1.34) in the perirenal adipose tissue and the total oxidation rate of fatty acid in muscle were observed. Lipid absorption was not affected by the inclusion of octacosanol. Thus, the present results suggest that the dietary incorporation of octacosanol into a high-fat diet affects some aspects of lipid metabolism.

[A prospective study of septic episodes due to Staphylococcus aureus and the background of the patients]

From January 1983 to December 1991, 94 cases of Staphylococcus aureus septicemia were identified at Matsue Red Cross Hospital and were evaluated. Methicillin-resistant Staphylococci aureus counted 49%. Seventy two percent of the patients were 60 years or over in age. Intravascular catheters were the most common foci (33%), respiratory infections in 25% and so on. Administration of antibiotics before isolation of Staphylococcus aureus were thought to be the most significant factor in producing the methicillin-resistant septicemia, used in 41% of MSSA and 91.3% of MRSA cases. Especially, the trend of unproper usage of the 3rd generation cephems derivative antibiotics had a major role in producing multi-drug resistant bacteria. No significance was seen in the clinical background, underlying diseases, primary site of infection in between the two groups of methicillin resistant and sensitive cases. Mortality due to septicemia was 47.9% in the MSSA group of patients, while it was much higher in cases of MRSA (73.9%). In conclusion, as the administration of antibiotics even in non-infectious episodes is common in daily clinical activities in some out-patient clinics, the indications should be restricted, in order to prevent the further MRSA infections.

Basic evaluation of an immunoradiometric competitive inhibition assay for sialosyl-Tn antigen in sera in women. Assay conditions and normal values

The assay conditions needed for an immunoradiometric competitive inhibition assay of sera in healthy women were studied using the monoclonal antibody TKH2, which is known to recognize specifically sialosyl-alpha 2,6-GalNAc alpha 1-0-serine/threonine (S-Tn) antigen, a mucinous cancer-related antigen. Stable results were obtained with an incubation time of 1.5 hours at room temperature. The intra-assay and inter-assay coefficients of variation were 3.27% and 3.07%, respectively. The mean (+/- standard deviation [SD]) levels of serum S-Tn in 602 healthy women was 21.2 U/ml (+/- 8.4 U/ml). Values showed a normal logarithmic distribution. Although slightly higher levels were seen in postmenopausal compared with premenopausal women, the differences were not significant. The cutoff value of 41 U/ml was determined from data obtained in 602 healthy women; higher levels were observed in only 2%. Serum S-Tn levels were not strongly influenced by Lewis or ABO (H) blood type, smoking, pregnancy, parturition, or phase of menstrual cycle. The use of the S-Tn antigen as a tumor marker for various gynecologic cancers requires study.

Magnetic resonance microscopy of rabbit eyes

Magnetic resonance (MR) micro-imaging was performed on enucleated eyes from rabbits previously injected with perfluoropropane gas (C3F8), with or without the surgical creation of retinal detachment. Condensed vitreous, which exhibited shortened longitudinal relaxation time (T1), could be differentiated with proton-density and T1-weighted imaging. Gradient-echo imaging could in addition detect vitreo-retinal tractions. The detached retina itself was also seen. Further, proton-density but not T1-weighted imaging showed lens opacities appearing as high-intensity regions. MR microscopy is a convenient method for gross morphological examination of intact eyes.

19F NMR quantitation of lens aldose reductase activity using 3-deoxy-3-fluoro-D-glucose

In the present study we have determined the kinetics of 3-deoxy-3-fluoro-D-glucose (3-FG) as a substrate for the aldose reductase reaction in vitro. In addition, we compared the 3-deoxy-3-fluoro-sorbitol (3-FS) production rates from 3-FG in the intact lens using 19F NMR with conventional aldose reductase determinations in extracts from the same lenses. The affinity of in vitro aldose reductase for 3-FG was approximately 20 times greater (9.3 mM) than that for glucose (188 mM). An excellent correlation between the rate of 3-FS production in the intact canine lens, determined with 19F NMR, and extracted aldose reductase activity was observed. The relatively high affinity of aldose reductase for 3-FG and the correlation of 3-FS production with enzyme activity in the intact lens suggests that 3-FS production from 3-FG detected by 19F NMR could provide an accurate noninvasive determination of aldose reductase activity in the eye lens.

Magnetic resonance imaging of the rabbit eye. Improved anatomical detail using magnetization transfer contrast

Proton nuclear magnetic resonance (NMR) imaging previously has been used to examine structure and pathologies of the eye. The present study investigates the use of a saturation-transfer technique, which exploits water-macromolecular proton magnetic interactions, to enhance image contrast in the rabbit eye in vivo. Upon steady-state saturation of the macromolecular-proton magnetization, the water-proton signal intensity will decrease in proportion to the degree of water-macromolecular proton magnetic interaction. NMR images of the eye collected using saturation transfer are shown to have superior contrast compared to conventional NMR imaging techniques, in regard to numerous ocular structures, including the iris, ciliary bodies, muscle, lens, and cornea.

Clinical value of sialyl Tn antigen in patients with gynecologic tumors

Sialyl Tn antigen was measured by the immunoradiometric competitive inhibition assay in sera from patients with various gynecologic tumors: 49 uterine myomas, 97 cervical cancers, 42 endometrial cancers, 63 benign ovarian tumors, and 59 ovarian cancers including eight cases of borderline malignancy. Among the patients with uterine malignancies, a few cases showed a sialyl Tn antigen level in excess of the cutoff limit (39 U/mL). In the patients with ovarian cancers, serum sialyl Tn antigen was significantly elevated: clinical stage I, 31%; stage II, 29%; and stage III, 69%. The antigen level also correlated with the effect of treatment. In addition, malignant fluid exhibited a high sialyl Tn antigen level, whereas benign fluid showed no elevation. However, serum sialyl Tn antigen was elevated in 6% of the patients with benign ovarian cysts and in 1.5% of normal volunteers. The current findings demonstrate that the lack of tumor specificity of sialyl Tn antigen limits its diagnostic value in gynecologic malignancies, but that serial measurement of this antigen appears to be useful for monitoring patients and evaluating therapy.

Clinical evaluations of the tumor marker sialyl SSEA-1 antigen for clinical gynecological disease

Sialyl SSEA-1 antigen (SLX) is a highly specific tumor marker composed of sugar chain antigens that have Lewis X at their terminals and bind to sialic acid. This antigen is rarely detected in normal tissues, and is present in adenocarcinoma and fetal tissues. We studied the clinical usefulness of SLX in gynecological patients and obtained the following results. (1) The antigen was frequently positive in patients with ovarian cancer with a mean of 89.5 +/- 48.3 U/ml (72.8%, 8/11) and in those with endometriosis with a mean of 39.8 +/- 10.3 U/ml (75.0%, 6/8). (2) Among the gynecological malignancies, the percent positivity was low in those with cervical cancer (20.0%, 5/25), endometrial cancer (33.3%, 1/3), and cancer of the fallopian tube (33.3%, 1/3). (3) The antigen was negative in 20 with myoma uteri, 20 normal pregnant women, and 9 nonpregnant healthy women during the follicular, luteal, or menstrual phase. It was negative in 8 of 9 patients with benign ovarian cyst. False negative results were rare. (4) The SLX level was higher in the ascites than in the serum in patients with ovarian cancer and in those with benign ovarian tumors. (5) The serum SLX in patients with ovarian cancer, which was positive before tumor resection, became negative 2 weeks postoperatively. These results suggest that SLX is a tumor marker with a high specificity to adenocarcinoma of the reproductive organs.

Differential diagnosis of ovarian cancer, benign ovarian tumor and endometriosis by a combination assay of serum sialyl SSEA-1 antigen and CA125 levels

We used a combination assay of serum sialyl SSEA-1 antigen (SLX) and CA125 levels, and evaluated the clinical usefulness of this technique for a differential diagnosis of ovarian cancer, benign ovarian tumor and endometriosis. In 82 patients with ovarian tumors, the sera of 20 (64.5%) of 31 with ovarian cancer and 15 (48.4%) of the 31 with endometriosis (endometrial cyst) were positive for both SLX and CA125, but serum SLX level was 5 U/ml or less in these 14 SLX- and CA125-positive patients with endometriosis. The sera of 16 (80.0%) patients with benign ovarian tumor were negative for both tumor markers. The sera of 3 (9.7%) of 31 with ovarian cancer and the sera of 2 (6.5%) of 31 with endometriosis were negative for both markers. The diagnostic accuracy (true positive rate X true negative rate) of the combination assay for ovarian cancer was 49.0% when the cutoff value of the serum SLX was 38 U/ml but improved to 78.5% when the value was set at 50 U/ml. When the cutoff value of serum SLX was set at 50 U/ml and that of serum CA125 at 35 U/ml, 27 of 37 patients who were positive only for CA125 had endometriosis. From the above observations, a combination assay of serum SLX and CA125 is a promising method for the differential diagnosis of malignant and benign ovarian tumors. Our results also suggest that to improve the diagnostic accuracy, the cutoff value of the serum SLX level should be 50 U/ml for ovarian tumors alone.

MR imaging of morning glory syndrome

The magnetic resonance (MR) imaging features of morning glory syndrome are described. In our case, MR demonstrated a colobomatous area in the region of the optic disk, as well as an associated cataract and retinal detachment.

Surface coil MR imaging of orbital blowout fractures: a comparison with reformatted CT

Four patients with orbital blowout fractures were evaluated by surface coil MR imaging, and the resulting images were compared with computer reformatted CT scans. The surface coil afforded significant improvement in spatial resolution, resulting in better demonstration of the blowout fracture. Surface coil MR was found superior to CT in the assessment of fracture site, extent of prolapsed orbital fat, and muscle entrapment.

[Classification of asymptomatic autoimmune thyroiditis by thyrotropin-releasing hormone loading]

Thyrotropin-releasing hormone loading was performed on 91 patients with asymptomatic autoimmune thyroiditis. Four women had no response to this loading test and had high levels in serum total and free thyroxine (TT4, FT4) and in serum total and free triiodothyronine (TT3, FT3). These patients might be classified as subclinical hyperthyroidism (Group G). Twenty-four patients had normal levels of both basal and peak thyrotropin after loading and were classified as Group I. There were no significant differences between 45 controls (Group C) and Group I patients in serum thyroid hormone levels. Patients with normal basal and high peak levels of thyrotropin were included in Group II. The number of patients in this group was 53. The mean levels of basal and peak thyrotropin were 4.8 microU/ml and 39.6 microU/ml, respectively, and were significantly higher than in Group C and Group I (P less than 0.005). In 10 patients classified as Group III with high levels of both basal and peak thyrotropin, serum concentrations of TT4, FT4 and FT3 were significantly lower than in the other groups (P less than 0.025); however, significant differences in TT3 could not be seen among them. Serum cholesterol levels gradually increased from Group C to Group III. There were significant differences between Group C and Group II (P less than 0.05).

Epidemiological study of Yersinia enterocolitica and Yersinia pseudotuberculosis infections in Shimane Prefecture, Japan

In Shimane Prefecture, Japan, 175 Yersinia enterocolitica isolates from 6,479 stools and 347 appendixes of patients were separated into biotype 3B (VP-, sorbose-, inositol-) serotype O3 phage type II (22 isolates); biotype 4 (84 isolates), biotype 4 (ornithine-) (16 isolates) and biotype 4 (maltose-) (9 isolates) of serotype O3 phage type VIII, biotype 2 serotype O9 (1 isolate) and biotype 1 (43 isolates). This may be the first documentation of isolation of Y. enterocolitica biotype 3B serotype O3 phage type II from patients. Twenty-three Yersinia pseudotuberculosis isolates from stools of 23 patients were grouped into serotypes IB (13 isolates), III (2 isolates) and IVB (8 isolates). Clinical manifestations were more numerous in Y. pseudotuberculosis infections than Y. enterocolitica O3 infections. Y. enterocolitica O3 was more frequently isolated between summer and autumn but Y. pseudotuberculosis and Y. enterocolitica biotype 1 were isolated between winter and spring. Secondary infection with Yersinia among close family members was frequent. Y. enterocolitica O3 and Y. pseudotuberculosis infected persons excreted 10(4) to 10(9) viable cells per g stool during 27 and 19 days, but Y. enterocolitica biotype 1 strains were detected only when using enrichment techniques. Serological responses were not observed in under 2 year old persons infected with Y. enterocolitica O3.

Effect of coenzyme Q10 on hypertrophied ischemic myocardium during aortic cross clamping for 2 hr, from the aspect of energy metabolism

In order to perform intracardiac repair safely during aortic cross clamping, we designed this study to evaluate the protective effect of coenzyme Q10 (CoQ10) on hypertrophied ischemic myocardium from the aspect of energy metabolism. Six to nine months preceding the study, aortic bandings were carried out on 14 puppies to produce left ventricular hypertrophy (LVH). These dogs with LVH were then subjected to total cardiopulmonary bypass and were evenly divided into control and CoQ10-treated groups (10 mg/kg of intravenous administration plus 1 mg/kg per hr of intracoronary injection). Myocardial ischemia was induced by aortic cross clamping for 2 hr under moderate systemic hypothermia. The results indicated that the administration of CoQ10 had a protective effect on hypertrophied ischemic myocardium, since depletion of high-energy phosphate (HEP) was uniformly prevented, and accumulation of lactate was simultaneously decreased during the 2 hr of aortic cross clamping. On the other hand, there were marked exhaustion of HEP and rapid increase in lactate following the 2 hr of ischemia in the control group, these being much more predominant in the subendocardial layer.