Diagnóstico y tratamiento de las lesiones benignas de la mama en el embarazo

OBJECTIVES

To retrospectively study the diagnosis and treatment of benign breast disease during pregnancy and breastfeeding at our department. To review the relevant literature.

MATERIALS AND METHODS

From January 2001 to March 2005, a total of 91 pregnant or breastfeeding women (age range: 23-36 years) were diagnosed with benign breast pathology. All patients presented with palpable nodules or inflammatory symptoms. Ultrasound-guided fine-needle cytology was performed in all cases and percutaneous core biopsy was considered necessary in three cases. Abscesses were drained when present. Patients provided their informed consent before all procedures.

RESULTS

Tumors were detected in 28 cases (30%): fibroadenomas (n = 12), lactating adenomas (n = 9), galactoceles (n = 5), and papillomas (n = 2). Conservative treatment with ultrasound follow-up was employed in all cases except one, which required surgical treatment in the third trimester. On 63 occasions (70%), the pathology was inflammatory, including abscesses in 24 cases (38%); abscesses were drained using fine-needle aspiration (n = 16) or pig-tail catheter (n = 3), according to protocol, depending on the size of the abscess (less than or greater than 3 cm). In 5 cases the abscesses were drained surgically.

CONCLUSIONS

The most common benign breast pathology during pregnancy is inflammatory and is satisfactorily managed with antibiotics and percutaneous drainage with good esthetic results. Ultrasound is the diagnostic technique of choice, together with cytology; percutaneous biopsy is only performed in uncertain cases to minimize the risk of fistulas. Management of tumors after histological confirmation should be conservative with close follow-up. These tumors cause no problems for the child, the mother, or breastfeeding.

Differential activation in the medial temporal lobe during a sound-sequence discrimination task across age in human subjects

To elucidate the brain mechanisms to encode sequential events, event-related potentials (ERPs) were recorded during a sound-sequence discrimination task using young and middle-aged adult subjects. In the task, a series of six or 12 kinds of natural sounds were sequentially presented; 70-80% of the stimuli were presented in a fixed order (Non-target), but the remaining stimuli, in a random order (Target). The subjects were instructed to detect the Targets and press a button at the end of each Target. In a control task, the same sounds were randomly presented (Control), and they were instructed to press the button at the end of each sound. Behavioral results indicated that the young subjects learned the task faster than did the middle-aged subjects. Positive ERP waves were evoked by Targets and Non-targets in the parieto-occipital area around 300-700 ms after stimulus onset. The mean amplitudes during this period in the young subjects were larger in Target than Control conditions, and those in Target condition were larger in the young than middle-aged subjects. Furthermore, the mean amplitudes in the Target condition were significantly correlated with behavioral performance. Equivalent dipoles for the ERPs evoked by Targets were estimated in the medial temporal lobe including the hippocampal formation and parahippocampal gyrus. The results suggest that the ERPs around 300-700 ms latency are involved in sound-sequence information processing. Furthermore, decrease in amplitudes of this positivity in the middle-aged subjects suggests that age-related memory decline is associated with deficits in encoding and retrieval of unfamiliar sequence.

Tetrasomy 8p: discordance of amniotic fluid and blood karyotypes

We describe a girl with congenital heart defect (ventricular septal defect), facial, ear and bone anomalies, agenesis of corpus callosum and conventional cytogenetic studies showing tetrasomy 8p. The identity of the isochromosome was confirmed by fluorescent in situ hybridization (FISH) using painting, subtelomeric and alpha satellite probes for chromosome 8. The extra isochromosome was observed in 100% of cultured peripheral lymphocytes (47,XX,+i(8)(p10)), but normal chromosomes were recorded in cultured amniotic fluid. Microsatellites analysis of the patient's DNA with two markers mapping 8p showed three different peaks, and two markers mapping 8q showed two peaks. To the best of our knowledge, this patient represents the twelfth reported case of tetrasomy 8p. In addition, our report is the first case with a pure tetrasomy 8p in blood, (the other published cases are mosaic 8p), and the second case with a discordance of amniotic fluid and blood karyotypes [Robinow et al., 1989: Am J Med Genet 32:320-324].

Ménière's disease and delayed endolymphatic hydrops in children

In order to study the characteristics of pediatric patients (< or = 15 years at onset) with endolymphatic hydrops disorders, we selected 5 patients with Ménière's disease (MD) and 3 patients with delayed endolymphatic hydrops (DEH) from 7418 patients who had visited the Neurotological Clinic of the Toyama Medical and Pharmaceutical University Hospital between 1979 and 1999. Clinical features were characterized as follows: (i) pediatric MD patients were rare, comprising approximately 1.5% of all the 337 MD patients in the sample; (ii) a fluctuating hearing loss, strong positive response in glycerol test, high SP/AP amplitude ratio in electrocochleography and moderate positive response in furosemide vestibulo-ocular reflex test were recorded; (iii) in 2 of the 5 pediatric MD patients, vertiginous attacks had persisted for a long period and they had undergone surgical procedures (sac operation and vestibular neurectomy); and (iv) the ipsilateral type of DEH was observed in 2/3 children, and contralateral DEH in 1/3.

Symptomatic spur formation of bilateral proximal tibiofibular joints

Excessive, repetitive mechanical stress of the proximal tibiofibular articulation during sports activity can lead to degenerative changes and a syndesmotic joint.

Hypoplastic basement membrane of the lens anlage in the inheritable lens aplastic mouse (lap mouse)

Adult homozygous lap mice show various eye abnormalities such as aphakia, retinal disorganization, and dysplasia of the cornea and anterior chamber. In the fetal eye of a homozygous lap mouse, the lens placode appears to develop normally. However, the lens vesicle develops abnormally to form a mass of cells without a cavity, and the mass vanishes soon afterward. Apoptotic cell death is associated with the disappearance of the lens anlage. We examined the basement membranes of the lens anlage of this mutant by immunohistochemical methods under light microscopy using antibodies against basement membrane components of the lens anlage, type IV collagen, fibronectin, laminin, heparan sulfate proteoglycan, and entactin and by transmission electron microscopy. Immunohistochemistry showed the distribution and intensity of antibody binding to the lens anlage to be almost the same for each these antibodies regardless of the stage of gestation or whether the anlagen were from normal BALB/c or lap mice. Thus, positive continuous reactions were observed around the exterior region of the lens anlage from day 10 of gestation for type IV collagen, fibronectin, laminin, heparan sulfate proteoglycan antibodies, and at least from day 11of gestation for entactin antibody. The basement membrane lamina densa of both normal and lap mice was shown by electron microscopy to be discontinuous at days 10 and 10.5 of gestation. However, by day 11 the lamina densa was continuous in the lens anlagen of normal mice but still discontinuous in the lap mice. By day 12 of gestation, the lamina densa had thickened markedly in normal mice, whereas in lap mice it remained discontinuous and its thinness indicated hypoplasia. These results indicate that, while all basement components examined are produced and deposited in the normal region of the lens anlage in the lap mouse, the basement membrane is, for some reason, imperfectly formed. The time at which hypoplasia of the basement membrane was observed in this mutant coincided with the stage during which apoptosis in the lens anlage occurred. This result may indicate a possibility of the relationship between the basement membrane and apoptosis in this mutant.

Clinical study of elderly patients with Meniere's and related diseases

In order to study the characteristics of elderly patients (70 or over at onset) with endolymphatic hydrops disorders, we selected six patients with Meniere's disease (MD), five patients with delayed endolymphatic hydrops (DEH), and two patients with syphilis of the labyrinth (SL) from 7112 patients who had visited the Neurotological Clinic of the Toyama Medical and Pharmaceutical University Hospital during 1979-1998. Clinical features were characterized as follows: (1) Since 1990, the proportion of elderly patients increased as lifespans lengthened. (2) A narrow fluctuation in hearing, low positive rate on glycerol test, high positive rate of dominant-SP in EcochG, and the moderate abnormal rate of the oculomotor system tests were found. (3) The prognosis was relatively good. From these neurotological observations, it could be concluded that elderly patients with endolymphatic hydrops disorders were characterized by the multipathological finding of the endolymphatic hydrops and the complications of CNS disorders.

Effects on growth of rat offspring born from dams treated subcutaneously with a surfactant, polyoxyethylene(10)nonylphenyl ether(NP-10), during lactational period

A surfactant NP-10 was administered subcutaneously to Jcl:Wistar female rats at dose levels of 5, 20 and 80 mg/kg/day from date of birth to day 21 after birth of F1 offspring to assess its effects on the growth, behavior and functions of the offspring. For F0 dams, scab formation and loss of hair at the test substance administration site were observed in all treatment groups and induration of the skin at the test substance administration site in the 20 and 80 mg/kg groups in general condition and necropsy findings at the end of the dosing period. In necropsy findings, in addition to these changes, hemorrhage and whitish change of the subcutis at the test substance administration site were seen in all treatment groups, adhesion to the somatic muscles and granulation of the subcutis at the test substance administration site in the 20 and 80 mg/kg groups, and swelling of the spleen and adrenals in the 80 mg/kg group. Reduction or a tendency for reduction in food consumption was also detected from the initial day of dosing (day 0) to day 17 after birth F1 offspring in the 80 mg/kg group. Body weight or the findings on the day after birth and day of weaning failed to reveal any evidence of an effect that could be ascribed to the test substance. In F1 born offspring, a decrease or tendency for decrease in body weight was observed from day 7 after birth in both sexes and for females during the gestation period in the 80 mg/kg group. However, body weight gains based on the weights at 4 weeks after birth or on day 0 of gestation in the 80 mg/kg group failed to reveal any difference from that in the control group. The observation on the day of birth and during the period of lactation, physical development test, reflex test, general condition, open-field test, water-maze test, reproductive ability test, observations at cesarean section, necropsy findings, organ weights, histopathological findings of females or males that did not achieve successful gestation, skeletal examination, and the observations at cesarean section and external examination of F2 fetuses failed to reveal any evidence that could be ascribed to the test substance. These results indicate that NP-10 had no effect on the behavior or functions of the offspring, although it affected the growth of the offspring born, under the conditions of this study. The non-effective dose level is considered to be 20 mg/kg for general toxicity of the dams and for their offspring.

Effects on reproduction and fetal development of female rats treated subcutaneously with a surfactant, polyoxyethylene(10)nonylphenyl ether(NP-10), for 15 weeks

A surfactant NP-10 was administered subcutaneously to 7-week-old Jcl:Wistar female rats at dose levels of 2 and 20 mg/kg/day for 15 weeks to assess its effects on their reproductive ability and fetal development, and on the growth, behavior and functions of the offspring they delivered. In the general condition of the F0 dams, changes that were considered to be the local irritation effect of the test substance, such as scab formation and loss of hair at the test substance administration site in the 2 and 20 mg/kg groups and induration of the skin at the test substance administration site in the 20 mg/kg group were observed. Whitish changes of the subcutis were detected at the test substance administration site in the 2 and 20 mg/kg groups and adhesion of abdominal organs in the 20 mg/kg group in the necropsy findings. In addition, an increase was observed in body weight and in food consumption in the 20 mg/kg group. The reproductive ability test failed to reveal any evidence of an effect that could be ascribed to the test substance. The observations at cesarean section or external, visceral and skeletal examinations revealed no effects attributable to the test substance in the F1 fetuses. The observations on the day of birth and during the period of lactation, external examination, physical development test, general condition, body weight and necropsy findings for F1 and F2 offspring and reflex test, open-field test, water-maze test, organ weight and reproductive ability test performed on the F1 offspring failed to reveal any evidence that could be ascribed to the test substance. These results indicate that under the conditions of this study, NP-10 had no effect on the reproductive ability of females or the fetal development or growth, behavior and functions of their offspring.

A study on development of a home health care support information system

As the need for home health care has been increasing with the rising number of the elderly in Japan, the application of medical informatics to home health care delivery is considered to be useful. Therefore, development of a home health care support information system was planned. The system can collect patient's PHD (Personal Health Data) such as data of ECG, complaints, etc. at patient's home and can send the PHD to medical facilities. We designed and constructed two subsystems on a trial basis. One subsystem has function of gathering, recording and transmitting vital signs of the aged such as ECG, physical activity rate, oxygen saturation rate in arterial blood. Another subsystem can collect and send image data of the old people at their home. Experiments for trial use of the system was conducted and it was recognized that the PHD can be smoothly collected and recorded at home of the elderly and can be sent to the medical facilities with good success by using the system.

Apoptosis in the lens anlage of the heritable lens aplastic mouse (lap mouse)

Adult homozygous lap mice show various eye abnormalities, such as aphakia, retinal disorganization, and dysplasia of the cornea and anterior chamber. In the fetal eye of a homozygous lap mouse, the lens placode seems to develop normally. However, the lens vesicle progresses abnormally to form a mass of cells without a cavity, and the mass vanishes soon afterward. We examined cell death in the lens anlage of this mutant. The lens anlagen of homozygous lap and normal mice from days 10 to 12 of gestation were observed by light microscopy after DNA end-labeling by immunohistochemistry and by transmission electron microscopy. By light microscopy, a slight frequency of cell death was detected in the lens anlage encircling the surface ectoderm and in the anlage or in the anlage of both homozygous lap mice and normal mice at day 10 of gestation. Cell death was seen in the lens anlage encircling the surface ectoderm in the normal mouse and sporadically in the anlage of the homozygous lap mouse at day 10.5 of gestation. Cell death was visible at the area of the lens vesicle attached to the surface ectoderm and encircling the surrounding surface ectoderm in the normal mouse, and in the lens anlage encircling the surface ectoderm and the apex areas of the lens anlage in the homozygous lap mouse at day 11 of gestation. At day 12 of gestation, almost no cell death was observed in the lens anlage of the normal mouse. However, extensive areas of cell death were still seen in the lens anlage at its apex, at the inner region, and encircling the surface ectoderm in the homozygous lap mouse. Electron microscopic observation showed that the dead cells observed in the lens anlagen by light microscopy in normal and lap mice are the result of apoptosis. In lap mice, cells with cytoplasmic condensation were observed mainly at days 10 and 10.5 of gestation. Many apoptotic bodies which had been phagocytosed by adjacent cells were seen predominantly at day 11 of gestation. At day 12 of gestation, apoptotic bodies phagocytosed by adjacent cells, which were seen at day 11, were still predominant, but there were more apoptotic bodies per cell and more digested apoptotic bodies than at day 11. These results indicate that cell death, resulting from apoptosis is involved in the disappearance of the lens anlage of lap mice.

[Clinical study of acute supraglottitis as a disease entity]

Adult supraglottitis is an acute inflammation of the supraglottic structures first reported by Shapiro et al. While multiple anatomical sites in the larynx and oropharynx are inflamed, the epiglottis is not always the most involved area. In this paper, we refer to "adult supraglottitis" as "acute supraglottitis" because pediatric supraglottitis is rare in Japan. There have been no reports of acute supraglottitis in Japan to date. We report a clinical study of 15 cases of acute supraglottitis. In addition, we investigated whether acute supraglottitis can be recognized as a special form of acute laryngitis, the same as epiglottitis. Thirteen of 15 patients had severe sore throat or pain on swallowing. Oropharyngeal and laryngeal examinations revealed that the most involved area in the oropharynx and larynx was the aryepiglottic folds and the arytenoids. Five patients with edema extending from the aryepiglottic folds to the arytenoids complained of referred otalgia on swallowing. Strep. Pyogenes, Strep, pneumoniae, alpha-strep., and Staph aureus were isolated from the oropharynx. All patients were hospitalized because of severe presenting symptoms. Treatment consisted of intravenous antibiotics, including piperacillin, clindamycin, flomoxef, aspoxicillin, and cefotiam. Nine patients also received intravenous steroids. Signs and symptoms of supraglottitis resolved within 10 days in every case. No patient required airway intervention. Acute supraglottitis manifested more severe clinical symptoms than acute laryngitis. the local inflammatory findings of this disease were different from those of acute laryngitis and epiglottitis. therefore, we propose that acute supraglottitis is a special form of acute laryngitis.

Clinical study of the role of melanocytes in the inner ear of patients with Harada's disease

Harada's disease is an autoimmune disorder involving melanocytes. Twenty patients with Harada's disease underwent otoneurological examination to investigate the inner ear involvement in Harada's disease and the function of the melanocytes in the inner ear. All 20 exhibited clinical and/or laboratory abnormal inner ear findings. The incidence of inner ear involvement in Harada's disease is very high. The melanocytes in the inner ear play important roles in both auditory and equilibrium function.

Surgical techniques for insertion of a multi-electrode implant into a postmeningitic ossified cochlea

Severe ossification within the cochlea occurs in more than 20% of children deafened by meningitis. A multi-electrode cochlear implant can dramatically restore useful hearing to such children, providing it can be inserted satisfactorily within the cochlea. Various surgical techniques for cochlear implantation into an ossifying cochlea are discussed. Partial ossification often can be negotiated by clearing the new bone from the scala tympani or by inserting the array through the scala vestibuli. Total ossification is not a contraindication to the use of a multi-electrode cochlear implant. A method of drilling out the basal cochlear turn without removal of the overlying promontory is proposed. The results of "inlay" insertion into a totally ossified cochlea are evaluated in five ears.

Lens aplasia: a new mutation producing lens abnormality in the mouse

One female with bilaterally closed eyelids was observed in a breeding colony of BALB/c mice in our laboratories. This eye abnormality was considered to be heritable because offspring with the same abnormality were produced from the mating of this female with a normal male littermate. From the results of various crosses made to determine the mode of inheritance, this abnormality is considered to be attributable to a mutation on a single autosomal recessive gene. Histologic observations of 30-day-old and adult mutant mice revealed various eye abnormalities such as microphthalmia, aphakia, absence of the anterior chamber, dystrophy of the cornea and vitreous body, and retinal disorganization. Observations of fetal eye development from days 9 to 17 of gestation, indicated that the eye developed normally until the start of invagination of the lens placode at day 10. However, formation of the lens vesicle progressed abnormally to form a mass of cells without a cavity at day 11; this mass was reduced in size at day 12 and had vanished by day 13 or 14 of gestation. Also abnormal development was observed in the cornea, vitreous body, or retina after day 12 of gestation. Complementary mating between mice homozygous for this mutation and homozygous aphakia mice, which have similar modes of inheritance and lens development, produced no F1 newborns with abnormal eyes. From these results, the present mutation is considered to be a new one. Because lens development in this mutant is disrupted at an early stage and the anlage vanishes soon after, we propose the name lens aplasia, with the suggested symbol "lap."(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of a cold front upon the onset of Meniére's disease in Toyama, Japan

In order to clarify the influence of a cold front (CF) upon the onset of Meniére's disease (MD), major CFs were defined by meteorological observations, and the influence of CFs on MD was evaluated by using the time n method. From our preliminary study it was seen that the onset of MD had its highest incidence exactly on days where a CF passed by. Out of the patients with MD, sudden deafness (SD) and Bell's palsy (BP) who visited our neurotological clinic of the Toyama Medical and Pharmaceutical University from 1987 to 1992, 67 MD patients, 70 SD patients and 70 BP patients could clearly define the date of the onset of their disease, and were therefore selected for this epidemiological study. Thirty-six our of the 67 MD patients had the first attack on the day when a CF passed by or on the next day. The results obtained from these studies were as follows. i) The onset of MD was influenced by the passing of a CF, and this influence was more specific in MD than in SD or BP. ii) In the 36 CF influence MD patients, the majority were over the forty years, and their hearing level was worse than that of the other 31 MD patients during the observation periods.

[A case of tuberculous anal fistulae complicated by pulmonary tuberculous]

Tuberculous involvement of the anus is very rare at present as the result of BCG-Vaccination and improvement of public health. We report a juvenile case of tuberculous anal fistulae complicated to pulmonary tuberculosis. A 22-year-old male was admitted with symptoms of 13 month- history of intermittent anal pain, low grade fever and cough. Chest X-ray showed bilateral middle zone infiltrates with cavitation. Perianal inspection revealed a large ulcer with purulent exudate and a few fistulae. Sputum smears showed acid fast bacilli. A biopsied specimen of perianal fistulae showed granulomatous lesions with central necrosis, epitheloid cells and multi-nucleated giant cells. With three-drug antituberculous regimen, his symptoms resolved, radiographic infiltrates improved, and the perianal fistulae were cured. It was speculated that the tuberculous anal fistulae in this case were caused by the dissemination from the pulmonary focus via the hematogeneous and lymphogeneous routes, because any tuberculous lesion was not detected in the gastrointestinal tract and rectum.

A case of Behçet's disease with otologic symptoms

Behçet's disease is generally known as an autoimmune disease. We report a case of Behçet's disease who had fluctuating hearing loss, tinnitus and dizziness. A 37-year-old woman had bilateral hearing loss in low audiometric frequencies. Audiological and vestibular examinations revealed an inner ear lesion. The patient had an enlarged negative summation potential in the electrocochleogram and a positive glycerol test, which suggested endolymphatic hydrops. The pathological characteristic of Behçet's disease is thought to be vasculitis. So this case suggests an association of autoimmune vasculitis with endolymphatic hydrops.

Electrocochleography in profoundly deaf children: comparison of promontory and round window techniques

It is important to be able to accurately assess residual cochlear function in profoundly deaf children. Profound hearing loss in children requires special consideration, because the choice between a cochlear implant and a hearing aid depends on accurate estimation of the residual hearing. Previous reports confirm that promontory (needle) electrocochleography (ECochG) is useful for evaluation of residual hearing in severely deaf children, but there were some limitations in assessing the lower audiometric frequencies and for assessing profound hearing loss. It is argued that accurate placement of a round window electrode (RW ECochG) provides better recordings. Round window ECochG testing is performed under general anesthesia in young children and gives an opportunity for inspection of the middle ear using an endoscope. This report describes a special "golf club" electrode that can be placed under direct vision into the round window niche, minimizing the risks of damaging an abnormal round window while providing the optimum extracochlear recordings. Round window ECochG gives better responses, especially in lower audiometric frequencies, than conventional promontory ECochG. In the Sydney children's cochlear implant program, RW ECochG has become an essential preoperative test.

Vitrectomy for diabetic macular heterotopia

PURPOSE

The authors performed 15 vitrectomies for diabetic macular heterotopia, and then compared visual prognoses and postoperative complications with those of 88 macular detachments to determine the role of, and indications for, vitrectomy for diabetic macular heterotopia.

METHODS

Fifteen patients with diabetic macular heterotopia and 88 with traction macular detachment, in which the vitreous cavities were sufficiently clear for posterior poles to be observed, underwent vitrectomies. Preoperative and postoperative visual acuity and postoperative complications were assessed and documented retrospectively.

RESULTS

There was no statistically significant difference between the two groups in terms of eyes showing improvement in visual acuity postoperatively. However, a final postoperative visual acuity better than 20/20 was documented in 93% of patients with macular heterotopia and 48% of patients with macular detachment (P < 0.002), whereas 47% of the former and 10% of the latter had visual acuities better than 20/40 (P < 0.001). Postoperative neovascular glaucoma and retinal detachment developed in 10% and 13%, respectively, of patients with macular detachments. None of the patients with macular heterotopia experienced these complications.

CONCLUSION

Based on the above results, the authors conclude that diabetic macular heterotopia is a very good indication for early vitrectomy.

Perilymphatic fistula with no visible leak of fluid into the middle ear: a new method of intraoperative diagnosis using electrocochleography

A new method for the intraoperative diagnosis of a perilymphatic fistula is presented. Two cases are reported in which the test clearly indicated the presence of a fistula even though no visible leak of fluid was noted by the surgeon. In each case, there was a clear history of vertigo and hearing loss. Preoperatively, the presence of a perilymphatic fistula was suggested using raised intrathoracic pressure test in electrocochleography (ECochG). During the surgery, there was no visible leak of fluid into the middle ear. Electrocochleography was undertaken intraoperatively by placing an electrode in the round window niche and suctioning the oval window area; in neither case was any ECochG change seen. Next the electrode was repositioned on the oval window and when the round window area was suctioned, obvious ECochG changes occurred. Action potential (AP) amplitude dramatically decreased in both cases and summating potential (SP) increased in one case.

Electrocochleography in the diagnosis of delayed endolymphatic hydrops

It is known that delayed endolymphatic hydrops (DEH) occurs in patients with unilateral and/or bilateral profound hearing loss. In the ipsilateral and bilateral types of DEH, no audiological tests can be performed on the affected ear because of profound deafness, although these tests can be done in the contralateral type. Electrocochleography (ECochG) was recorded on better hearing ears in both types of DEH. The results showed an increased negative summating potential (SP) in 6 out of 10 contralateral DEH patients whereas it could be measured in only one of 10 ipsilateral DEH patients. The mean SP/AP ratio of the contralateral type was 0.42 which was significantly larger than that of the ipsilateral type. The results suggest that contralateral-type DEH has the same pathology in the cochlea as Meniere's disease, and that ECochG can distinguish between these two types of DEH.

Changes in auditory evoked responses during intravenous lidocaine

Auditory evoked responses in 21 cases with tinnitus were recorded before and after the administration of intravenous lidocaine. A dosage of 1 mg/kg body weight was diluted with 20% glucose (20 ml) and administered intravenously over a one-min period. The loudness of tinnitus was evaluated during electrocochleography (ECochG) or auditory brain-stem response (ABR) recordings using a score between 0 and 11. The stimulus sound was a tone burst in a frequency that corresponded to the pitch of tinnitus. AP latency on ECochG and the inter peak latency (IPL) of wave I-III and wave III-V on ABR were prolonged momentarily and tinnitus was reduced. These findings reveal that the sites of action for lidocaine are both the inner ear and the brain-stem.

Electrocochleography in syphilitic hearing loss

Syphilitic labyrinthitis presents such symptoms as hearing loss, tinnitus, vertigo and/or dizziness, and is well known as one of the endolymphatic hydropic diseases. In order to elucidate the relationship between syphilitic hydrops and ECochG findings, we performed ECochG in patients with syphilis following our previously reported study of patients with Meniere's disease. Twenty-two patients who have been serologically and clinically diagnosed as having syphilitic labyrinthitis were examined with ECochG between December, 1982 and November, 1991. Of the 27 ears tested with ECochG, 2 showed no response due to severe hearing loss, and increased SP (SP/AP ratio > 0.37) was observed in 14 (56.0%) out of the remaining 25 ears. The SP/AP ratio of patients with syphilitic labyrinthitis was not significantly different from that of the patients with Meniere's disease or delayed endolymphatic hydrops, while it was significantly higher than that of the patients with sudden deafness and other types of sensorineural hearing loss. We conclude that the electrocochleographic features of endolymphatic syphilitic lesions resemble those in Meniere's disease.

Vestibular nerve disorder in patients suffering from sudden deafness with vertigo and/or vestibular dysfunction

Vestibular nerve disorder (VND) in cases suffering from sudden deafness with vertigo was studied. Between 1987 and 1991, we observed 46 patients suffering from sudden deafness with or without vertigo, who had undergone the caloric test and galvanic body sway test (GBST). Twenty-seven patients had vertigo and canal paresis (CP) upon the caloric test, 6 vertigo without CP and 13 CP without vertigo. VND was detected in 12 of the 46 patients. All those with VND had vertigo and CP upon the caloric test, 12/27 (44%). The degree of hearing loss in those with VND was significantly (p < 0.05) more severe and their recovery of hearing loss was poorer than in patients without VND. These results indicate that VND is a common finding in cases of sudden deafness with vertigo especially in those with severe hearing loss.

Result of decompression surgery in late-stage severe facial paralysis

We investigated the usefulness of decompression surgery in the treatment of the facial nerve in 23 patients with severe complete facial paralysis regardless of etiology. All patients were followed up for at least one year after onset. Nine patients underwent decompression surgery within a month of onset (Group A), 10 underwent surgery at a later time (Group B), and 4 did not receive surgery (Group C). In Group A, 2 patients showed satisfactory recovery and 2 fair recovery. In Group B, 4 patients showed satisfactory outcome, and one patient who underwent surgery 131 days after onset showed fair outcome. No patient in Group C showed satisfactory or fair recovery. There were no significant differences among the three groups in the percentage showing sequelae after treatment. We conclude that decompression surgery is indicated even for patients with severe facial paralysis who have a history of palsy of 2 months' or more duration.

The intravenously administered glycerol test

Three different methods of performing the glycerol dehydration test were evaluated. Method one involved the oral administration of 50 g of 50% glycerol solution; method two was the intravenous administration of 500 ml of 10% glycerol in saline with 5% fructose; and method three involved the administration of 200 ml of the same solution. It was found that intravenous administration was safe and did not give any unpleasant side effects. Both intravenously administered methods appeared to give similar rates of positive diagnosis for Menière's disease.

Furosemide VOR test for the detection of endolymphatic hydrops

In order to detect endolymphatic hydrops, we applied three neuro-otologic examination methods, including the furosemide VOR test, the glycerol dehydration test, and electrocochleography in 61 patients with unilateral Menière's disease, 21 patients with delayed endolymphatic hydrops, and 10 patients with syphilitic labyrinthitis. The positive rate of the furosemide VOR test in patients with endolymphatic hydrops was more than 50%. Inconsistencies were observed between the results of the furosemide VOR test, the glycerol test and/or electrocochleography. Therefore, combined test battery of these tests is useful clinically for detecting endolymphatic hydrops in the vestibular and cochlear systems.

Clinical significance of the galvanic body sway test in cerebellopontine angle tumors

Since 1984, we have been modifying a new method of recording fine body sway elicited by low current stimuli of less than 0.4 mA, and of quantitatively evaluating the responses by Fourier transform. In order to easily and early detect acoustic tumors, we have applied a test battery consisting ABR, caloric test and galvanic body sway test (GBST) to 31 cases with acoustic neurinoma, to 5 cases with other CPA-tumors, and to 24 cases suspected of having CPA tumors. Of 27 cases with acoustic neurinoma on whom the GBST was performed, 25 cases (92.6%) shows abnormal responses. On the other hand, the ABR was abnormal in all cases, except for one case in the early stage of an ear tumor. However, the ABR was positive in 12 cases out of 24 with suspected findings without tumor, but the GBST was positive in only 3 cases out of 17 tested. Moreover, 26 cases (83.9%) with acoustic tumors showed abnormal CP in their first caloric tests. Comparing these observations with the results of image diagnosis, we conclude that the GBST is as useful for detecting small acoustic neurinomas as the ABR and the carloric test. Therefore, we have routinely used a test battery consisting ABR, caloric test and GBST for evaluation of acoustic neurinomas. However, we could not differentiate between acoustic neurinoma and CPA-tumor by using the three-test battery.

[Reproductive and developmental toxicity study of prednisolone farnesylate (PNF)--teratogenicity study in rabbits by subcutaneous administration]

The effect of Prednisolone farnesylate (PNF), a newly synthesized corticosteroid, on fetal development of the rabbit was studied. PNF was administered subcutaneously at dose levels of 0(control), 0.01, 0.05 and 0.25 mg/kg/day during the fetal organogenesis period. In the pregnant animals, PNF caused no abnormalities in clinical sign, body weight gain, food consumption, or autopsy findings at 0.01 and 0.05 mg/kg/day groups; the animals at 0.25 mg/kg/day group showed a reduction in body weight gain and food consumption. Two of 13 animals at 0.25 mg/kg/day group aborted. And hydrothorax, mucosal hemorrhage of the stomach, or fading of the liver were observed in some animals. In the fetuses, PNF was observed no abnormalities in external, visceral, or skeletal examination; slight increase of embryofetal mortality, or reduction of live fetal body weight and placental weight were observed at 0.25 mg/kg/day. The results suggest that the non-effective dose level of PNF is 0.05 mg/kg/day for pregnant females in general and reproductive toxicity, and for fetuses under the condition of this study.

[Reproductive and developmental toxicity study of suplatast tosilate (IPD-1151T) (1)--Fertility study in rats by oral administration]

The effect of suplatast tosilate (IPD-1151T) on reproductive ability and fetal development of the rat was studied. IPD-1151T was administered orally at dose levels of 0 (control), 200, 600, and 1800 mg/kg/day for the premating, mating and early pregnant period. For parent animals, IPD-1151T caused no abnormalities in clinical signs, reproductive ability, or autopsy findings; the females at 1800 mg/kg/day showed a reduction in body weight gain from one week after the start of administration and a decrease in food consumption from the day of the start of administration to day 6 of pregnancy. For fetuses, IPD-1151T produced no abnormalities in external, visceral or skeletal examinations; embryofetal mortality was increased at 1800 mg/kg/day. The results suggest that the non-effective dose level of IPD-1151T is 1800 mg/kg/day for males and 600 mg/kg/day for females in general toxicity, 1800 mg/kg/day for both sexes in reproductive ability, and 600 mg/kg/day for fetuses under the conditions of this study.

[Reproductive and developmental toxicity study of suplatast tosilate (IPD-1151T) (4)--Perinatal and postnatal study in rats by oral administration]

In order to assess the effect of suplatast tosilate (IPD-1151T) on pregnancy of the rat, and the post natal development to maturity of the F1 generation, daily doses of 0 (control), 200, 600 and 1800 mg/kg/day were administered orally to female Wistar rats from day 17 of pregnancy to day 21 after delivery. All females were allowed to give birth and rear their young to weaning. F0 dams showed no treatment-related changes in general conditions including the state of delivery or nursing, gestation period, birth rate, or autopsy findings. The dams at 1800 mg/kg/day showed a tendency to reduction in body weight gain and a decrease in food consumption. F1 offspring showed no treatment-related changes in clinical signs on the birth day or during the nursing period, external examination on the birth day, general condition, physical or reflex development, open-field test, water multiple T-maze test, autopsy findings, organ weights, skeletal examination, reproductive ability, or histopathological examination on the reproductive organs of the animals of both sexes that failed to produce pregnancy. The offspring at 1800 mg/kg/day showed a reduction or its tendency in body weight gain. There were no treatment-related changes in any of reproductive parameters of F1 dams including external examination of F2 fetuses. The results suggest that the non-effective dose level of IPD-1151T is 600 and 1800 mg/kg/day for F0 dams in general toxicity and reproductive ability, respectively, and 600 mg/kg/day for F1 offspring in post natal development under the conditions of this study.

[Histopathology of retinochoroidal adhesions of diode laser endophotocoagulation lesions in monkey eyes]

Retinochoroidal coagulation effect of 810 nm diode laser was studied using monkey eyes to determine the energy necessary to produce retinochoroidal adhesion safely. Power settings were at 100, 200 and 300 mW. The lesions produced with a power of 100 mW were faint grayish spots. One month after photocoagulation, there was degeneration from the outer granular layer to the superficial choroidal layer. However, chorioretinal adhesion was not obtained due to external limiting membrane formation. The lesions produced with a power of 200 mW were characterized by small whitish spots surrounded by grayish rings and retinochoroidal adhesions were produced by proliferated cells. However choroid were intensely coagulated, and there was a rupture of Bruch's membrane in one lesion. The lesions produced with a power of 300 mW were intense white spots surrounded by grayish rings. Histologically, severe cell loss of the retina was seen and three was no retinochoroidal adhesion. It can be said that it is difficult for 810 nm diode laser to obtain adequate retinochoroidal adhesion safely.

[Retinochoroidal adhesions of diode laser endophotocoagulation lesions. 1. Histopathology of rabbit eyes]

I experimented with a prototype diode laser in order to determine how effective it is for intraocular endophotocoagulation of the retina and how much energy is required to produce chorioretinal adhesions. Retinal endophotocoagulation was performed in all 8 eyes of 4 rabbits. I used power settings at 100-140, 200 and 300 mW and an exposure time of 0.2 seconds. The lesions produced with powers of 100-140 mW were faint whitish spots surrounded by grayish rings. One month after photocoagulation, there were chorioretinal adhesions histologically. The lesions produced with powers of 200-300 mW were characterized by intense whitish spots surrounded by grayish rings and histologically they were over-irradiated ones. One month after photocoagulation, rupture of the internal limiting membrane could be seen in one of the 300 mW lesions. It can be said that the retinal burn which appeared ophthalmoscopically as a faint whitish spot surrounded by a grayish ring may be the most useful to produce chorioretinal adhesion.

A clinical study of electrocochleography in Menière's disease

Electrocochleography (ECochG) of 168 ears with definite Meniere's disease was studied. The results were compared with recordings from 29 normal ears and 444 ears with other types of sensorineural hearing loss. It is shown that the SP/AP ratio is much more useful than SP amplitude for detecting endolymphatic hydrops. There was little difference in the mean values of SP/AP from those proposed by many other investigators; the mean values all being near 0.25. From 0.30 to 0.40 of SP/AP was considered adequate as the upper limit. Following intravenous administration of glycerol, a significant decrease in SP/AP was found in 21 Meniere's ears. However, there was no change of SP/AP after oral administration of glycerol and isosorbide. This difference may be due to the fact that a larger oral than intravenous administration is necessary to affect SP/AP. Although a postoperative decrease of 10% or more in SP/AP was observed in 5 patients, 10 patients followed up for 2 years or more after surgery did not show a statistically significant change of SP/AP and pure tone threshold. ECochG should be repeatedly recorded to be useful as a monitor for the presence of hydrops. It is discussed whether biochemical or mechanical changes in endolymph may cause a decrease in SP/AP after the use of dehydrating agents and endolymphatic sac surgery.

Otoneurological findings in inner ear syphilis

Eighty-one ears in 48 patients who had had ear syphilis for the past ten years were studied and otoneurological examinations reviewed. Twenty-five of 48 cases complained of vertigo, 13 of giddiness and/or unsteadiness, and 10 cases denied dizziness. Approximately one half of the patients had abnormal findings on primary equilibrium examinations, such as Mann's test and stepping test. Spontaneous nystagmus and positional nystagmus were frequently seen on electronystagmographic examinations. Many patients showed abnormal responses to the bithermal caloric test and pendular rotation (VOR) test. Moreover, 5 of 8 patients had positive furosemide VOR tests. On transtympanic electrocochleography, 13 of 22 ears demonstrated a dominant -SP response. Eleven of 26 ears had positive findings on an intravenously administered glycerol test. In conclusion, some cases of inner ear syphilis show the characteristic findings of endolymphatic hydrops.

[Clinical electrocochleography in Menière's disease]

Transtympanic electrocochleography (ECochG) was performed on 137 definite Menière ears, 29 normal ears and 383 ears with other diseases. The average SP/AP amplitude ratio (SP/AP) was significantly larger than that of normal subjects in the following four disease groups whose causes are thought to be endolymphatic hydrops: 1) definite Menière's disease, 2) suspected Menière's disease, 3) delayed endolymphatic hydrops and 4) labyrinthine syphilis. The SP amplitude could not provide any information for a differential diagnosis of endolymphatic hydrops from normal subjects nor from other sensorineural deafness . The upper 99% confidence limit of normal SP/AP using a 100dBSPL click was 0.37 for 29 subjects. In patients with Menière's disease the relationship between SP/AP and clinical data such as pure tone threshold, audiogram pattern, results of glycerol test and duration of illness from the first vertiginous attack to the test were investigated. In patients with severe hearing loss, the number of those showing SP/AP of greater than 0.37 was much higher than in patients with less severe hearing loss. There were no relationship, however, between SP/AP and duration of illness, or audiogram pattern, or glycerol test. ECochG was recorded before and after intravenous administration of 50 gr of glycerol (10% solution, 500ml), and a significant decrease of SP/AP was found in 21 Menière ears. However, there were no change of SP/AP after oral administration of 50 gr of glycerol (50% solution, 100ml) and isosorbide (70% solution, 2.0gr/kg of body weight). After endolymphatic sac surgery a decrease of SP/AP of 10% or more was found in 5 ears, an increase of SP/AP in 3 ears, and no change of SP/AP in 3 ears. In the patients showing no change of SP/AP after the surgery, numerical values of vertigo by AAOHNS were higher than in patients showing an increase or a decrease of SP/AP. The results demonstrate the usefulness of ECochG in diagnosis of endolymphatic hydrops and indicate a possibility of monitoring the state of hydrops after administration of glycerol and endolymphatic sac surgery.

[Study of the antibody to alcohol altered hepatocyte plasma membrane in alcoholic patients]

Significance of the antibody to alcohol altered hepatocyte plasma membrane (AAHM) was studied in various types of alcoholic liver diseases (ALD). AAHM was detected in the sera that were collected within 3 months of alcohol abstinence from patients with various types of ALD, with higher frequency in alcoholic hepatitis and cirrhosis. Serum acetaldehyde, gamma-globulin fraction, immunoglobulin A and G were higher in patients positive for AAHM, though the levels of GOT, GPT, mGOT were indifferent of the existence of AAHM. Histologically, hepatocyte ballooning and pericellular fibrosis were frequently seen in patients positive for AAHM, but close relationship between the extent of necrosis and existence of AAHM was not observed. These findings suggest that the occurrence of AAHM is closely related with the functional and morphological changes of the hepatocyte induced by acetaldehyde but not with hepatocyte necrosis.

Biochemical nature of pyruvate dehydrogenase complex in the patient with primary lactic acidaemia

The biochemical nature of the pyruvate dehydrogenase complex (PDHC) in muscle was studied in a patient with pyruvate dehydrogenase complex deficiency. The enzyme activity was approximately 30% of the control level and the apparent Km value of the enzyme was similar to the control value. The immunoblot pattern of each subunit protein, E1 alpha, E1 beta, the component X, E2 and E3, was comparable to that of the control on both one- and two-dimensional electrophoresis, the staining of each subunit protein being reduced in intensity, corresponding to the reduced enzyme activity. The enzyme deficiency is likely to be quantitative rather than qualitative, although the actual mechanism is unknown.

A nationwide incidence survey of Kawasaki disease in 1985-1986 in Japan

Nationwide epidemiological surveys of Kawasaki disease have been conducted nine times in Japan since 1970. By the end of 1986, 83,857 (male:female ratio, 1.4) cases were reported. We summarize the results of these surveys, especially the latest survey of cases from January 1985 to December 1986. There were three epidemic years - 1979, 1982, and 1986. The ratios of the number of patients diagnosed in each of those years to the number in the preceding year were 2.0, 2.4, and 1.7, respectively. The last epidemic started in a metropolitan area of Tokyo in December 1985 and propagated northwards and southwards to involve almost all of the country in six months. The age-specific incidence curve showed a unimodal peak at nine to 11 months of age. The proportion of sibling cases was approximately 2%. The epidemiological pictures suggested that the disease was caused by an unknown biologic agent that is common in the community and that spreads easily among very young children.