[Analysis of parent-child sleeping and living habits related to later bedtimes in children]

PURPOSE

To find the relationship between parents' sleeping and living behaviors and their children's sleeping habits, and to investigate factors specifically related to children staying up late in recent Japan.

METHODS

During regular health check-ups of children at three local health centers in the city A, we recruited the parents of one-and-half-year-old and three-year-old children to participate in the Child Sleep Cohort Project (ChiSCoP). Parents of 184 children who consented to participation were mailed three questionnaires by placement method. These are "sleeping diary for 10 days," "sleeping and lifetime rhythm survey," and "emotional behavior assessment scale (CBCL : Child Behavior Checklist 2rd/3rd edition)," of which valid data on 178 children were collected over two years and analyzed.

ANALYSIS

Participants' demographic data, perceived and actual sleeping and living habits, and bedtime patterns were compared among the groups classified by bedtime of children. Bedtimes were classified as early (before 21 : 00), normal (21 : 00 to 21 : 59), and late (after 22 : 00). Using one-way analysis of variance with two (early vs. late) and three bedtime categories, significant differences were found among the three bedtime categories about childcare environmental factors (meal, daytime activity, TV, nap, and bath). So we performed logistic regression analysis with "late bedtime" as the dependent variable and scores of environmental factors (upper or lower than median values) as independent variables in a stepwise manner to eliminate collinear variables and to obtain adjusted odds ratios.

RESULTS

1) Among the 178 children, 96 and 82 were recruited during the physical check-up for one-and-half-year-old and three-years-old, respectively. There were 49, 72, and 57 children in the early, normal, and late bedtime groups, respectively, and no significant difference in attribute factors was found. 2) In children of the early bedtime group, proportions of those with "efforts to establish good life rhythm" (P < 0.0001), "efforts to cultivate sleeping habits" (P < 0.0001), and "keeping a regular bedtime" (P < 0.05) were significantly higher, as well as for children who had more than 105 minutes of "daytime nap" compared to children who had less (P < 0.05). 3) Children's bedtimes were significantly correlated with "mother's wake-up time on weekdays" (r = 0.33) and "mother's bedtime on weekdays" (r = 0.33). Children's wake-up times were also correlated with "mother's wake-up time on weekdays and weekends" (r = 0.49) and "mother's bedtime on weekdays" (r = 0.34), which indicates that children's wake-up times had relationship with mother's sleeping and life habits. 4) Later "wake-up time on weekends" (odds ratio = 4.9) and "regular bedtime hour" (odds ratio = 3.53) were found to be the determinant of late bedtimes of children.

CONCLUSIONS

To encourage earlier bedtimes in children, it is important to take he mother's sleeping and living habits into account and to maintain a regular wake-up and bedtime schedule across weekdays and weekends.

[Analysis of late bedtime and influencing factors for it with respect to infants' development age and sleep behavior of parents and children]

PURPOSE

To understand influencing factors for late bedtime of infants having nocturnal life, with respect to each development age and sleep behavior of parents and children. We researched on sleep-awake behaviors and ten-day sleep logs of 277 subjects, who registered for a three-year cohort survey. The cohort is recruited at the time of routine examinations for 4 month, 1.5 years, and 3 years, held at three Health and Welfare centers in Fukuoka city in September and October, 2007. We conducted two-way analysis of variance and post-hoc test of Turkey's multiple comparative tests. The independent variables are three age groups (infants, 1.5 years, and 3 years) and three bedtime categories (late: after 22 o'clock, normal: between 21 and 22 o'clock, and early: before 21 o'clock), and the dependent variables are background date, sleep parameter of parents and children, and factors of sleep behavior and so on. The qualitative data including physical conditions, growth status, frequencies of each life activity are analyzed by tabulation, and fulfillment in child raring is analyzed by stepwise multiple linear regression analysis with 15 objective variables, to bring out factors to induce nocturnal life.

RESULTS

Children's bedtime had significant effect for bedtime variables. The bedtime difference was about 40 minutes between the early bedtime group and the late bedtime group. The early bedtime group had the earliest wake-up time among the all age groups, followed by the normal, and then the late bedtime group. Efforts to keep regular sleep and wake-up times were made greatly in the early bedtime group, and the normal and then the late bedtime group followed after. The mothers in the late bedtime group considened an ideal bedtime was around 21h although they were not able to realize it. The lengths of TV viewing and daytime nap had also significant effects for children's bedtimes. As a result of multiple comparisons, there were significant differences between the early and the late bedtime groups and between the normal and the late bedtime groups. For the bedtime of children, only mothers' total sleep hours on weekdays had a significant negative correlation, while all the other parameters were significantly and positively correlated.

DISCUSSION

The study showed influencing factors for bedtime of children were mothers' routine duties in daily life, especially wake-up time, total sleep hours, daytime napping hours of children, and the length of TV viewing. This suggests that further effort on education for sleep environment management is needed.

The manual zero potential shifting method in dipole analysis: comparison with neuroimagings in a patient with epilepsy

We previously introduced the manual zero potential shifting (MZPS) method into dipole analysis to reduce the influence by error potential at the analytical stage. The source localizations of epileptic spikes as an equivalent current dipole (ECD) were estimated in a patient with symptomatic epilepsy and contrasted with findings obtained by magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT). When spikes were analyzed by the MZPS method, ECDs had high values of dipolarity, an indicator of ECD reliability. Moreover, their locations corresponded with lesions shown by MRI and SPECT. When the same spikes were analyzed by the conventional method, dipolarity values were declined and the locations did not correspond with lesions. These results provide further evidence that the MZPS method is of clinical utility in evaluating the electric source generator of epileptic spikes.

Effect of normal aging upon interhemispheric EEG coherence: analysis during rest and photic stimulation

The present study was conducted to examine and compare interhemispheric EEG coherence at rest and during photic stimulation (PS; 5, 10 and 15 Hz) in 30 younger subjects aged 22.1 +/- 2.2 (mean +/- S.D.) and 25 elderly subjects aged 56.8 +/- 4.9. The elderly subjects had significantly lower coherence in the resting EEG for the delta, theta, alpha-3, beta-1 and beta-2 frequency bands. In contrast, EEG analysis during PS showed that elderly subjects had significantly higher coherence in the frequency corresponding to PS at 15 Hz. In addition, when we examined the changes in coherence from the resting state to the stimulus condition (i.e., coherence reactivity), elderly subjects had significantly higher coherence reactivity to PS at 15 Hz. These findings suggest a low interhemispheric functional connectivity in elderly subjects under non stimulus conditions and a high connectivity during photic stimulus.

Aberrant functional organization in schizophrenia: analysis of EEG coherence during rest and photic stimulation in drug-naive patients

EEG coherence provides a measure of functional correlations between two EEG signals. The present study was conducted to examine intrahemispheric EEG coherence at rest and during photic stimulation (PS) in 18 drug-naive patients with paranoid schizophrenia and 30 control subjects. Compared with the controls, the schizophrenic patients had significantly higher intrahemispheric coherence of the resting EEG for the delta band, although no significant group differences were found for other frequency bands. EEG analysis during PS showed that the patients also had significantly higher EEG coherence over the left posterior regions. In this study, we also examined the changes in intrahemispheric coherence from rest to the stimulus condition (i.e., PS-related coherence reactivity); the patients were found to show significantly smaller changes, with significant group differences being also confined to the posterior regions in the left hemisphere. These findings provide evidence that schizophrenic patients have abnormal EEG coherence in both resting and stimulus conditions and suggest more diffuse, undifferentiated functional organization within hemispheres. In addition, diminished coherence reactivity suggests a failure of PS-related functional reorganization in schizophrenia.

Effects of scopolamine on interhemispheric EEG coherence in healthy subjects: analysis during rest and photic stimulation

The present study of coherence analysis, in 16 healthy male volunteers, aged 24-31 years, showed that the administration of 0.25 mg of scopolamine significantly reduced interhemispheric coherence in the delta and beta-1 bands in the resting state. Scopolamine also caused a significant increase both in EEG coherence during PS and in PS-related coherence reactivity in the beta band. In addition, this compound significantly reduced total WMS scores. These findings suggest that, in addition to causing cognitive impairments, central cholinergic dysfunction can alter interhemispheric functional connectivity under both nonstimulus and stimulus conditions.

EEG changes following scopolamine administration in healthy subjects. Quantitative analysis during rest and photic stimulation

This study examined the effects of the anticholinergic drug, scopolamine (0.25 mg) in 16 right-handed healthy volunteers. EEGs were recorded before and 60 min after intramuscular administration, and spectral analysis was performed on EEGs recorded at rest and during photic stimulation. Each subject was also evaluated by the Wechsler Memory Scale (WMS; form 1 or 2) before and 90 min after drug administration. In the resting EEG, the scopolamine administration resulted in a significant increase in the absolute power on the delta band (2.0- 3.8 Hz) and in the relative power on the delta and theta-1 bands (4.0-5.8 Hz) mainly over the central and parieto-occipital regions. In contrast, scopolamine significantly decreased the relative alpha-2 band (9.2-12.8 Hz) power mainly over the frontal regions and the absolute alpha-2 band power at most of the recording sites. The analysis of stimulus data showed that scopolamine significantly decreased fundamental photic driving responses elicited by photic stimulation at 15 Hz, with significant effects confined to the occipital regions. These EEG changes occurred in association with a significant reduction in total WMS scores as well as in scores of logical and visual memory subtests. These findings suggest that, in addition to cognitive impairments, central cholinergic dysfunction can cause EEG changes under both nonstimulus and stimulus conditions.

Abnormal functional connectivity in Alzheimer's disease: intrahemispheric EEG coherence during rest and photic stimulation

Electroencephalography (EEG) coherence provides a measure of functional correlations between two EEG signals. The present study was conducted to examine intrahemispheric EEG coherence at rest and during photic stimulation (PS; 5, 10 and 15 Hz) in ten unmedicated patients with presenile dementia of the Alzheimer type (AD; mean age at onset 56 years). In the resting EEG, the AD patients had significantly lower coherence than gender- and age-matched control subjects in the alpha-1, alpha-2 and beta-1 frequency bands. The EEG analysis during PS also showed that the patients had significantly lower coherence in the frequency corresponding to PS at 10 and 15 Hz. In this study, the changes in coherence from the resting state to the stimulus condition (i.e. PS-related coherence reactivity) were examined. The patients were found to show significantly smaller coherence reactivity to PS at 5 and 15 Hz. These findings suggest that, in addition to the resting state, AD patients have an impairment of intrahemispheric functional connectivity during PS. They also suggest that AD shows a failure of PS-related functional reorganization.

Role of substance P in increased airway hypersensitivity following induced stress in a guinea pig asthma model

Stress is one of the important factors influencing bronchial asthma, but many questions still remain unanswered. To clarify this point we examined airway hypersensitivity before and after electric shock stress and the role of substance P in an animal model of asthma. We determined airway hypersensitivity to histamine and the substance P levels in serum, bronchoalveolar lavage fluid, and bronchial tissue before and after electric shock stress in biphasic asthma-responsive guinea pigs which had been sensitized using ovalbumin. The cell components in bronchoalveolar lavage fluid were also examined. Airway hypersensitivity to histamine (4.9-156 micrograms/ml) was significantly increased (p < 0.01) by electric shock stress. The substance P level was also significantly increased in plasma and bronchoalveolar lavage fluid, but it was significantly decreased in bronchial tissue. The number of eosinophils in bronchoalveolar lavage fluid increased significantly after electric shock stress. These findings demonstrated that airway hypersensitivity to histamine was increased by stress and suggested that substance P, as well as eosinophils, contribute to the pathogenesis of hypersensitivity.

Interhemispheric EEG coherence in never-medicated patients with paranoid schizophrenia: analysis at rest and during photic stimulation

We assessed functional relationships between hemispheres by calculating interhemispheric EEG coherence at rest and during photic stimulation in 18 never-medicated patients with paranoid schizophrenia and 30 control subjects. Although no significant group differences were found in the resting EEG, the schizophrenic patients had significantly higher coherence on EEGs recorded during photic stimulation, compared to the control subjects. In this study, we also examined the changes in interhemispheric coherence from rest to the stimulus condition (i.e., stimulation-related coherence reactivity); the patients were found to show significantly greater coherence reactivity to photic stimulation. These findings provide further evidence that schizophrenic patients have a higher degree of interhemispheric functional connectivity and thus have less lateralized cerebral organization than normal subjects. Our results also suggest that schizophrenic patients have excessive functional reorganization between hemispheres in association with photic stimulation.

Dipole analysis of epileptic source generator with manual zero potential shifting method

The dipole tracing method is a technique whereby an electric source generator is estimated as an equivalent current dipole (ECD) based on potential distribution on the scalp. To estimate the electric source generator of low amplitude spikes, a manual zero potential shifting (MZPS) method was introduced in which a zero potential is set manually in dipole analysis. The subjects were three patients with localization-related epilepsy with temporal spikes. When low-amplitude spikes (< 50 microV) were analyzed by the conventional mean zero potential method, the dipolarity, an indicator of ECD reliability, had a low value and its locations were scattered. In contrast, when these low-amplitude spikes were analyzed by the MZPS method, ECD showed a high dipolarity value comparable to that obtained when high-amplitude spikes (> or = 50 microV) were analyzed by the mean zero potential method. Furthermore, the locations of the former ECD tended to converge and were almost identical to those of the latter ECD. These findings suggest the usefulness of the MZPS method in dipole analysis in terms of the dipolarity and ECD locations of low-amplitude spikes.

Reduced interhemispheric EEG coherence in Alzheimer disease: analysis during rest and photic stimulation

The present study was conducted to examine interhemispheric electroencephalogram (EEG) coherence at rest and during photic stimulation (5, 10, and 15 Hz) in 10 patients with presenile dementia of the Alzheimer type (AD; mean age at onset, 56 years) and 10 sex- and age-matched control subjects. Compared with the control subjects, the AD patients had significantly lower interhemispheric coherence in the resting EEG for the delta, theta-2, alpha, and beta-1 frequency bands. EEG analysis during photic stimulation also showed that the patients had significantly lower coherence, irrespective of the stimulus frequency. In addition, when we examined the changes in coherence from the resting state to the stimulus condition (i.e., coherence reactivity), significant group differences were found at the brain region primarily involved in visual functioning; the patients had significantly smaller coherence reactivity to photic stimulation at 5 and 15 Hz over the posterior regions. These findings suggest that AD patients have an impairment of interhemispheric functional connectivity in both nonstimulus and stimulus conditions. The findings also suggest a failure of normal stimulation-related brain activation in AD.

[Topographic analysis of resting EEG and photic driving responses in patients with presenile Alzheimer's disease]

Topographic analysis of the resting EEG was performed in nine patients with presenile Alzheimer's disease(AD) and nine sex- and age-matched normal subjects. We also analyzed EEG activity recorded during photic stimulation(5, 10 and 15 Hz) to evaluate photic driving responses. The square root of absolute power was determined for each frequency band using a Fast Fourier Transform. Compared with the controls, the AD patients had increased delta and theta in the resting EEG mainly over the frontal regions. The patients also had reduced alpha and beta, and did not show posterior predominance of alpha activity. EEG analysis during photic stimulation showed that the patients had a reduction in photic driving responses, and significant topographic differences were found over the parieto-occipital regions. These findings provide further evidence that AD patients have background EEG slowing with a reduction in alpha and fast activity. They also suggest an impairment of visual functioning in AD.

Electroencephalographic abnormalities in patients with presenile dementia of the Alzheimer type: quantitative analysis at rest and during photic stimulation

In the present study, quantitative electroencephalographic (EEG) analysis was performed at rest and during photic stimulation (5, 10, and 15 Hz) in nine patients with presenile dementia of the Alzheimer type (AD; mean age at onset, 55 years) and nine sex- and age-matched control subjects. Compared with the normal controls, the AD patients had a significantly lower alpha-2 and beta band power in the resting EEG as well as a significant increase in delta and theta band power. EEG analysis during the photic stimulation demonstrated that the AD patients had a significantly lower EEG power during photic stimulation for the alpha (9.8-10.2 Hz) and beta bands (14.8-15.2 Hz) corresponding to photic stimulation at 10 Hz and 15 Hz, respectively. In addition, when we examined EEG changes from rest to the stimulus condition, the AD patients were found to show significantly smaller changes in EEG power mainly over the posterior regions, irrespective of the stimulus frequency. These findings provide evidence that AD patients have EEG abnormalities in both non-stimulus and stimulus conditions, and suggest diminished EEG reactivity to photic stimulation.

Interhemispheric EEG coherence during photic stimulation: sex differences in normal young adults

The present study was conducted to examine sex differences in interhemispheric EEG coherence in 15 male and 15 female healthy young adults. EEG was recorded during rest and photic stimulation (PS) at 5, 10 and 15 Hz using a linked earlobe reference. Interhemispheric coherence of the resting EEG revealed no significant sex-related differences for any frequency band. In contrast, significant sex-related differences were found in EEG coherence during PS; the females had a significantly higher coherence than the males for F3-F4 and C3-C4 in the frequency band (4.5-5.5 Hz) corresponding to 5 Hz PS. In addition, the changes in interhemispheric coherence from rest to the stimulus condition (i.e. PS-related coherence reactivity) showed sex-related differences at the brain region primarily involved in visual functioning; the females had significantly greater coherence reactivity for O1-O2 in EEG during PS at 5 and 15 Hz. These findings indicate sex-related differences in interhemispheric EEG coherence during PS, and support the well-demonstrated evidence that sex differences exist in the degree of lateralization of cerebral function.

Inter- and intrahemispheric EEG coherence during light drowsiness

The present study was conducted to examine inter- and intrahemispheric EEG coherence in 14 healthy, right-handed adults during wakefulness and light drowsiness as assessed by eye movement and EEG activity. Interhemispheric coherence was significantly lower during light drowsiness than during wakefulness for O1-O2 in the alpha-1 band and for F3-F4 in the beta-1 band. Intrahemispheric EEG coherence was significantly higher during light drowsiness for C4-O2 in the theta-1 and beta-1 bands. These findings indicate that light drowsiness can alter both inter- and intrahemispheric EEG coherence when compared with wakefulness, suggesting that cerebral functional organization changes during light drowsiness. It is important, therefore, to control arousal level of subjects in future studies dealing with the relationship between EEG coherence and various pathological conditions.

[Pryce type I intralobar pulmonary sequestration]

A 53-year-old woman had a abnormal shadow in the left lower lung field on a chest radiograph, and occasional bloody sputum. CT scans and an MRI showed an abnormal vessel shadow between the aorta and the heart. An aortogram showed an abnormal artery originating from the descending aorta and entering the left lower lobe, and a pulmonary angiogram revealed no blood supply to the left basal segments. Pryce type I pulmonary sequestration was diagnosed. The patient underwent surgery, and the abnormal artery, 13 mm in diameter, was found to be connected from the descending aorta to the left lower lobe. The abnormal artery was dissected, and the left lower lobe was removed. The postoperative course was uneventful. We collected data on 24 cases of Pryce type I pulmonary sequestration reported in Japan. Such cases are comparatively rare and males are affected more often than females. The patient in the present case was the oldest woman to have undergone surgery for this condition in Japan. In patients who underwent surgery the greatest diameter of the abnormal artery was 18 mm.

[Sex-related differences in EEG coherence in normal young adults--evaluation during rest and photic stimulation]

EEG coherence is a noninvasive technique for studying functional relationships between brain regions. Although EEG coherence would be a useful method to explore the differences in cerebral functional organization between the sexes, sex differences in coherence have not been well documented. The present study was conducted therefore to examine sex differences in interhemispheric EEG coherence during rest and photic stimulation (PS) in 15 male and 15 female healthy young adults. Interhemispheric coherence of the resting EEG revealed no significant sex differences for any frequency band. In contrast, coherence during PS revealed significant sex differences, and the females had a significantly higher coherence than the males in the frequency band (4.5-5.5Hz) corresponding to 5Hz PS. In addition, the changes in interhemispheric coherence from rest to the stimulus condition (i.e., coherence reactivity) showed sex differences at the brain region primarily involved in visual functioning; the females had significantly greater coherence reactivity for O1-O2 in EEG during PS at 5 and 15Hz. These findings indicate sex differences in interhemispheric EEG coherence during PS, and provide further evidence that sex-related differences exist in the degree of lateralization of hemispheric function.

Biochemical and topological analysis of adult T-cell leukaemia-derived factor, homologous to thioredoxin, in the pregnant human uterus

Adult T-cell leukaemia-derived factor (ADF), homologous to thioredoxin, displays various biological activities, such as radical scavenging action and the reduction of protein disulphide bonds. We examined the biochemical and immunohistochemical localization of ADF in the pregnant human uterus, using two heteroantibodies to ADF, antibody C and W. Immunohistochemically, decidua and trophoblast cells were intensely stained by antibody C. The concentration of ADF-like substance in the decidua was 95.9 ng/mg protein, determined by enzyme-linked immunosorbent assay. The molecular weight of ADF-like substance in these tissues was determined by gel electrophoresis to be 13 kDa, the same as that of recombinant ADF. These findings indicate that abundant ADF is present in decidua and trophoblast cells; the localization of such a potent dithiol reducing substance may be beneficial in protecting the fertilized egg and placental trophoblasts from the cytotoxic effects of oxygen radicals.

Immunohistochemical localization of heat shock proteins HSP70 and HSP90 in the human endometrium: correlation with sex steroid receptors and Ki-67 antigen expression

Heat shock proteins of 72 kDa and 90 kDa (HSP70, HSP90) have been suggested to be involved in the functional modulation of sex steroid receptors. We examined the immunohistochemical localization of HSP70 and HSP90 in both the functionalis and basalis layers of normal human endometrium during various phases of the menstrual cycle. Topological correlation with localization of estrogen receptors (ER), progesterone receptors (PR), and proliferation-related Ki-67 antigen was also analyzed. HSP70 was expressed in glandular cells of the basalis but not in the cells of the functionalis during the proliferative phase. In the secretory phase, however, glandular cells of both the basalis and functionalis markedly expressed HSP70. Endometrial stromal cells at the basal layer were positive for HSP70, whereas those cells in the functional layer were negative for HSP70 throughout the menstrual cycle. The topological expression of HSP70 in glandular and stromal cells of the basalis was inversely related to Ki-67 localization. Overexpression of HSP70 in the secretory glands was associated with down-regulation of ER and PR. These findings suggest that HSP70 expression is related to either hormonal regulation of cell proliferation and/or down-regulation of sex steroid receptors. HSP90 was strongly expressed in both glandular and stromal cells during the proliferative phase of the menstrual cycle; in the secretory phase, HSP90 expression was weak in both types of the cells. However, no topological difference in HSP90 expression between the basalis and the functionalis was observed.

[Effect of inhaled steroid on bone metabolism in the treatment of bronchial asthma]

In order to clarify the effects of longterm inhaled steroid therapy on bone metabolism, we examined 72 patients with bronchial asthma treated mainly with BDP (beclomethasone dipropionate). Multiple scanning X-ray photodensitometry was used to evaluate the degree of bone mineral loss. Osteocalcin, alkaline phosphatase (total and type III) was measured as a marker of bone synthesis and urinary pyridinoline, and deoxy-pyridinoline was measured as a marker of bone resorption. There was age related bone mineral loss. Urinary pyridinoline increased with aging. Treatment related bone mineral loss was not observed either in cases treated with BDP or in cases treated with continual oral steroids. Urinary pyridinoline and deoxy-pyridinoline decreased in patients treated with larger doses of for longer periods with BDP. Serum osteocalcin levels were lower in patients on continual oral corticosteroids. We conclude that inhaled steroid do not deteriorate bone metabolism in patients with bronchial asthma, when used appropriately.

[A study on the dosage of carboplatin for bronchial arterial infusion in combination with radiation therapy]

Radiation therapy holds an important position as one of the multidisciplinary methods of treating lung cancer (non-small cell carcinoma). As a result of the development of platinum preparations such as cisplatin (CDDP) and wide use of digital subtraction angiography (DSA), selective bronchial arterial infusion (BAI) therapy made possible more effective use of anti-lung cancer drugs. The use of radiation therapy in combination with BAI is now recommended as a more effective method. Meanwhile carboplatin (CBDCA) has recently been developed as a second generation platinum preparation with less side effects, and is being used for BAI, too. However, the maximum tolerated dose (MTD) of CB DCA for BAI to be used in combination with radiation therapy is not known yet. We, therefore, carried out a phase-study to determine MTD of CBD CA for combination with radiation therapy. The results show that the MTD of CBDCA is 400 mg/m2, and that clinically recommendable infusion limit is 350 mg/m2. In an angiographic study performed at the same time, a plural number of tumor affected blood vessels were found in 81.3% of the patients with lung cancer. Therefore, infusion of a drug for such patients should be carefully applied.

Expression of c-erbB-2 protein and epidermal growth receptor in endometrial carcinomas. Correlation with clinicopathologic and sex steroid receptor status

BACKGROUND

The c-erbB-2 (HER-2/neu) protein is a membrane glycoprotein growth factor receptor showing molecular homology with the epidermal growth factor receptor (EGFR). In endometrial carcinomas, little is known about the relationship between the expression of c-erbB-2 protein and that of EGFR.

METHODS

The immunohistochemical reactivity of monoclonal antibodies against both of these proteins was examined in 34 endometrial carcinomas, and the presence or absence of correlation with the clinicopathologic features or with the immunohistochemical expression of sex steroid receptors (estrogen receptor [ER] and progesterone receptor [PR]) was analyzed.

RESULTS

Of the 34 patients, 22 (64.7%) had c-erbB-2 protein-positive and EGFR-negative tumor, and 8 (23.5%) had tumor positivity for both proteins. Four patients had tumors negative for both proteins. ER or PR positivity was found in 24 (70.6%) of the 34 patients. Intense immunostaining for c-erbB-2 protein was found in 5 (14.7%) of the 34 patients but was not correlated with the stage or grade of differentiation in endometrial carcinoma. However, expression of EGFR in addition to c-erbB-2 protein was more frequently observed with advancing stage of disease and was inversely correlated with the grade of differentiation and with the expression of ER or PR of the tumor.

CONCLUSION

The expression of EGFR, in addition to that of c-erbB-2 protein, is an important event that presumably is linked with progression or with a poorly differentiated state of endometrial carcinomas.

[A case of hypersensitivity pneumonitis in Pholiota nameko's manufacturer]

A 58-year-old female was admitted to our hospital because of fever and dyspnea on exertion. She has been working in the factory making Pholiota nameko for 8 years. Her chest X-ray revealed diffuse linear and fine nodular shadows in both lower lung fields. Hypoxemia was seen on blood gas analysis. Bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) were performed. Differential cell count of the BAL fluid showed lymphocytosis and CD4/8 was decreased. TBLB specimens revealed bronchioloalveolitis. Precipitins against Trichosporon cutaneum were detected by Ouchterlony method. These findings are compatible with hypersensitivity pneumonitis, and Trichosporon cutaneum may have been causative antigen in this case. Trichosporon cutaneum is often detected in the Japanese summer-type hypersensitivity pneumonitis. This case suggests that Trichosporon cutaneum is one cause of hypersensitivity pneumonitis in workers at factories making Pholiota nameko.

Immunohistochemical localization of c-erbB-2 protein and epidermal growth factor receptor in normal surface epithelium, surface inclusion cysts, and common epithelial tumours of the ovary

The c-erbB-2 (HER-2/neu) protein is a membrane glycoprotein growth factor receptor showing molecular homology with the epidermal growth factor receptor (EGFR). We examined the immunohistochemical reactivity of monoclonal antibodies against both of these proteins in normal surface epithelium, surface inclusion cysts, and common epithelial tumours of the ovary. The ovarian tumours were classified as benign (16), borderline malignant (2), and malignant (19). Normal surface ovarian epithelium was weakly positive for both c-erbB-2 protein and EGFR. In surface inclusion cysts, however, the epithelial cells lining the lumen exhibited stronger staining for c-erbB-2 protein, but no staining for EGFR. All 16 benign ovarian tumours and the 2 borderline malignant ovarian tumours were positive for c-erbB-2 protein and negative for EGFR. Of the ovarian carcinomas, 13 of the 19 (68.4%) were positive for c-erbB-2 protein and negative for EGFR, while 4 showed positivity for both c-erbB-2 protein and EGFR. Two cases were negative for both proteins. Expression of both c-erbB-2 protein and EGFR was found in endometrioid carcinoma with squamous differentiation and in clinically advanced poorly differentiated serous carcinomas. Expression of c-erbB-2 protein appears to be increased and that of EGFR is reduced in the early stage of epithelial ovarian oncogenesis. The expression of EGFR with c-erbB-2 protein in ovarian carcinoma is related both to histological differentiation and/or advanced clinical stage.

Expression of c-erbB-2 protein and epidermal growth factor receptor in normal tissues of the female genital tract and in the placenta

The c-erbB-2 (HER-2/neu) protein is a membrane glycoprotein growth factor receptor that has molecular homology with the epidermal growth factor receptor (EGFR). To investigate the relationship between the expression of c-erbB-2 protein and EGFR in the tissues of the human female genital tract and in the placenta, we examined the immunohistochemical reactivity of monoclonal antibodies against both of these proteins. In the müllerian-derived genital tract, epithelial cells of the fallopian tube, endometrium, and endocervix showed reactivity for c-erbB-2 protein, whereas reactivity for EGFR was distributed mainly in the stromal cells throughout the menstrual cycle and during pregnancy. In addition, the staining intensity for EGFR in the endometrial stroma increased with its decidualization. In the exocervical squamous epithelium, basal cells were c-erbB-2 protein-negative and EGFR-positive, but the more differentiated squamous cells of the intermediate layer were c-erbB-2 protein-positive and EGFR-negative. In the placental tissues, cytotrophoblasts and syncytiotrophoblasts of the chorionic villi were c-erbB-2 protein-negative and EGFR-positive. In contrast, intermediate trophoblasts in the extravillous space were c-erbB-2 protein-positive and EGFR-negative. Thus, there is an inverse relationship between the expression of c-erbB-2 protein and EGFR in the tissues of the female genital tract and in the placenta. This suggests that there may be a regulatory mechanism(s) for the expression of both proteins that is associated with the differentiation and/or function of cells in the female genital tract and the placenta.

Expression of adult T-cell leukaemia-derived factor, a human thioredoxin homologue, in the human ovary throughout the menstrual cycle

An immunohistochemical study of the expression of adult T-cell leukaemia-derived factor (ADF), a human thioredoxin homologue, was performed in the normal human ovary throughout the menstrual cycle. Primordial follicles were negative for ADF. Both granulosa cells and theca interna cells at the stages of preantral and antral follicles contained ADF. The staining intensity of these cells was very strong in the preovulatory dominant follicle. After ovulation, both granulo-lutein and theca-lutein cells were positive for ADF. During pregnancy, the theca-lutein cells revealed very intense ADF staining. The theca interna cells of the atretic follicles showed ADF staining, while the granulosa cells of such follicles did not. These results suggest that ADF localizes in the ovarian steroidogenic cells which have the binding sites of either luteinizing hormone or follicle-stimulating hormone, and that ADF expression is closely associated with the activity of the ovarian steroidogenic cells.

Expression and growth-promoting effect of adult T-cell leukemia-derived factor. A human thioredoxin homologue in hepatocellular carcinoma

Adult T-cell leukemia-derived factor (ADF), originally defined as an interleukin-2 receptor inducer, is a human thioredoxin homologue. ADF is detected in many malignant tissues and has a growth-promoting effect on transformed cells. In this study, ADF expression was examined immunohistochemically in human liver cell lines and liver tissues, and its growth-promoting effect was tested on human hepatoma cells. On three liver cell line--PLC/PRF/5, HepG2, and Chang liver cells--ADF stained positively and also was detected by immunoblotting. ADF had strong staining in the fetal liver (n = 8), although it was faint in the normal adult liver (n = 6). In hepatocellular carcinoma (n = 25), ADF expression generally was enhanced and was very strong in 52% (13 of 25) of the cases, although it was moderate in cases of chronic hepatitis or cirrhosis. ADF augmented the growth of PLC/PRF/5 cells and showed an additive effect with epidermal growth factor. These results indicate possible involvement of ADF in cell activation and growth of hepatocytes, as is the case with lymphocytes.

Serial changes of serum CA125 levels during menstrual cycles

Serial changes of serum CA125 levels during 32 menstrual cycles were examined in 32 healthy young women (19-21 years of age) charting basal body temperature (BBT) and measuring serum estradiol and progesterone levels. Analysis of BBT charts and serum progesterone levels revealed that the 32 menstrual cycles could be classified into either an ovulatory cycle with a sustained BBT temperature increase for at least 10 days (type I: 9 cycles), an ovulatory cycle with a sustained BBT temperature increase for less than 10 days (type II: 17 cycles), or anovulation (type III: 6 cycles). All 32 cycles exhibited basal CA125 levels of less than 35 u/ml throughout the cycle, except during the period of menstruation. At menstruation, 7 of the 9 cycles of type I showed a marked, transient elevation of CA125 levels from previous basal levels (a mean net increase). On the other hand, 12 of 17 cycles of type II showed only a slight elevation of CA125 levels during the period of menstruation. None of the 6 cycles of type III showed any apparent increase in CA125 levels during the period of menstruation. The mean net increase of CA125 levels during the period of menstruation in the cycles of type I was significantly higher than that of the cycles of type II (p less than 0.05) and type III (p less than 0.05). These results imply that a transient elevation of serum CA125 levels during the period of menstruation occurs in cycles with ovulation, and the levels of elevation seem to be closely associated with the duration of the sustained BBT temperature increase.

An extraordinarily high CA 125 level in a woman without apparent pathologic foci of CA 125 production: dissociation between serum levels of CA 125 and CA 130

We describe a patient with high serum CA 125 levels before and after surgery (greater than 403 U/ml) who had no apparent pathologic foci of CA 125 production. Serum levels of CA 130, which exists on the same glycoprotein as CA 125, were within normal ranges (less than 35 U/ml) before and after surgery.

Coexpression of adult T-cell leukemia-derived factor, a human thioredoxin homologue, and human papillomavirus DNA in neoplastic cervical squamous epithelium

Adult T-cell leukemia-derived factor (ADF) is an autocrine interleukin-2 receptor-inducing factor produced by human T-lymphotropic virus-1 (HTLV-1)-transformed lymphocytes, which has a high structural homology with an endogenous dithiol reducing coenzyme, thioredoxin. Its localization was investigated immunohistochemically in the cervix, using normal tissue (27 samples) and squamous neoplastic tissue (three condylomas, 42 cervical intraepithelial neoplasia [CIN] samples, 34 invasive squamous cell carcinoma samples). The expression of human papillomavirus (HPV) DNA was also studied in serial sections of the same subjects. Normal squamous cells and glandular cells of the cervix were negative for ADF. However, intracytoplasmic and/or intranuclear ADF-positive cells were usually found in the intermediate and superficial layers of the neoplastic squamous epithelium of condylomas (three of three cases) and CIN (35/42 cases). HPV DNA was detected in all condylomas and in 27 of 42 CIN specimens. HPV DNA-positive cells were usually localized in the intermediate and superficial layers of the neoplastic squamous epithelium. These HPV DNA-positive cells were also positive for ADF. Invasive squamous cell carcinoma was also positive for ADF (24/34 cases) and HPV DNA (11/34 cases). The coexpression of HPV DNA and ADF was observed in all HPV DNA-positive cases. Coexistence of HPV DNA and ADF immunopositivity in neoplastic squamous cells of the cervix suggests that ADF expression closely reflects the intracellular event on HPV DNA replication.

Effect of human chorionic gonadotropin on the expression of progesterone receptors and estrogen receptors in rabbit ovarian granulosa cells and the uterus

To investigate whether LH/human CG (hCG) or progesterone acts as a regulator of estrogen receptors (ER) and progesterone receptors (PR) in granulosa cells, we studied the immunohistochemical expression of both ER and PR in the ovary and the uterus of mature rabbits, during the induction of ovulation by FSH followed by administration of hCG, progesterone, or a progesterone antagonist (RU486) and hCG. Granulosa cells pretreated with FSH for 3 days showed ER staining, but negligible PR staining. The staining pattern for ER and PR changed in animals pretreated with FSH followed by hCG injection; by 6 h after hCG injection, we observed the disappearance of ER and the appearance of PR, and by 3 days after hCG injection, we observed the reappearance of ER and the disappearance of PR. However, the expression of ER and PR in the granulosa cells of animals pretreated with FSH followed by progesterone administration instead of hCG was almost the same as that of animals pretreated with FSH alone. In addition, the expression of ER and PR in the granulosa cells of animals pretreated with FSH followed by RU486 and hCG was almost the same as that of animals pretreated with FSH followed by hCG administration. The uterine glandular epithelium, in contrast, began to show decreased appearance of ER and PR by 48 h after hCG injection, and we observed the disappearance of both receptors by 3 days after hCG administration. These results suggest that the expression of ER and PR in granulosa cells is not regulated by the action of progesterone, but by that of LH/hCG.

Immunohistochemical analysis of estrogen receptors, progesterone receptors, Ki-67 antigen, and human papillomavirus DNA in normal and neoplastic epithelium of the uterine cervix

To investigate the relationship between the sex steroid receptor (estrogen receptor [ER] and progesterone receptor [PR]) status and the cell proliferation kinetics during the menstrual cycle in normal and neoplastic epithelium of the uterine cervix, immunohistochemical localization of ER, PR, and cell proliferation-associated antigen, Ki-67, was investigated in 35 normal cervical specimens, 3 condylomas, 26 cervical intraepithelial neoplasia (CIN) samples, and 22 invasive squamous carcinoma samples. The presence of human papillomavirus (HPV) DNA was also studied. In the normal cervix, basal cells were usually ER positive, PR negative, and Ki-67 negative throughout the menstrual cycle. Parabasal cells were ER positive and PR negative in the follicular phase, but ER negative and PR positive, and Ki-67 positive in the luteal phase, and Ki-67-positive cells increased in number in the luteal phase. In contrast, PR positivity was observed in the cells of condyloma (2 of 2 cases), CIN (19 of 26 cases), and invasive squamous carcinoma (13 of 22 cases) irrespective of the menstrual phase. Moreover, most neoplastic cells containing HPV DNA type 16/18 were ER negative, whereas several lesions containing HPV DNA type 31/33/35 were weakly ER positive. Many Ki-67-labeled cells were observed in the neoplastic lesions. These results suggest that reduced ER expression and increased PR expression are associated with the proliferation of normal cervical squamous epithelium, and this proliferation-related receptor status, which is probably induced by HPV infection, is usually expressed in neoplastic cervical squamous cells.

Immunohistochemical analysis of oestrogen receptors, progesterone receptors and Ki-67 in leiomyoma and myometrium during the menstrual cycle and pregnancy

Immunohistochemical distribution of oestrogen receptors (ER), progesterone receptors (PR), and the cell proliferation-associated antigen Ki-67 was investigated in leiomyomas and the myometrium during the menstrual cycle and pregnancy. In the myometrium, ER expression was observed in the proliferative phase, but was suppressed in the secretory phase and during pregnancy. In leiomyomas, ER expression was observed throughout the menstrual cycle, but was suppressed during pregnancy. However, PR was expressed both in the myometrium and leiomyomas throughout the menstrual cycle and pregnancy. In both the myometrium and leiomyomas, a higher number of Ki-67-positive cells was observed during pregnancy than in the secretory phase, and Ki-67 was negative during menopause. The Ki-67-positive cell count in leiomyomas was significantly higher than that in the myometrium throughout the menstrual cycle and pregnancy. Thus both myometrium and leiomyomas have high growth activity under the hormonal milieu of high progesterone levels. The growth potential of leiomyomas is apparently higher than that of myometrium throughout the menstrual cycle and during pregnancy.

Immunohistochemical localization of adult T-cell leukaemia-derived factor, a human thioredoxin homologue, in human fetal tissues

An immunohistochemical study of the expression of adult T-cell leukaemia-derived factor (ADF), a human thioredoxin homologue, was performed using a rabbit antibody against the C-terminal peptides of ADF. Tissues were obtained from human fetuses between 9 and 23 weeks of gestation. It was revealed that ADF was widely distributed in different organs and tissues during the fetal period. The ADF antibody reacted selectively with medullary cells of the thymus, lung epithelium, the epithelium of the digestive tract, hepatocytes, bladder epithelium, peripheral nerve cells, hair follicles, sebaceous glands, osteoblasts and the proximal tubules of the kidney. It also reacted with cells destined to differentiate into ciliated cells in the fallopian tube and efferent ductules of the testis, interstitial cells in the ovary, Leydig cells of the testis, and dendritic cells in the spleen and lymph nodes. This is the first report on the thioredoxin system in human cells during the early fetal period. The selectivity of ADF staining in fetal tissues suggests that, during early fetal life, ADF expression correlates well with the cellular function of certain tissues.

[Clinico-pathological study of cervical carcinoma with massive infiltration of eosinophils]

Eight patients with cervical carcinoma with massive stromal infiltration of eosinophils were selected for a clinicopathological study among 474 patients with cervical carcinoma at stages Ib-IIIb who underwent radical hysterectomy between 1971 and 1989 at Kyoto University Hospital. The 8 patients ranged in age from 28 to 48 years and had menstrual cycles. The peripheral leucocyte count in 5 patients showed eosinophilia of the peripheral blood. Histologically, the cervical carcinoma was a locally advanced tumor with invasion of more than 2/3rds the depth of the cervical wall in 6 cases, and with parametrial involvement in 4 cases. Massive infiltration of eosinophils was observed not only around the cancer nests but also within the regional lymph nodes. Mast cells expressing immunoreactivity for histamine were scarce around the tumor. Consequently, the production of an eosinophil chemotactic factor by the tumor cells was strongly suggested. PAS and Alcian-blue staining as well as electron microscopy revealed that the tumor cells in most cases had the histological characteristics of both squamous carcinoma and adenocarcinoma. Collectively, these clinicopathological characteristics of cervical carcinoma with massive infiltration of eosinophils distinguish this tumor from conventional cervical carcinomas.

Estrogen receptor localization in normal and neoplastic epithelium of the uterine cervix

To investigate the estrogen receptor (ER) status of cells during carcinogenesis of the uterine cervix, the immunohistochemical reactivity for a monoclonal anti-ER antibody (H 222) was studied in 26 normal cervical specimens, 21 cases of cervical intraepithelial neoplasia (CIN), and 21 cases of invasive cervical carcinoma. In addition, the presence of human papillomavirus (HPV) DNA (types 6/11, 16/18, or 31/33/35) was analyzed by in situ hybridization. In the normal cervix, basal cells of the squamous epithelium, metaplastic cells, and endocervical glandular cells were ER positive. In contrast, neoplastic cells of CIN (17 of 21 cases) and invasive carcinoma (19 of 21 cases) were ER negative. The remaining four cases of CIN and two cases of invasive carcinoma were focally ER positive. The HPV DNA analysis revealed that HPV DNA in ER-negative cases was either types 16/18 or undetectable, but all ER-positive neoplasms contained HPV DNA types 31/33/35. These results suggest that most neoplastic cells in CIN and invasive cervical carcinoma lose their ER expression and that this may be related to the HPV DNA types which they possess.

Immunohistochemical localization of CA130 in fetal tissues, and in normal and neoplastic tissues of the female genital tract

A murine monoclonal antibody, 130-22, produced against a human lung adenocarcinoma cell line (PC-9) has been suggested as recognizing an antigenic determinant (CA130) which is different from an epitope recognized by OC125 on CA125 glycoprotein molecules. The immunohistochemical reactivity with the 130-22 antibody (anti-CA130) was examined in human fetal tissues, and normal and neoplastic tissues of female genital tracts, and compared to those using OC125. Among the fetal tissues, the amnion and the cells of coelomic epithelium and mullerian-derived epithelia reacted with anti-CA130. In normal adult tissues, cervical and endometrial gland cells, tubal epithelial cells, and ovarian surface cells reacted with anti-CA130. In addition, predecidual cells in the late secretory endometrium and decidual cells during gestation were positive. Among the neoplastic tissues, tubal and endometrial adenocarcinomas and epithelial ovarian tumors were positive for anti-CA130. There were no differences in the respective specimens between the immunohistochemical localization of anti-CA130 and of OC125. Therefore, anti-CA130 is considered to be useful in the immunohistochemical detection of CA125 glycoprotein molecules as well as OC125.

Immunohistochemical localization of oestrogen receptors and progesterone receptors in the human ovary throughout the menstrual cycle

Immunohistochemistry was used to determine the distribution of oestrogen receptors (ER) and progesterone receptors (PR) in the human ovary during folliculogenesis. Primordial and preantral follicles did not contain ER or PR. The granulosa cells of antral follicles had ER, but negligible PR, before the LH surge. In contrast, at the time of LH surge, these cells of the dominant follicle contained PR, but not ER. On the other hand, granulosa cells of the non-dominant follicles had ER, but not PR. After ovulation, the PR persisted in the luteinized granulosa cells and in the corpus luteum during early pregnancy. The theca interna and surrounding stromal cells were ER-negative and PR-positive throughout the menstrual cycle. Thus, the results show that ER and PR are not expressed simultaneously in the granulosa cells, the thecal cells, or the stromal cells during folliculogenesis. Mechanisms controlling the expression of steroid receptors during the normal menstrual cycle and in early pregnancy are discussed.

[A case of acute lupus pneumonitis followed by high-resolution CT]

A 43-year-old woman was admitted to our hospital because of fever and dyspnea. She had facial rash, hair-loss, arthralgia, urinary casts, thrombocytopenia, lymphocytopenia, and deposits of IgG, IgM, C3 in the epidermis. SLE was diagnosed. She also had severe dyspnea, which gradually progressed. In spite of steroid pulse therapy and cyclophosphamide, she eventually died about two months after admission. Chest X-ray film showed bilateral ground-glass shadow and volume-loss. High-resolution CT of the lung showed marked high density area with airbronchogram in the posterior part and a gradually enlarging slight high density area in the anterior area. Pathological findings of the posterior area were atelectasis and dense fibrosis. The findings of the anterior area were collapsed alveoli and dilated alveolar ducts. These findings might suggest that alveolar collapse play a major role in the course of pulmonary fibrosis of this patient.

[Bronchiectasis with normal paranasal sinus roentgenogram]

Bronchiectasis has come to be considered as a type of sinobronchial syndrome in Japan, but there exist some cases without chronic sinusitis. We studied the clinical features of 14 cases of bronchiectasis with definitely normal paranasal sinus roentgenogram, diagnosed during the past ten years. There were eleven middle-aged women and three men. Ten patients (71%) complained of hemoptysis, one (7%) of dry cough, one (7%) of productive cough, and the two (14%) had no complaint. In seven patients (50%) CT and bronchography showed localized cylindrical bronchiectasis in the right middle lobe and/or left upper lobe lingular division. They were considered to be middle lobe lingular syndrome. Three patients (22%) with localized varicose or cystic bronchiectasis had a history of pneumonia or pertussis in their infancy, so their bronchiectasis were considered secondary to infantile bronchopulmonary disease. Two patients (14%) had diffuse cystic bronchiectasis and were almost asymptomatic. They might be cases congenital bronchiectasis or Williams-Campbell syndrome. Pulmonary function tests were normal in most of the cases and sputum culture revealed no cases of persistent bacterial infection. These clinical features are quite different from those of bronchiectasis reported as sinobronchial syndrome, in which chronic productive cough, poor pulmonary function, persistent bacterial infection, etc. are significant. So we conclude that there are two distinct groups in bronchiectasis.

[Levels of CA130 in maternal sera and amniotic fluid at various gestational ages]

We examined the CA130 concentration in the amniotic fluid, maternal sera, amnion, chorion, decidua and placenta. CA130 in the maternal sera showed an initial increase during early pregnancy, remained low from the 15th weeks of pregnancy until delivery, and then increased after term delivery (249u/ml, mean, n = 27) or mid-trimester abortions (844u/ml, n = 22). The CA130, concentration in the amniotic fluid was high in the mid-trimester and remarkably low at term. Among the tissues examined, amnion and decidua contained a relatively high concentration of CA130. Immunohistochemical examination also demonstrated abundant CA130 in the cytosol of amnion and decidua tissues. The pattern of changes in CA130 in amniotic fluid was similar to that in the amnion and decidua tissue. The results suggest that the amnion cells are the source of CA130 in the amniotic fluid and that the high concentration of CA130 in maternal serum after delivery originates in decidua tissue affected by the separation of the placenta.

[A case of desquamative interstitial pneumonia (DIP) suggesting a relationship to chronic eosinophilic pneumonia (CEP)]

A 43-year-old man was admitted to our hospital because of cough and dyspnea. His chest X-ray showed bilateral basal infiltrative shadows. The increased eosinophils in BAL suggested chronic eosinophilic pneumonia (CEP), whereas the TBLB specimens showed findings compatible with desquamative interstitial pneumonia (DIP). The open lung biopsy specimens showed typical findings of DIP with a peripheral zone, suggestive of CEP. These two diseases may be only phasal differences of reaction to the same extrinsic stimulation.

Primary ovarian malignant amelanotic melanoma arising in cystic teratoma

A case of primary ovarian malignant amelanotic melanoma arising in a cystic teratoma is presented with the histology, immunohistochemistry, and ultrastructure of the tumor.

Mucin leakage into the cervical stroma may increase lymph node metastasis in mucin-producing cervical adenocarcinomas

The relationships between the histologic feature of mucin leakage into the cervical stroma, lymph node metastasis, and the levels of serum carcinoembryonic antigen (CEA), CA 19-9, and CA 125 were analyzed in 35 cases of cervical adenocarcinoma. Histologically, mucin leakage was identified in 14 (40%) cases as amorphorous materials dissecting the connective tissues and permeating the lymphatic channels, associated with or without cancer cells. The cases with mucin leakage showed a significantly higher incidence of lymph node involvement than those without mucin leakage (71.4% versus 23.8%; P less than 0.01). In addition, when the mucin leakage was immunohistochemically positive for CEA or CA 19-9, elevated serum levels of these antigens were frequently observed. These results suggest that the mucin leakage into the cervical stroma represents not only stromal invasion, but also a means that frequently conducts cancer cells into the lymphatic channels. Clinically, this is reflected in an elevation of serum CEA or CA 19-9 levels in cervical adenocarcinoma patients.

Construction of an immunoradiometric assay for ovarian cancer associated antigen CA125 recognizing different antigenic determinant

We generated five murine monoclonal antibodies reactive with ovarian cancer-associated antigen CA125. These monoclonal antibodies seemed to bind to separate epitopes from OC125 antibody, known to recognize CA125. A series of immunoradiometric assays for measuring serum CA125 values rapidly and sensitively were devised using these monoclonal antibodies. The antigenic determinant of a new immunoradiometric assay was different from that of a currently used CA125 kit employing OC125 both as a catcher and a tracer. However, serum antigen levels were closely correlated to each other and were elevated not only in patients with ovarian cancer, but also in patients with endometriosis and in some normal females during menstruation. These results suggest that CA125 has at least two antigenic determinants close to each other and this new rapid assay is useful, although not specific for ovarian cancer, in patients with gynecological disorders.

CA 125 in the epithelium closely related to the embryonic ectoderm: the periderm and the amnion

The amnion is believed to be derived from either cytotrophoblastic cells or embryonic ectoderm. However, it produces and secretes CA 125, which is considered a differentiation antigen of fetal coelomic epithelium derived from the mesoderm of germ cells. To verify this, the immunohistochemical localization of CA 125 in human fetal tissues (between 7 and 23 weeks of gestation) derived from the ectoderm, endoderm, or mesoderm, and in the fetal membranes and placenta was studied. Among the mesoderm-derived tissues, only the fetal coelomic epithelium-related tissues were positive for anti-CA 125 from 15 weeks of gestation. The endoderm-derived tissues did not react with anti-CA 125. However, among the ectoderm-derived tissues, only the periderm reacted with anti-CA 125 from 7 weeks until it sloughed from the stratum intermedium by 23 weeks of gestation. Among the fetal membranes and placenta, only the amnion reacted with anti-CA 125 from 9 weeks to term. These findings indicate that the amnion and the periderm, both of which constitute the epithelia covering the amniotic cavity, in addition to the fetal coelomic epithelium-related tissues, produce CA 125.

Immunohistochemical localization and tissue levels of tumor-associated glycoproteins CA 125 and CA 19-9 in the decidua and fetal membranes at various gestational ages

To investigate the sources and biologic significance of CA 125 and CA 19-9 in amniotic fluid, immunohistochemical and biochemical localization of these tumor-associated glycoproteins in the decidua and fetal membranes was studied. Immunohistochemically, CA 125 and CA 19-9 were localized in the cytoplasm of decidua cells and amnion epithelial cells but not in the chorion and placental tissue. Biochemically, the 12,000 X g supernatant fractions of decidua and amnion tissues contained relatively large amounts of CA 125 and CA 19-9, 73% to 96% of which was present in the cytosolic fractions of these tissues. The CA 125 levels in the amniotic fluid decreased, whereas those of CA 19-9 increased with gestation, which correlated well with the respective levels in amnion tissues. These findings suggest that amnion cells produce and secrete these glycoproteins into the amniotic cavity. However, it is possible that the decidua also secretes CA 125 into the amniotic cavity through the chorion and amnion such as in the case of prolactin.