[Acute myelogenous leukemia developing in pregnancy with complete remission--a case report]

A 27-year-old woman was admitted to our hospital complaining of purpuras and legs' edema in the 38th week of pregnancy. On admission, the hemoglobin was 7.8 g/dl, platelets 20,000/microliter and WBC 6,600/microliters with 52% blast cells. Bone marrow aspirate demonstrated 77.2% myeloblasts with prominent Auer rods, consistent with acute myelogenous leukemia. Receiving packed-red-cell and platelet transfusions, she delivered a normal male infant in the 39th week of pregnancy by normal labor. After delivery, she was placed on a combination chemotherapy of BHAC-MMP, subsequently DNR added. Four weeks later, a complete remission was obtained, lasting for almost one year, and her child has grown well without hematological disorder. Microscopic findings of the placenta obtained at delivery revealed no invasion of leukemic cells, but 9% blast cells were present in the placental cord blood. We reviewed 18 cases reported in Japan of acute leukemia in gestational period, that could obtain complete remission and keep the children growing well. Placental transmission of leukemic cells from mother to infant was discussed.

[Squamous cell carcinoma of the lung metastasized solitary cystic formation in the cerebellum]

A 54-year-old male previously diagnosed as having a lung squamous cell carcinoma T2N2M0 in stage III A was readmitted to our hospital, as he was complaining of a gait disturbance. A brain CT, an MRCT scan, and vertebral arteriography revealed that the lung carcinoma had metastasized as a solitary cystic formation in the right cerebellum. Thus, a craniotomy, a cyst fluid aspiration, and tumoral resection was performed. Histopathological findings of the cyst wall indicated a squamous cell carcinoma, and the protogram of the cyst fluid found it similar to that of the serum. These findings suggest that destruction of the blood-brain-barrier by the invasion of the carcinoma caused an exudation of serum, resulting in the accumulation of cyst fluid.

Self-priming effect of LH-RH on pituitary gonadotropins in hyperprolactinemic women

To investigate how various concentrations of serum prolactin (PRL) influence the priming effect of luteinizing hormone releasing hormone (LH-RH) on the pituitary gland, 24 women with various blood PRL concentrations received intravenous injections of 100 micrograms of synthetic LH-RH twice at an interval of 60 minutes and their serum LH and follicle-stimulating hormone (FSH) were measured and analysed. In the follicular phase with a normal PRL concentration (PRL less than 20 ng/ml, n = 6), marked first peaks of the two hormones following the first LH-RH stimulation and enhanced second peaks after the second LH-RH administration were observed, indicating a typical priming effect of LH-RH on gonadotropins, though the second response of FSH was more moderate than that of LH. In hyperprolactinemia, in which the serum PRL concentration was higher than 70 ng/ml (n = 13), the basal concentration of gonadotropins was not significantly changed but the priming effect of LH-RH on LH and FSH was significantly decreased (p less than 0.01). No marked second peaks of LH and FSH were observed, suggesting an inhibitory effect of hyperprolactinemia on the second release of LH and FSH. In contrast, this effect was restored in a group of women whose serum PRL concentration was between 30 and 50 ng/ml (n = 5). Furthermore, enhanced second peaks of both LH and FSH were noted after successful bromocriptine therapy reduced hyperprolactinemia (PRL greater than 70 ng/ml) to less than 25 ng/ml (n = 5).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of the chromosomal abnormalities of a woodchuck hepatocellular carcinoma-derived cell line (WH257GE10)

The normal woodchuck karyotype was determined by the G-banding technique, and the chromosomal abnormalities of a woodchuck hepatocellular carcinoma-derived cell line (WH257GE10) were analyzed and compared with it. The normal woodchuck karyotype was 38,XY in a male, and 38,XX in a female. Autosomes were classified into 2 groups (A and B). Group A consisted of 13 pairs (1-13) of metacentric or sub-metacentric chromosomes, and group B consisted of 5 pairs (14-18) of telocentric or sub-telocentric ones. The X chromosome was sub-metacentric, and the Y chromosome was telocentric. In WH257GE10, the modal number was 36. Deletion of one of the chromosome 5 pair, of the chromosome 13 pair, and of the Y chromosome was observed. Two marker chromosomes (M1 and M2) were found. These markers showed the same G-banded patterns except for a small chromosome fragment at the distal part of the long arm of M1. The chromosome aberrations were very stable through successive passages in vitro. These findings suggest that the chromosomal abnormalities found in WH257GE10 might be associated with the pathogenesis of woodchuck hepatocellular carcinoma.

Sequences responsible for erythroid and lymphoid leukemia in the long terminal repeats of Friend-mink cell focus-forming and Moloney murine leukemia viruses

Despite the high degree of homology (91%) between the nucleotide sequences of the Friend-mink cell focus-forming (MCF) and the Moloney murine leukemia virus (MuLV) genomic long terminal repeats (LTRs), the pathogenicities determined by the LTR sequences of the two viruses are quite different. Friend-MCF MuLV is an erythroid leukemia virus, and Moloney MuLV is a lymphoid leukemia virus. To map the LTR sequences responsible for the different disease specificities, we constructed nine viruses with LTRs recombinant between the Friend-MCF and Moloney MuLVs. Analysis of the leukemia induced with the recombinant viruses showed that a 195-base-pair nucleotide sequence, including a 75-base-pair nucleotide Moloney enhancer, is responsible for the tissue-specific leukemogenicity of Moloney MuLV. However, not only the enhancer but also its downstream sequences appear to be necessary. The Moloney virus enhancer and its downstream sequence exerted a dominant effect over that of the Friend-MCF virus, but the enhancer sequence alone did not. The results that three of the nine recombinant viruses induced both erythroid and lymphoid leukemias supported the hypothesis that multiple viral genetic determinants control both the ability to cause leukemia and the type of leukemia induced.

[Follow-up study of children born following immunization therapy for habitual abortions]

A follow up study was carried out on 24 children whose mothers were treated with HLA immunization as therapy for habitual abortion. Among 350 couples who had experienced recurrent spontaneous abortions registered at this clinic, 117 women were immunized with their husbands' leucocytes. Seventy became pregnant and so far 24 have delivered. The sex ratio of the babies was 16 males to 8 females. The average body weight and height at birth were 3,294 +/- 88.5 g (mean +/- S.E., male) and 3,079 +/- 114.4 g (female), 50.0 +/- 0.38 cm (male) and 49.0 +/- 0.60 cm (female), respectively. Average gestational duration was 39.0 +/- 0.23 weeks and mean labor hours were 7.0 +/- 0.73 without any complication except two cesarean sections. Four out of 24 children were more than 2 years old and 12 were less than one year old. All of them were interviewed or investigated by questionnaires on the developments of body weight, height, sensory organs as well as dental development after birth. Emotional and other physical developments and history of disease after the neonatal period were also examined. Though basic immunological studies will be required in future, all investigations indicate that no abnormal sign normal developments were found in these children, indicating further application of this therapy for habitual abortion.

[A case of hepatocellular carcinoma associated with multiple pulmonary tumor thrombi and rupture of its right adrenal metastasis]

A 54-year-old man, who had the history of a blood transfusion 29 years ago, was admitted to our hospital because of dyspnea and abdominal fullness. Physical examination revealed jaundice and massive ascites and laboratory data suggested liver cirrhosis. The high level of AFP and a CT scan indicated the association of hepatocellular carcinoma and its metastasis to the right adrenal gland. On the 21st hospital day, he suddenly complained of severe pain in the right upper quadrant and the right flank, and fell into hemorrhagic shock. Blood transfusion was given, but he died on the 24th hospital day. Autopsy revealed liver cirrhosis, accompanied by hepatocellular carcinoma with the metastasis to the right adrenal gland and multiple pulmonary tumor thrombi. Massive hemorrhaging due to rupture of the right adrenal metastasis was seen in the retroperitoneal space.

Effect of high perilymphatic potassium concentration on the guinea pig vestibular sensory epithelium

The 'rupture theory' has been proposed to explain the vertiginous attack of Meniere's disease, and the high perilymphatic potassium concentration was thought to be the most important factor in this theory. In this investigation, potassium ion was introduced through the round window into the perilymphatic space in guinea pigs by means of iontophoresis, to investigate the effect of high perilymphatic potassium concentrations on the vestibular sensory epithelium, histochemically. Following the iontophoretic procedure, spontaneous nystagmus was observed, directed toward the iontophoretic side (irritative nystagmus) for the first 10 min, and then toward the unaffected side (paralytic nystagmus) for 24 h. Both these nystagmus types were quite reversible and left no morphological change in sensory cells. However, histochemical analysis revealed an increased ATPase activity during the irritative nystagmus and decreased ATPase activity during the paralytic nystagmus in the synaptic area between the hair cells and the nerve endings of the vestibular sensory epithelium on the iontophoretic side. Judging by these results, high perilymphatic potassium concentration is assumed to affect the synaptic area of the sensory epithelium, leading to reversible nystagmus.

Stable integration of woodchuck hepatitis virus DNA in transplanted tumors and established tissue culture cells derived from a woodchuck primary hepatocellular carcinoma

The fate of integrated woodchuck hepatitis viral (WHV) DNA was systematically investigated in DNA samples from primary hepatocellular carcinoma (HCC) of woodchucks, solid tumors transplanted in athymic mice derived from a primary HCC of woodchuck, and an established cell line of tissue culture originating from the transplanted tumor. In four of five woodchuck primary HCCs, WHV DNA integration was demonstrated in addition to various amounts of extrachromosomal replicative intermediate WHV DNA. The integration pattern of the primary HCCs does not indicate a common integration site on the host chromosome. The integration pattern in the established cells is identical to that in the transplanted tumor and similar but slightly different from that of the primary HCC. No extrachromosomal or replicative intermediates of WHV DNA were detected in the transplanted tumors or in the established cells of tissue culture. There are three integration sites on the chromosomes of the established cells. Results of Southern hybridization and restriction maps of cloned fragments suggest that all of these integrated WHV DNA sequences are not a complete genome but a part of the genome. A small portion corresponding to the cohesive region of the genome was not detected in all of these integrated WHV DNA. A positive role of WHV DNA integration on the generation of HCC is strongly suggested by the high incidence of WHV DNA integration in woodchuck primary HCCs and the stable maintenance of a certain mode of WHV DNA integration in the hepatoma-derived cell populations during passages of transplantation or serial growth of tissue culture.

[Study on the correlation between self-priming effect of LH-RH and luteal insufficiency by LH-RH two step test]

To clarify not only the releasing function but the self-priming effect of gonadotropins in the anterior pituitary gland, two step administration of 100 micro-grams of synthetic LH-RH at a 60 minute interval (LH-RH two step test) was investigated in 19 women with luteal insufficiency, 7 women in puerperium (3rd-10th postpartum) and 6 women immediately after first ovulation following spontaneous abortion (pregnancy 5-7 weeks). In the luteal phase, blood samples were drawn at 0', 30', 60', 90', 120' and 180' after first LH-RH stimulation for measurement of serum LH and FSH by radioimmunoassays. delta 1 standing for hormone release = 1st peak level -0' level. delta 2 standing for selriming effect = 2nd peak level -60' level. delta 1 delta 2 ratio = delta 2/delta 1. In the luteal insufficiency group, delta 1 was significantly higher and delta 1 delta 2 ratio was lower than those in the control group. In the puerperium group, delta 1 and delta 2 responses were not detected, suggesting marked depression of the pituitary function by pregnancy. In the aborted group delta 1 and delta 2 were similar to those in the control group, indicating rapid recovery of the pituitary function. This study demonstrated that the LH-RH two step test was useful in evaluating luteal function by measuring gonadotropins.

Experimental studies on mechanism of the Menière's attack: investigation into vestibulo-cochlear response of the guinea pig induced by potassium ion

After introducing potassium ion through the round window into the perilymphatic space of 40 guinea pigs by means of iontophoresis, physiological and histochemical investigations were performed to determine the role of the high perilymphatic potassium concentration in the vertiginous attack of Ménière's disease. About 15 min after the iontophoretic procedure, electronystagmography revealed irritative nystagmus for the first 5 min and then paralytic nystagmus for the following 6 to 24 hr. Histochemical analysis of the vestibular sensory epithelia revealed the increased activity of succinic dehydrogenase and Na-K-ATPase during irritative nystagmus and the decreased activity during paralytic nystagmus. The Na-K-ATPase activity was dominant in the synaptic area between the hair cells and the nerve-endings of the vestibular sensory epithelia. There was some delay between the reversal of nystagmus-direction and the change of enzyme activity. This delay was thought to be produced by the central regulatory mechanism for the disturbed tonus-balance in the vestibular nucleus. On the other hand, electrocochleography revealed the decrease of the action potential without any initial irritative cochlear sign, and the enzyme activity of the cochlear sensory cells was decreased from the beginning.

Establishment of a cell line from a woodchuck hepatocellular carcinoma

A new cell line derived from a woodchuck hepatocellular carcinoma serially transplanted in athymic nude mice has been established and named WH257GE10. The original tumor in the nude mouse system produces woodchuck hepatitis surface antigen and albumin. In addition, woodchuck hepatitis virus DNA is integrated into cellular DNA. Adaptation of the cells to the in vitro culture condition was completed after 15 months with the doubling time of 40 hr. The morphologic features of the cell by light microscopy are of an epithelial type. The modal chromosome number is 36 and the karyotype is mainly metacentric, similar to that observed in normal woodchuck liver cells. Ornithine and tyrosine aminotransferase activities were detected. Production of albumin was demonstrated in the cytoplasm by indirect immunofluorescence. Integration of woodchuck hepatitis virus DNA was shown by Southern blot analysis, although the secretion of woodchuck hepatitis surface antigen was not detected. This cell line provides an excellent in vitro model to study human hepatocellular carcinoma related to hepatitis B virus.

Transplantation of woodchuck hepatocellular carcinoma in nude mice

Woodchuck hepatocellular carcinoma has been successfully transplanted into nude (athymic) mice. The morphology of heterotransplanted tumor is similar to that of naturally occurring hepatocellular carcinoma before transplantation. The growth rate of transplanted tumor was very slow compared with those of other transplanted tumors. During the first month, only two tumors appeared. However, definitive tumor growth was noted in 6 of 20 nude mice about 3 months later. Seventeen of 20 nude mice exhibited sustained tumor growth after 6 months. The woodchuck hepatocellular carcinoma in nude mice provides an in vivo model for the study of oncogenesis of human hepatocellular carcinoma related to hepatitis B virus.

[Multidisciplinary treatment of malignant melanoma of the nose and paranasal sinuses--with special reference to oral administration of enterosoluble BCG capsules]

In authors' clinic, seven patients with malignant melanoma of the nasal cavity and paranasal sinuses were treated with "per oral BCG" immunotherapy combined with other treatments for 3 years and 7 months from September 1978 to March, 1982. Eighty mg of BCG was enclosed in an enterosoluble capsule and administered to these patients orally once a week. Total doses of BCG administered were ranged from 2,240 mg to 11,860 mg. These treatments were effective for metastasis to the lung, but ineffective against the abdominal metastasis. Immunological parameters of these patients indicated good scores during the treatments. Mean survival time of four cases who died was 3 years and 3 months, and three other cases lived for 5 months, 11 months, and 2 years and 10 months, respectively. On the other hand, mean survival time of six historical control cases was 1 year and 10 months. Multidisciniplinary treatment was thought to be effective to extend their survival time. Three cases complained of arthralgia as a side effect by oral BCG administration.

[Evaluation of clinical efficacy of sulbenicillin following surgery of malignant maxillary tumors. Transport of sulbenicillin to the exudates from the surgical wound of the maxilla and its therapeutic effects]

In order to know the amount of sulbenicillin (SB-PC) transported to the maxillary sinus through the blood supply after injecting by intravenous drip infusion, the authors measured SB-PC content of the exudate which was gathered from the exploratory operative maxillary sinus. This measurement was performed 3 times at 2, 4 and 6 hours after injecting 5 g of SB-PC by intravenous drip infusion. From results of these measurements, it became obvious that the SB-PC content reached to the maximum value (24.5 +/- 16.69 mcg/ml) at 2--4 hours after the injection. Next, the preventive and therapeutic effect on the postoperative maxillary infection was evaluated for 13 patients of maxillary cancer. The effect was excellent in 2 cases (16.7%), good in 8 cases (66.7%) and fair in 2 cases (16.7%). So, the ratio of effectiveness was 83.3%. The side effect of SB-PC was observed only in 1 patient who complained of palpitation, but it was not severe.

Role of uridine phosphorylase for antitumor activity of 5'-deoxy-5-fluorouridine

5'-Deoxy-5-fluorouridine (5'-DFUR) was parenterally and orally effective on various transplantable tumors and its activity was better than that of other fluorinated pyrimidines. However, like 5-fluorouracil and 2'-deoxy-5-fluorouridine (FUdR), 5'-DFUR was ineffective on L1210 leukemia resistant to 5-fluorouracil, suggesting that it would exert its antitumor activity through converted 5-fluorouracil. In tissue culture, 5'-DFUR inhibited the growth of various tumor cells similarly to ther fluorinated pyrimidines. However, 5'-DFUR was unique in that uridine completely reversed its inhibitory effect. Enzymological study clarified that uridine inhibited the conversion of 5'-DFUR to 5-fluorouracil by a uridine phosphorylase, in parallel to its reverse effect on cell growth inhibition by 5'-DFUR. Furthermore, a subline of L1210 leukemia resistant to 5'-DFUR but not to 5-fluorouracil was found to lack the uridine phosphorylase. These results indicate that 5'-DFUR is a depot form of 5-fluorouracil which can be promptly activated by uridine phosphorylase. In addition, the uridine phosphorylase was found to be abundant in sarcoma-180 solid tumor, leading to a significantly higher concentration of converted 5-fluorouracil in this tumor than in other normal tissues. This provides a good explanation for the high chemotherapeutic index of 5'-DFUR against this tumor, which may be applicable also for other tumors.

Neuraminidase in mucolipidoses: normal activity in frozen autopsy tissues from three patients with I-cell disease and adult beta-galactosidase deficiency

Neuraminidase was assayed in the frozen autopsy tissues from three patients with I-cell disease and an adult patient with cherry-red spots, myoclonus, cerebellar ataxia and beta-galactosidase deficiency. Both diseases showed normal neuraminidase activity toward neuramine lactose and fetuin in cerebral gray matter, liver and kidney. These results suggest that the neuraminidase deficiency is limited only to some tissues and that this biochemical abnormality is not caused by a primary genetic mutation in these diseases.

GM1-gangliosidosis: accumulation of ganglioside GM1 in cultured skin fibroblasts and correlation with clinical types

Uptake of radioactivity from 14C-galactose into gangliosides by cultured skin fibroblasts was studied. GM3 was the major ganglioside in control human fibroblasts. An increase of GM1 was demonstrated in GM1-gangliosidosis fibroblasts. The degree of GM1 accumulation was correlated with the clinical types of this disease. The fibroblasts from an infantile-type patient showed a marked increase of GM1. In late-onset types the amount of total gangliosides was only slightly increased, but the distribution of individual gangliosides was definitely abnormal; a relative increase of GM1 was demonstrated in these cases. GM1 beta-galactosidase activities were not detectable in either infantile or late-onset cases.

beta-Galactosidase deficiency in juvenile and adult patients. Report of six Japanese cases and review of literature

Six juvenile and adult patients with progressive neurological diseases and beta-galactosidase deficiency were reported. Any diseases known to date were denied. These cases together with ten case reports in the literature were reviewed and were classified into three groups from clinical and biochemical points. Group 1 patients were characterized by progressive ataxia and myoclonus with gargoyl changes and macular cherry-red spots. In this syndrome beta-galactosidase activity seems to be secondarily affected by other biochemical defects. A group 2 patient showed similar neurological manifestations without gargoyle changes or macular cherry-red spots. Patients with these clinical features not associated with beta-galactosidase deficiency have also been described in the literature. Group 3 patients had progressive pyramidal and extrapyramidal disease without gargoyl changes or macular cherry-red spots. These cases may represent juvenile and adult type GM1-gangliosidosis. Accumulation of GM1 has not yet been demonstrated.

beta-Galactosidase in mucopolysaccharidoses and mucolipidoses. Deficiency of GM1 beta-galactosidase in liver and leukocytes

beta-Galactosidase activities were studied in livers and leukocytes of mucopolysaccharidoses and mucolipidoses (I-cell disease and adult "beta-galactosidase deficiency" with macular cherry-red spots). Marked deficiency of hepatic 4-methylumbelliferyl (4MU) and GM1 beta-galactosidases was demonstrated in these diseases. Leukocyte GM1 beta-galactosidase was also deficient in mucolipidoses. The parents of the patients with I-cell disease and "beta-galactosidase deficiency" had normal beta-galactosidase activity in plasma and leukocytes, compared to the low enzyme activity in heterozygous carriers of GM1-gangliosidosis. The cause of this enzyme deficiency in these diseases is not clear at present. It seems to be affected seondarily by exgenous factors such as unknown stored materials in the cells. Mucopolysaccharides were not increased in the livers of two cases of I-cell disease and a case of "beta-galactosidase deficiency".