[Survey of fungemia cases during the past seventeen years at Teikyo University Hospital]

Fungi were isolated from 642 cases (3.5%) of 18,403 blood samples at Teikyo University Hospital during the 17-years period between 1979 and 1995. The number of fungemia cases began to increase around 1985, reached a peak in 1988, and since then, it has been gradually decreasing. The fungal species of isolates were: (1) Candida albicans in 224 cases (34.9%), (2) C. parapsilosis in 149 cases (23.2%), (3) C. tropicalis in 87 cases (13.6%), (4) C. glabrata in 65 cases (10.1%), (5) Hansenula anomala in 58 cases (9.0%), (6) C. guilliermondii in 24 cases (3.7%), (7) C. famata in 14 cases (2.1%), (8) Trichosporon beigelii in 11 cases (1.7%), (9) C. inconspicua in 5 cases (0.8%) and C. lusitaniae in 5 cases (0.8%), and other yeasts in 33 causes (5.1%). The number of isolates of C. albicans has been decreasing since 1989, concomitant with the clinical introduction of fluconazole in this hospital. However, the number of fluconazole-insusceptible fungi such as non-albicans Candida and Trichosporon spp. has increased. Fungemia cases infected concomitantly or sequentially with two or more different fungal species have been found occasionally since 1983 and have shown a high mortality rate. The spectrum of the causative organisms of fungemia appears to be, at least, partly influenced, by the usage of antifungal agents, particularly fluconazole.

Lymphoplasmacyte-rich meningioma: a case report with histological and immunohistochemical studies

This report concerns a 64-year-old woman with a lymphoplasmacyte-rich meningioma. Radiographically and macroscopically, the tumor had the appearance of an ordinary meningioma. Components of the meningothelial cells were positively immunostained for epithelial membrane antigen. The results of immunohistochemical assays with the antibodies to surface markers of lymphocytes L26 and UCHL-1 indicated that the lymphoplasmacellular proliferation was not neoplastic but probably represented an immune reaction of the host.

Multiple primary malignant neoplasms associated with prostate cancer in 312 consecutive cases

The relative risk for a second primary cancer after the diagnosis of prostate cancer and the prognostic impact of the association of multiple primary malignant neoplasms (MPMNs) in patients with prostate cancer were analyzed in a retrospective study. The development of MPMNs was examined in 312 consecutive patients who had been diagnosed with prostate cancer between 1966 and 1992. The population-based cancer incidence rates in Japan were utilized to calculate the expected number of MPMNs. Of the 312 patients, 60 fulfilled the diagnosis of MPMNs. In 13 men, prostate cancer and other malignancies were diagnosed simultaneously. In 35 of the 312 patients, prostate cancer was the second or third cancer diagnosis. In the remaining 287 patients, prostate cancer developed initially. Of the 287 patients, 12 developed a second primary malignancy compared with 17 expected (relative risk 0.71, 95% confidence interval 0.45-1.4). No single anatomic site showed a significantly increased risk above that expected either. The overall survival of patients with prostate cancer was not reduced by the association with MPMNs. This may be explained by the fact that the stage of the prostate cancer was lower in patients with MPMNs than in patients without MPMNs.

Chromophobe cell renal carcinoma in childhood

We report the first case of chromophobe cell renal carcinoma in childhood. A 12-year-old boy presented gross hematuria following minor trauma. He was diagnosed as having a left renal tumor 45-mm in diameter. Radical nephrectomy was performed. One year later the boy was well.

"Crushed glass" appearance of particles observed in roentgenograms after hysterosalpingography as an indicator of pelvic abnormalities

OBJECTIVE

To evaluate the diagnostic value of the crushed glass appearance of particles observed on roentgenogram after hysterosalpingography in patients with pelvic abnormalities.

DESIGN

Retrospective study of 32 patients whose roentgenogram had particles with a crushed glass appearance and 16 patients without crushed glass appearance, with laparoscopy conducted to determine the location and severity of the pelvic disease.

SETTING

Fujita Health University Hospital, Aichi, Japan.

PATIENT(S)

A total of 240 patients underwent hysterosalpingography to determine the cause of infertility.

MAIN OUTCOME MEASURE(S)

We compared the location of the pelvic endometriosis and/or inflammation that was observed on roentgenogram as the crushed glass appearance versus definitive findings at laparoscopy.

RESULT(S)

A total of 30 of the 32 cases (93.8%) with the crushed glass appearance were confirmed as having pelvic abnormalities, such as endometriosis (73.3%) and pelvic inflammation (26.7%). The rate of the concurrence of the location of the crushed glass appearance observed on the film and that of the lesions verified by laparoscopy was 66.7%. Histopathological examination showed that specimens taken from endometriosis or inflammatory lesions that comprised the crushed glass appearance were lacking in epithelium in proportion to the size of the particles.

CONCLUSION(S)

Identification of the crushed glass appearance of particles was a useful noninvasive method of detecting pelvic abnormalities, such as pelvic endometriosis and inflammation, in infertile women.

Correlation between salpingoscopic score and subsequent pregnancy outcome in patients with tubal infertility

PURPOSE

This study evaluated the efficacy of the salpingoscopic scoring system of tubal function.

METHODS

Twenty-seven infertile patients, including 10 patients with proximal tubal occlusion, 12 with endometriosis and 5 with inflammatory hydrosalpinx, were studied. All 54 tubes were examined using a 0.5-mm-diameter salpingoscope and scored.

RESULTS

The mean scores for patients with proximal tubal occlusion, endometriosis, and inflammation were 18.6 +/- 2.0, 15.6 +/- 0.7, and 20.8 +/- 3.4, respectively. Eight patients (29.6%) conceived; their mean tubal score was 12.6 +/- 0.5 (12-16). Nineteen patients did not conceive, and their mean score was 18.8 +/- 1.4 (12-31). There was a significant difference between these two scores (P < 0.001).

CONCLUSIONS

Scoring of the tubes by salpingoscopic examination is useful for evaluating tubal function with regard to prediction of pregnancy and also for selecting IVF or tubal reconstructive surgery as the preliminary treatment.

Bezoar (Capra aegagrus) is a matriarchal candidate for ancestor of domestic goat (Capra hircus): evidence from the mitochondrial DNA diversity

The leading hypothesis on the ancestor of domestic goats (Capra hircus) is that it is the wild goat called the bezoar or pasang (Capra aegagrus). To verify this hypothesis, we sequenced and compared the cytochrome b gene of mitochondrial DNA from six domestic goats and bezoar. A further sequence for the markhor was taken from the database. In total we detected 51 nucleotide substitutions among the domestic goats, bezoar and markhor. However, only one specific nucleotide substitution was found between the domestic goats and the bezoar. On the other hand, 43 nucleotide substitutions were specific for the markhor. This result suggested a close relationship between the domestic goats and the bezoar. A neighbor-joining and parsimony phylogenetic tree constructed using the sequences showed that the domestic goats and the bezoar belong to the same cluster, while the markhor showed a distinct cluster separate from that of the domestic/bezoar cluster. This result was confirmed by trees based on the sequence of the mitochondrial displacement loop regions. These results suggest that the strongest candidate for a matriarchal ancestor of domestic goats is the bezoar.

[Small cell carcinoma of the urinary bladder: a case report and review of the Japanese literature]

A 50-year-old man presented with asymptomatic gross hematuria which he had first noticed 3 months earlier. Clinical examinations revealed a non-papillary, broad-based tumor on the left lateral wall of the urinary bladder with a clinical stage of T3N0M0. The pathological diagnosis of a transurethral biopsy tissue specimen was small cell carcinoma. Neoadjuvant intraarterial infusion chemotherapy using cisplatin and adriamycin was initially administered but proved to be ineffective. Thus, we performed a radical cystectomy. The tumor tissue was apparently homogenous and composed of small cells arranged in sheets and solid patterns, and was staged to be pT3bR1L2V0N0. An electron microscopic study confirmed small cell carcinoma with neurosecretory granules. Postoperatively, 4 courses of adjuvant chemotherapy consisting of cisplatin, etoposide and ifosfamide were administered. The patient is alive without any evidence of tumor recurrence 26 months after the operation.

[Prostatic endometrioid carcinoma: a case report]

An 89-year-old man presented with urinary retention. Digital rectal examination was benign despite elevated serum prostate-specific antigen (PSA) level. Suprapubic prostatectomy was performed under the diagnosis of benign prostatic hyperplasia. Histopathological diagnosis was endometrioid carcinoma showing positive immunohistochemical staining for PSA. Postoperatively, estrogen was administered for 9 months. After 37 months, serum PSA level began to increase and a palpable nodule was detected on digital rectal examination. Biopsy showed coexistence of endometrioid carcinoma and acinar adenocarcinoma. Hormonal treatment was resumed and the disease has been well controlled for 65 months postoperatively.

[The in vitro antifungal activities of fluconazole against pathogenic yeasts recently isolated from clinical specimens]

The emergence of Candida albicans resistance to azole antifungal agents have been reported in the U. S. and Europe. We examined the in vitro antifungal activities of fluconazole against clinical isolates collected by seven investigators in three years to examine if a tendency existed toward the development of azole-resistance among fungal isolates in Japan. The following results were obtained: 1. Sensitivities to fluconazole (FLCZ) were determined for yeast-like fungi, including 113 strains isolated in 1993, 149 strains isolated in 1994 and 205 strains isolated in 1995. No significant differences in sensitivities in the three years were detected. 2. Minimum inhibitory concentrations of FLCZ were 0.1-0.78 microgram/ml for C. albicans and 3.13-25 micrograms/ml for C. glabrata. Strains with 25 micrograms/ml of FLCZ's MIC were detected; two strains of C. krusei and one strain each of C. krusei, Trichospron beigelii and Hansenula anomala. No strains with higher than 50 micrograms/ml MIC of FLCZ were detected. 3. In vitro activities of FLCZ were compared between clinical strains isolated between 1993 and 1995 and clinical strains isolated before the marketing of FLCZ (up to December 1987) or clinical yeasts isolated between 1991 and 1992. No significant differences were observed, suggesting that no tendency existed toward azole resistance among fungal strains examined.

Effect of retained placenta on subsequent bacteriological and cytological intrauterine environment and reproduction in holstein dairy cows

To determine the effect of retained placenta on the characteristics of the intrauterine environment in dairy cows, bacteriological and cytological tests were performed on intrauterine perfusion fluid. The rate of cows with more than 70% neutrophils or fewer than 40% lymphocytes in inflammatory cells was 48.0% (12/25), while the rate and with more than 50 bacterial colonies/0.1 ml of perfusate was 96.0% (24/25) at 30 d after parturition. Actinomyces pyogenes was isolated from 56.0% (14/25). At 60 d after parturition, however, these values were significantly improved to 20.0% (5/25), 48.0% (12/25) and 12.0% (3/25), respectively. No significant differences in subsequent reproductive performance were observed between cows with and without retained placenta. The results suggest that injury to the intrauterine environment caused by retained placenta is largely healed by 60 d after parturition.

Rheological study of the dynamic process of fibrinolysis

The dynamic process of fibrinolysis induced by tissue plasminogen activator was examined using a rheological technique. Change in a rheological parameter (logarithmic damping factor) of whole blood and platelet-free plasma during fibrinolysis was largely dependent on the initial concentration of tissue plasminogen activator. Addition of activated partial prothrombin time reagent allowed determination of the time both of onset and end of fibrinolysis without affecting the coagulation process. The changes in the clot structure of fibrin during fibrinolysis were observed with a scanning electron microscope and compared with the time-dependent behavior of the logarithmic damping factor. Differences in the logarithmic damping factor during fibrinolysis were evident in alteration of the network structure of clots. It will be shown that the present rheological technique is useful for examining the concentration dependence of fibrinolytic reagent on fibrinolysis as well as for monitoring the dynamic process of fibrinolysis.

Stronger suppression of serum testosterone and FSH levels by a synthetic estrogen than by castration or an LH-RH agonist

Serum levels of LH, FSH and testosterone (T) were measured by radioimmunoassays in 36 patients with advanced prostate cancer before and during androgen ablation therapies. Both leuprolide acetate (LH-RH agonist: LHRH-A) and diethylstilbestrol diphosphate (DES-DP) administration decreased serum LH significantly to an undetectable level (LHRH-A: P < 0.01, DES-DP: P < 0.05). LHRH-A and DES-DP diminished serum FSH to 20% of the pre-treatment level (P < 0.005) and to an undetectable level (P < 0.001), respectively. LHRH-A and DES-DP decreased serum T to the castration level and an undetectable level, respectively (P < 0.001). Serum levels of the same 3 hormones before and after DES-DP administration were measured in 8 patients who received DES-DP after LHRH-A treatment or castration because of relapse of the disease. DES-DP lowered serum FSH further than LHRH-A to an undetectable level (P < 0.005) and diminished T further than previous treatments to an undetectable level (P < 0.05 vs. LHRH-A, P < 0.01 vs. castration). These results suggest that 1) DES-DP is able to reduce T production from extra-testicular site(s), and achieve the minimal serum T level, and 2) this DES-DP action appears to be one of the mechanisms of the effectiveness of the estrogen on refractory prostate cancer after castration or LHRH-A. In addition, basal (independent of LH-RH) FSH secretion in elderly men is about 20% of total FSH secretion and DES-DP inhibits the basal FSH secretion at the level of the pituitary.

[Metastatic tumor of spermatic cord and tunica vaginalis testis from gastric cancer: a case report]

A 62-year-old man with advanced gastric cancer was admitted with a swelling of the left scrotum. He had undergone subtotal and total gastrectomies 10 and 5 years earlier, respectively. A hard mass was palpated along the left spermatic cord associated with hydrocele testis. A left high orhiectomy was performed. Multiple small nodules were noted on the surface of the tunica vaginalis. Also, a tumor in the spermatic cord was present at the level of the internal inguinal ring, protruding into the peritoneal cavity and adherent to the colon. Peritonitis carcinomatosa was recognized. Histopathological diagnosis was tubular adenocarcinoma showing extensive vascular invasion, consistent with a metastasis from gastric cancer.

Bacillus Calmette-Guérin enhances production and secretion of type IV collagenases in peripheral blood mononuclear cells

Intravesical administration of bacillus Calmette-Guérin (BCG) is an effective and widely accepted treatment for superficial bladder cancer. Rapid progression of the disease after BCG therapy, however, has been reported in some cases refractory to the treatment. We examined whether BCG treatment and coexistence of peripheral blood mononuclear cells (PBMCs) alter the invasive potential of bladder cancer cells. Production and secretion of two type IV collagenases, matrix metalloproteinase (MMP) 2 and MMP 9, by PBMCs from five healthy donors or bladder cancer cells (T24, JTC 30, and JTC 32) were evaluated by gelatin zymography, western blot analysis, and northern blot analysis. Invasion of bladder cancer cells was also examined using reconstituted basement membrane (Matrigel). BCG (5, 50, and 500 micrograms/ml) had no effect on secretion of MMP 2 and MMP 9 by bladder cancer cells, but increased the production and secretion of MMP 9 by PBMCs in a dose-dependent manner. The coexistence of PBMCs increased invasion of T24 cells and BCG further enhanced the invasion. Thus, BCG promotes invasion of bladder cancer cells under certain conditions. An increase in the secretion of MMP 9 by PBMCs may account in part for the effect.

In-situ ocular absorption of ophthalmic beta-blockers through ocular membranes in albino rabbits

Ocular membranes have been characterized by in-situ absorption of the ophthalmic beta-blockers carteolol (hydrophilic) and timolol and befunolol (lipophilic) using a cylindrical cell. After introduction of drug solution into the cell on the cornea, sclera (bulbar conjunctival and scleral layer) or palpebral conjunctiva, the disappearance of the drug from the cell was determined as in-situ absorption. The ophthalmic drugs disappeared from the conjunctival and scleral membranes although disappearance from the cornea was hardly observed. The conjunctival membrane showed the highest permeability. Lipophilic drugs were more permeable than hydrophilic. In-situ apparent permeability coefficients of the ophthalmic drugs through the conjunctiva and sclera correlated with the lipophilicity of drugs. A high drug concentration in the aqueous humor was observed after corneal application. There is a relationship between concentration in the aqueous humor was observed after corneal application. There is a relationship between concentrations of drugs in the aqueous humor and previously reported in-vitro apparent permeability coefficients of the drugs in the cornea. This in-situ method using a cylindrical cell is a useful method of investigating the ocular absorption of ophthalmic drugs.

[Endometrioid adenocarcinoma of the prostate: a case report]

A 69-year-old man was referred to our department with gross hematuria. Magnetic resonance imaging revealed the tumor directly invading the rectum. Biopsy of the tumor by transurethral resection demonstrated endometrioid adenocarcinoma of the prostate. Serum prostate specific antigen (PSA) level was normal. Because the tumor did not respond to hormonal therapy for a month, radical prostatectomy combined with rectal amputation was performed. Immunohistochemically, carcinoembryonic antigen was detected but PSA and prostatic acid phosphatase were not.

Prognostic significance of prostate-specific antigen levels two months after hormonal manipulation of metastatic prostate cancer

OBJECTIVE

To assess the prognostic significance of prostate-specific antigen (PSA) levels before and during therapy in patients with metastatic adenocarcinoma of the prostate receiving hormonal manipulation.

METHODS

The PSA levels before and during treatment, together with various clinicopathological parameters, were measured retrospectively in 48 patients with newly diagnosed metastatic prostate cancer. The prognostic importance of these measurements was analyzed by both univariate and multivariate techniques.

RESULTS

PSA levels 2 months after treatment were the most useful predictors of progression-free (p = 0.004) or cause-specific survival (p = 0.006) in a multivariate Cox proportional-hazard model including histologic grade, age, performance status and pretreatment hemoglobin.

CONCLUSIONS

We have found that a low PSA level 2 months after treatment is prognostically superior to conventional clinicopathological parameters, such as histologic grade, in patients with metastatic prostate cancer undergoing treatment by hormonal manipulation.

[Study of directional differences on static and stress urethral pressure profiles of female urethra]

PURPOSE

We investigated the female continence mechanisms by comparing directional differences of static and stress urethral pressure profiles (UPP) in urinary continent females with those in stress incontinent females. Also, the mechanisms of bladder neck suspension were investigated by comparing directional differences of UPP pre- and post-operatively.

METHODS

UPP at rest and under stress were recorded by means of double lumens microtip transducer catheter in 21 females without urinary incontinence (normal group) and 38 females with stress urinary incontinence (SUI group). And UPP were recorded pre- and postoperatively in 19-females of SUI group who had surgical cure of SUI (ope group). These measurements were performed on the urethral directions (anterior-direction of symphysis pubis, lateral and posterior) to which the pressure sensor in the catheter were pointed. Pressure transmission ratios (PTR) were calculated in each quartile dividing functional urethral length (FUL) into four equal lengths. We compared the parameters (the maximum urethral closure pressure = MUCP, FUL and PTR) when the sensor lies at the anterior, lateral and posterior direction in each group. The parameters in normal group were compared with those in SUI group in each direction and those in ope group were, compared pre- and postoperatively.

RESULTS

In all groups, MUCP is always highest in the anterior direction but FUL shows no differences in the three directions. In all directions, MUCP and FUI are higher in the normal group than in the SUI group and there is no significant change in MUCP and FUL following successful bladder neck suspension. In the normal group, PTR of anterior, lateral and posterior urethra were approximately equal, but SUI group patients demonstrated significantly decreased PTR in the lateral and posterior urethra in comparison with PTR observed in the anterior urethra. Also, PTR of the anterior urethra in the SUI group approximates that in the normal group but PTR of the lateral and posterior urethra are lower in the SUI group than in the normal group. In the ope group, in the proximal three-quarters of the FUL, PTR in the lateral and posterior urethra approximated to those in the anterior urethra postoperatively.

CONCLUSION

These findings suggest that urethral support is destructed in the SUI group as mentioned in DeLancey's hammock hypothesis and lateral and posterior weakness were corrected by bladder neck suspension. Bladder neck suspension restored the continence by constructing posterior support of urethra as the substitution for destructed urethral support.

[Results of genitoplasty for virilized genitalia of 41 females with congenital adrenal hyperplasia]

OBJECTIVE

The results of genitoplasty performed at our clinic for 41 female patients with congenital adrenal hyperplasia (CAH) were reviewed.

PATIENTS

Among 57 females with CAH (56 with 21-hydroxylase deficiency and 1 with 11 beta-hydroxylase deficiency) diagnosed between 1961 and 1995, 41 underwent genitoplasty. For the rest of 16 patients, 1 received already clitorectomy, 11 (19%) needed no surgical reconstruction, 2 died before surgery, and 2 are in a waiting list for surgery.

RESULTS

According to Prader's classification of virilized genitalia, 41 patients who received surgery included 8 of type I, 10 of type II, 17 of type III, and 4 of type IV. There was no patients of type V, and 2 were not classified because of previous surgery. Four patients underwent genitoplasty 7 times in total before visiting us. The age receiving initial genitoplasty at our clinic ranged from one year and 9 months to 20 years (median: 4 years and 5 months). Follow-up period averaged 17 years with the range of 2 months to 33 years. For enlarged clitoris, clitorectomy (amputation of clitoris) was carried out for 22 patients before 1975 and corporal resection for 17 after 1975. Two patients manifested recurrence of clitoromegaly after the surgery because of either incomplete resection of the clitoris or patient's ignorance of taking glucocorticoid regularly. Thirty-six patients needed labiovaginoplasty. Simple midline cutback was performed for 6 patients and Y-V plasty (skin flap labiointroitoplasty) for 30. Vaginal orifice was not identified in 5 patients at the initial surgery. Two patients received successful second introitoplasty at the older age than 10. Post-operative stenosis of vaginal orifice was confirmed in 6 patients and 3 underwent second introitoplasty. Among 23 patients older than 25 years at present, 7 got married and 4 raised 6 children with assistance of Caesarian section.

CONCLUSIONS

Most of female patients with CAH needed genital plastic surgery including clitoroplasty and labiovaginoplasty. Corporal resection for enlarged clitoris with sufficient hormone therapy brought a satisfactory result. Y-V plasty for labiovaginoplasty proved to be an excellent method, especially from cosmetic viewpoint, but remained some problems as one stage operation including difficult identification of vaginal orifice and post-operative stenosis of introitus in some patients.

Polycystic ovaries: implications of diagnosis with MR imaging

PURPOSE

To review the prevalence and clinical usefulness of a previously described magnetic resonance (MR) imaging finding of polycystic ovarian disease.

MATERIALS AND METHODS

MR images of the uterine adnexa of 1,074 consecutive female patients suspected of having various gynecologic diseases were retrospectively reviewed for the presence of an MR imaging finding that has been described for polycystic ovarian disease.

RESULTS

The prevalence of the previously described MR imaging finding of polycystic ovarian disease was 1.1% (12 of 1,074). Of the 12 patients, five had confirmed polycystic ovarian disease. Seven had no clinical or endocrinologic findings suggestive of polycystic ovarian disease. Six of these patients had endocrinologic findings related to ovarian dysfunction (n = 5) or had undergone hormonal therapy (n = 1). The other patient had vaginal agenesis but no clinical or endocrinologic evidence of abnormal ovarian function.

CONCLUSION

The finding of multiple peripheral ovarian cysts at MR imaging may not be specific for polycystic ovarian disease.

Morphometric study on the fetal thyroid gland in the nude mouse (BALB/cAnNCrj-nu/nu)

Fetal thyroid glands of athymic nude mice (BALB/cAnNCrj-nu/nu) were examined morphometrically on day 18 of gestation. Compared to euthymic litter mate controls (BALB/ cAnNCrj-nu/+), both the cell height and diameter of thyroid follicles were significantly smaller; fewer well-developed follicles were found in the peripheral region of the thyroid; the body weight and total volume of the thyroid gland were also smaller in nude mice. These results suggest underdevelopment of the fetal thyroid gland of the athymic nude mouse.

In situ ocular absorption of tilisolol through ocular membranes in albino rabbits

The purpose of this study is to characterize the in situ absorption properties of ocular membranes using a cylindrical cell. Drug disappearance in the cell was determined as in situ absorption after an application of drug solution into the cell on the comea, sclera (bulbar conjunctiva and sclera layer), or palpebral conjunctiva. Tilisolol was used as a model of an ophthalmic beta-blocker. Tilisolol disappeared from the conjunctival and scleral surfaces although hardly any disappearance of tilisolol from the corneal surface was observed. Depletion of drug from the precorneal space was much faster in situ than extrapolated from permeability measurements (in vitro) of the separate tissues. This may arise from an influence of blood flow. The in situ apparent permeability coefficient of tilisolol through the conjunctiva was almost constant at various concentrations of drug (5-100 mM), suggesting a passive diffusion of tilisolol that was affected by medium pH. A high concentration of tilisolol in the aqueous humor was observed in the corneal application although the scleral and conjunctival applications showed a slight concentration of tilisolol. The corneal route was a dominant route of access to the aqueous humor. Access to the vitreous body for tilisolol was 4 times more effective through the sclera than through the cornea. On the other hand, the corneal application showed an extremely low concentration of tilisolol in plasma compared to the scleral and conjunctival applications. Thus, the in situ method using a cylindrical cell is a useful method for investigation of the ocular absorption of ophthalmic drugs.

Sonographic characteristics of recurrent hepatocellular carcinoma

Our purpose was to determine the characteristics findings of recurrent hepatocellular carcinomas (HCCs) on sonography. We reviewed sonographic findings of 85 recurrent tumors in 57 patients with prior partial hepatectomy for HCCs. Of 57 patients, 47 (82.5%) had localized recurrence; one or two tumors in a segment (44 patients) and a recurrent tumor near the resected hepatic stump (3 patients). Of 85 tumors, 58 (68.2%) were less than 2 cm, and 82 of 85 tumors (96.5%) were less than 4 cm. A total of 49 tumors (57.6%) were seen as hypoechoic, and 20 tumors (23.5%) as hyperechoic. Posterior echo enhancement was seen in 36 tumors (42.4%), hypoechoic halo in 24 tumors (28.2%), lateral shadow in 21 tumors (24.7%), and mosaic pattern in 6 tumors (7.1%). Recurrent HCC can be detected at an early stage by sonography. Hypoechoic pattern and posterior echo enhancement are commonly seen. These findings suggest recurrent HCCs.

Homozygosity for Machado-Joseph disease gene enhances phenotypic severity

Images

Observation of gain in an optically pumped surface-normal multiple-quantum-well optical amplifier

An optically pumped surface-normal optical amplifier with a 100-period InGaAs/InGaAlAs multiple quantum well is fabricated, and a signal gain exceeding 2 dB is observed for what we believe to be the first time. A laser diode with the wavelength lambda of 1.45 microm is used for pumping. An optical single-pass gain as high as 2.4 dB is obtained at lambda = 1.585 microm with 65-mW pumping (spot diameter 12 microm).

Adnexal masses: transvaginal US and gadolinium-enhanced MR imaging assessment of intratumoral structure

PURPOSE

To evaluate the accuracy of transvaginal ultrasound (US) and gadolinium-enhanced magnetic resonance (MR) imaging in the assessment of the intratumoral structure of an adnexal mass.

MATERIALS AND METHODS

The population comprised 82 patients with an adnexal mass who underwent both transvaginal US and gadolinium-enhanced MR imaging and had surgical confirmation. The findings from both modalities were compared retrospectively with those of surgery.

RESULTS

The sensitivity, specificity, and accuracy were 100%, 98%, and 99% with MR imaging and were 97%, 46%, and 68% with transvaginal US for the identification of solid tissue in the masses. Transvaginal US exhibited many (n = 25) false-positive results, especially in evaluation of lesions filled with blood or fatty tissue and small echogenic excrescences adherent to the wall, such as blood or fatty tissue.

CONCLUSION

Both transvaginal US and gadolinium-enhanced MR imaging were highly sensitive in identification of solid components within an adnexal mass. Gadolinium-enhanced MR imaging was specific, whereas transvaginal US was nonspecific.

A cell model for the detection of local image motion on the magnocellular pathway of the visual cortex

We propose that five types of cell on the magnocellular pathway of the visual cortex constitute a function hierarchy for detecting local image motion. Lateral geniculate nucleus cells and two simple cell types analyse one-dimensional velocities perpendicular to oriented components within a moving stimulus. Combining these velocities, a group of complex cells along a sine wave fire over the cell array. The amplitude and phase of the wave correspond to the local motion's speed and direction. A motion-detection cell in the middle temporal area then extracts the wave of activated complex cells to detect the motion. Applying Hough and inverse Hough transforms and Reichardt's spatio-temporal correlation to the hierarchy, we modeled these cell types as a series of formulas that represent the synaptic functions of neurons. The modeled cells reflect the response to various stimuli in actual cells, and explain Adelson and Movshon's two-stage hypothesis neurophysiologically. The intersection-of-constraint-lines solution of the hypothesis is equivalent to the inverse Hough transform processed in motion-detection cells. We propose tests for validating this cell model using microelectrodes and optical imaging.

Evidence for the presence of an inactive precursor of human hepatocyte growth factor in plasma and sera of patients with liver diseases

Human hepatocyte growth factor (hHGF), which is now known to be the same protein as the scatter factor and the tumor cytotoxic factor, is a heterodimeric protein with one heavy chain and one light chain linked together by a disulfide bond, and is thought to be involved in liver regeneration. Using an enzyme-linked immunosorbent assay (ELISA) and Western blot analysis, we found that a significant amount of single chain precursor of hHGF (pro-hHGF) was present in plasma of patients with fulminant hepatic failure (FHF) and that normal human serum contained a protease or proteases that convert pro-HGF to a heterodimeric (mature) form of hHGF. We also showed that the processing protease activity for hHGF was suppressed by such serine protease inhibitors as leupeptin, antipain, and aprotinin, and that sera of patients with liver diseases such as fulminant hepatic failure, acute hepatitis, chronic hepatitis, and cirrhosis contained not only pro-hHGF but also the protease. This is the first report showing the presence of pro-hHGF in human blood, and our observations suggest that hHGF is synthesized and secreted from the hHGF-producing cells as an inactive pro-hHGF after hepatic injuries, and the pro-hHGF is then converted to an active heterodimeric form of hHGF in the blood. It is also suggested that plasma of patients with liver diseases contains an active protease or proteases that convert pro-hHGF to a mature form of hHGF.

In vitro evaluation of antithrombogenicity of hybrid-type vascular vessel models based on analysis of the mechanism of blood coagulation

In vitro evaluation of antithrombogenicity of materials of artificial vascular vessels was carried out based on an analysis of the coagulation mechanism of blood. Coagulation of blood in tubes coated with endothelial cells (ECs) or segmented polyurethane (SPU) was measured by a rheological technique. Coagulation of blood in hybrid-type vascular vessel model tubes consisting of cultured ECs proliferated on carbon-deposited SPU was also examined. Coagulation of blood in these tubes occurred within 40 min, and appears to be due to the interaction between erythrocytes and a coagulant factor in plasma. From the in vitro evaluation test, when the time of onset of the coagulation of blood in contact with a surface of the artificial materials is longer than 20-39 min, the materials can be considered to provide an inert surface against thrombus formation and blood coagulation.

Adenylyl cyclase activity in human decidua and myometrium during pregnancy and labour

Adenylyl cyclase activity was studied in human decidua and myometrium in early pregnancy and at term before and after the onset of labour. Decidual basal, prostaglandin-, catecholamine- and forskolin-stimulated adenylyl cyclase activities at term before the onset of labour were significantly lower than those in early pregnancy. After the onset of labour at term, decidual basal, prostaglandin-, catecholamine-, NaF- and forskolin-stimulated adenylyl cyclase activities significantly increased compared with those at term before the onset of labour. Myometrial prostaglandin- and catecholamine-stimulated activities did not alter during pregnancy, except for basal and forskolin-stimulated activity. Myometrial basal, prostaglandin-, catecholamine-, NaF- and forskolin-stimulated activities at term showed no change after the onset of labour. At term, before the onset of labour, myometrial basal, prostaglandin, catecholamine-, NaF- and forskolin-stimulated activities were the same as those in the decidua. However, after the onset of labour at term, decidual basal and the stimulated activities were significantly higher than those in the myometrium. These results suggest that decidual prostaglandin- and catecholamine-stimulated adenylyl cyclase may play an important role in the initiation or maintenance of human labour or in both processes.

Rheological approach to the analysis of blood coagulation in endothelial cell-coated tubes: activation of the intrinsic reaction on the erythrocyte surface

Coagulation of blood in cultured endothelial cell-coated tubes was examined using a rheological technique. Coagulation of recalcified, platelet-free plasma in contact with an endothelial cell monolayer did not occur within the experimental time period (more than 150 min). The endothelial cell surface did not activate the intrinsic coagulation reaction or the extrinsic coagulation reaction initiated by tissue factor. The time of onset of coagulation in platelet-free plasma supplemented with erythrocytes was nearly the same as that of whole blood (31.2 +/- 5.5 min), which was shorter than that for platelet-rich plasma (54.3 +/- 14.3 min) and platelet-free plasma supplemented with granulocytes (58.3 +/- 6.3 min). In factor VII-, XI- or XII-deficient, platelet-free plasma supplemented with erythrocytes, the time of onset of coagulation was about 30 min. The coagulation of factor IX-deficient, platelet-free plasma supplemented with erythrocytes, however, did not occur within the experimental time period. These data suggest that activation of factor IX on the erythrocyte surface is capable of activating the intrinsic coagulation system.

[A case of traumatic diaphragmatic hernia accompanied with rupture of pericardium]

We experienced a case of left traumatic diaphragamatic hernia accompanied with rupture of pericardium after blunt trauma by traffic accident. A 55-year-old man who had suffered blunt chest and upper abdominal trauma because of smash of two cars when he had been turning to right in the corner was admitted to our hospital. On arrival at the hospital, the patient complained severe dyspnea that reduced by lying on his right. Another position couldn't be taken because of deterioration of dyspnea. Chest X-ray showed disappeared left diaphragmatic line and abnormal transparent mass that suggest alimentary canal in the left intrapleural space. Cardiac ultrasonography showed abnormal tubular mass close to the left side of mediastinum that deviated to right. The patient was diagnosed as traumatic diaphragmatic hernia and emergency operation was performed. Left diaphragma was lacerated sagitally toward its top for about 12 cm in length. Left pleuropericardium was seen to be lacerated longitudinally for about 8 cm in length in front of the phrenic nerve intraoperatively. Both lacerations were closed by direct suture. The patient discharged on the 37th postoperative day without phrenic nerve palsy. At making diagnosis of patient with chest and abdominal trauma, injure of diaphragma and/or pericardium also must be considered. If it is possible, operation must be performed without hesitation in order to get good prognosis.

[Clinical study of renal cell carcinoma with brain metastasis]

Of 130 cases with renal cell carcinoma treated at Cancer Institute Hospital from January, 1981 to December, 1992, 14 (10.6%) developed brain metastasis, 12 of whom had had preceding pulmonary metastasis. Interval between the initial treatment of the primary lesion (nephrectomy in 13, embolization in 1) and the diagnosis of brain metastasis ranged 0 to 57 months with a median of 11 months. Twelve patients had clinical symptoms such as headache, vomiting, paralysis or disturbance of consciousness. Eleven patients were treated with external beam irradiation (30-60 Gy linear accelerator). Only 3 (30%) of 10 patients with measurable lesion on CT scan achieved PR but 6 (66.7%) of 9 had symptomatic improvement. Especially, chronic intracranial hypertension such as headache and vomiting disappeared in 5 (83.3%) of 6. Average survival period and one year survival after the diagnosis of brain metastasis were 5 months and 14.3%. Although most of the patients with brain metastasis died of the progression of other organ metastasis, radiation therapy for brain metastasis was useful to palliate the agonizing symptoms.

Mechanical left ventricular support in patients with Marfan's syndrome: a report of two cases

Left ventricular assist device (LVAD) was utilized for the treatment of postcardiotomy heart failure in two patients with Marfan's syndrome. Patient 1 (a 22-year-old) with annuloaortic ectasia (AAE) and DeBakey type II dissection had been supported by LVAD for 87h after composite graft replacement of the ascending aorta and aortic valve. Patient 2 (a 52-year-old) with AAE and DeBakey type I dissection had been supported by LVAD for 91 h after aortic valve replacement. During the assist, both patients complicated bleeding from the fragile left atria near the sites of cannulation. Patient 1 died of multiple organ failure on the 62nd postoperative day, but patient 2 returned to work after surgery.

[Intra-arterial chemotherapy with cisplatin, vincristine, methotrexate and adriamycin for recurrent penile cancer: a case report]

A 60-year-old man visited our hospital with a chief complaint of penile tumor on November 13, 1984. Circumcision of true phimosis was performed and biopsy of the 27 x 27 mm fixed tumor on the glans revealed well differentiated squamous cell carcinoma. Seventy Gy of electron irradiation to the penis revealed a complete response. On February 1, 1985 bilateral inguinal lymph node dissection was performed and revealed metastasis to a left inguinal node. In May 1990, erosive changes occurred on the irradiated region, and local recurrence was confirmed. Since 2 courses of MBD (methotrexate, bleomycin, cisplatin) chemotherapy was not effective, additional wedge dissection was performed. In January 1992, local recurrence was found. Four courses of intra-arterial chemotherapy (cisplatin, vincristine, methotrexate, adriamycin) was performed with a complete response. No evidence of disease has been recognized for more than two years after completion of the treatment.

MR appearance of malignant lymphoma of the uterus

OBJECTIVE

The uterus is rarely the initial site of malignant lymphoma. The purpose of this article is to present the MRI of malignant lymphoma of the uterus.

MATERIALS AND METHODS

Four cases with pathologically proven malignant lymphoma, in which the uterus was the only and the initial site of recognized visceral involvement, are presented; MRI was retrospectively evaluated.

RESULTS

All the lesions exhibited homogeneous hypointense signal on T1-weighted imaging and relatively hyperintense signal on T2-weighted imaging. One case exhibited diffuse and uniform enlargement of the uterine corpus and cervix in the presence of preserved endometrium and cervical epithelium. With these findings, a prospective diagnosis of lymphoma was feasible. The three other cases exhibited MR findings that closely resembled those of carcinoma of the cervix. However, in one case, preserved cervical epithelium in the presence of extensive involvement of the cervical stroma may have been a clue to the diagnosis of malignant lymphoma. Involvement of the vagina (three cases) and the urinary bladder (two cases) was clearly identified on MRI.

CONCLUSION

Lymphoma of the uterus exhibited various MR appearances; however, specific diagnosis might be feasible in limited cases. In addition, clear visualization of the extent of disease seen on MRI could contribute to clinical decisions about treatment.

Different time-course production of peptidic and nonpeptidic leukotrienes and prostaglandins E2 and F2 alpha in the ovary during ovulation in gonadotropin-primed immature rats

Temporal changes in ovarian leukotrienes (LTs) and prostaglandins (PGs) were examined during ovulation to assess roles they may play in this process. Ovulation was induced in immature rats by injection with human chorionic gonadotropin (hCG; 10 IU, s.c.) 2 days after they had been primed with pregnant mare serum gonadotropin (10 IU, s.c.). The ovaries were extirpated at various intervals after hCG administration and assayed for LTB4, and LTC4/D4/E4, as well as PGE2, and PGF2 alpha. Ovarian concentration of LTB4 increased (P < 0.01) rapidly, reaching a peak at 1 hour after hCG administration, then declined (P < 0.05) by 4 hours and remained low thereafter. In contrast, LTC4/D4/E4 peaked (P < 0.01) between 1 and 2 hours, declined (P < 0.05), and then increased (P < 0.01) to achieve a second, larger peak at 10 hours. Prostaglandin E2 increased (P < 0.01) at 6 hours after hCG and did not decrease from the peak value until (P < 0.01) 14 hours after hCG. Concentrations of PGF2 alpha increased (P < 0.01) at 4 hours after hCG, but decreased (P < 0.01) from the peak by 10 hours. Although LTB4, LTC4/D4/E4, PGE2, and PGF2 alpha all increased during ovulation, the time-course differed. This suggests that each eicosanoid may play a distinct role in the process of follicular rupture.