Maternal serum placental leucine aminopeptidase (P-LAP)/oxytocinase and preterm delivery

OBJECTIVE

To test the applicability of maternal serum placental leucine aminopeptidase (P-LAP) as a parameter for predicting preterm delivery.

PATIENTS AND METHODS

Maternal serum P-LAP activity of 61 consecutive women with preterm labor at admission were assayed and examined to assess the relationship of levels to the incidence of preterm and term deliveries.

RESULTS

When P-LAP activity of study patient serum was at or below the 10th percentile, we found a greater ratio of preterm delivery (P=0.0085) and an approximately 2.3-fold increase risk. The sensitivity, specificity, positive predictive value and negative predictive value were 29, 97, 89 and 62%, respectively.

CONCLUSION

Maternal serum P-LAP activity decreases in cases with spontaneous preterm delivery and may be a clinically potential marker for some cases of preterm labor.

[Twenty-year follow-up of visual field defects in primary glaucoma eyes]

PURPOSE

The time course of visual field defects in patients with primary glaucoma was investigated for 20 or more years.

METHODS

The subjects were 51 eyes of 29 patients (open angle glaucoma, 40 eyes of 21 patients angle closure glaucoma, 11 eyes of 8 patients). The mean intraocular pressure of these subjects was within 21 mmHg during the follow-up periods. All the eyes were monitored with Goldmann's perimetry, and the visual field was graded using Kozaki's classification.

RESULTS

At the 20-year follow-up, 68% of the open angle cases and 45% of the angle closure cases had significant progression of visual field defects. There was no significant difference in average intraocular pressure during the follow-up period between the progression group and the stable group.

CONCLUSION

These results suggested that, in a follow-up of twenty years, visual field defects both in primary open angle glaucoma and chronic angle closure glaucoma can progress frequently, even if the intraocular pressure of these patients was well controlled.

Senile deafness and metabolic bone disease

In 56 patients with senile deafness, the degree of bone atrophy was quantitatively assessed by microdensitometry (MD). Biochemical examinations were also made. The following results were obtained: 1. Abnormal bone metabolism is suspected in many patients with senile deafness. 2. Serum calcium level is significantly lower and BUN significantly higher in patients with senile deafness than in normal subjects. 3. A significant positive correlation is noted between hearing levels and serum alkaline phosphatase levels in patients with senile deafness. After treatment of 12 patients suspected of having abnormal bone metabolism (as judged by MD) with an active vitamin D preparation (1 alpha-[OH]D3) at 1 microgram/day for 6 to 10 months, hearing improvement was noted for six ears (four patients). However, long-term observation is necessary to be able to assess the efficacy of active vitamin D on senile deafness, which is a result of chronic aggravation of hearing impairment.

Intratympanic gentamycin therapy for Menière's disease placed by tubal catheter with systemic isosorbide

In 1974, six patients with incapacitating unilateral Menière's disease were given an empiric treatment with intratympanic gentamycin sulfate via the eustachian tube using a tubal catheter with a small side-branch. These patients then showed excellent results with relief from vertigo over a 13-year period. Since 1980, we have treated patients suffering from Menière's disease with isosorbide. When patients could not be controlled with this therapy, isosorbide was given in addition to intratympanic gentamycin therapy using a tubal catheter. Of 75 patients with Menière's disease who received gentamycin and isosorbide therapy, 41 patients could be evaluated by the classification for Menière's disease proposed by the American Academy of Ophthalmology and Otolaryngology (AAOO). Subsequent results showed that vertigo improved in 73% of the patients. According to the AAOO classification, 11 patients (27%) were group A, 16 patients (39%) were group B, and 4 patients (10%) were group C. Eleven patients were group D (27%) and experienced persistent vertigo despite treatment. Our experiences show that patients with severe Menière's disease can be readily treated with intratympanic gentamycin therapy using a tubal catheter, even on an outpatient basis. This treatment is also a most effective treatment, as it allows the effects of isosorbide to be obtained with smaller doses of gentamycin sulfate.

[Menière's disease and isosorbide as an oral hyperosmotic agent (author's transl)]

According to a nationwide survey in 1977 and average of 54.7% of Menière's disease patients were unable to function normally in their daily lives. These patients mostly complained of repeated attacks of vertigo (male 40.3%, female 29.2%) (Watanabe et al. 1980). For the purpose of improving the repeated attacks of vertigo, Isosorbide as an oral hyperosmotic diuretic was first administered orally to 21 patients with Menière's disease from November 1979 to January 1981 for reducing the endolymphatic hydrops that can be presumed to be of pathogenetic importance. The electrocochleographic examinations were carried out on these patients at the same time. Usually, the SP/AP wave form in the electrocochleographic examinations appears to be more abnormal in patients with a fluctuating hearing loss or a flat hearing loss. The average of negative SP/AP in 24 patients with Meniére's disease was 0.54. The indication of Isosorbide administration was determined by this particular SP/AP wave abnormality, and clinical of Isosorbide for the patients with Menière's disease were evaluated. In 18 patients who experienced relief, attack of vertigo did not occur in 12 (63%) and vertigo was relieved in six (31%). In two patients with long administration, hearing improvement could already be observed during the period of treatment. The electrocochleographic examinations showed a decrease in the SP/AP wave form. In two patients with short administration, hearing loss was temporarily observed in middle and low frequencies; the hearing loss later improved more than before treatment in these patients. In only one patient, aggravation of hearing was observed after administration, but whether it was a side effect or not, remains to be understood. The period of observation of these results was a mean value of 4 months and 12 days. The Isosorbide therapy in patients with Menière's disease in expected to replace saccus surgery.