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Summary A 21-year-old neutered female domestic shorthaired cat was presented with a history of inappetence, vomiting and haematuria. The cat was humanely destroyed at the owner's request and a necropsy examination was performed. A 0.8 × 0.5 × 0.5 cm mass was located in the left lobe of the pancreas. The mass was gelatinous in nature and the external and cut surfaces were pale yellow in colour. Microscopically, the mass was non-capsulated and comprised an accumulation of extracellular stromal mucin containing suspended neoplastic columnar epithelial cells forming tubular structures. Immunohistochemically, these cells diffusely expressed cytokeratin (CK) AE1/AE3, CK7 and carcinoembryonic antigen and were partially positive for CK19 and trypsin, but negative for vimentin. The tumour was diagnosed as a colloid carcinoma. The clinical presentation in this case was caused by chronic renal failure complicated by secondary renal hyperparathyroidism and associated metastatic calcinosis. To the best of our knowledge, this is the first report of colloid carcinoma arising from the pancreas in a cat.

This study was prospectively designed to evaluate a phase II study of gefitinib for non-small-cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations. Clinical samples were tested for EGFR mutations by peptide nucleic acid-locked nucleic acid PCR clamp, and patients having EGFR mutations were given gefitinib 250 mg daily as the second treatment after chemotherapy. Poor PS patients omitted chemotherapy. Of 107 consecutive patients enrolled, samples from 100 patients were informative, and EGFR mutations were observed in 38 patients. Gefitinib was given to 27 patients with EGFR mutations, and the response rate was 78% (one complete response and 20 partial responses; 95% confidence interval: 58-93%). Median time to progression and median survival time (MST) from gefitinib treatment were 9.4 and 15.4 months, respectively. Grade 3 hepatic toxicity and skin toxicity were observed in one patient each. There were significant differences between EGFR mutations and wild-type patients in response rates (78 vs 14%, P = 0.0017), and MST (15.4 vs 11.1 months, P = 0.0135). A Cox proportional hazards model indicated that negative EGFR mutation was a secondary prognostic factor (hazards ratio: 2.259, P = 0.036). This research showed the need for screening for EGFR mutations in NSCLC patients.

Helicobacter pylori is the most common gastric bacteria of human beings. Animal-borne helicobacter have been associated with gastritis, ulceration, and gastric mucosa-associated lymphoid-tissue lymphoma in people. We attempted to identify the species of Helicobacter spp. that infect human beings in north Parana, Brazil. Samples of gastric mucosa from 38 dyspeptic patients were analyzed by optic microscopy on silver stained slides, polimerase chain reaction (PCR), and enzymatic cleavage. Genus and species-specific primers to H. pylori, H. heilmannii, H. felis, and consensual primers to H. bizzozeronii or H. salomonis were used. The PCR products were submitted to enzymatic cleavage by VspI (Helicobacter spp. product) and HinfI (species products) enzymes. Thirty-two out of 38 patients evaluated had 3.2 to 5 µm long bacteria that resembled H. pylori in Warthin-Starry stained slides and were positive to the genus Helicobacter by PCR. In 30 of these patients the bacteria were identified as H. pylori. Two samples positive by silver stain were negative to all species tested by PCR. None of the 38 samples was positive to animal-origin helicobacter species. These results show that PCR and enzymatic restriction are practical methods to identify the species of helicobacters present in gastric mucosa of human beings. People in north Parana appear to be infected mostly with H. pylori.

To identify the molecular mechanism which primarily plays a role in the pathogenesis of Crohn's disease (CD) without prior hypothesis, differential display method was employed to detect differentially expressed genes between the inflamed and uninflamed colonic samples from one patient with CD. The mRNA levels of these genes were subsequently semi-quantitated in affected and unaffected tissues from six patients using reverse transcriptase polymerase chain reaction (RT-PCR). Six genes including long form FLICE inhibitory protein (FLIPL) were found to be consistently overexpressed in the inflamed colonic CD tissues. Immunohistochemical studies revealed that FLIPL expressing cells were lamina propria lymphocytes (LPLs). The present study suggested that overexpression of FLIPL in the LPLs may be involved in the pathogenesis of CD through defective activation-induced cell death. In addition, this study provided evidence for a possible role of several previously unsuspected genes in the pathogenesis of CD.

Human Fc gamma receptor (Fc gamma R) genes form a clustered gene family on chromosome 1q21-24. Although the association of Fc gamma R polymorphisms with systemic lupus erythematosus (SLE) has been extensively studied, the results are often contradictory. In this study, Fc gamma RIIA-131H/R, Fc gamma RIIIA-176F/V and Fc gamma RIIIB-NA1/2 genotypes were determined in the Japanese patients with SLE (n = 81) or rheumatoid arthritis (RA, n = 115) as well as in healthy individuals (n = 217), and possible association with the disease was tested using case-control analysis. Unlike in other populations, significant difference was not observed in the frequencies of Fc gamma RIIA and Fc gamma RIIIA genotypes between patients with SLE and healthy individuals. However, significant difference was detected in the frequencies of Fc gamma RIIIB genotypes between SLE and healthy individuals (P = 0.008). The odds ratio [OR] of the Fc gamma RIIIB-NA2/NA2 homozygotes for the development of SLE was 2.52 (95% confidence interval [CI]: 1.33-4.79). Among the patients with SLE, individuals with NA2/2 were significantly more likely to have lupus nephritis (P = 0.007). No association was observed between any of the Fc gamma R polymorphisms and RA. Significant linkage disequilibrium was detected between Fc gamma RIIIA and IIIB, but neither between IIA and IIIA, nor between IIA and IIIB. These observations may underscore the relevance of defective immune complex handling in the pathogenesis of SLE, or may suggest the presence of primarily associated gene(s) in linkage disequilibrium with Fc gamma R genes.

Objectives The purpose of this study was to elucidate the existence of the experience of and the frequency and severity of related concerns of distressful ethical situations encountered by nursing professionals in organ transplantation. Methods An anonymous self-administered questionnaire was mailed to 569 nurses in 79 facilities that performed organ transplantation with living or brain-dead donors who provided approval for this study. The questionnaire, developed according to the Likert method, was composed of 12 items referring to the basic attributes of nursing professionals based on the results of previous studies and the scientific literature, as well as 27 items referring to the presence or absence and the frequency and severity of concerns regarding ethical situations. The data were analyzed using descriptive statistics. Results The questionnaire was distributed to 569 nursing professionals working in 79 facilities that had provided consent for study participation. Responses were obtained from 218 participants (recovery rate: 38.3%). Among the 3 highest-ranking items, those in the first and second positions in terms of the presence or absence and the frequency of worries were the same as those in the second and third positions in terms of the severity of concerns. In addition, the 3 lower-ranking items also were the same. Among the ethical situations encountered by nursing professionals, the ones most often experienced that caused the most concern were the following: “I have questioned whether it was better for the recipient, who could not do self-care after the transplant, to undergo transplantation”, and “I have felt that a recipient decided to receive a transplant without considering the importance of posttransplant self-management when making a decision about transplant surgery.” Conclusions The results indicate that most of the ethical issues related to organ transplantation in nursing practice were experienced because recipients, their families, and donors could not foresee the various problems that might occur after transplantation.

We developed an enzyme-linked immunosorbent assay (ELISA) for human serum mannose binding protein (MBP), an animal lectin known to function as opsonin and complement activator. A total of 1085 normal Japanese sera from individuals ranging in age from 3 to 100 years old and additional body fluids were measured for the MBP level. Individual serum MBP levels ranged from 0.07 to 6.40 micrograms/ml with a frequency distribution profile of the log-normal type. Arithmetic mean +/- standard deviation (M +/- SD) of serum MBP as a whole was 1.72 +/- 1.15 micrograms/ml, whereas those of cerebrospinal fluid and urine were 1/100 and 1/1000 of serum levels, respectively. When the M +/- SD of serum MBP was calculated for each age group (10-year intervals) and compared, the value declined from age group of 3-9 years old (2.42 +/- 1.31 micrograms/ml) to that of 20-29 years old (1.72 +/- 1.03 micrograms/ml), and thereafter it remained almost constant. Comparing the frequency distribution profile among each group, that of young group revealed a distinct bimodal pattern, one peak at around 1 micrograms/ml and the other at 3 micrograms/ml. The latter peak was gradually depressed with advance of age and finally a typical log-normal type appeared after the age of 30. There was a high age dependency in serum MBP level as well as in distribution profile. It should be stressed that care should be taken with age in the evaluation of MBP level.

Urgent pump conversion during off-pump coronary artery bypass (OPCAB) results in high morbidity and mortality. We retrospectively evaluated if the peri-operative integrated strategy prevents this lethal event in our 400 consecutive OPCAB operations. The patients with preoperative cardiogenic shock and/or ventricular arrhythmias underwent on-pump coronary artery bypass grafting (CABG). All other patients (99% of total CABG) were scheduled to undergo OPCAB (n=400). Prophylactic intraaortic balloon pumping (IABP) was applied to the patients with critical (95%) left main trunk stenosis or low (0.35) left ventricular ejection fraction. All the patients received the deep pericardial suture, apex-traction device, suction-type stabilizer, test-clamp of target coronary arteries by micro bulldog clamp, and intra-coronary shunts. Intra-operative IABP was applied in the case of sustained ST-segment change and/or elevated pulmonary artery pressure. Pump conversion was indicated for the patients with ventricular fibrillation and/or cardiogenic shock. Two patients (0.5%) had pump conversion due to ventricular arrhythmia and sustained hypotension, respectively. These pump conversion did not result in hospital mortality. Three hospital deaths (0.7%) occurred due to non-cardiac causes. The integrated strategy using prophylactic or intra-operative IABP in OPCAB produce a low pump conversion rate even during an early period of surgeon's learning curve.

Inflammatory cytokines, such as interleukin (IL)-6, have been shown to reflect clinical signs in certain conditions in diseased animals. In this study, we quantified the IL-6 concentrations in the serum and milk whey from 94 dairy cows with acute clinical mastitis and 55 healthy lactating cows. The IL-6 concentrations in serum from mastitic cows were significantly higher on the first day of illness compared to those of normal cows. Higher concentrations of IL-6 were also detected in the whey from mastitic cows, whereas low concentrations of IL-6 were detected in both serum and whey samples from normal cows. IL-6 concentrations in the serum taken at the onset of illness from cows that later required euthanasia were significantly higher than those in samples from cows that later recovered. These results suggest that serum IL-6 concentrations may be of prognostic value in identifying cows with severe mastitis.

Although a number of studies reported the association of HLA-DRB1 and Crohn's disease (CD), the actual alleles associated with CD are considerably variable among populations. On the other hand, the relevance of tumor necrosis factor alpha (TNF alpha) in the pathogenesis of CD is established through experimental as well as clinical studies, raising the possibility that TNFA polymorphism is primarily or independently contribute to the association of HLA region genes with CD. New polymorphisms which may affect the transcriptional activity were recently reported within the upstream promoter region of TNFA gene. In the present study, we compared HLA-DRB1, TNFA promoter and TNF receptor 2 (TNFR2) genotypes in 154 Japanese patients with CD and 265 unrelated healthy controls to evaluate the individual contribution of these genes to the genetic predisposition to CD. Significant positive association was observed in HLA-DRB1*0405 (P = 0.001, odds ratio (OR) = 2.02) and 0410 (P = 0.002, OR = 4.79). Among the TNFA promoter haplotypes, TNFA-U03 (-1031C, -863A, -857C) was significantly increased (P = 0.008, OR = 1.64), while TNFA-U04 (-1031C, -863C, -857C) was significantly decreased (P = 0.014, OR = 0.12), in CD. The association with TNFA-U03 was independent of that with DRB1*0405 and 0410, and apparent additive or multiplicative effect was not observed between these susceptibility alleles. No association was observed between TNFR2-196M/R polymorphism and CD. These results indicated that both of HLA-DRB1 and TNFA promoter polymorphisms contribute to the susceptibility to CD in an independent manner.

Multiple genetic as well as environmental factors are considered to be involved in the development of systemic lupus erythematosus (SLE). A number of previous studies have suggested a possible role for tumor necrosis factor (TNF) in the pathogenesis of SLE. In addition, one of the candidate loci suggested by the genome-wide linkage analysis corresponds to the chromosomal position encompassing the TNF receptor 2 gene (TNFR2). The purpose of this study was to analyze the polymorphism of TNFR2 and its possible association with the susceptibility to SLE, using the case-control association analysis. Polymorphism screening of the exons containing previously reported nonsynonymous base substitutions was carried out by the polymerase chain reaction (PCR)-single strand conformation polymorphism (SSCP) method, using genomic DNA from 81 Japanese patients with SLE and 207 healthy individuals. Two alleles were present in exon 6, coding for methionine (196M) and arginine (196R) at position 196. 30 of 81 patients (37.0%) with SLE were positive for the 196R allele, which was significantly more frequent compared with 39 of 207 healthy individuals (18.8%) (chi2=10.6, df=l, P=0.001, odds ratio=2.53, 95% CI: 1.45-4.43). Genotype analysis revealed that the presence of one 196R allele was sufficient for rendering susceptibility. The association of 196R allele with SLE was independent from that of HLA-DRB1*1501. In conclusion, the TNFR2 196R allele was found to be significantly associated with the susceptibility to SLE in the Japanese population. Further population and functional studies will be of particular importance to establish TNFR2 as one of the susceptibility genes to SLE.

CD22, a member of the immunoglobulin superfamily, is a B-cell transmembrane glycoprotein that acts as an accessory-signaling component of the B-cell antigen receptor (BCR). Recent evidence indicating the role of CD22 as a negative regulator of BCR signal transduction prompted us to test the possibility that genetic variations of human CD22 may be associated with autoimmune diseases. In this study, variation screening of the entire CD22 coding region was performed, and possible association with rheumatic diseases was tested, using the genomic DNA from 207 healthy Japanese individuals, 68 patients with systemic lupus erythematosus (SLE), and 119 patients with rheumatoid arthritis (RA). Through the variation screening, seven non-synonymous and four synonymous substitutions were identified. In addition, single base substitutions were found in two introns flanking exon-intron junctions. Among these variations, Q152E substitution within the second extracellular domain was observed with a marginally higher frequency in the patients with SLE (3/68, 4.4%) than that in healthy individuals (1/207, 0.5%) (P=0.048. SLE vs healthy individuals), although this difference was no longer significant after correction for the number of comparisons (Pc=0.62). No significant association was observed between any of the variations and RA. These findings indicate that a number of genetic variants are present in CD22, and suggest that CD22 could be considered a candidate for the susceptibility genes to autoimmune diseases.

A new mutation in the serine-threonine kinase domain of the transforming growth factor beta type II receptor (TGF beta RII) was found in a case of diffuse, B cell non-Hodgkin's lymphoma of the stomach. A missense mutation (ACA to GCA, Thr to Ala) was detected in exon 5, and a wild type allele was also present. This is the first naturally occurring mutation in the kinase domain of this gene identified in human primary lymphoma. The replication error at three loci was negative, and the poly A tract of exon 3, which is frequently a target of mismatch repair genes, was intact. Malignant lymphoma of B cell origin in the stomach is an addition to an expanding catalogue of tumors with TGF beta RII alterations, and the biological sequelae of the change in the functional domain and the clinical characteristics of the patient in this study are intriguing.

Two cases of CA 19-9 producing pulmonary papillary adenocarcinoma were reported. Pathological examination showed a well differentiated papillary adenocarcinoma with partially bronchiolo-alveolar cell type. Immunohistochemical study showed a positive straining for CA 19-9 on tumor cells. The level of CA 19-9 decreased after lobectomy and anti-cancer chemotherapy using CDDP and VDS. The series of CA 19-9 level is very useful to evaluate the effect of surgery and chemotherapy. Also it is useful to find out the recurrence of carcinoma.

The mechanism of consumption coagulopathy observed in cases of human envenomation by Bothrops jararaca is well established. However, this mechanism may vary according to the animal species studied. In order to study both the clinical and laboratory aspects of bothropic envenomation in dogs, a sublethal defibrinating dose of venom (100 micrograms/kg) was given intravenously. A coagulopathy similar to that observed in humans - including fibrinogen depletion, consumption of factors II, X, V and antithrombin III, and moderate thrombocytopenia - was observed. The presence of circulating activated platelets was also noted. Neutrophilic leukocytosis, lymphopenia, and monocytosis occurred at different times. Erythrocytic values remained normal in dogs treated with B. jararaca venom compared with those treated with saline alone. The erythrocyte sedimentation rate fell rapidly after venom administration and this fall was correlated logarithmically with fibrinogen concentration. Since the effects of envenomation in dogs is similar to that in humans, it was concluded that the dog can be used as a good animal model for studying human venom-induced coagulopathy.

The prevalence of thyroid dysfunction and its relation to thyroid autoantibodies (TAA) and urinary iodide concentration (UI) was studied in apparently healthy adults in Sapporo (n = 4110) (Sapporo group), and in five coastal areas of Hokkaido (n = 1061) (coastal group) which produce iodine-rich seaweed (kelp). The frequency of above normal UI (high UI) in the morning urinary samples of coastal group was 10.8%, significantly higher than that of Sapporo group (6.4%) (p0.001). Frequency of positive TAA in both groups were similar. In Sapporo group TAA was positive in 6.4% of males and 13.8% of females with an age-related increase. The overall prevalence of hyperthyroidism (TSH0.15 mU/L) in coastal group (0.6%) was similar to that in Sapporo group (1.1%), while that of hypothyroidism (TSH5.0 mU/L) in coastal group (3.8%) was significantly higher than that in Sapporo group (1.3%) (P0.001). The frequency of high UI correlated significantly with that of hypothyroidism with negative TAA (r = 0.829, P0.05), but not with positive TAA, or with that of hyperthyroidism. Hypothyroidism was more prevalent in TAA negative subjects with high UI than with normal UI. Moreover, serum TSH and thyroglobulin levels were higher and free T4 level was lower in former than in latter group. These results indicate that 1) the prevalence of TAA negative hypothyroidism in iodine sufficient areas may be associated with the amount of iodine ingested, 2) this hypothyroidism is more prevalent and marked in subjects consuming further excess amounts of iodine, and 3) excessive intake of iodine should be considered an etiology of hypothyroidism in addition to chronic thyroiditis in these areas.

The present experimental study shows that anticancer agents may accumulate around electrodes placed in saline and in lung when the electrodes are charged with direct electric current. We also observed that electrochemical therapy (ECT) in combination with chemotherapy was more effective for treatment of localized tumours (human lung cancer PC-13 transplated to nude mice) than was ECT or systemic chemotherapy alone. In a clinical study, 26 patients (27 lesions) received ECT with or without systemic chemotherapy. We observed a decrease in tumour size in more than 70% of the cases, and in two cases the use of ECT alone resulted in complete regression of the tumour. In one case there was an increase in tumour size. The main side-effects observed during treatment of lung cancer was pain during treatment, fever after treatment, and pneumothorax. We conclude that ECT may be effective in controlling localised tumours. The clinical use of ECT is, however, associated with several problems and the mechanism of this treatment has not yet been completely established.

We experienced two cases of iatrogenic left main coronary artery stenosis (IOCS) following double (aortic and mitral) valve replacement (DVR). The solid coronary perfusion catheter may attribute IOCS, with grave consequence. There have been no IOCS since the time we exchanged a solid catheter for a soft one. One case, she was successfully treated percutaneous transluminal coronary angioplasty (PTCA), because she developed angina pectoris about 5 years after PTCA. But she developed angina pectoris again and angiographically left main coronary was severe stenotic. So she was undergone aorto coronary bypass grafting (CABG) to the left anterior descending. The other case, he developed angina pectoris about 3 months after DVR. He was treated with PTCA. Angiographically left mine coronary artery stenosis reduced 50% from 90%. Generally the treatment of IOCS is CABG, but we performed PTCA for 2 patients. Because we thought it was very hazardous for us to perform them open heart surgery. When it is very hazardous to perform patients open heart surgery, they need to be performed PTCA.

Mammographic features of 87 breast cancer patients were studied in comparison with their previous survey films. Changes in the mammographic features included microcalicification (28 cases), tumor shadow (35 cases) and intratumorous microcalicifications (6 cases). Seven cases had several extremely faint calcifications on the previous films, and three of six cases with clustered and scattered microcalcifications that extended over an entire breast quadrant had increased in number, density and extent. Eight cases in which clustered microcalcifications had increased in number, density and extent suggested a relationship between the increase in the extent of microcalcifications and length of time between visits. In most cases with tumor shadow, a slight localized increase in mammary gland density, irregular margins and straightened trabeculae were overlooked because of breast density.

Two women (16-year-old, 54-year-old) of atrial septal defect with absence of right superior vena cava and persistent left superior vena cava were successfully operated on. Electrocardiographic findings show coronary sinus rhythm and atrial fibrillation. When we closed atrial septal defect cannulated to persistent left superior vena cava via the coronary sinus directly, sick sinus syndrome was not appeared postoperatively.

Mitral stenosis associated with left atrial ball thrombus is rare. Removal of left atrial ball thrombus and mitral valve replacement was performed in two patients successfully. The rate of thromboembolism was high in patient who has left atrial ball thrombus. Also, sudden death was reported in these cases due to incarceration of ball thrombus in the mitral orifice (hole-in-one thrombus). We concluded that we should operate the MS associated with left atrial ball thrombus as soon as possible.

A 1-year-old girl was admitted to our University Hospital with a history of fever, vomiting, left-sided hemiconvulsion, gait disturbance, and drowsiness. The cerebrospinal fluid (CSF) on the 9th day of illness revealed 157 white blood cells/mm 3 (68 % monocytes), 64 mg/dl of protein, 59 mg/dl of glucose, and 4.2 ng/ml ( < 4.0 ng/ml) of myelin basic protein. Herpes simplex virus (HSV) DNA was detected in the CSF on the 9th day by the use of polymerase chain reaction method [4]. A high Ig M titer against to HSV type I was also detected in the CSE Periodic slow and sharp wave discharges were recorded in the right fronto-temporal region on the electroencephalogram. Intravenous acyclovir was given atadoseofl0 mg/kg8 hourly for 10 days.The T2-weighted MRI on the 15th day showed increased signal intensities in the white matter of the right temporal lobe (Fig. 1 a). No HSV DNA was detected in the CSF on day 23. The patient's symptoms had resolved by day 37. T2-weighted MRI follow-up on day 71 revealed widespread involvement of the right temporal lobe (Fig. 1 b). MRI on day 92 demonstrated no progression of the lesions. A mild left hemiparesis was still present when she was discharged on day 109.

We have examined the clinical usefulness for free thyroxine (FT4) measurement by equilibrium dialysis of undiluted serum and by radio-immunoassay of T4 concentration in the dialysate (ED/RIA). The results were compared with those by ultrafiltration of undiluted serum (UF/RIA), which is believed to offer the best possible approach towards estimation of in vitro serum level of FT4. The precision with both methods was excellent. There was a high degree of correlation of FT4 concentration by both methods (r = 0.831, p less than 0.001, n = 99). FT4 concentration by ED/RIA and UF/RIA methods agreed well for hyperthyroidism, hypothyroidism, normal pregnancy, and for low T4-binding globulin concentration. In nonthyroidal illness (NTI), FT4 levels were all within or above normal for UF/ED method, while some FT4 values in low T4 syndrome were below normal for ED/RIA method. The effect of progressive serum dilution on FT4 concentration was also examined for both methods. There was no fall in FT4 concentration in sera from normal, hyperthyroid patient and in serum with low T4 syndrome for both methods, but in a serum from low T3 syndrome, there was a fall in FT4 concentration by dilution with UF/RIA method, indicating that serum dilution with ED/RIA method might underestimate FT4 concentration in some NTI sera. From these results it is concluded that the present ED/RIA method is adaptable to clinical laboratory use as a reference standard method for FT4 measurement.

To investigate disseminated intravascular coagulation (DIC) after valve replacement, we studied DIC score in 80 patients with combined cardiac valvular disease. Thirty-three patients with (TR group) and 47 patients without (control group) tricuspid regurgitation were compared. 1) TR group, that included patients with severe cases, showed a significantly longer operative time and greater bleeding volume (p less than 0.01). 2) The DIC score was significantly higher in TR group. Administration of gabexate mesilate to patients with DIC improved their platelet counts. These results indicate that patients with combined cardiac valvular disease with tricuspid regurgitation have a hemorrhagic tendency and are subject to DIC. Administration of gabexate mesilate is useful for DIC.

The major surgery for gastroduodenal ulcer, gastric cancer, esophageal cancer, and mediastinal tumor, were performed on 5 patients during anticoagulant therapy after prosthetic valve replacement. In the postoperative management, Dipyridamole (30 mg/day) was given in case 1, Heparin sodium (24,000 mu/day) in case 2, 3, and Gabexate Mesilate in case 4, 5. Postoperative course was uneventful in case 1, 3, 4, 5, intratracheal bleeding was recognized on the 3rd postoperative day and treated by reducing of heparin dose in case 2. Gabexate Mesilate was thought to be effective and free from complication in case 4, 5.

The serum from two patients with IgA myeloma displayed double precipitin arcs upon immunoelectrophoresis with class-specific (light chain absorbed) anti-IgA antisera obtained by immunization with monoclonal IgA1, but not IgA2 proteins. Both sera contained large amounts of monoclonal IgA2m(2) together with some polyclonal IgA1. No incomplete IgA molecules were found. The double precipitin arcs resulted from the reaction of large amounts of monoclonal IgA2m(2) with class-specific antibodies, and of small amounts of polyclonal IgA1 with subclass-specific anti-IgA1 antibodies of the same antiserum. Such double arcs, if not due to incomplete IgA molecules, could indicate the IgA2m(2) nature of the monoclonal IgA in these rare sera.

A pair of male monozygotic twins discordant for Rubinstein-Taybi syndrome is reported. Monozygosity of the twins was established using blood grouping, typing of serum proteins, isozymes, HLA, and chromosomal heteromorphisms. The twins are the first twin pair discordant for the syndrome in which monozygosity has been firmly established. The pathogenesis of the syndrome is discussed in relation to the occurrence of both discordant and concordant monozygotic twins.

Complete hydatidiform moles, an abnormal pregnancy of androgenetic origin consisting of swollen villi without an embryo, were studied to determine the protein constitution of vesicular fluids in the swollen villi and the ability of the molar tissue to synthesize protein. All 16 serum proteins tested were identified in the molar fluid. A reverse correlation was obtained when the logarithms of the molar fluid versus maternal serum concentration ratios of different proteins were plotted against the logarithms of their molecular weights. Logarithmic regression analysis showed a linear regression with a high coefficient (gamma = 0.9626). Phenotyping of haptoglobin in the molar fluid and in the parental sera indicated a definite contribution of maternal proteins to the molar fluid. The molar tissues synthesized no serum proteins but produced human chorionic gonadotrophin beta-subunit (hCG-beta) and pregnancy-specific beta 1-glycoprotein (SP1) when examined in tissue cultures metabolically labelled with [35S]methionine. These findings indicate that a variety of maternal serum protein components is transferred to the molar fluid without being selected by the molar trophoblastic cells.

The study group was organized to evaluate the usefulness of cefmenoxime (CMX) injection, a new synthetic cephalosporin, for the treatment of infections in the field of obstetrics and gynecology. Fundamental and clinical studies were made by the society and the following results were obtained. 1. The peak distribution of CMX's MIC for E. coli, Klebsiella sp., Enterobacter sp., Bacteroides sp. and Peptococcus sp. isolated from obstetrical and gynecological infections with relatively high frequencies area 0.1, less than or equal to 0.05, 0.2, 3.13, 1.56 micrograms/ml, respectively, with an inoculation of 10(6) cells/ml. 2. When 1 g of CMX is administered by intravenous drip infusion for 1 hour, the maximum concentrations in various tissues of female genital organs were as follows: 14.2 and 13.2 micrograms/g in ovary and oviduct, respectively, at 1.20 hours after the start of administration, and 16.9 and 26.3 micrograms/g in corpus uteri and cervix uteri, respectively, after 1 hour. As for the transfer to the exudate in the pelvic dead cavity, the peak concentration was 15.6 micrograms/ml after 2.13 hours. 3. In the clinical studies, CMX was given to 258 cases with female genital organ infections and others. As for the clinical effects, with exclusion of 3 cases in which other antibiotics are concomitantly used, responses were excellent in 76 cases, good in 162 cases and poor in 17 cases, among 255 cases in total. The efficacy rate was 93.3%. The efficacy rates by diseases were 97.1% (68/70) for intrauterine infections, 88.8% (79/89) for intrapelvic infections, 98.4% (62/63) for adnexitis, and 100% (23/23) for infections of external genital organs. As for the clinical effects on causative bacteria, the efficacy rates were 100% (19/19) for single infections due to Gram-positive bacteria, 94.8% (55/58) for single infections due to Gram-negative bacteria, and 88.2% (15/17) for single infections due to anaerobic bacteria. And its efficacy rates were 89.6% (69/77) for mixed infection cases. Side effects were observed in 2 cases (0.8%); 1 case with eruption, and 1 case with diarrhea and vomiting. As for abnormal laboratory findings, lower white blood cell count was observed in 2 cases and elevation of the values regarding hepatic functions in 9 cases. All cases were returned to the normal after the completion of the administration. Cefmenoxime showed a satisfactory clinical efficacy and a potent bacteriological effect in treatment of the infections in the field of obstetrics and gynecology, and it has been concluded that cefmenoxime will be useful addition to the antibiotics for the therapy of these infections.

From January 1982 to March 1987, an exfoliative cytological examination of abnormal nipple discharge was carried out on 790 patients. Of 22 histologically confirmed mammary carcinomas, 7 cases (31.8%) were diagnosed as positive by conventional cytologic techniques. By using the concentration method, in which the nipple secretion was collected in a series of testings that lasted 3 to 5 days and stored in a glass tube containing a fixative, the diagnostic accuracy was seen to increase significantly and 9 out of 15 malignant cases (60.0%) were accurately diagnosed as having cancer. Moreover, all 5 cases without any palpable mass were found to be positive by the smears made by this procedure.

The occurrence of leptospiral infection in cats was determined through the detection of specific antibodies based on the results of microscopic agglutination test and the attempts of isolation and histological demonstration of leptospires from the kidneys of these animals. Of 172 serum samples examined by microscopic agglutination test, 22 (12.8%) were positive with titers greater than or equal to 100. The most frequent serovar was pomona. In relation to the sex, significant differences were not seen; however the age distribution showed that feline leptospirosis is more frequent in adult cats. The attempts for isolation and demonstration of L. interrogans from renal parenchyma by culture or Warthin Starry technics were unsuccessful.

Triiodothyronine (T3) uptake as determined with albumin (AT3U) and with charcoal (CT3U) as binders were compared for patients with low-T3 syndrome. Both T3U values were identical in normal subjects and in patients with thyroidal disorders, pregnancy, low thyroxin-binding globulin (TBG), or acute hepatitis with high concentration of TBG. In the low-T3 syndrome, AT3U was significantly higher than CT3U (38.5 +/- 7.2% vs 29.4 +/- 4.9%, mean +/- SD, n = 37, p less than 0.001), and this difference increased as TBG and albumin concentrations decreased. Decreasing the concentration of TBG and albumin in serum by dilution increased the AT3U more than the CT3U value. Adding albumin to serum decreased AT3U, but not CT3U, when serum TBG and albumin concentrations were low. The free-thyroxin (T4) index as calculated by the AT3U ratio and T4 more accurately reflects the concentration of free T4 in low-T3 syndrome than does the index calculated from the CT3U ratio and T4. Thus AT3U is determined primarily by changes in TBG and albumin concentrations, so that the free-T4 index based on the AT3U ratio and T4 may be more useful than the CT3U method for evaluating free-T4 concentrations in low-T3 syndrome, which frequently has concomitant decreases in TBG and albumin concentrations.

To evaluate tissue changes, we studied myocardial texture using two-dimensional echocardiographic images. We investigated 19 normal subjects, 28 patients with left ventricular hypertrophy, and 12 patients with old anteroseptal myocardial infarction of longer than one year duration. Using 2.5, 3.5, and 5.0 MHz transducers, two-dimensional echocardiograms in the parasternal long-axis view were obtained, and the textures of the interventricular septal images were classified in three types; type I, with a nearly uniformly speckled or echolucent appearances; type II, with multiple, discrete, small (2 to 4 mm) highly refractile echoes; type III, with larger highly refractile echoes (greater than 4 mm) appearing as a cluster of broad patches or band-like echoes. Normal subjects belonged to the type I texture, while many with left ventricular hypertrophy belonged to the type II category. Type III was often observed in patients with old anteroseptal infarction. Using a transducer of higher frequency, there tended to be a shift from type II to I or type III to II. In phantom experiments using carbolandam granules instead of the myocardium, the echocardiographic texture became rough when the phantom was farther from the transducer or the transducer was of low frequency. We suggest that the texture in two-dimensional images may reflect myocardial tissue changes, when other factors including the apparatus and technique remain stable.

Therapeutic efficacy and safety of a new cephalosporin for injection, cefotaxime (CTX) have been examined in gynecological infection cases. CTX has demonstrated in this study excellent therapeutic efficacy in infections with aerobes only, anaerobes only and with mixture of aerobes and anaerobes. No side effect has been observed in our patients who had been administered total dose of 8 approximately 28 g during the period of 4 approximately 7 days.

A case (56 year-old, female) of the aneurysm of sinus of Valsalva due to infectious endocarditis with aortic stenosis and regurgitation was described. The patient was successfully operated upon by patch closure of the orifice of the aneurysm and aortic valve replacement with Medtronic Hall 23A. Post operative course was uneventful and discharged from the hospital at 37 post operative days in good condition.