Spontaneous acute subdural haematoma and intracerebral haemorrhage in patient with HELLP syndrome: case report.

HELLP (haemolysis, elevated liver enzymes, and low platelet count) syndrome can result in a fatal intracranial haemorrhage during the perinatal period. We report treatment of a 32-year-old primigravida who fell into a deep coma during labour with fetal distress, complicated by a spontaneous acute subdural haematoma and intracerebral haemorrhage. Simultaneous emergency operations, evacuation of the acute subdural haematoma and a caesarean section, were performed, during which a diagnosis of HELLP syndrome with disseminated intravascular coagulation was made. Both mother and infant recovered, though hemiparesis persisted in the mother. Patients with HELLP syndrome should be managed as high-risk, which requires an excellent working relationship of the physicians involved. Prompt recognition of intracranial haemorrhagic complications and neurosurgical intervention are particularly important.

Urinary tract infections in patients undergoing transurethral prostatectomy.

The incidence of urinary tract infections was determined in 1,660 patients undergoing transurethral prostatectomy. Preoperative infection was found in 25% of all patients and in 35% of the 276 patients aged 80 years or over. Of the 1,251 patients without a preoperative infection, 17% had postoperative infections. The incidence of new postoperative infection was significantly related to the duration of surgery and the weight of the resected prostate. The incidence of infection was higher in summer than in winter months.

Epididymitis after transurethral prostatectomy.

Transurethral prostatectomy was performed in 2,407 patients and open subcapsular prostatectomy in 308 patients. Postsurgical epididymitis developed in 1.0% of the patients undergoing transurethral resection and in 3.2% of the patients undergoing open resection (P less than 0.05). Factors associated with the incidence of epididymitis, such as prostate weight and operating time, were also associated with the incidence of urinary tract infection. Epididymitis was significantly associated with the presence of preoperative catheterization and postoperative urinary tract infection.

Comparison of transurethral and open subcapsular prostatectomy: relation to weight of the prostate.

The results of transurethral prostatectomy in 2,269 men and open subcapsular prostatectomy in 300 men were compared. The only significant differences between the two groups were in the duration of hospital stay (18.3 vs 26.2 days) and the number of days that the drainage catheter was indwelling (5.4 days in the transurethral and 10.9 days in the open surgery group [P less than 0.01, both comparisons]). Blood loss, the need for transfusion, the amount of blood transfused, and the duration of surgery, catheterization, and hospital stay were all related to prostate size. Transurethral resection was superior to open resection for prostates weighing less than 20 gm; prostates of 20 gm to 30 gm were the easiest to enucleate.

Transurethral resection in prostatic cancer.

Complications arising from transurethral and open subcapsular prostatectomy were studied in 121 patients with prostatic cancer and in 121 patients matched in age and prostate weight who had undergone prostatectomy for benign prostatic hypertrophy (BPH). After transurethral resection, cancer patients had a significantly longer hospital stay than did patients with BPH (P less than 0.01) and more had complications, such as perforation and bleeding. Compared to transurethral prostatectomy, open resection resulted in greater blood loss and more complications for the cancer patients. It is concluded that transurethral resection is as safe for most cancer patients as it is for patients with BPH, but the dangers of massive bleeding and dissemination of the cancer cells should not be overlooked.

Cytologic finding of chyloascites in lymphangioleiomyomatosis. A case report.

BACKGROUND: Lymphangioleiomyomatosis is a rare disease, histologically characterized by an abnormal proliferation of smooth muscle around the lymphatics. Lung is the most common site of involvement, and patients usually present with dyspnea, chest pain, and cough. Chylous pleural effusion and ascites occasionally appear during the course of the disease. There are only a few reports on the cytologic findings in this disease. To our knowledge, the cytologic findings of chylous pleural effusion and chyloascites have not been reported before. CASE: A 23-year-old female presented with chylothorax, chyloascites and a retroperitoneal mass. Cytologic examination of chylous pleural effusion and chyloascites revealed numerous cohesive and thick clusters of cells with a high nuclear/cytoplasmic ratio, oval nuclei and slightly increased chromatin content. Mitosis and necrosis were not observed. Exploratory laparotomy and transbronchial lung biopsy were performed, and the histologic diagnosis was lymphangioleiomyomatosis involving the retroperitoneal lymph nodes, uterine fundus and lungs. Immunohistochemistry showed that the characteristic clusters in chylous fluids were positive for alpha-smooth muscle actin. CONCLUSION: A diagnosis of lymphangioleiomyomatosis is possible from cytologic findings of effusions with the aid of clinical findings.

Roles of head, gaze, and spatial orientation in the production of oscillopsia.

To clarify the factors causing oscillopsia, we investigated head movement, gaze stability, and perception under various situations. High-frequency head movements, whether they were horizontal rotations or passively induced vertical oscillations, produced blurred vision and gaze fluctuations in patients with labyrinthine loss. However, this sensation differed from the oscillopsia perceived during walking, as it did not involve a sensation of oscillation of the surrounding space or a loss of body balance. Although patients with labyrinthine loss showed large irregular head perturbations during stepping, the resultant retinal velocity slips seemed too small to explain oscillopsia. Walking while wearing horizontal reversing prisms produced loss of spatial orientation, dysequilibrium, and instability of vision in normal subjects, which resembled the symptoms found in patients with oscillopsia. The present study suggests that oscillopsia represents a perceptual inability to detect spatial orientation during head or body movements rather than a mere blurring of vision caused by deficient compensation.

Locomotion and motion sickness during horizontally and vertically reversed vision.

Locomotion and motion sickness during reversed vision were studied in ten normal subjects and a patient with bilateral labyrinthine loss. Whereas horizontal reversal produced moderate to severe gait disturbances as well as motion sickness in all normal subjects, vertical reversal failed to induce such symptoms. The patient, being free of motion sickness during both reversals, could not walk straight during horizontal reversal. The difference in the strength of sensory mismatch between both directions seemed to result from a difference in the role of vision for spatial orientation which is produced by the proprioceptive as well as otolithic inputs of gravity.

[The influence of target blurring and simulated opacity of the ocular media on automated perimetric thresholds].

The influence of target blurring and simulated opacity of the ocular media on the sensitivity of the central visual field in quantitative static perimetry was studied using a SARGON program of the automated perimeter Octopus 201. Ten eyes of 10 normal subjects aged from 21 to 35 were examined with target sizes 1, 3, and 5; 4 spherical plus lenses of +1.0D, +2.0D, +3.0D, and +5.0D; 5 kinds of occlusion diffusers which corresponded to the visual acuities of 1.0, 0.8, 0.6, 0.4, and 0.1; and 4 neutral density filters of 0.1, 0.3, 0.6, and 1.0 log units. The studies suggested that there was little difference between the sensitivity for target size 1 and that for target size 3 in spite of slight blurring of the target and simulated opacity of the ocular media. We concluded that target size 1 was as useful as target size 3 in quantitative static perimetry.

[Control of gaze and locomotion by spatial orientation].

We reported a new theory for daily vestibular functions which advocates top-down regulation of posture and gaze by supposing the coordinates in the brain. The hypothesis consists of three principles; first, the vestibular system is primarily a sensory system to detect spatial orientation; second, multisensory integrations reconstruct three-dimensional coordinates in the brain, which ascertain spatial orientation; third, daily behaviours like gazing or walking are controlled in a feed-forward manner by programming on the coordinates in the brain. The hypothesis was useful to understand strategic differences between active and passive movements, to distinct gaze control from ocular reflexes, to apply the rules of gaze control to posture control, and to clarify the mechanism to produce motion sickness.

[The motion sickness under reversing goggles (1st report)].

We observed locomotion and motion sickness in 10 normal adults wearing reversing goggles while moving outdoors. Horizontal reversal of the visual field produced moderate to severe ataxia and motion sickness in all subjects except one. There was marked variability in the sensitivity among different subjects. In contrast, vertical reversal produced no symptoms. Confusion of information relation to spatial orientation possibly caused both the motion sickness and abnormal locomotion. Horizontal reversal of visual information produces disorientation because visual information is equal in importance to that from the semicircular canals. In the case of vertical reversal of visual information, orientation may be assured by gravity. The present study suggests that motion sickness is a biological signal alerting the organism to loss of spatial orientation rather than a mere autonomic symptom produced by mismatched sensory information. It appears that motion sickness is accompanied by dysequilibrium and abnormality of locomotion.

Immunological evaluation of a streptococcal preparation (OK-432) in treatment of bladder carcinoma.

When 21 patients with bladder cancer (transitional cell carcinoma) were given local and systemic injections of a streptococcal preparation, OK-432, tumor regression was observed in 3 cases (14.3%). The marked infiltration of lymphocytes observed on histological examination of regressed tumors suggested that a host-mediated action was involved in the antitumor effect of OK-432.

[Clinicopathological study of latent carcinoma--with special reference to prostatic cancer].

At routine examination, latent carcinoma was found in 147 (11.4%) of 1291 autopsy cases and 142 (14.5%) of 981 patients with malignant neoplasms. The incidence of latent carcinoma with multiple malignant neoplasma was extremely high. Latent prostatic cancer was found in 24 (4.3%) of 560 autopsy cases aged more than 45 and in 22 (5.3%) of 425 surgical specimens of prostatic hypertrophy. Malignant and nonmalignant tissue of the prostate was stained by the immunoperoxidase method of PSA and PAcP. We can distinguish between cancer and normal or benign tissue by observing the positive portion and stained manner in detail.

[A case report of pedunculated hepatoma with very rare remote metastases after the resection].

A 44-year-old woman presented with a tumorous mass on the right hypochondrium, however, no clear tumor was detected. One year later she was found to have an abdominal tumor. Upon surgery, the abdominal tumor was identified as a pedunculated hepatoma arising from the right hepatic lobe and was resected radically. Two years later, the hepatoma recurred as very rare remote metastases to the lung, brain and gingiva, and the patient died of respiratory failure. Autopsy showed no local recurrence in the liver, but remote metastases were present in the lung, brain and lymph nodes. The gingival tumor had disappeared following irradiation therapy.

Questionnaire evaluation of balance in the performance of everyday activities after acoustic neuroma surgery.

We report the results of a questionnaire survey of balance during the performance of everyday activities in 57 patients who underwent acoustic neuroma surgery from one month to 13 years previously. Performance of everyday activities was temporarily impaired after surgery, but soon recovered to preoperative levels in most items. Unilateral labyrinthine loss impaired balance during actions involving head movement. However, there was no correlation between the results of rotation test VOR and the results of the questionnaire. Here we propose a new method of evaluating balance in everyday activities which takes into account the following five basic factors in assessing the difficulty of every day actions: 1) passivity, 2) involvement of head motion, 3) absence of vision, 4) shifting of center of gravity, 5) reduction of supporting foot area.

Effect of alcohol on VOR compensation after unilateral labyrinthine loss.

It has been reported that alcohol ingestion reduces cerebellar control of the vestibulo-ocular reflex (VOR). To investigate the compensatory processes following labyrinthine loss, we examined gaze function and VOR before and after alcohol ingestion in 10 patients with unilateral lesion. The subjects were rotated sinusoidally in an electrically driven chair under two different visual conditions, i.e., mental arithmetic in the dark, and gaze fixation on a target on the wall. Whereas a control group (17 normal adults) showed no significant change after alcohol ingestion, patients showed a greater difference in gain between rotation to the intact side and affected side under the two conditions. The present study suggested significant cerebellar control of VOR and gaze function during recovery from unilateral labyrinthine dysfunction.

[Organ specificity and common factors in latent tumors].

Materials displaying latent tumors were obtained from autopsy cases and from surgically removed organs at our hospital during the past 20 years. Organ specificity and the common factors of these latent tumors indicated the following: a high incidence of latent tumors was found in the small organs and/or endocrine organs (prostate, thyroid, pancreas). In addition, it was found that these tumorous organs are of sufficient interest for clinicopathologic study (stomach, esophagus). Latent tumors show an increasing tendency to manifestation at an advanced age. Further, shade of difference between females and males has been noted in comparing clinically manifested tumors. Also latent tumors occasionally coexist with multiple primary neoplasms in the same and indifferent organs. The histological characteristics of latent tumors is frequently associated with thickened capsules and fibrosis. It has been speculated that the appearances of a reaction are local autoimmune mechanisms and the hosts suppressive effects against the proliferation of tumors. The biological behaviour of latent and clinical tumors should be considered different.