Analysis of glucose tolerance in twin gestations using an oral glucose load.

The effect of twin gestation on carbohydrate metabolism was evaluated using a 75 g oral glucose tolerance test (75 g OGTT). A 75 g OGTT was performed in 63 twin gestations and 3 791 singleton gestations during the third trimester. Plasma glucose concentrations were measured in the pregnant women under fasting conditions as well as 30 min, 1 h, and 2 h after ingestion of glucose (75 g oral load), and serum insulin concentrations were measured in fasting and 30 min post-ingestion samples. Women with twin gestations showed significantly lower plasma glucose concentrations during fasting and 30 min after the glucose load in the samples taken than those with singleton gestations. No significant difference in serum glucose concentrations was found in the other specimens. There were no cases of gestational diabetes mellitus in our study. Although women with twin gestations demonstrated lower plasma glucose concentrations than women with singleton gestations, the difference observed was subtle. We could not find any significant differences in these plasma glucose values as used to define a pathologic OGTT between twin and singleton pregnancies, with the exception of the fasting value.

[Infection route of MRSA to pregnant women and to newborns].

It has been reported that newborn babies are compromised hosts, and to be MRSA carriers means that the danger of occurrence of MRSA infection is high. Our department has focused on improving the hospital environment to guard against hospital infections. Infection from the hospital environment was prevented by looking for staphylococcus bacteria in the nasal cavity during pregnancy, and isolating pregnant MRSA carriers from others. Such effects as MRSA infection of the body members and organs, the newborn babies, nasal cavities of their family members, and discharging MRSA into hospital environments were investigated. 1. The rate of MRSA carriers among pregnant women was 0.8% (3.7% of pregnant women engaged in medical services, and 0.5% of pregnant women engaged in non-medical services). In the former case it was suspected that their children became MRSA carriers for some reason and they became infected through their children. In the latter case, there are two possibilities; one was that MRSA was picked up at the place of work was not removed by sterilization, so that they became carriers and the other is infection through children similarly to non-medical workers. 2. A healthy carrier was observed to be spreading MRSA in to the environment. 3. In the environment where hospital infections were fully dealt with, MRSA infection of newborn babies was always from puerperal women who were carriers. 4. The rates for both MRSA carrying in the nasal cavities of newborn babies at the time of dehospitalization and 1-month-old babies were distinctly low, when the nasal MRSA of puerperal was removed by sterilization, compared to without sterilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Human papillomavirus type 16 infection: a morphological spectrum with evidence for late gene expression.

Human papillomavirus (HPV) type 16 is a unique strain found almost exclusively in squamous precancerous lesions and invasive carcinomas of the genital tract. A histological and immunohistochemical analysis of 34 cervical biopsies from which HPV 16 was isolated was performed to determine: the morphological spectrum of HPV 16 "infection" and if HPV late genes were expressed in lesions containing this virus. Twenty-eight of thirty-four (82%) biopsy specimens contained areas fulfilling the histological criteria for cervical intraepithelial neoplasia (CIN) (defined as the presence of abnormal mitoses and/or diffuse nuclear atypia in a portion of the biopsy). However, 19 of 28 (68%) CIN lesions also contained focal areas of epithelium indistinguishable from condylomata. Three biopsy specimens each contained condyloma only and normal-appearing squamous epithelium. Three of thirty-one lesions (10%) showed evidence of HPV capsid antigens. The presence of areas of condyloma, as well as capsid antigens, indicates that lesions containing HPV 16 share certain similarities with conventional warts associated with other HPVs. Furthermore, the wide range of morphology in lesions containing HPV 16 suggests that histological or cytological recognition of HPV 16-associated CIN lesions may not always be possible.

Latent papillomavirus and recurring genital warts.

After anogenital condylomata and intraepithelial neoplasms are removed, they frequently recur. Since these lesions are related to papillomaviruses, it has been suggested that latent papillomavirus infection is responsible for recurrence. We studied 20 cases of anogenital lesions that were treated by laser therapy and analyzed biopsy specimens of margins of normal skin adjacent to the lesions for papillomavirus sequences by Southern blot hybridization. In nine cases (45 per cent), papillomavirus sequences were detected in the normal skin margin; lesions recurred in 6 of the 9 patients (67 per cent), in contrast to only 1 of 11 patients (9 per cent) whose margins were negative for the presence of papillomavirus sequences. All but one recurrence developed within 15 mm of the treatment area. Our results demonstrate that clinically and histologically latent papillomavirus exists beyond the treatment area and that its presence influences subsequent recurrences.

Cervical papillomaviruses segregate within morphologically distinct precancerous lesions.

We combined molecular hybridization and histological analysis of 58 biopsy samples from the uterine cervix to correlate the presence of certain strains of human papillomaviruses (HPVs) with specific pathological changes. HPV sequences were frequently detected (85%) in biopsies that contained a broad spectrum of precancerous changes. The presence of HPV 16 correlated strongly with precancers that exhibited morphological aberrations commonly found in invasive carcinomas and precancers that have a high risk of progression. This association underscores the potential importance of HPV type 16 in the genesis of genital cancers and emphasizes the value of histological analysis for detecting potentially oncogenic HPVs.

Immunoperoxidase localization of chlamydial antigens in acute salpingitis.

Seventy surgically excised fallopian tubes in which there was originally a diagnosis of acute salpingitis were reviewed histologically and screened for chlamydial antigens by the immunoperoxidase technique. Chlamydial antigens were localized within tubal epithelial cells in two of the 70 cases (3%). Endometrial specimens from these two patients were also positive for chlamydial antigens. There was no definite correlation between the histologic features of the salpingitis and chlamydial immunoperoxidase positivity.

Chlamydial endometritis. A histological and immunohistochemical analysis.

A series of 90 endometrial biopsies and curettings originally diagnosed as chronic endometritis were reviewed and histological findings of plasma cells, lymphoid infiltrate, stromal necrosis, acute inflammation, lymphoid follicles, and epithelial atypia were correlated with the demonstration of chlamydial antigens by the immunoperoxidase technique. Chlamydial antigens were localized within endometrial epithelial cells in four cases. Although these four cases represented only 4% of the total number, chlamydial immunoperoxidase positivity was best discriminated by the severity of the inflammation and the presence of an acute inflammatory infiltrate. Among cases of severe endometritis 22% were chlamydia-positive, and in those cases with an associated acute inflammatory infiltrate, 57% were positive. A high index of suspicion of chlamydial infection should exist when severe endometritis is diagnosed in patients with clinical histories of post-abortal state, pelvic inflammatory disease, secondary infertility or menometrorrhagia, and chronic pelvic pain.

Chlamydial cervicitis and cervical intraepithelial neoplasia: an immunohistochemical analysis.

Studies using serological and culture techniques indicate that chlamydial infection is frequently associated with cervical intraepithelial neoplasia (CIN). This relationship was investigated by examining a series of biopsies containing normal epithelium, non-neoplastic condylomatous epithelium, and neoplastic epithelium (CIN). In each case the degree of inflammation and the presence of reparative atypia were recorded from an examination of the hematoxylin and eosin stained sections and serial sections were stained for chlamydial antigens using a polyclonal antichlamydial antibody and the immunoperoxidase technique. Overall, staining for chlamydia was positive in 0, 2, and 16% of biopsies with mild, moderate, and severe inflammation, respectively. In cases of severe inflammation positive staining was present in 20, 25, and 8% of biopsies containing non-neoplastic, condylomatous, and neoplastic epithelium, respectively. In all positive cases the staining was most prevalent in areas of the most intense inflammation. A spectrum of squamous epithelial changes was found in the infected biopsies and their distinction from CIN is discussed. This study suggests that tissue staining for chlamydia is related more to the extent of the coexisting inflammation than the presence or absence of CIN. Chlamydial infection, however, was frequently associated with inflammation-related squamous atypia in the transformation zone, which may be confused histologically with CIN.

Localizing chlamydial infection in cervical biopsies with the immunoperoxidase technique.

One hundred and two cervical biopsy specimens containing varying degrees of chronic inflammation were stained for chlamydial antigens with the immunoperoxidase technique. Seven cases (6.9%) were positive. Histologically, six (84%) of the Chlamydia-positive cases contained severe chronic inflammation, all contained reparative atypia, and two (28%), follicular cervicitis. When evaluated separately, 22% (six of 27) of the specimens with severe inflammation were positive in contrast to 0% (0 of 45) of cases with mild inflammation. Positively staining cells were located primarily in columnar epithelium and reparative atypia and occasionally in areas of immature squamous metaplasia. The cytological finding which correlated with positive staining was cytoplasmic vacuolation; however, cytoplasmic vacuoles were common in cells which did not stain positively, and it was impossible to predict on histological grounds which cells/specimens would stain positively by immunoperoxidase. Because of these findings, the presence of chlamydial infection should be strongly suspected whenever the cervical biopsy specimen contains severe inflammation and repair. Although tissue staining may not be as sensitive as culture for diagnostic purposes, it can be performed rapidly and simply and may be a useful special stain in cases where the diagnosis of chlamydial infection is not suspected clinically or cultures are not immediately available.

[Evaluation of postoperative radiotherapy by the moving strip technique for malignant ovarian tumor].

As a treatment for malignant ovarian tumor, whole abdominal irradiation including the upper abdomen is more useful. Between December, 1975 and November, 1980, we additionally applied whole abdominal irradiation by the moving strip technique (1,600 rad) after operation and whole pelvic irradiation (3,000 rad) to 43 cases of malignant ovarian tumor (serous cystadenocarcinoma-24, mucinous cystadenocarcinoma-7, mesodermal mixed tumor-3, clear cell carcinoma-2, endometrioid carcinoma-2, malignant granulosa cell tumor-1, malignant Brenner tumor-1 and metastatic tumor-3). Out of 10 cases with complete resection of the tumor, nine patients are surviving without recurrence, and also some advanced cases with incomplete operation have shown a remarkable reduction in the tumor size. As to complications, diarrhea during lower abdominal irradiation as well as nausea and vomiting during upper abdominal irradiation were observed, but no characteristic changes were observed upon checking peripheral blood, liver and renal function; thus most cases completed the whole therapy without interruption. Some cases that had appeared to respond favorably course showed a rapid recurrence after 1.5-2 years, so four cases were given repeated irradiation, but results were not so satisfactory. Further study of radiation and combinations with other therapies is now being tried.