[A case of Bellini duct carcinoma producing granulocyte colony-stimulating factor (G-CSF)].

A case of Bellini duct carcinoma producing granulocyte colony-stimulating factor (G-CSF) is reported. The patient was a 75-year-old female with the chief complaint of appetite loss. Abdominal ultrasonography and abdominal computed tomography revealed left renal pelvic tumor. Left radical nephrouretrectomy was performed. The histopathological report showed Bellini duct carcinoma. Immunohistochemical staining using the anti-G-CSF antibody showed positive staining in the cancer cells. Preoperatively, the white blood cell count and serum G-CSF concentration were elevated to 34,100/microliter and 334 pg/ml respectively. After operation these values became normal. However, these values were elevated again and CT scan revealed a left pulmonary metastasis 3 months after the operation. In spite of chemotherapy, she died of brain metastases 7 months after the operation.

Systemic fusariosis after a preparative regimen including thiotepa, VP-16 and busulfan used for blood stem cell transplantation in Hodgkin's disease.

Fusarium infection is rare but important infection after bone marrow transplantation (BMT). A 27-year-old man developed systemic fusarial infection following severe skin damage probably caused by high-dose thiotepa administration. Systemic fusariosis rapidly progressed to a variety of organs despite antifungal treatment, and he finally died of this infection on day 75. Considering that this organism usually invades via damaged skin and that the penile lesion was the first manifestation of systemic fusariosis in this patient, careful examination of the skin might be helpful for early diagnosis of fusarial infection. His clinical course provided us with an important clue for diagnosis of fusarial infection.

[Management of medical practice at home].

We present here how medical practice is managed at the patients home. Medical care at home is conducted in conjunction with a variety of professionals who provide health care in the community. The use of computers allows us to easily download information, and transfer it from the clinic to community services. Fluid replacement, total parenteral nutrition, palliative treatment of pain in cancer patients, management of urethral catheters, and other skills that are carried out at home would be stated.

Biomechanical analysis of effects of foot placement with varying chair height on the motion of standing up.

Individual experience reveals that posterior foot placement enables one to stand up easily from a chair. However, the way in which foot placement affects this motion has not been investigated in detail. This study was performed to examine the effects of foot placement in the initial stage of the dynamics of standing up from a chair. Subjects wearing light-emitting diode markers and surface electrodes stood up from a chair over force plates, and ground reaction force, joint angle, and muscle activity were measured. The motions required to stand up from chairs 30, 40, or 50 cm in height were analyzed with anterior, vertical, and posterior foot placement. With anterior foot placement, the forward-acceleration components of the ground reaction force were recorded with simultaneous and long-sustained activity of the muscles in order to shift the center of gravity of the body forward even more after lift-off. Our findings indicate that the distance between the center of gravity and the point of application of ground reaction force at lift-off are critical factors in the standing-up motion, and that chairs should be of adequate height as well as having sufficient space under the seat to permit the backward movement of the lower legs.

Sickness absence due to mental disorders in Japanese workforce.

This study was conducted to elucidate sickness absence due to mental disorders in Japanese companies. Data on sickness absence taken for seven consecutive days or more at eight companies (total number of employees: 44,816) was used for the analysis. Diagnosis of mental disorders was based on medical certificates prepared by physicians. The frequency of absence due to all diseases and mental disorders was 3.0% and 0.3%, respectively. The proportion of frequency absence due to mental disorders compared to that for all diseases was 9.4%. Figures for absence prevalence were almost the same as those for frequency absence. The average length of absence due to mental disorders and non-mental disorders was 119.5 days and 47.3 days, respectively. Rate of absence days due to mental disorders compared to that for all diseases was 21.0%. Percent of sickness absenteeism was 0.4%. In one company, the proportion of frequency absence and rate of absence days due to mental disorders compared to those for all diseases had an increasing tendency over the last six years.

Concentration of levofloxacin in cervical mucus and its clinical effects on cervicitis.

An investigation was made on the concentration of levofloxacin (LVFX) in cervical mucus and its clinical effects on cervicitis. The results were as follows: 1) The concentrations of orally administered LVFX in the cervical mucus of 110 subjects were determined by HPLC. During 1-4 hour after the administration the mean concentration of LVFX in the cervical mucus reached a level of 2 micrograms/g, which was higher than the serum level. The transfer of LVFX to the cervical mucus was almost the same as that to other genital organs. 2) When LVFX was given to 102 patients at a dose of 100-200 mg, t.i.d for 4-5 days and the efficacy was evaluated with clinical improvement, the clinical efficacy rate of LVFX was 72/102 (70.6%). Significant bacteriological effects were observed in 70/73 (95.9%), especially, the disappearance rate of C. trachomatis was 18/18 (100%). 3) The administration LVFX did not cause any subjective or objective side effects and any abnormalities were not detected in the laboratory test done in this study. These results demonstrate that LVFX can be sufficiently transferred to the cervical mucus for the treatment of cervicitis due to the infection of C. trachomatis etc.

Aging changes in the alignment of chromosomes after human chorionic gonadotropin stimulation may be a possible cause of decreased fertility in mice.

The relation between the alignment of chromosomes in the aged oocyte and its capacities of fertilization and development of oocytes was examined. More embryos in the condition of insemination at 12 and 16 h after human chorionic gonadotropin (hCG) however grew into two and more cell stages than those in the insemination of 20, 24 and 28 h. Some embryos in the group of insemination at 12, 16 and 20 h after hCG injection had grown into the blastocyst stage. The embryos inseminated 24 h after hCG and later had shown no further development. Twelve hours after hCG injection, 67% of oocytes have chromosomes on a straight line (A), and 29% have chromosomes scattered in one group (B). Three percent of oocytes have them separated toward both spindle ends (C) and 2% of oocytes have no chromosomes (D). At 16 h after hCG, the alignments of chromosomes are almost the same as that of 12 h after hCG injection. At 20 h after hCG, the most common alignment of chromosomes was scattered in a small group. The alignment of chromosomes of most oocytes was splitting at 24 and 28 h after hCG injection. Thus the oocytes with the chromosome alignment of A or B can be fertilized and developed into the blastocyst stage. The alignment of A and B lasts only about 8 h after ovulation, and the time was extremely restricted for oocytes to develop normally.

Effect of an aromatase inhibitor in human follicular fluid on DNA synthesis of granulosa cells, theca cells, and follicles.

An aromatase inhibitor was identified in human follicular fluid. We sought to examine the effects of this inhibitor on granulosa cells, theca cells, a mixture of granulosa and theca cells, and follicles. Granulosa cells, theca cells, the mixture of granulosa and theca cells, and follicles were incubated with [3H]-thymidine and aromatase inhibitor at 37 degrees C for 40 h in Ham F-10 medium. The radioactivities of acid-soluble fractions were counted. Aromatase inhibitor markedly inhibited the DNA synthesis of granulosa cells and follicles, but it did not inhibit the mixture of granulosa and theca cells. This suggested that aromatase inhibitor was a factor in the follicle paracrine system and acted mainly on granulosa cells.

Factors promoting embryo implantation in in vitro fertilization and embryo transfer.

The low implantation rate after embryo transfer (ET) is the most important problem to be solved in in vitro fertilization and embryo transfer (IVF-ET). Various factors which may affect embryo implantation in the endometrium have been examined. In this study, the influence of the timing of luteinization on the establishment of pregnancy was investigated. Follicle stimulation was performed by luteinizing hormone-releasing hormone agonist, human menopausal gonadotropin and human chorionic gonadotropin (hCG). hCG was injected on the day when the mean diameter of two follicles exceeded 16 mm, and 36 h after the injection the oocyte was retrieved. Progesterone (P4) supplement was started on the day of ovum retrieval (50 mg), followed by 30 mg for 14 days. The patients were divided into three groups: (1) the pregnant patients (n = 20: group Pre); (2) the nonpregnant patients without bleeding during P4 injection (n = 35; group N), and (3) the nonpregnant patients with bleeding during P4 injection (n = 30; group B). The number of follicles that developed, endometrial thickness, the day of operation, the number of oocytes harvested, the number of good quality oocytes, the number of oocytes fertilized, the number of embryos transferred, estradiol (E2) and P4 levels, and the E2/P4 ratio were examined. The endometrial thickness of group Pre (10.9 +/- 0.6 mm; mean +/- SEM) on the day of hCG injection was significantly (p less than 0.05) greater than that of groups N (9.0 +/- 0.4 mm) and B (9.2 +/- 0.3 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Decreased natural killer cell activity in women with endometriosis.

Natural killer (NK) cell activity is characterized by the spontaneous capacity of lymphoid cells derived from nonimmunized hosts to recognize and lyse certain tumor cell lines, virus-infected cells and transplanted tumor cell lines. Endometriosis is characterized by implantation and proliferation of autologous ectopic tissue in the pelvic cavity. Therefore, we focused on examining NK cell activity in women with endometriosis. NK cell activity in peripheral blood from women with endometriosis was lower than in women without endometriosis. On the basis of this finding, we analyzed also the effect of peripheral sera of women with endometriosis on NK cell activity. In the presence of peripheral sera of women with endometriosis, NK cell activity was significantly suppressed as compared with the sera of women without endometriosis. The suppressive effect of sera of women with endometriosis on NK cell activity showed dose-dependent curves. These studies provide the speculation that natural immunity mediated by NK cells may modulate the development of endometrial implants.

[Pituitary apoplexy with hypercreatinekinasemia].

A 59 year-old female with hypercereatinekinasemia associated with pituitary apoplexy was presented. The patient showed headache, nausea, vomiting and pyrexia. On admission, slight nuchal rigidity and photophobia were observed. However all the cranial nerves were intact; neither ophthalmoplegia nor visual defect were observed. Cerebrospinal fluid analysis revealed an elevated protein concentration of 164 mg/dl. There were 157 cells/mm2 (30% neutrophils). Skull X-P disclosed the ballooning of the sella turcica. CT scan, endocrinological examination and angiography lead us to the diagnosis of pituitary apoplexy. By the sphenoidal approach necrotic tissue with a little chromophobe adenoma were removed. No haematoma was detected. The isozyme pattern of serum CK showed 100 percent MM type. Serum CK concentration reached as high as 2502 IU/l on the fifth day from the onset of the symptom and then normalized in 12 days. Though the cause of the hypercreatinekinasemia uncertain, the similar pattern of hypercreatinekinasemia is known in the acute stage of cerebrovascular accident, and it is more often observed in thalamic hemorrhage. We assumed that the hypercreatinekinasemia in our case was caused by hypothalamic irritation, which lead hyperpermeability of sarcolemma and leakage of the enzymes of muscle origin.

Turner's syndrome--review of the literature with reference to a successful pregnancy outcome.

A 30-year-old Japanese female with Turner's syndrome had become pregnant and delivered a normal male infant by cesarean section. Her menarche was at age 14, and secondary sex characteristics developed normally. She had some features of Turner's syndrome, and cytogenetic studies from peripheral blood lymphocytes and several tissues revealed only 45,XO karyotype without evidence of mosaicism. To our knowledge, she is only the thirteenth case of monosomy X to achieve pregnancy. A review of the literature indicates a high incidence of fetal wastage and increased chromosomal errors in the offspring of women with a 45,XO cell line with or without mosaicism.

Involvement of prolactin in the control of follicular maturation.

This study was designed to explore the role of prolactin (PRL) in the modulation of follicular growth and steroidogenesis. An ovarian perifusion technique was used to determine the effect of PRL on steroid production by ovarian tissue. Immature female rats were injected with 5 IU pregnant mare's serum gonadotropin to induce follicular maturation. After 40 h rats were killed, ovaries removed, and follicles dissected out. Follicles were divided into two groups (small, less than or equal to 4 mm; large, greater than or equal to 5 mm in diameter), cut into fine fragments, and perifused for 6 in the presence or absence of ovine PRL (100 or 1,000 ng/ml). In the group of small follicles, either of the PRL doses reduced the ability of follicular tissues to convert androgen to estrogen. HCG-induced production of progesterone by small follicles was also suppressed by higher doses of PRL. On the other hand, in the group of large follicles, PRL showed no effects on the aromatization and progesterone release by the follicular fragments. These results suggest that the small immature follicle is more sensitive to the inhibitory action of PRL on steroidogenesis and folliculogenesis. Thus it is possible that PRL may have a modulatory role in follicular growth and maturation and, consequently, in the selection of ovulatory follicle.

Further evidence that prolactin controls the prepubertal sexual development in the female rat.

To assess the role of prolactin (PRL) in the puberty onset and the ovarian aromatase activity, hyper- and hypoprolactinemic conditions were induced by treating chronically prepubertal female rats with PRL and bromocriptine, respectively. Injection of rat PRL (5 micrograms, twice daily) from day 20 onward advanced the day of vaginal opening. By contrast, the suppression of PRL release by bromocriptine, which was provided in the drinking water at a concentration of 40 micrograms/ml, caused a significant delay in the age of occurrence of vaginal opening. This bromocriptine-induced delayed puberty was prevented by the concomitant administration of exogenous PRL, suggesting that the effect of bromocriptine is exerted through its suppressive effect on the endogenous PRL release. The in vitro release of estradiol by the ovaries from 30-day-old rats treated with PRL was found to be higher than that from the control animals, when the ovaries were perifused for 6 h with an excess of androstenedione. On the other hand, the ovaries perifused in the presence of androgen produced less estradiol in the bromocriptine-treated rats than in their controls. It appears, therefore, that PRL is more likely related to the aromatase activity in the maturing ovary. These results suggest that PRL may be one of the factors that regulate the timing of puberty onset by influencing the aromatase activity in the ovary.

45,XO/46,X,dic(Yq) mosaicism in Turner's phenotype with endodermal sinus tumor of the ovary.

A case of a endodermal sinus tumor of the ovary in a patient with 45,XO/46,X,dic(Y) mosaicism is reported because of the rarity of the karyotype and condition. A 15-year-old girl was admitted to Yamagata University Hospital because of constipation for several days. Physical examination showed webbing of the neck, cubitus valgus and short stature. Her abdomen was bulging. Chromosomal analysis showed 45,XO/46,X,dic(Yq) mosaicism in karyotype. alpha-Fetoprotein and CA-125 in the serum were high. A left ovarian tumor was found by laparotomy; however, the right ovary was a streak gonad and the uterus was hypoplastic. An endodermal sinus tumor was diagnosed by a pathologist. After operation, cisplatin-vinblastin-bleomycin chemotherapy was instituted and the tumor marker went down. This patient is still healthy and under observation at the outpatient clinic.

Thromboxane A2 synthesizing activity of platelets in coronary artery diseases.

To observe platelet TXA2 synthesizing activities in acute myocardial infarction (AMI, 38 cases) and effort angina (EA, 23 cases), radioimmunoassay was used to measure the amount of synthesized TXB2 at 5 min after an addition of arachidonic acid or thrombin to the platelet suspension. The amount of TXB2 in AMI patients did not show a significant difference from that of 13 healthy controls. However, there were significant changes during the time course of AMI. It increased in the super acute phase within the first 12 hrs from the onset of AMI. The activity decreased in 4 days, increased again in 10 days and then gradually recovered to the normal value. Platelet aggregation was elevated immediately after the onset of AMI and recovered during the time course. A significant negative correlation was observed between aggregation and TXA2 production in AMI, but not in the healthy controls, suggesting that platelets with hyper TXA2 synthesizing activity are consumed selectively in AMI. In EA, activity increased after treadmill exercise. Under ticlopidine-treatment, activity was depressed, and these patients were able to tolerate a longer exercise time than before ticlopidine. Since the pressure rate products did not change under treatment, changes in microcirculation such as the appearance of platelet aggregates may be important in the occurrence of anginal attacks.

[Left ventricular systolic and diastolic functions evaluated by the computerized cardiac nuclear probe].

Left ventricular diastolic function and systolic function were evaluated using a recently-developed computerized cardiac nuclear probe (CNP). We measured left ventricular ejection fraction (LVEF) and ejection rate (ER) as the systolic function, and peak filling rate (PFR) and time to peak filling rate (TPFR) as the diastolic function in 95 patients including 34 ischemics, 38 hypertensives, and 23 anthracyclin-treated after the intravenous injection of 5 to 20 mCi Tc99m-albumin. The reproducibility of the measurements was studied, and the measurements were correlated with conventional gamma-camera cardiac blood scintigraphic and echocardiographic measurements. Reproducibility of the measurements using the cardiac nuclear probe were excellent for each measurement, and the correlation coefficients were 0.96 for LVEF, 0.88 for ER, 0.91 for PFR, and 0.80 for TPFR, respectively. LVEF by CNP correlated well with that by the gamma-camera (r=0.82, p less than 0.001) and echocardiography (r=0.76, p less than 0.001). LVEF, ER and PFR in ischemic heart disease were all significantly less (p less than 0.05), and TPFR was significantly greater (p less than 0.05) than those in the other study groups. These results emphasized the high resolution temporal imaging capacity of CNP and suggested that left ventricular filling abnormalities evaluated by CNP would be useful for the identification of incipient cardiac dysfunction.