[Clinical studies of 145 cases of endometrial carcinoma--analysis of prognostic factors, especially pathological types].

One hundred and forty-five patients with confirmed endometrial carcinoma treated at Kumamoto University Hospital were studied from the clinicopathological point of view. As risk factors, the incidence of high age, postmenopause, atypical genital bleeding, sterility, nulliparity, diabetes mellitus, hypertension and obesity was showed to be high. These factors may be expected to assist in screening for early diagnosis by using each factor or combination of factors. As prognostic factors, we examined the relationship between stage, depth of myometrial invasion, histological grade, histological type and survival rate. The stage was shown to be a most important predicator of survival. The depth of myometrial invasion and the histological grade closely correlated with the stage. The relationship between the histological subtype, especially papillary serous carcinoma (PSC) and prognosis, was investigated in our series of studies. PSC found in an incidence of 9.4% had a relatively poor prognosis compared with endometrioid carcinoma. Its 5-year survival rate was only 30%. Because PSC has a potential for aggressive invasion and rapid metastasis as compared to endometrioid carcinoma, careful histological examination and aggressive treatment are warranted.

[Exfoliative cytology of mixed mesodermal tumors of the uterus--review of cytologic smears sampled prior to therapy].

Nine cases of mixed mesodermal tumor of the uterus were reviewed cytologically. Abnormal cytologic findings were seen in all cases, but malignant cells were detected in only 17 of 30 cytologic smears sampled prior to the therapy (2 of 7 pool smears, 2 of 3 portio rubbing-smears, 6 of 8 endocervical smears and 7 of 12 tumor-rubbing smears). The most commonly encountered cellular components were epithelial malignant cells which showed a close resemblance to those derived from uterine carcinomas, but tended to have multiple nuclei. In other cytologic components, a rhabdomyosarcoma was characterized by large, isolated, round or strap-shaped malignant cells with granular cytoplasms, bizarre and eccentric nuclei and one or more prominent nucleoli. Another infrequent cellular component was a fibrogenic sarcomatous cell which had an illdefined lacy cytoplasm and single or multiple nuclei containing rather finely granular chromatin, and occasionally formed a cluster. In several cytologic specimens, there were also seen multinucleated giant cells which were not in keeping with their histologic origins.

A graduated regimen of clomiphene citrate: its correlation to glycogen content of the endometrium and serum levels of estradiol and progesterone in infertile patients at the midluteal phase.

The glycogen content, glycogen synthetase level, and glycogen phosphorylase level were studied in endometrial samples obtained from 14 infertile patients during the midluteal phase before and after clomiphene citrate (Clomid, Shionogi & Company, Ltd., Osaka, Japan) treatment, simultaneously with measurement of the serum concentrations of estradiol and progesterone. Increase in the endometrial glycogen content in the clomiphene cycle was accompanied by a corresponding increase of the dosage of clomiphene. Also, the midluteal concentrations of estradiol and progesterone in the clomiphene cycle were significantly higher (P less than 0.005 and P less than 0.005, respectively) than those in the nontreatment cycle. Clomiphene therapy at 50 mg/day resulted in pregnancy in three of ten patients, while clomiphene at 100 mg/day resulted in pregnancy in three of six patients. These results suggest a fair correlation between the dosage of clomiphene and the improvement of endometrial function in infertile patients following stimulated ovarian steroidogenesis.

[Fundamental and clinical studies on T-1982 (cefbuperazone) in the field of obstetrics and gynecology].

Fundamental and clinical studies on T-1982 (cefbuperazone), a new cephamycin antibiotic, were carried out in the field of obstetrics and gynecology, and the following results were obtained. In a fundamental study, T-1982 was given to 7 patients with postpanhysterectomy at a dose of 1 g by intravenous drip infusion, and T-1982 concentrations in uterine artery and elbow vein serum and each uterine tissue (fallopian tube, ovary, endometrium, corpus uteri, cervix uteri and portio) were serially determined. The concentration in the endometrium (though the range of values was wide) was found higher than that in the other tissues. In a clinical study, T-1982 was given to 5 patients; 2 patients with parametritis and each one patient with right salpingitis, pyometra and metroendometritis. The efficacy rate was 80%. No side effects nor remarkable abnormalities in hematology, urinalysis and renal and hepatic function were observed during the therapy.

Hormone dependency of carcinoma of the human endometrium. Effect of progesterone on glycogen metabolism in the carcinoma tissue.

The glycogen content and glycogen synthetase and glycogen phosphorylase levels were studied in tissues of endometrial carcinoma obtained from 30 patients (27 postmenopausal and three premenopausal) before and after administration of progestogen, and the values were compared with those obtained previously from normal endometrial tissue of premenopausal patients. After the patients had undergone an oral glucose tolerance test (OGTT), the progestogen Lyndiol (lynestrenol, 5.0 mg, and mestranol, 0.15 mg) was administered daily for seven days. In 15 cases of well differentiated carcinoma the glycogen content after the progestogen administration, accompanied by a corresponding increase in the glycogen synthetase enzyme levels, was significantly higher (P less than 0.005) than that in the initial tissue, whereas in the other 15 cases of less differentiated carcinoma no change was observed. This finding that hormonal stimulus in well differentiated carcinoma leads to a similar effect on glycogen metabolism as in normal endometrium of the proliferative phase of the menstrual cycle, supports the possibility of progestogen therapy for human endometrial cancer.

Effect of progestogen on glycogen metabolism in the endometrium of infertile patients during the menstrual cycle.

The glycogen content and glycogen synthetase and glycogen phosphorylase levels were studied in endometrial samples obtained from 19 normal and 37 infertile patients during the menstrual cycle before and after administration of progestogen. Each of the above groups received the progestogen Lyndiol (lynestrenol, 5.0 mg, and mestranol, 0.15 mg) daily for 7 days during the follicular phase of the menstrual cycle. In both groups an increase in the endometrial glycogen deposition and an increase in glycogen synthetase enzyme levels were seen. When the administration of progestogen was started on day 7 after ovulation, during the luteal phase, the glycogen content of endometrial tissue from infertile patients increased significantly; no change was found in endometrial samples from normal patients. No difference was found in the serum progesterone levels of normal and infertile patients in the midsecretory phase of menstrual cycle, and Lyndiol reduced the serum level of progesterone to approximately that found during the follicular phase in untreated normal women. These studies suggest that the proliferative endometrium of infertile patients may be less stimulated by ovarian estrogen than is normal endometrium, whereas endometrial tissue obtained from both groups during the luteal phase responded similarly to progesterone in glycogen synthesis and storage.