[Prototype of a new pediatric emergency scale tape: PES tape].

Drug dosage and appropriate size of medical equipment for emergency pediatric patients are determined by age, body weight and/or height. In an emergency situation, however, such information about the patients is not always clear. Body height is easily measured when the patient lies down supine. Furthermore, child's height could be a better parameter than age to predict appropriate endotracheal tube (ETT) size and body weight. We propose a new pediatric emergency scale tape (PES Tape). PES Tape is graduated in centimeters to measure body height in supine position. Height-based body weight, drug dosage, energy dosage for defibrillation, appropriate size of ETT and lip-tip distance (LTD) are printed on the tape. We studied the reliability of this tape in pediatric anesthesia. Body weight estimated from the tape was accurate, and predicted size of ETT and LTD was appropriate. PES Tape is a reliable tool in pediatric emergency.

Clinical study of the effectiveness of a dual amplified immunoassay (IDEIA PCE Chlamydia) for the diagnosis of male urethritis.

A clinical study of patients with male urethritis (n=316) was undertaken to determine the sensitivity potential for a new dual amplified immunoassay (IDEIA PCE Chlamydia). Increased sensitivity (98.8%, 84/85) was obtained for IDEIA PCE Chlamydia compared to a conventional antigen detection test (IDEIA Chlamydia, 81.2%, 69/85) when testing urine samples. In a smaller patient population (n=104) the positivity rate for the first-void urine tested with IDEIA PCE Chlamydia of 30.8% (32/104) was similar to the 27.9% (29/104) obtained from urethral swabs tested with a DNA probe assay (PACE 2). The increased sensitivity of the test was confirmed with a commercial PCR kit (Amplicor) and nested PCR. The IDEIA PCE Chlamydia kit has the sensitivity potential to be a clinically reliable alternative for detecting Chlamydia trachomatis.

Secretory carcinoma of the breast associated with juvenile papillomatosis in a 12-year-old girl. A case report.

A rare case of juvenile secretory carcinoma (SC) associated with juvenile papillomatosis (JP) is described. Tumor biopsy and fine needle aspiration cytology (FNAC) were performed in a 12-year-old girl who had noticed a painful right breast mass. One of the two types of tumor cells found on FNAC smears formed mainly sheets or clusters, intercellular spaces within the sheets and intracytoplasmic vacuolation. These cells, a few of which had a signet-ring cell appearance with completely disordered and randomly arranged nuclei, were considered to be SC cells. Cells of the other type were found in scattered papillary clusters and had well-defined cytoplasmic borders, uniform cell and nuclear size, and an orderly nuclear arrangement, suggesting a benign papillary lesion. Histologic examination of the tumor biopsy and breast quadrantectomy specimens revealed SC with JP. The cytologic, histologic and electron microscopic features of SC are described, and the relationship between SC and JP is discussed.

[Investigation of Chlamydia trachomatis-specific IgA, IgG antibody with EIA method].

Recently, two new kits, HITAZYME (Hitachi Chemical Co., Ltd.) and SERO IPALISA (Savyon Diagnostics, Ltd.), for the assay of anti-C. trachomatis antibodies by the enzyme immunoassay (EIA) method have been developed and put into clinical application. In the study reported here, the authors investigated the clinical usefulness of these assay kits, together with the IPAzyme and micro-IF test, in the diagnosis of cases of urogenital tract C. trachomatis infections. 1. The positive rates for IgA antibodies, which are considered to be an indicator of active infection, obtained with the HITAZYME and SERO IPALISA kits in the 82 antigen-positive cases were significantly (p < 0.005) higher than the rates obtained with the IPAzyme and micro-IF test. These results showed the usefulness of the HITAZYME and SERO IPALISA kits for detecting C. trachomatis infections. 2. A comparison was made of the assay results obtained with the HITAZYME and SERO IPALISA kits, and it was found that there was a large number of cases (142) that tested negative for IgA antibodies with the HITAZYME but positive with the SERO IPALISA kit. We carried out a confirmatory test on the specimens of cases for which the results obtained with the HITAZYME and SERO IPALISA kits were not in agreement. This test employed the Western blotting method using COMC (the antigen extracted from EB of C. trachomatis strain L2 and used in the HITAZYME kit) and whole EB of C. trachomatis strain L2 (the antigen used in the SERO IPALISA kit). The results showed a significantly higher degree of agreement between the HITAZYME kit data and the Western blotting data than between the SERO IPALISA kit data and the Western blotting data. 3. In addition, with the objective of investigating the existence of cross reactivity with anti-C. pneumoniae antibodies, we performed Western blotting using as the antigen crude whole EB of C. pneumoniae strain TW-183. The results showed that anti-C. pneumoniae antibodies were detected in 25 of 35 (71.4%) cases that were negative with C. trachomatis antigen and the HITAZYME kit and positive with the SERO IPALISA kit. These findings indicate a strong possibility that these cases positive with the SERO IPALISA kit are due to a cross reaction with anti-C. pneumoniae antibodies.(ABSTRACT TRUNCATED AT 400 WORDS)

[Detection of human papillomavirus DNA in cases of sexually transmitted diseases (STD)].

Human papillomavirus (HPV) has been detected on the genitalia without any macroscopic abnormality and the possibility of latent infection of HPV has been suggested. Using Vira Type (Toure Co.), we have detected 7 genotypes of HPV DNA under a high stringent condition on the genitalia of patients with sexually transmitted diseases (STD), who were suspected of having had many sexual partners. In male cases of STDs other than condyloma acuminatum, the HPV-positive rate of the glans and sulcus coronarius was 4.7% (5/106). In healthy men, the HPV-positive rate was 6.1% (2/33), while in chronic prostatitis cases it was 3.4% (7/205) and in benign prostatic hypertrophy cases HPV was not detected. In female cases of STDs other than condyloma acuminatum, the HPV-positive rate of uterine cervix was 5.1% (3/58). In pregnant women, the HPV-positive rate was 4.6% (9/197). With regard to the HPV-positive rate within different age groups of STD and non STD cases, the rate tended to be higher in young people. After several weeks, follow-up studies were conducted on HPV-positive cases. HPV DNA was detected in one case of 10 males STD cases and two of 10 pregnant women, and the HPV DNA was the same type as at the first examination. However, after 3-4 months, all three of these cases had become negative for HPV DNA.

[Study on Chlamydia trachomatis antigen detection by an EIA kit using a monoclonal antibody--comparison with a polyclonal EIA kit in urogenital infections].

We evaluated the clinical usefulness of a new EIA kit using a monoclonal antibody, IDEIA CHLAMYDIA (IDEIA, Novo Nordisk), for detection of C. trachomatis antigen from the genital tracts of male and female cases. The results were compared with those by Chlamydiazyme (Abbott). 1. C. trachomatis antigen detection by the IDEIA and Chlamydiazyme tests before treatment; IDEIA has a significantly higher detection rate (38.0%, 105/276) than Chlamydiazyme (29.8%, 80/276), for C. trachomatis antigen from urethral smears of 276 male patients with urethritis. In 646 female cases, including cervicitis and so on, IDEIA detected C. trachomatis antigen from cervical smears in 14.5% (94/648) of the total, while Chlamydiazyme did so in 11.9% (77/648). When considering the different results using IDEIA and Chlamydiazyme, approximately 20% of the IDEIA-positive cases were Chlamydiazyme-negative. However, when IDEIA was negative, less than 1% showed Chlamydia-positive. 2. C. trachomatis antigen detection during and after treatment; We studied the clinical courses of 14 male urethritis and 8 female cervicitis cases who had had positive results with both IDEIA and Chlamydiazyme before treatment. Two of the 14 urethritis cases showed positive results with IDEIA, but not with Chlamydiazyme after either 7 or 14 days treatment by an antimicrobial agent. These two also had symptoms indicating persistent urethritis. One of the 8 female cervicitis cases showed a positive result with IDEIA but not with Chlamydiazyme after 7 days treatment by an antimicrobial agent, and this case also had symptoms indicating persistent cervicitis. Thus, these clinical findings suggest that IDEIA can detect even a small quantity of antigen soon after treatment, but Chlamydiazyme can not. In conclusion, IDEIA has a higher sensitivity than Chlamydiazyme, in the detection of C. trachomatis antigen, suggesting that IDEIA is more useful.

[Study on Chlamydia trachomatis antigen detection in first-voided urine sediments].

C. trachomatis antigen in first-voided urine sediments was detected by a new EIA kit using a monoclonal antibody, IDEIA CHLAMYDIA (IDEIA, Novo Nordisk), in males with urethritis and females with cervicitis. The result was compared with that by Chlamydiazyme (Abbott). 1. C. trachomatis antigen detection in male urethritis (285 cases) by the IDEIA test: The antigen detection rate was 37.9% (108/285) in urethral smears, and 33.7% (96/285) in first-voided urine sediments of the patients. The positive co-incidence rate between urethral smears and first-voided urine sediments was 82.4% (98/108). Thus, the detection of the antigen seems feasible in first-voided urine sediments. 2. Comparison of C. trachomatis antigen detection by the IDEIA and Chlamydiazyme tests: In 78 male cases with urethritis undergoing both tests, the rates of antigen detection from urethral smears and first-voided urine sediments were studied. The detection rate from urethral smears was 41.0% (32/78) for IDEIA, and 37.2% (29/78) for Chlamydiazyme. In first-voided urine sediments, the rate was 35.9% (28/78) for IDEIA and 24.4% (19/78) for Chlamydiazyme. In both specimens, the detection sensitivity was higher for IDEIA. 3. C. trachomatis antigen detection in chlamydial cervicitis (28 cases) by the IDEIA test: The antigen detection rate was 46.4% (13/28) in urethral smears and 60.7% (17/28) in first-voided urine sediments. The detection rate in first voided urine sediments was higher. Thus, in patients suspected of having chlamydial cervicitis, it seems necessary not only to search the antigen in cervical smears but also to study the first-voided urine sediments.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidemiologic and therapeutic study on gonococcal infections--clinical efficacy of cefetamet pivoxil].

We studied the epidemiology of 109 cases of gonococcal infections (105 males with urethritis and 4 females with cervicitis), together with the basic and clinical effects of cefetamet pivoxil in the cases. The peak of age distribution of the male patients was in the younger half of their twenties, and all of the 4 female cases were between 20 and 39 years old. The major source of infections in the males younger than 25 years old was their girl friends or so-called pick-up friends, and that of the males older than 25 years old workers serving at an amusement center, for example, bars and so-called special massage parlor, which accounted for about three fourths of the male cases between 35 and 44 years old. The distribution of the MIC (inoculum size; 10(6) CFU/ml) of Cefetamet against beta-lactamase non penicillinase producing Neisseria gonorrhoeae (non-PPNG) ranged from 0.025 to 0.1 microgram/ml and that against beta-lactamase producing Neisseria gonorrhoeae ranged from 0.025 to 0.05 microgram/ml. The isolation rate of PPNG was 10.2% (9/88). In male patients with gonococcal urethritis, the efficacy rate was 100% on days 3 and 7 for 1,000 mg single dose and 7-day treatment and 500 mg single dose treatment. One of the cases treated with 250 mg single dose therapy was unchanged at 3, but the efficacy rate of the remaining cases was 100% at day 7. Complicated urethritis with C. trachomatis was noticed in 25.7% (5/105) of the male urethritis and in 25.0% (1/4) of the female cervicitis cases. The only side effect was diarrhea observed in 1 of the 124 case (0.8%).

Leiomyosarcoma of the thyroid gland. A case report with a comparative study of five cases of anaplastic carcinoma.

We report on a case of leiomyosarcoma of the thyroid with ultrastructural features and expression of intermediate filament proteins different from that of anaplastic carcinomas. Histologic examination of multiple sections showed that they were leiomyosarcomatous, and neither epithelial features nor giant cell configurations were found. Electron microscopic examination showed microfilament bundles with dense patches and discontinuous basal lamina. Desmin, vimentin, and actin were positive for tumor cells, and cytokeratin, thyroglobulin, and calcitonin were negative. In contrast, the anaplastic carcinoma cases did not contain microfilament bundles with dense patches in their tumor cells. There were no desmin-positive or cytokeratin-negative tumor cells. We concluded that this case was a primary leiomyosarcoma, presumably derived from the smooth muscle cell of the vascular wall.

[A clinical study of genital herpes and the clinical efficacy of acyclovir tablets].

A clinical study for genital herpes was conducted on 154 patients and the efficacy of treatment with oral acyclovir was investigated in 51 of these patients. The diagnosis was confirmed by direct immunofluorescence or viral isolation from the lesion. This disease has increased in both males and females in recent years and was found in 2.3-2.9% of the out-patients examined in 1986. Seventy percent of the patients were between 20 and 30 years old. About 70% of the male patients had phimosis. In patients with the first infection, bilateral eruption (62%) and lymphadenopathy (54%) were more common than unilateral lesions. However, in those with recurrent infection, unilateral eruption (72%) and lymphadenopathy (52%) were more common. Sixty two percent of those with the first infection had scattered eruption on external genitalia, but 71% with recurrent infection, had lesions concentrated in several areas. Local symptoms such as pain in the external genitalia (male: female, 16%: 85%), pain in the lower extremities (26%: 45%), discomfort in the lower extremities (20%: 41%) and systemic symptoms such as malaise (22%: 48%) and anorexia (4%: 35%) were seen more frequently in females than in males. In addition, systemic symptoms such as fever (first episode: recurrent episode, 36%: 4%), malaise (34%: 9%) and anorexia (18%: 2%) were seen more frequently in patients with the first episode than in those with recurrence. HSV type 1 infections were found in 16% of males and 28% of females with the first episode, but were less common in the recurrent episode, 0% and 13%, respectively. Direct immunofluorescence was positive in 75 (59%) of 128 samples diagnosed by viral isolation. Treatment with oral acyclovir tablets, 200 mg five times daily, was very effective in 26 of 30 patients (87%). No side effects were observed. In this study, acyclovir tablet has been shown to be a very effective and well-tolerated treatment for genital herpes infections.

[Epidemiological and therapeutic studies of gonorrheal infections (I)--clinical efficacy of long acting amoxicillin (L-AMPC)].

During the period from October of 1981 through March of 1982, our research group in Sapporo treated 178 patients (158 males and 20 females) for gonorrheal infections. We performed epidemiological and therapeutic studies on these patients. The youngest of the 158 male patients with acute gonorrheal urethritis was 15 years old. The age distribution was 32 patients (20.3%) under 20 years, 46 patients (29.1%) aged 20 to 24, 34 patients (21.5%) aged 25 to 29, 22 patients (13.9%) aged 30 to 34, 10 patients (6.3%) aged 35 to 39, and 14 patients (8.9%) aged 40 to 54. The fact that 20% of gonorrheal urethritis occurred in youths under 20 years of age, is especially noteworthy. The infection in the teenage boys was found to be picked up mostly from girls met at discos , etc., On the other hand, the patients in their 20s, were infected more frequently by contact with hostesses at massage parlors and bars, these sources making up the majority of male patients who were 25 years or older. These findings are quite interesting because they reflect the socio-economic status of the patients. In addition, the fact that hostesses working at massage parlors are a frequent source of gonorrheal urethritis infections can represent a considerable problem in terms of public hygiene. The 20 female patients with gonorrheal infections were all found to be cases of cervicitis, except for a 1-year-old girl with gonorrheal infection of external genitals. The fact that about half of these female patients were teenagers, aged 16 to 19 years is worth special note. The duration of the latent period was less than 5 days in 83 male patients (58.9%) with urethritis, 6 approximately 10 days in 39 patients (27.7%), 11 approximately 20 days in 13 patients (9.2%), 21 approximately 30 days in 4 patients (2.8%), and over 30 days in 2 patients (1.4%), It can thus be said that the number of cases showing a long incubation period is increasing. The MICs of 154 gonococci strains isolated from the urethral or vaginal discharge were determined. Thirteen (8.4%) of these clinically isolated strains were found to be beta-lactamase producers. When a bacterial inoculation level of 10(6) cells/ml was used in the in vitro MIC determination, the MIC was 1.56 micrograms/ml or higher for 12 of these beta-lactamase-producing strains; the MIC of the 13th strain was 0.78 microgram/ml. At the same time, the MICs of these beta-lactamase-producing strains to doxycycline were also high; 1.56 micrograms/ml or higher.(ABSTRACT TRUNCATED AT 400 WORDS)

Blood-testis barrier in men with idiopathic hypogonadotropic eunuchoidism and postpuberal pituiary failure.

Immature-type Sertoli cells in the testes of idiopathic hypogonadotropic eunuchoidism (17-30 years of age) had no specialized junctions. The specialized Sertoli junctions that blocked the penetration of lanthanum were formed six months to two years after hCG treatment (5000 IU twice a week) in patients of hypogonadotropic eunuchoidism. In two patients with postpubertal pituitary failure (one had a ectopic pinealoma, irradiated one year ago, and the other had a pituitary adenoma, hypophysectomized four years ago), the ultrastructural integrity of these Sertoli junctions was maintained. Therefore, it may be suggested that the development of the blood-testis barrier is dependent on gonadotropins, but the maintenance of the blood-testis barrier is not.