Umbilical cord venous pulsation in normal fetuses and its incidence after 13 weeks of gestation.

A total of 1175 umbilical venous Doppler flow velocity waveforms were acquired from 449 normal pregnant women whose fetuses were delivered at term without neonatal asphyxia or anomalies. Arterial and venous flow velocity waveforms were acquired from a free loop of the umbilical cord. The incidence of umbilical venous pulsation decreased from 30.4% at 13-14 weeks of gestation to 14.8% at 21-22 weeks of gestation. After 23 weeks, this incidence was settled within 5.0-7.8%. There was no difference between the umbilical arterial resistance index of the fetuses with venous pulsation and without pulsation before 22 weeks. But the resistance index was lower in the pulsatile fetuses than in the nonpulsatile fetuses after 23 weeks of gestation. The origin of venous pulsations before early second trimester was suspected to be different from that after late second trimester.

Umbilical venous pulsation and regional circulatory disturbance.

The umbilical cord conditions at the point where regional umbilical venous pulsation occurred were examined in 15 patients between the 28th and 40th gestational week. The patients delivered appropriate-for-date infants without anomalies. Regional venous pulsation was observed in cases of large-angle cord winding (especially more than 60 degrees). It was also observed where the umbilical cord was compressed by the fetus, uterine wall or placenta, even if the umbilical cord was straight. From these findings, we concluded that regional umbilical venous pulsation is the result of regional circulatory disturbance of the umbilical cord.

New technologies for the management of preterm premature rupture of membranes.

The catheterization described is still incomplete, posing many problems yet to be solved. However, this method has shed light on new issues, including the intraamniotic administration of antibiotics against amniotic fluid infection and fetal infection, amnioinfusion of saline for oligohydramnios, and development of artificial amniotic fluid. These issues are much easier than the nursing of extremely small premature babies and should be solved by the collective wisdom of obstetricians.

Uterine blood flow velocity waveforms during early postpartum course following caesarean section.

OBJECTIVE: To assess the change of uterine blood flow after Caesarean section. STUDY DESIGN: Doppler flow velocity waveforms were acquired from the uterine arteries and small arteries near the myometrial wound detected by transvaginal power Doppler ultrasonography in 23 patients on the 3rd, 6th and 9th postoperative days. RESULTS: The resistance index for the uterine artery did not show any change during the study period, while that for the small arteries slightly decreased. CONCLUSION: Uterine blood flow resistance after Caesarean section did not show any change during the early postpartum period.

Massive fetomaternal hemorrhage.

We evaluated the potential prognostic factors for fetomaternal hemorrhage (FMH). Sinusoidal heart rate pattern and decrease in fetal movement are considered important signs of FMH. However these findings were detected in only two of six cases of FMH and were thought to be late signs of FMH. Fetal hemoglobin levels in the maternal circulation for infants born alive following FMH were less than 5%. Our findings suggest that this amount of blood loss could cause fetal death.

Significance of fetography in prenatal diagnosis of limb-body wall complex (LBWC).

The diagnosis of limb body wall complex (LBWC) by ultrasonography does not usually present a problem. The major difficulty we found was severe oligohydramnios or a very complex relationship between the herniated viscera and the deformities. We performed fetography in a pregnant woman with fetal anterior abdominal wall defect at the 28th gestational week to show a peculiar structure of intrauterine membranes of LBWC, and we could obtain a successful prenatal diagnosis of LBWC.

A scanning electron microscopic study of the two-step effect of cytochalasin B on Ehrlich ascites tumor cells.

The effect of cytochalasin B (CB) on the surface structure of Ehrlich ascites tumor cells was investigated using the scanning electron microscope. The effect occurs in two steps: formation of zeiotic knobs on the cell surface and subsequent grouping of the knobs at one pole of the cell. The early step of zeiotic knob formation occurs at low concentrations of CB (0.5-1 microgram/ml) at 37 degrees C and at high concentrations of the drug (5-10 microgram/ml) at low temperature but within 1 min at 37 degrees C. This step is only partially inhibited by 5 x 10(-3) M sodium azide. The subsequent grouping of zeiotic knobs lasts for more than 2 min at 37 degrees C and occurs only in the case of high concentrations of CB. It is inhibited by sodium azide and is often associated with grouping of the microvilli, which are then lost from all of the cell surface except the area of knob-grouping.

Identification of phylloquinone (vitamin K1) as an unknown peak in electron capture detection gas chromatograms of pyrethroid insecticide residues.

An unknown peak was observed in spinach extract during routine analysis of 7 pyrethroid insecticides by gas chromatography with electron capture detection (GC-ECD) using a DB-1 column (20 m x 0.25 mm id, 0.1 micron film thickness). It eluted later than the 7 pyrethroids, and it was also found in other agricultural crops. The intensity of the unknown peak was related to the green color of the sample: It was absent in white vegetables such as radish root or onion. Data from GC/direct deposition/Fourier-transform infrared spectroscopy (FTIR) suggested it might be phylloquinone (vitamin K1). The identity was confirmed also by using electron impact capillary GC/mass spectrometry (MS). Although phylloquinone has no halogens, it showed very high sensitivity by ECD (63Ni), responding to 10 pg.

Intake ratio of water-insoluble dietary fiber to the water-soluble one in Japanese: an estimation on dietary records and the secular consideration on the national nutrition survey.

Thirty-four foods were analyzed in order to determine the content of water-soluble dietary fiber (SDF) and insoluble dietary fiber (IDF). Using the results with the standard table for 227 foods, the intake ratio of IDF/SDF of an average Japanese was calculated for the period 1946-1990. The ratio was 3.22 in 1990 as calculated on the food intakes shown in the national nutrition survey, and the secular change was not detected since 1946 when the ratio was 3.30. The ratio was also shown to be well preserved between types of households including the age of the head. Using dietary records of 60 healthy city workers (average 42.8 years) for 4 weeks, however, the weekly average ratio for an individual was found to vary in the range of 2.25-5.13 although the total average for 60 individuals was 3.33. Thus, the well preserved IDF/SDF intake ratio for an average Japanese showed, on the contrary, a wide variation of food selection between each person.

Tracheo-esophageal shunt speech: report of an unusual case.

A rare case of laryngectomee who acquired TE shunt speech is reported. Our patient was a 64-year-old woman with laryngeal cancer (glottic type T3N0M0). She underwent laryngectomy in 1990, and a Komorn tracheo-esophageal shunt operation was performed simultaneously. A voice prosthesis (BIVONA) was inserted into the shunt, but the voice valve was not used. She acquired shunt speech soon after the operation, and there was no need to close the tracheostoma during phonation. Fiberoptic, X-ray and aerodynamic findings of the shunt and esophagus were as follows: (i) The one-way valve of the voice prosthesis was open during inspiration and closed during phonation. (ii) Swallowing of air, as seen in esophageal speech, was not observed. (iii) The neoglottis was in the upper part of the esophagus. It was concluded that the air for the vibration of the neoglottis entered the esophagus through the T-E shunt during inspiration.

Favorable response to heparin in a pregnant woman with possible glomerular thrombosis as a complication of systemic lupus erythematosus and anti-phospholipid antibody syndrome.

A rare case of possible glomerular thrombosis during pregnancy is reported in a patient with active systemic lupus erythematosus and the presence of anti-phospholipid antibodies. Acute renal impairment was restored by administering infusions of heparin. Cesarean section was performed due to fetal distress, and resulted the live birth of a healthy infant.

Effects of cocaine and ethanol on mouse fetuses.

In the presence of ethanol, cocaine is metabolized to its ethyl homolog, cocaethylene. To investigate the embryotoxic effects of cocaethylene, pregnant ICR mice receiving ethanol orally during pregnancy were treated with 50 mg/kg/day cocaine i.p. on days 7, 8 and 9 of gestation. Treatment with either cocaine or ethanol alone did not affect the fetal mortality rate or the mean fetal body weight. Concurrent cocaine and ethanol treatment increased the fetal mortality rate, and decreased the mean fetal body weight, although teratogenicity was not noted. These results suggest that concurrent use of cocaine and ethanol during pregnancy is more harmful to fetal body weight gain and their lives than the use of either drug alone, at least in the present experimental settings.

[Determination of bisphenol A in foods using GC/MS].

An analytical method using GC/MS was developed for bisphenol A (BPA) in foods and BPA was determined in canned foods and fresh foods such as vegetables, fruit and meat. BPA was extracted with acetone from the samples and the extract was concentrated at under 40 degrees C in vacuo to afford an aqueous solution, which was washed with hexane after alkalization and extracted with 50% diethyl ether-hexane after acidification. Extracts were cleaned up on a PSA and/or a C18 cartridge column, and BPA was derivatized with heptafluorobutyric anhydride and determined by GC/MS (SIM). This method was applicable to the detection and determination of BPA residues in food samples at the level of 1 ng/g. Among canned foods, BPA was found in 6 corned beef, 1 chicken, 9 sweet corn and 3 bean samples at the levels of 17-602 ng/g, 212 ng/g, 2.3-75 ng/g and 3.5-26 ng/g, respectively. BPA was also detected in 1 retort soup and 1 retort pack product at the levels of 11 ng/g and 86 ng/g, respectively. As for dairy products, BPA was not detected in butter and milk. Among fresh foods, BPA was detected in 2 fish and 3 liver samples at the levels of trace (tr)-6.2 ng/g and tr-2.2 ng/g, respectively. In vegetables, fruits and chocolates, a trace level of BPA was detected in only 1 chocolate. Traces of BPA were also detected in 3 samples of 6 boxed lunches.

[The questionnaire concerned with the start and end point of the treatment for nasal allergy].

The precise primary end point of the treatment for nasal allergy has never been indicated. In this study, we conducted a questionnaire of specialists who actually treat with nasal allergy. The questionnaire is about start and end point of the treatment for nasal allergy. Answers were obtained from 49 doctors. The results were as follows. 1. About the goal at the start of the treatment. Perennial nasal allergy was put stress on control of the symptom, keeping of remission and improvement of quality of life. Pollinosis was put stress on control of the symptom, prevention of acute exacerbation and improvement of quality of life. No significant difference was observed between adult and child. 2. About the condition at the end point of the treatment. Perennial nasal allergy was put stress on the condition that symptoms were indisposition, no obstacle to daily life and no or a little medication was necessary. Pollinosis was put stress on the condition that symptoms were indisposition, no obstacle to daily life, and a little medication was necessary or that symptoms were continually stable and acute exacerbation was very rare. No significant difference was observed between adult and child.

[Empyema thoracis accompanied by hyperammonemic encephalopathy].

A 50-year-old man was admitted to our hospital due to consciousness disturbance. On admission, he was comatose (200 on the Japan Coma Scale) but brain computed tomographic (CT) scans were normal. Chest radiographs and CT scans on admission revealed massive pleural effusion in the right hemithorax. A culture of purulent pleural fluid yielded three species of anaerobes, including Bacteroides fragilis. Laboratory examinations revealed markedly elevated WBC count, CRP, and serum ammonia (586 micrograms/dl). However, liver function was almost normal and no other metabolic disorders were demonstrated. After the initiation of antibiotic therapy and pleural drainage, the patient's cousciousness level gradually improved in parallel with decreasing serum levels of ammonia and CRP. Because no other potential causes of hyperammonemia were observed, we concluded that the consciousness disturbance was due to hyperammonemia presumably caused by a urease-producing anaerobe infecting the right pleural space.

[Hemophagocytic syndrome associated with tuberculosis and mycoplasma infection in two patients].

Patient 1: A 48-year-old man was admitted to Osaka Red Cross Hospital because of fever and dyspnea. Laboratory examination revealed pancytopenia, liver dysfunction and hematostatic abnormality. Chest radiographs obtained on admission revealed ground-glass opacity in both lung fields, and an analysis of arterial blood showed severe hypoxemia (PaO2:46.8 Torr). Pulse therapy with methylprednisolone was started. Although the hypoxemia subsided and radiographic findings rapidly improved, pancytopenia persisted. Examination of bone marrow aspirate revealed mature histiocytes with marked hemophagocytosis. Amplified Mycobacterium tuberculosis direct tests of bronchoalveolar lavage fluid, sputum, urine, and bone marrow were all positive, and Mycobacterium tuberculosis was cultured from sputum and urine. Although the patient was taking antituberculous agents, his pancytopenia persosted. Treatment with etoposide induced remssion. Patient 2: A 19-year-old woman was admitted to Osaka Red Cross Hospital because of prolonged cough and fever. Laboratory examination revealed leukocytosis, liver dysfunction, and hematostatic abnormality. Serologic tests provided conclusive evidence of Mycoplasma infection and a CRP test was strongly positive. Chest radiographs obtained on admission revealed infiltration shadows in the middle and lower lung fields on both sides, with left pleural effusion. An analysis of arterial blood showed hypoxemia (PaO2: 54.2 Torr). Examination of bone marrow and pleural effusion samples revealed mature histiocytes with marked hemophagocytosis. Although treatment with antibiotics and pulse therapy with methylprednisolone was started, the patients respiratory functions deteriorated. Endotracheal intubation was performed. Therapy with etoposide induced remission. Hemophagocytic syndrome associated with Mycoplasma infection and tuberculosis appears to be exceedingly rare. In these 2 cases, it was difficult to achieve remission with therapy for the underlying infections, but etoposide treatment was effective.

[Combined treatment of head and neck cancers by radiation therapy and chemotherapy with a small dose of CDDP].

Two-route infusion chemotherapy with a smaller dose of CDDP was applied for combined modality treatment with radiation therapy for head and neck cancer from 1985 to 1992. To determine the appropriate dose of CDDP in this treatment, we investigated parameters concerned with its toxicity by comparing two groups given 5 and 10 mg of CDDP as a daily dose. Complete response was attained in 18 of 24 cases in the 5 mg group and 8 of 11 cases in the 10 mg group. The toxicity due to CDDP in this protocol was found generally to be slight in both groups. Among the parameters of toxicity, creatinine clearance was most affected. A decrease in 24 hr. creatinine clearance was noted in 15 of 29 cases in the 5 mg group and 10 of 12 cases in the 10 mg group. We had to discontinue this treatment after the first course because of lowered creatinine clearance in a patient in the 5 mg group. Stomatitis due to radiation therapy appeared to become worse in combination with this chemotherapy. The 10 mg dose of CDDP can be applied as a safe combination treatment with radiation therapy for head and neck cancer. To improve the outcome of this treatment modality for carcinomas of the tongue and oral floor, the 10 mg dose of CDDP was thought to be more beneficial. However, in the case of cumulative doses of CDDP over 100 mg, precaution should be taken to avoid the risk from the toxicity of more CDDP administration.

[Cytofluorometric DNA analysis in different histological patterns of thyroid papillary carcinoma].

Some papillary carcinomas of thyroid glands contain not only typical papillary structures but also various histological features in the same tumor. To investigate how areas with variable histological features differ in proliferative activity and how these differences influence the biological behavior of the whole tumor, we measured DNA contents by cytofluorometry in six papillary carcinomas with different histological features in the same tumor. DNA ploidy patterns were determined and the percentage of S plus G2M phase cells (S + G2M fraction) was calculated only in diploid tumors to assess the proliferative activity. The following conclusions were drawn. 1) It was demonstrated that there were differences in proliferative activity among areas with variable histological features in 4 of six tumors. 2) In the tumors which invaded adjacent tissues, the proliferative activity of the invasive area tended to be higher than that of the original area of the tumor. Therefore, the possibility exists that more precise evaluation of the biological behavior of the tumor can be obtained by measuring DNA contents of the tumor cells in invasive areas. 3) There was the gap in S + G2M fractions among some tumors with the same histological differentiation. Accordingly, DNA analysis of tumors would be of value in estimating proliferative activity.

Saline solution amnioinfusion for oligohydramnios after premature rupture of the membranes. A preliminary report.

In the conservative management of premature rupture of the membranes, most patients have oligohydramnios caused by continuous leakage of amniotic fluid. To avoid unfavorable effects of oligohydramnios on fetal development and well-being, we infused physiologic saline solution continuously into the amniotic cavity at a flow rate of 10 to 20 ml/hr with a new cervical indwelling catheter (PROM-fence). As a result the average pocket size of amniotic cavity was 2.7 cm before amnioinfusion, 5.9 cm 1 day after, 5.8 cm 5 days after, and 5.0 cm 10 days after amnioinfusion. The saline solution amnioinfusion made it possible to keep the amniotic cavity fluid level adequate. Variable deceleration disappeared in one case. No side effects such as uterine contractions were observed. We recommend the method of saline solution amnioinfusion for its favorable effects on fetal environment during management of premature rupture of membranes.