Serum angiotensin converting enzyme activity in human bronchial asthma.

Using hippuryl-L-histidyl-L-leucine as a substrate analog, serum angiotensin converting enzyme (ACE) was spectrophotometrically estimated in patients with bronchial asthma. There were significantly low activities of serum ACE in 115 patients with bronchial asthma irrespective of the presence or absence of acute attack. The activity of serum ACE was reduced more markedly in the chronic type of bronchial asthma than in the paroxysmal type.     

Bilateral Wilm's Tumor: A Case Report and a Survey of Nineteen Cases in Japanese Literature

A eleven month old boy with bilateral Wilms' tumor has been reported. Hemine-phrectomy was performed and the boy lived fifteen months after surgery ultimately dying of metastatic disease. The remaining kidney was free from tumor at autopsy. The nineteen cases of bilateral Wilms' tumor in the Japanese literature were summarized.     

Serious complication of retrograde perfusion during repair of dissecting aneurysm: compression of the true lumen]

Between 1982 and 1990, 61 patients underwent the repair of dissecting aneurysm. Retrograde perfusion from the unilateral femoral artery were performed for 56 patients and the selective false lumen perfusion occurred in 3 patients. As for those 3 patients, compression of the true lumen and insufficient cerebral perfusion were suspected. Selective cerebral perfusion and antegrade systemic perfusion from the ascending aortic graft were performed. Although 2 patients took uneventful postoperative courses, 1 patient died of massive brain damage. It is very important to accomplish the means to maintain adequate cerebral circulation as soon as possible toward this fetal complication.     

Early invasive adenocarcinoma of the uterine cervix: criteria for nonradical surgical treatment

OBJECTIVE: This retrospective study was undertaken to identify selection criteria for nonradical surgery for early invasive adenocarcinoma of the uterine cervix. METHODS: Seventy-nine patients with surgically treated cervical adenocarcinomas (with invasion to 5 mm or less) were examined clinicopathologically. The evaluation of stromal invasion was conducted according to the FIGO (1995) staging system. RESULTS: The mean age was 46 (range: 29-73) years, and the median follow-up was 118 (9-348) months. Definitive treatment modalities included radical hysterectomy in 71 (89.9%) cases, modified radical hysterectomy in 2 (2.5%), and simple extrafascial hysterectomy without pelvic lymphadenectomy in 6 (7.6%). Postoperative adjuvant external radiation therapy was given to 5 (6.3%) patients. The histological subtypes were endocervical in 37 (46.8%) cases, endometrioid in 32 (40.5%), and adenosquamous in 10 (12.7%). Forty-one (51.9%) patients had lesions with up to 3 mm of stromal invasion; of these, 24 (58.5%) had lesions with up to 7 mm of horizontal extension (stage IA1). Thirty-eight (48.1%) patients had lesions with stromal invasion greater than 3 mm and no greater than 5 mm; of these, 4 had lesions with no wider than 7 mm of horizontal extension (stage IA2). Of 73 patients with pelvic lymphadenectomy, one (1.4%) tumor (depth: 5 mm; width: 15 mm) had node metastases. Parametrial involvement was present in one (1.4%) patient (lesion depth: 5 mm; lesion width: 16 mm). None had adnexal metastasis. Eighty-eight percent of the patients with stromal invasion up to 3 mm had well-differentiated adenocarcinoma, compared to 53% of the patients with lesions invading more than 3 mm. Of all of the patients, 5 (6.3%) patients who received curative radical hysterectomies had recurrences and died. Among 5 patients, one patient with central pelvic recurrence had a lesion invading to a depth of 3 mm and width of 7 mm, and the others had lesions with more than 3 mm of invasion and 15 to 36 mm of width. CONCLUSIONS: Patients with early invasive adenocarcinoma to a depth of 3 mm or less stromal invasion, including those who meet the criteria for FIGO stage IA1, may be treated with simple extrafascial hysterectomy without lymphadenectomy and oophorectomy.     

Recent trend of increase in proportion of low birthweight infants in Japan

BACKGROUND: The proportion of low birthweight babies (LBW: 1500-2499 g) in Japan decreased steadily from 1950 to the 1970s. However, since then it has started to increase consistently, the reason for which has not been discussed in detail. METHODS: Trends of birthweight and the two known factors for low birthweight (maternal smoking, and pre-pregnancy weight) were analysed with vital statistics, national nutritional and smoking prevalence survey data. RESULTS: Increase in term LBW due to intrauterine growth retardation, is the major risk factor for the overall increase since the 1970s. The increase of smoking prevalence in women in their thirties started in the 1970s, while that for women in their twenties started in the 1960s. The decrease of body mass index for women in their thirties also began in the 1970s, while that for women in their twenties began in the 1960s. The ratio of delivery to mothers in their thirties to mothers in their twenties has increased more than threefold compared to the late 1970s. CONCLUSIONS: Since the 1970s increase in smoking prevalence and decrease in body mass index in young women, especially those in their thirties, appeared to be the major factors involved in the increase in LBW babies.     

Clinical characteristics and risk factors of chronic subdural haematoma associated with clipping of unruptured cerebral aneurysms

Chronic subdural haematoma (CSDH) is an uncommon but potentially serious complication of clipping unruptured cerebral aneurysms. We conducted a study to identify the patients who are at risk of developing postoperative CSDH. The data from 713 consecutive patients who underwent clipping of unruptured anterior circulation aneurysms were reviewed, and risk factors correlated with CSDH were identified by multivariate regression analysis of demographic variables. Fifteen patients (2.1%) developed CSDH after the surgery. Advanced age (odds ratio [OR] 1.151, 95% confidence interval [CI] 1.051–1.261) and male gender (OR 3.167, 95% CI 1.028–9.751) were correlated with CSDH. Subsequently, all 713 patients were quadrichotomized on the basis of gender and age, with 70 years as the cut-off value for age. The frequency of CSDH in men <70 years of age was 1.3% and that in men ?70 years of age was 15.1%, with risk of CSDH was significantly higher in the older men (OR 13.39; 95% CI: 3.42–52.44). The frequency of CSDH in women <70 years of age was 0.6% and that in women ?70 years of age was 3.7%. As in men, the risk of CSDH was significantly higher in the older women (OR 6.69, 95% CI 1.10–40.73). The interval between the aneurysm clipping and CSDH development was 0.5–6 months, suggesting that clinical observation should be continued up to 6 months after surgery. Although prognosis for patients with a postoperative CSDH complication is generally favourable, the risk of CSDH should be taken into account when considering elective clipping of unruptured aneurysms in patients ?70 years of age.     

Antifungal activity of the new agent latoconazole in two tinea models.

In vitro and in vivo antifungal activities of the new imidazole derivative latoconazole ((+-)-(E)-[4-(2-chlorophenyl)-1,3-dithiolan-2-ylidene]-1- imidazolylacetonitrile, NND-318; CAS 101530-10-3) were studied in comparison with three major topical agents, clotrimazole, bifonazole and tolnaftate. The in vitro activity of latoconazole against dermatophytes was much stronger than that of any reference agent tested. Both the recently developed tinea pedis model and the conventional tinea model in guinea pigs were employed for evaluation of topical usefulness of latoconazole. The 1% solution or cream preparation of latoconazole was highly effective in both of the two tinea models and its 5 or more doses achieved almost complete mycological cure. However, both tinea models, especially the former, were considerably resistant to the therapeutic treatment of all of the reference drugs. These results suggest that latoconazole is a promising topical antifungal agent, probably applicable to the treatment of tinea pedis as well as other types of dermatomycoses.