[Truncal valvoplasty for post-operative truncal valve regurgitation of truncus arteriosus: a case report].

The surgical treatment for truncal valve regurgitation is still controversial in patients with truncus arteriosus. A two-year-old girl with complaints of low weight gain and tachypnea was referred for treatment of truncal valve regurgitation. She had undergone an emergency pulmonary artery banding for severe congestive heart failure due to truncus arteriosus-type I at six months of age. This anomaly had been corrected by Barbero-Marcial method at seven months of age. But the truncal valve regurgitation started appearing at sixteen months of age with the progression of the stenosis of the pulmonary artery orifice and the right ventricular outflow tract regurgitation. Echo cardiography and cineangiography revealed the truncal valve to be bicuspid, and the regurgitation severe, especially through the prolapsed left sided cusp. The truncal valve was repaired by commissural suspension method, and the right ventricular outflow tract reconstructed with patch angioplasty of the pulmonary artery orifice and Carpentier-Edwards pericardial Bioprosthesis (19 mm). The post-operative course was uneventful. One year after, truncal valve regurgitation is small by color Doppler study. We conclude that valvoplasty is to be considered as the first choice of treatment for truncal valve regurgitation.

Risk determination in cases with an extra minute chromosome: prenatal diagnosis.

The interpretation of an extra minute chromosome (EMC) detected in utero presents both diagnostic and prognostic problems. Two EMC cases are presented and a flow-chart guideline is proposed for the determination of developmental risk. A prenatally detected EMC was familially inherited through a normal phenotype father. The pregnancy was continued and a normal baby boy was delivered. At one year his development was within normal ranges. The second EMC case was a mentally retarded girl examined at 4 years and 7 months of age. The EMC was identified with a combination of various staining techniques to be an inversion duplication (15). The importance of differential diagnosis of EMCs by DA/DAPI staining is emphasized.

[The expression of c-myc, c-fms, c-sis oncogenes in the trophoblast of normal pregnancy and trophoblastic disease].

Recently it has been suggested that proto-oncogene plays a role not only in cellular proliferation, development and differentiation, but also in neoplastic transformation. We now show the expression and its localization of c-myc, c-fms and c-sis proto-oncogenes in human developing chorionic tissue and fresh surgical specimens of mole and choriocarcinoma with the method of Northern blotting and In-situ hybridization. The 2.4kb c-myc transcript has been localized to the cytotrophoblast in early placenta and also localized to the C and S typed trophoblastic cells in mole and choriocarcinoma. The 4.0kb c-fms transcript has been localized to the syncytiotrophoblast, especially the highly differentiated syncytiotrophoblast in the second and third trimesters and S typed trophoblastic cells in mole and choriocarcinoma. Moreover, the 4.0kb c-sis transcript has been localized to the cytotrophoblast in early placenta, but not detected in mole or choriocarcinoma. First, these results suggest that the stage and site specific expression of c-myc, c-fms and c-sis proto-oncogenes are clearly related to the proliferation, development and differentiation of normal trophoblastic cells. Second, the expression of c-myc, c-fms proto-oncogenes may be of particular importance in the tumorigenesis and progression of trophoblastic disease.

[Experimental induction of yolk sac tumor in rat (author's transl)].

Unlike those experiments described in the previous several reports, a carcinogen was given to pregnant rats in our experiment to induce a tumor similar to yolk sac tumor which often occurs in human cases, aiming at contribution to establishment of an experimental model. Using Wister rat on the 10th day of gestation, ater removal of the fetus, the yolk sac was extracted out of the uterus, and a carcinogen was administered to it. Induced tumor was examined morphologically. By the 16th week after experiment, tumor was induced in 70% out of rats treated. The tumor volume was varied from a bean to a thumb tippize. Histologically, most of them were considered to be teratoma. But in 30% of them, human pure-type yolk sac tumor or the tumor similar to it were observed. Reticular and endodermal sinus or polyvesicular vitelline patterns were also clearly observed. Presence of hyaline body by PAS-staining and AFP by fluorescent antibody method were confirmed.

Histologic stromal reaction of the host with gestational choriocarcinoma and its relation to clinical stage classification and prognosis.

One of the factors determining the prognosis of choriocarcinoma is the stromal reaction of the host. We have been interested in the histologic findings of this reaction, and we studied the relationship between the CPV classification, which had been used in our department, and our clinical stage. There was no relation of stage distribution to CPV classification. For instance, Type C, which has a strong stromal reaction, did not display any parallel relation with stage. When mortality rates and stages are compared, however, it is noteworthy that the mortality rate for Type C cases is small in Stage I and is less than 50% even in Stage III, in which metastasis is considered to be inevitable; thus, more than half of the cases are cured. On the contrary, Types P and C tend to be associated with high mortality rates even in Stages I and II, in which metastasis is not certain.

[Pathogenesis and behavior of invasive mole without preceding hydatidiform mole (author's transl)].

From 89 cases of invasive mole, collected by our department since 1948, 12 (13.5%) cases without preceding hydatidiform mole (group A) were taken out, and their clinical data and histological observations were studied in comparison with those preceded by hydatidiform mole (group B) in the remaining 77 (86.5%), with the following results: 1. Invasive mole in group A was preceded by artificial or spontaneous abortion, but not by premature or normal delivery. 2. All of the 12 cases developed the invasive mole within 6 months. 3. Relation between the size of the focus and the latency period was not observed in either of the two groups. 4. The incidence of preoperative metastasis was somewhat lower in group A, but no difference was visible between the two groups in prognostic result. 5. As for histological findings, edematization and vesiculation of stroma of villi were observed in all the cases of group A, though with difference in grade from case to case. These findings as well as proliferation and intervascular penetration of villous cells were similar to those of group B.