[Changes in intraoperative blood glucose and ketone body concentrations during the repair of lipomyelomeningocele in children].

Blood glucose and ketone body (3-hydroxy-butyrate) concentrations were measured in 8 children (4.2 +/- 2.8 years old) during the repair of lipomyelomeningocele (9.0 +/- 2.6 hours) to elucidate whether lipid mobilization can be prevented by glucose infusion at the rate of 0.2 +/- 0.05 g.kg-1.h-1. The operation was followed in about 4 hours by a significant increase in blood glucose and ketone body concentrations, with their maximum value of 195 +/- 75 mg.dl-1 and 656 +/- 75 mumol.l-1, respectively (P < 0.05), as compared with the preoperative level. The lipid mobilization soon returned to normal state by increasing the rate of glucose infusion, as indicated by ketone body level of 92 +/- 58 mumol.l-1 at the end of operation. These results show that glucose infusion rate should be adjusted based on serial analysis of both blood sugar and ketone body concentrations in the anesthetic management of children undergoing a long operation.

[Continuous epidural morphine for postoperative pain relief after spinal surgery--use of an epidural catheter placed at the time of surgery].

Postoperative analgesia by continuous epidural morphine infusion after spinal surgery was investigated in a retrospective study. An epidural catheter was placed by surgeons at the time of surgery. Postoperative pain was less intense and use of analgesics and sedative was less frequent in patients with continuous epidural morphine (n = 41) as compared with patients without continuous epidural morphine (n = 41). Among the patients with continuous epidural morphine, postoperative pain in patients (n = 16) with the dura opened or dural rent during surgery was less intense and the uses of analgesics and sedative was less frequent as compared with patients (n = 25) without the dural rent. There were no severe complications except for respiratory depression in a patient with chronic obstructive pulmonary disease. Our study demonstrated the ease of insertion of an epidural catheter at the time of surgery and the good quality of epidural analgesia after spinal surgery.

Human herpesviruses 6 and 7 in cervixes of pregnant women.

We looked for human herpesvirus 6 (HHV-6) and HHV-7 genomes in the cervixes of pregnant women in the late stages of their pregnancies. Of 72 samples collected with cervical swabs and amplified by nested PCR, we found that 14 (19.4%) and 2 (2.7%) contained detectable HHV-6 and HHV-7 genomes, respectively. The two samples in which HHV-7 DNA was detected also contained HHV-6 genomes. Hybridization of HHV-6 DNA amplified by PCR with variant-specific probes revealed that all of these DNA samples belonged to variant type B. These results indicated that HHV-6 and/or HHV-7 exists in the cervixes of infected women in late pregnancy and may cause perinatal infection.

[Clinical significance of serum CA130 level in women with spontaneous abortion, hydatidiform mole and early normal and tubal pregnancy].

We examined the serum CA130 level in women in early pregnancy with normal (n = 13), and abnormal (n = 28) course. The abnormal course consisted of intrauterine spontaneous abortion (n = 10), hydatidiform mole (n = 3) and tubal pregnancy (n = 15). The serum CA130 level was higher than for normal nonpregnant women (35u/ml) in 69% (9/13) of women with normal pregnancy, 90% (9/10) of those with intrauterine spontaneous abortion and 100% (3/3) of those with hydatidiform mole; the mean value and standard deviation for these three groups were 131 +/- 150u/ml (n = 13), 197 +/- 253u/ml (n = 10), and 47 +/- 15u/ml (n = 3), respectively. In contrast, the serum CA130 level of the 15 women with tubal pregnancy was 28 +/- 21u/ml. Among these patients, all of the 13 women without genital bleeding had a CA130 level within the normal range for nonpregnant women (mean +/- SD; 20 +/- 6u/ml). Since CA130 is abundant in the decidual tissue but is scant in tubal tissue, a high CA130 level in maternal sera during early pregnancy may indicate the presence of the destruction of decidual tissue, while a low or normal CA130 level throughout early pregnancy is regarded as characteristic of tubal pregnancy.

[Levels of CA130 in maternal sera and amniotic fluid at various gestational ages].

We examined the CA130 concentration in the amniotic fluid, maternal sera, amnion, chorion, decidua and placenta. CA130 in the maternal sera showed an initial increase during early pregnancy, remained low from the 15th weeks of pregnancy until delivery, and then increased after term delivery (249u/ml, mean, n = 27) or mid-trimester abortions (844u/ml, n = 22). The CA130, concentration in the amniotic fluid was high in the mid-trimester and remarkably low at term. Among the tissues examined, amnion and decidua contained a relatively high concentration of CA130. Immunohistochemical examination also demonstrated abundant CA130 in the cytosol of amnion and decidua tissues. The pattern of changes in CA130 in amniotic fluid was similar to that in the amnion and decidua tissue. The results suggest that the amnion cells are the source of CA130 in the amniotic fluid and that the high concentration of CA130 in maternal serum after delivery originates in decidua tissue affected by the separation of the placenta.

Immunohistochemical localization and tissue levels of tumor-associated glycoproteins CA 125 and CA 19-9 in the decidua and fetal membranes at various gestational ages.

To investigate the sources and biologic significance of CA 125 and CA 19-9 in amniotic fluid, immunohistochemical and biochemical localization of these tumor-associated glycoproteins in the decidua and fetal membranes was studied. Immunohistochemically, CA 125 and CA 19-9 were localized in the cytoplasm of decidua cells and amnion epithelial cells but not in the chorion and placental tissue. Biochemically, the 12,000 X g supernatant fractions of decidua and amnion tissues contained relatively large amounts of CA 125 and CA 19-9, 73% to 96% of which was present in the cytosolic fractions of these tissues. The CA 125 levels in the amniotic fluid decreased, whereas those of CA 19-9 increased with gestation, which correlated well with the respective levels in amnion tissues. These findings suggest that amnion cells produce and secrete these glycoproteins into the amniotic cavity. However, it is possible that the decidua also secretes CA 125 into the amniotic cavity through the chorion and amnion such as in the case of prolactin.

Mechanism and clinical significance of elevated CA 125 levels in the sera of pregnant women.

To clarify the mechanism of CA 125 elevation in maternal sera, serum levels of CA 125 and CA 19-9 were measured in 122 apparently healthy pregnant women (fifth to fortieth week of gestation) and 50 postpartum women (26 term deliveries and 24 second-trimester induced abortions). Serum levels of CA 125 showed an initial increase by the tenth week and then decreased to less than 35 U/ml, remaining below this level until delivery. However, within 1 hour after term delivery or second-trimester induced abortion, the CA 125 levels showed a second increase and decreased rapidly thereafter. In contrast, serum levels of CA 19-9 did not change significantly during these periods. Combined with our previous finding that the decidua contains abundant CA 125 but little CA 19-9, these results indicate that the elevated CA 125 levels in maternal sera originate from the decidual cells affected by chorionic invasion or the placental separation.

[The effects of nicotine on the synthesis and secretion of surfactant in the rabbit fetal lung].

The effects of nicotine administration on the synthesis and secretion of surfactant in the rabbit fetal lung were studied by measuring phosphatidylcholine (PC) and phosphatidylglycerol (PG) in the fetal lung tissue and amniotic fluid. The concentrations of both PC and PG in the lung tissue were decreased by administering nicotine to the mother. On the other hand, the concentrations of PC and PG in the amnniotic fluid were not altered by nicotine administration. Moreover, the PG/PC ratio in the amniotic fluid of the nicotine group was similar to that of the control group. The plasma catecholamine levels were elevated in the growth retarded fetuses from nicotine-treated mothers. These findings indicated that the administration of nicotine to the mother suppressed the synthesis of surfactant in the fetal lung but enhanced the secretion of surfactant to the alveolar cavity, probably via the stimulation of beta-receptor by catecholamine, and that the biochemical maturity of the surfactant was not altered by the administration of nicotine to the mother. The results of the present study might provide basic information to help to understand the clinical experiences reported by others i.e. that in the newborn from a smoking mother, respiratory distress occurred less frequently than in those from non-smokers.