Percutaneous transluminal angioscopy during coronary intervention.

To investigate the feasibility of angioscopic-guided percutaneous transluminal coronary angioplasty and to elucidate the mechanism of efficacy of coronary stenting for acute myocardial infarction, we performed coronary angioscopy in 102 patients with stable angina or acute myocardial infarction. Thrombi and intimal flaps were observed in most patients after coronary angioplasty. Large intimal splits were seen in one third of patients. Stents were inserted in 10 patients who were revealed to have a large flap or protruding split to the inner lumen. Thrombolytic agents were administered in 2 patients with large thrombi. Additional treatments were required in 32% of patients. No acute myocardial infarction or unstable angina occurred in patients during hospitalization. Thus, angioscopy of the coronary lumen enables clinicians to determine the most appropriate and least risky coronary intervention strategy. In patients with acute myocardial infarction, angioscopy revealed occlusive or protruding thrombi in 34 of 35 patients. The protruding thrombi disappeared after stenting. The frequency of large intimal flaps increased after predilatation with balloon, but these disappeared after stenting. The present angioscopic study demonstrates that the coronary stent compresses the occlusive or protruding thrombi and covers the ruptured thrombogenic plaque Consequently, smooth-surfaced and wide vessel lumen are obtained.

Leukomyelopathy in ataxic calves.

Seventy-three fattening calves ranging from 6 to 15 months old on a farm were affected by ataxia over a period of four months. About 10 ataxic animals recovered after the administration of various kinds of vitamins and needle puncture therapy. The principal lesions in 14 ataxic animals examined were characterized by bilateral vacuolation with axonal degeneration confined to the spinal white matter. Ultrastructurally, the vacuoles were present in the periaxonal areas and bounded by dissociated myelin lamellae. No pathogen was isolated from the visceral organs of the animals. The serum copper remained within the normal range. Possible etiological factors remain unknown in the ataxic disease.

A case of neonatal calf with meningitis associated with Klebsiella oxytoca infection.

A 16-days-old calf exhibited pyrexia, difficulty to stand and walk, cloudiness of the ocular aqueous humor, and swelling of the shoulder joints. The primary pathological lesion was fibrinopurulent meningitis with Gram-negative small bacilli, and which was concurrently accompanied with endophthalmitis, polyarthritis, and purulent inflammation in several visceral organs. Klebsiella oxytoca was isolated from the brain and spinal cord. These results suggest that this is a rare case of meningitis with septicemic K. oxytoca infection in neonatal calf.

Listeric septicemia with meningitis in a neonatal calf.

A 9-days-old calf which had exhibited depression and difficulty to stand and walk was examined pathologically and bacteriologically. The primary pathological changes consisted of multifocal necrosis in several visceral organs and fibrinopurulent meningitis. The necrotic lesions were most frequently found in the liver, and accompanied with mononuclear cell infiltration and Gram-positive small bacilli. The organisms were also present in the foci of mononuclear cells at the central gray matter of the mesencephalon. Listeria monocytogenes was isolated from the brain and other organs of the whole body.

Clinicopathology of meningoventriculitis due to Streptococcus bovis infection in neonatal calves.

Three neonatal calves ranging in age from 4 to 14 days were examined pathologically and bacteriologically. The calves showed depression, anorexia, pyrexia, and difficulty or inability to stand followed by cloudiness of the ocular aqueous humor or cornea. Autopsy revealed congestion, petechiae, and cloudy areas in the meninges. Histologically, the central nervous system (CNS) lesions were prominent and limited to the meninges where fibrinous exudate and infiltrations of neutrophils, macrophages, and lymphocytes were present. There were mild or slight degrees of choroid plexitis and ependymitis. Endophthalmitis was seen as a concurrent lesion in all cases. Fibrinous or fibrinopurulent changes were found in the peritoneum and epicardium as well as in several other organs. Numerous Gram-positive cocci were detected in affected areas of the whole body. Bacteriologically, Streptococcus bovis was isolated from all examined materials consisting of the brain, cerebrospinal fluid, ocular aqueous humor, and several other organs. These results suggest that the lesions were associated with infection of the organism and that the present cases were in the process of septicemia.

Changes in bone mineral density and fracture prevalence in Japanese women after oophorectomy.

The bone changes after gynecological surgery during the early phase of recovery were examined. The subjects were randomly selected from women who had undergone bilateral oopho-hysterectomies (OOX, n = 98, 46.0 +/- 5.0 year-old) or hysterectomies (HX, n = 75, 43.6 +/- 4.6 year-old) within 4 years prior to entering the study. The ovarian functions in the HX group were presumed to be intact following the hysterectomies, judging from the cytological evaluation of the vaginal pap smears. The bone morphological changes in both groups were examined to measure the cortical thickness of the metacarpal bone (MCI) on hands X-ray film using microdensitometry, and the posterior/anterior height ratios (P/A ratio) of the entire vertebral bodies, on vertebral X-ray films using a digitizer. The changes in bone mineral densities in both groups were measured by dual energy X-ray absorptiometry at lumbar vertebrae (L2-4 BMD) and by microdensitometry at the metacarpal cortical bone; the bone densities of metacarpal bone were referenced by the density of aluminum step wedge on the same X-ray films. The prevalence of vertebral body fractures (P/A ratio greater than 1.4) in the OOX group (5.1%) was 3.9 times higher than that in the HX group (1.3%). There was a significant decrease in MCI in the OOX group compared with the HX group (p less than 0.01). L2-4 BMD in the OOX and HX group were 1.07 +/- 0.15 and 1.16 +/- 0.13 g/cm2, respectively (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Time course changes in bone mineral density and calcium metabolism after oophorectomy].

Time course changes in bone mineral density and calcium metabolism after oophorectomy were investigated in comparison with those in hysterectomized and pre-operated women, retrospectively. A total of 191 women who had a regular menstrual period for 1 year prior to entering the study or to the operation, were divided into 3 groups; group 1 consisted of 33 women who were admitted to receive a gynecological operation (pre-OP group), group 2 consisted of 57 women who received hysterectomy within 5 years prior to entering the study (HX group) and group 3 consisted of 101 women who received hysto-oophorectomy (bilateral) at the same timing as the HX group (OOX group). All the subjects had their bone mineral density measured at the lumbar vertebrae (L2-4BMD) by means of dual energy X-ray absorptiometry (DXA) and at the metacarpal bone by the microdensitometrical (MD) method. Serum and urinary parameters related to bone and calcium metabolism were also evaluated. After dividing the subjects in accordance with the length of time after the operation, the time course changes in each parameter were calculated. In the 2 years after OOX, the L2-4BMD decreased significantly and rapidly, and the change in L2-4BMD in the subsequent period was quiescent. In the HX group, there was no significant change in L2-4BMD. When the period after the OOX was divided into 2 subcategories in accordance with the speed of decline in lumbar BMD as the rapid and the slow phases, the time course changes in blood and urine parameters showed different trends.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiological and pathological studies on congenital diffuse hyperplastic goiter in calves.

Perinatal diseases such as weak calf, stillbirth, or abortion were found in 86 calves from about 600 cows in a farm (A Farm) in 1987 and 1988. Such perinatal diseases were decreased to 36 calves in 1989 and 1990 after an additional supply of seaweed was made to the maternal feeds. From these cases, 23 stillborn and weak calves were pathologically examined. The mean weight with standard deviation of the 18 thyroid glands was 36.3 +/- 28.6 g before feeding of the seaweed supplement, and 12 (67%) of the glands showed moderate to marked degree of diffuse hyperplastic goiter in histological criteria. On the other hand, 5 glands weighed 12.0 +/- 3.4 g and revealed no such histological lesions after the additional supply. These results suggest that the goiter had been associated with birth of weak calves. Further study was performed on 37 newborn calves affected with Akabane disease in 1986 in A Farm and the neighbouring B Farm located. Seven (54%) of 13 thyroid glands from A Farm and 1 (4%) of 24 glands from B Farm showed histologically moderate to marked goitrous lesions. There were dotted "Inugarashi", Rorippa indica, family Cruciferae in both pastures. The mean iodine contents of the orchard grasses were 87 and 121 micrograms/kg on dry basis in A and B Farms. Marginal deficiency or lower limit of iodine and possible thiocyanate content of "Inugarashi" may have been responsible for the goiter in the farms.

[Changes in bone mineral density and bone turnover within 12 months after oophorectomy: a prospective study compared with hysterectomized controls].

Nineteen patients (pts) with stage Ib to IIb uterine cervical cancer were studied for changes in bone mineral density and bone turnover within 12 months after radical hysterectomy and pelvic lymphadenectomy. Eleven out of 19 pts also underwent oophorectomy (OX), and the other 8 pts without OX were studied as controls. A significant increase in FSH and decrease in E2 (p less than 0.01) in OX pts indicated the completeness of oophorectomy, whereas no significant change in those levels showed retained ovarian function in the controls. In OX pts significantly increased serum alkaline phosphatase (p less than 0.01), urine-calcium/creatinine (p less than 0.05) and hydroxyproline/creatinine ratio (p less than 0.01) indicating high bone turnover after the oophorectomy were observed. However, a transient but significant (p less than 0.05) rise in these levels in the 3rd month in the controls was noted. In OX pts the spinal bone mineral density (BMD) measured by dual photon absorptiometry was significantly reduced to approximately 10% (p less than 0.05) within 12 months after oophorectomy, while in the controls loss of BMD was also observed up to 6 months, and it appeared to have returned towards baseline levels at 12 months after hysterectomy. These data suggest that a rapid and considerable loss of spinal BMD was mainly accelerated by the oophorectomy, but in part was contributed to by the stress or reduced physical activity for up to 6 months after radical hysterectomy.

[Changes in spinal and femoral bone mineral density due to pelvic irradiation following oophorectomy].

Since radiation therapy has been known to be a cause of bone atrophy (radiation osteopathy), it could be important whether postoperative radiotherapy in patients who have undergone oophorectomy further promotes bone mineral loss or not. Nineteen patients with stage Ib to IIb cervical cancer were studied. Eleven of the 19 patients received only surgical treatment and 8 received postoperative radiotherapy (50 grays to the pelvis and 40 grays to the lumber spine), because of the presence of advanced lesions or positive lymphnodes. A significant increase in FSH and decrease in E2 (p less than 0.01) compared to before treatment were observed in both groups. A significant increase in serum alkaline phosphatase activities (p less than 0.01), urine-calcium/creatinine ratio (p less than 0.05) and urine-hydroxyproline/creatinine ratio (p less than 0.01), which indicated high bone turnover, compared to before treatment in both groups also appeared. Although these chemical parameters in both groups changed coincidentally, the decline in spinal bone mineral density in the irradiated group was delayed at 12 months after the treatment. On the other hand, there was no difference in the changes in femoral bone mineral density in the two groups. These results suggest that radiotherapy might inhibit the bone mineral loss at the irradiated bone site even when there was an estrogen lack.

[Treatment of advanced or recurrent cervical cancer by a new BOMP regimen consisting of bleomycin, vincristine, mitomycin-C, and low-dose consecutive cisplatin].

Twenty-five patients with cervical cancer (4 post-operative cases with FIGO stage Ib or IIb, 2 with stage IV, and 19 recurrence) were treated with a new BOMP consisting of bleomycin (5 mg/body, drip, i.v., days 1-7), vincristine (0.7 mg/m2, bolus, i.v., day 7), mitomycin-5 (7 mg/m2, bolus, i.v., day 7) and cisplatin (10 mg/m2, drip, i.v., days 1-7). The mean age of the patients was 54 years (range 30-77). Prior therapy included radiotherapy (13 cases), radical hysterectomy (11), and none (1). Fifteen (79%) of the 19 evaluable patients responded, including 6 with a complete response (CR) lasting over 15 months. Almost all the disease located in lung, liver, bone, and vulva showed a response. In particular, lesions confined to the lung had a 100% CR when the size of each tumor was under 2 cm in diameter even in the case of multiple metastasis. In contrast, 9 patients with pelvic disease had a 56% response with only 1 CR who had no previous radiotherapy. Such a poor response in the pelvic disease was considered to be due to vascularity reduced by prior radiotherapy. The important factors affecting the response to a new BOMP were found to be lesion size, prior radiotherapy, and the site of lesion. Patient age, performance status (PS), and the interval from a previous treatment to BOMP were not of significance with regard to response. The dose limiting factor was hematologic toxicities. Other toxicities including nausea, renal dysfunction, pulmonary fibrosis, and loss of hair were acceptable. Thus, the decrease in the PS of patients due to BOMP was minimal. It is suggested that this regimen will be useful as a neoadjuvant chemotherapy for advanced cervical cancer.

Spontaneous regression of bovine cutaneous leukosis.

Biopsies of skin from a 2-year-old heifer with spontaneously regressing dermal leukosis were examined. The heifer was not infected with bovine leukemia virus and was negative for tumor-associated antigens of enzootic bovine lymphosarcoma. By hematological standards for bovine leukemia, the heifer was positive at about 60 days post-occurrence of the disease (POD). At 53 days POD, lymphoblastic neoplastic cells in the dermis reacted with anti-T lymphocyte monoclonal antibody by the avidin biotin peroxidase complex method. The cells had intracytoplasmic clustered dense bodies under electron microscopy. From 53 to 83 days POD, figures of the transepithelial elimination (TE) against neoplastic cells and perivascular infiltration of small lymphocytes were in the dermis. Small lymphocytes reacted with anti-T lymphocyte monoclonal antibody. At necropsy there were no neoplastic lesions; there were flat lymph node-like tissues in the subcutis. Many germinal centers were seen in the lymphatic organs. Blood lymphocytes at 46 days POD were stimulated by phytohemagglutinin-P and concanavalin A. Sera, taken until 75 days POD and at necropsy, showed an inhibitory effect on mitogen-induced blastogenesis of normal bovine lymphocytes. These results suggested the existence of a spontaneous regressive mechanism against neoplastic lesions by TE and tumor immunity.