Keiichi Kurachi

Treatment of carcinoma of the uterine cervix by remotely controlled afterloading intracavitary radiotherapy with high-dose rate: a comparative study with a low-dose rate system

From September, 1974 through December, 1979, a total of 249 patients with carcinoma of the cervix uteri Stage IIb and III were randomly allocated to either remotely controlled high-dose-rate intracavitary radiotherapy or manual afterloading low-dose-rate therapy, with radiotherapy of 20 Gy in 2 weeks to Point A to whole pelvis and 40 Gy in 4 weeks to the parametria. The dose to Point A by intracavitary radiotherapy was 40-60 Gy with one or two fractions in the low-dose-rate group and 30 Gy for the high-dose-rate group by 3 fractions with a once a week schedule. The purpose of this paper is to compare the results between the groups and to clarify the problems in the high-dose-rate group clinically. The local control rate was higher in the high-dose-rate group; however, the complication rate was also higher in this group than in the low-dose-rate group. The dose schedule and the place of rectal dose measurement is discussed. The overall cumulative survival rate was nearly the same in both groups (55% at 5 years), although some difference was noted in each stage. The most common cause of death was distant metastasis outside the pelvis and the second most common was intercurrent disease in Stage IIb and local failure in Stage III.

Afferent fiber connections from lower brain stem to hypothalamus studied by the horseradish peroxidase method with special reference to noradrenaline innervation

SummaryAttempts were made to determine the afferent projections to the anterior hypothalamus including the preoptic area from the lower brain stem by means of the horseradish peroxidase method combined with monoamine oxidase staining to identify noradrenaline (NA) neurons. In addition to this technique, a histofluorescence analysis was performed. NA fibers in the medial part of the anterior hypothalamus were mainly supplied by A1 and A2 NA neuron groups, while the lateral part and periventricular zone received NA terminals from both pontine and medulla oblongata NA neuron groups. Furthermore, the present study indicated that there were direct projections to the anterior hypothalamus from non-noradrenergic neurons in the lower brain stem: nuclei raphe dorsalis, centralis superior, cells in the mesencephalic and pontine central gray matter, nuclei parabrachialis lateralis and medialis, cells around fasciculus longitudinalis medialis.

Congenital malformations of newborn infants after clomiphene-induced ovulation

The effect of clomiphene citrate (CC) on the incidence of congenital malformations in newborn infants was assessed from the outcome of 1034 pregnancies after CC-induced ovulation recorded at nine university hospitals in a 5-year period. Of these pregnancies, 14.2% ended in abortion, 0.5% in ectopic pregnancy, 0.1% in molar pregnancy, and 1.6% in stillbirth. In all, 935 infants were born, and 21 (2.3%) showed visible malformations. This incidence of malformations was not significantly different from that in 30,033 infants (1.7%) after spontaneous ovulation (spontaneous ovulation group), and the types of malformations after CC treatment were similar to e those in the spontaneous ovulation group. These data indicate that CC has no teratogenic effect.

Effect of sulpiride on poor puerperal lactation

Forty-two primiparous and 54 multiparous women with total yields of milk not exceeding 50 ml for the first 3 postpartum days were treated with 100 mg of oral sulpiride or placebo for 4 days from the third postpartum day. In the primiparous mothers, the mean daily yield of milk in the sulpiride group increased significantly (p less than 0.01) over that in the control group after the fourth postpartum day. Mean (+/- SE) total volumes of milk for the third to fifth postpartum days were 661.5 +/- 64.4 and 441.2 +/- 51.2 ml in the sulpiride and the control groups, respectively. However, in the multiparous mothers, no significant difference between the control and the sulpiride group was noted in total yield of milk, since a good increase in the secretion of milk was obtained without medication in these mothers. Determinations of daily serum levels of prolactin in 20 primiparous women revealed significantly higher concentrations in the sulpiride group. The ratio of primiparous mothers with complete breast-feeding 1 month after delivery was higher in the sulpiride group (55%) than in the control group (30%), whereas there was no difference between the control group and the sulpiride group of multiparous women. These data indicate that poor initiation of puerperal lactation in primiparous mothers can be effectively treated with oral sulpiride.

A clinicopathologic study of endometrial carcinomas with argyrophil cells.

Abstract Of 41 endometrial carcinomas examined with Grimelius staining, 9 tumors were found to be composed predominantly or partially of argyrophil cells. They were 4 well-differentiated adenocarcinomas, 4 moderately differentiated adenocarcinomas, and 1 adenosquamous carcinoma. Argyrophil granules were found mainly in the apical portion and sometimes in the entire cytoplasm of glandular tumor cells in the well- and moderately differentiated adenocarcinomas. In the adenosquamous carcinoma, argyrophil granules were located in the squamous cells as well as in the grandular cells. The distribution of argyrophil granules was in parallel with that of secretory granules identified by electron microscopy. A clinicopathologic study of these 9 cases revealed that the patients with endometrial argyrophil cell carcinoma tended to be associated more frequently with obesity, hypertension, and diabetes mellitus than the patients with usual endometrial carcinoma.

The diagnostic significance of LH-releasing hormone test in patients with amenorrhea

Abstract Serum levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) following intravenous injection of 100 μg of synthetic LH-releasing hormone (LH-RH) in 10 normal women in the follicular phase and in 80 amenorrheic women were determined by radioimmunoassay. The low or normal basal levels of LH and FSH with good response to LH-RH were observed in patients with galactorrhea, secondary amenorrhea responding to progestin with bleeding, and in some of the patients with anorexia nervosa. Low resting levels with little or no increase of LH and FSH following LH-RH were experienced in patients with Sheehans syndrome, postoperative patients with chromophobe pituitary adenoma, and in some of the patients with amenorrhea responding to progestin plus estrogen with bleeding. Elevated basal LH and FSH levels with further increase following LH-RH were seen in patients with Turners syndrome and in some of the patients with amenorrhea responding to progestin plus estrogen with bleeding. The three typical patterns stated above may indicate that the cause of anovulation lies in the hypothalamus, pituitary, or ovaries. It is concluded that the LH-RH test is useful in clarifying the pathophysiology of anovulatory conditions.

Improved method for determination of catecholamines in rat brain by isolation on boric acid gel and high-performance liquid chromatography with electrochemical detection

An improved sensitive, simple and time-saving method for determining catecholamine (CA) in rat brain is described. The method involves isolation on boric acid gel and high-performance liquid chromatography with electrochemical detection. Boric acid gel effectively adsorbs CA at weakly alkaline pH and the over-all recoveries of 5 ng and 10 ng samples of authentic norepinephrine (NE) and dopamine (DA) added to a homogenate of rat brain were 98.9 +/- 9.2% and 103.4 %/- 9.3% for NE and 96.2 +/- 4.6% and 99.4 +/- 4.8% for DA, respectively. Intra-assay variation was 5.3% (5 ng) and 3.0% (10 ng) for NE and 4.4% (5 ng) and 3.8% (10 ng) for DA. Inter-assay variation was 7.7% (1 ng) for NE and 5.0% (1 ng) for DA. With this analytical system, the lowest amount of NE or DA detectable was 40 pg. Application of this method to determination of the DA and NE contents of rat hypothalamus during estrous cycle revealed significant increases in the turnovers of both in the proestrus stage. This method should be useful for routine determination of plasma NE and DA because it is sensitive and inexpensive.

Response of pituitary LH and FSH to synthetic LH-releasing hormone in normal subjects and patients with Sheehan's syndrome.

Abstract Serum levels of LH and FSH were determined by radioimmunoassay in seven patients with Sheehans syndrome, eight women with normal menstrual cycles, and five normal men following intravenous injection of synthetic luteinizing hormone-releasing hormone (LH-RH) in a dose of 100 μg. The mean maximum increases of LH (M. ± S.E. mI.U./ml.) were in the following order: 279.4 ± 87.6 at the preovulatory phase, 69.2 ± 12.6 in normal males, 48.2 ± 3.5 at the midluteal phase, and 29.9 ± 4.9 at the early follicular phase. The response of serum levels of FSH was found to parallel the change in the levels of LH, but these changes were less pronounced. No response of LH and FSH to LH-RH was observed in five patients with Sheehans syndrome while the remaining two patients showed an increase of LH around normal lower limits. These findings seem to indicate that LH-RH test is useful for the evaluation of pituitary reserve function of gonadotropin secretion.

Effect of pituitary transplants on the LH-RH concentrations in the medial basal hypothalamus and hypophyseal portal blood

The effects of hyperprolactinemia on catecholamine turnover in the medial basal hypothalamus (MBH) and on the luteinizing hormone-releasing hormone (LH-RH) concentrations in MBH and hypophyseal portal blood were investigated in female Wistar rats. Chronic endogenous hyperprolactinemia was produced by implantation of anterior pituitary glands under the kidney capsule. Catecholamine turnover in the MBH was studied by inhibiting monoamine oxidase and then measuring the accumulation of catecholamines by high-performance liquid chromatography with electrochemical detection. Rats bearing pituitary transplants exhibited: (1) persistent vaginal diestrus within 3-6 days of the implantation; (2) increased serum concentrations of prolactin (PRL); (3) decreased serum concentrations of luteinizing hormone (LH); (4) increased pituitary concentrations of LH and follicle-stimulating hormone (FSH); (5) increased turnovers of dopamine in the MBH; and (6) decreased concentrations of LH-RH in the MBH and in plasma of hypophyseal portal blood. These findings suggest that chronic hyperprolactinemia may increase dopaminergic tone in the MBH that may inhibit LH-RH secretion from the MBH, and LH release from the pituitary. These processes may be responsible for disturbances of cyclic pituitary-ovarian activity.

Strumal carcinoid of the ovary: histological, ultrastructural, and immunohistological studies with anti-human thyroglobulin.

Abstract A strumal carcinoid arising in a benign cystic teratoma of the right ovary was reported in a 40-year-old woman. The solid tumor was histologically a trabecular carcinoid tumor associated intimately with thyroid follicle-like structures. By electron microscopy, spherical dense core secretory granules were found in the cytoplasm of tumor cells. Final diagnosis of strumal carcinoid, however, was established in the present tumor by the immunohistological confirmation of thyroid tissue with anti-human thyroglobulin.