Shunichi Fujisaki

Effects of pregnancy and hormone treatments on pressor response to angiotensin II in conscious rats.

Pressor responses to graded doses of angiotensin II in conscious rats were significantly reduced on days 13 and 19 of pregnancy compared with those in nonpregnant rats. To study the hormonal regulation of this altered pressor response to angiotensin II during pregnancy, we administered estradiol, progesterone, and human chorionic gonadotropin to nonpregnant rats. In ovariectomized rats no effect of estradiol on the pressor response to angiotensin II was found, but injections of progesterone with or without estradiol pretreatment significantly reduced the pressor response to angiotensin II. In intact rats human chorionic gonadotropin induced elevation of endogenous progesterone levels, followed by a significant decrease in the pressor response to angiotensin II. Injection of estradiol after human chorionic gonadotropin pretreatment produced a significant elevation in the pressor response to angiotensin II. These findings indicate that the decrease in angiotensin pressor response in pregnant rats is mediated mainly by progesterone rather than by estrogen.

Small cell carcinoma of the endometrium associated with adenosquamous carcinoma: A light and electron microscopic study

This report describes a 64-year-old woman with a primary small cell carcinoma of the endometrium associated with adenosquamous carcinoma. The light microscopic features resembled those of small cell carcinoma of the lung and those of the uterine cervix, and foci of adenosquamous carcinoma lay scattered sparsely in the small cell carcinoma. Electron microscopy revealed cytoplasmic neurosecretory type granules. The neoplasm behaved in a very aggressive manner such that at 3 months after surgery a metastatic neoplasm appeared in the vagina. This case is a rare example of an endometrial carcinoma with differentiation toward endocrine as well as adeno and squamous cell carcinoma.

Uterine papillary serous carcinoma with high levels of serum carcinoembryonic antigen. Response to combination chemotherapy

A case of metastatic uterine papillary carcinoma with elevated serum carcinoembryonic antigen (CEA) is reported. The patient presented with ascites and pleural effusions and with a high level of CEA (258 ng/ml) 3 months after primary surgical resection and postoperative irradiation had been performed. Her complete response, although temporary, to two kinds of combination chemotherapy was evaluated using serial estimations of the serum CEA.

Angiosarcoma of the vagina: A light and electronmicroscopy study

A 73‐year‐old woman, whose medical history reported radical hysterectomy and radiotherapy for squamous cell carcinoma of the cervix uteri 20 years earlier, was found to have an angiosarcoma of the vagina. The histological diagnosis was confirmed by immunohistochemical staining of tumor cells for factor VIH‐related antigen and ultrastructurally defined vasoformative structures. Primary angiosarcoma of the vagina is quite rare and reported in only two published cases. The present case is a third in general, and the first report confirmed by light microscopy, immunohistochemical, and electronmicroscopy studies.

Myasthenic crisis in the puerperium: the possible importance of α-fetoprotein. Case report

The patient was a 27-ycar-old in her first pregnancy with mild systemic myasthenia gravis (Osserman classification IIA), with weakness, ptosis and diplopia since the age of 24. There was no significant gynaecological history. She was admitted at 37 weeks gestation for observation but had been in remission from 20 weeks, and had no exacerbation before delivery. In addition to anti-acetylcholine receptor (anti-AChR) antibody, she was also found to have antinuclear antibodies. The assessment of thyroid function was normal. An ultrasound examination revealed that the fetus was normally developed and arthrogryposis was not seen. Normal fetal movements were recordcd and a non-stress test (NST) showed a reactive pattern. A 3090 g male infant was born normally a t 40 weeks with Apgar scores of 9 at 1 min, the postnatal development was normal. The mother remained clinically normal for 4 days after delivery, but on day 5 she was tired and had difficulty lifting her arms. She was discharged on day 8 postpartum, because she was well able to care for her infant, but on day 13, she had generalized weakness and dyspnoea at home. O n emergency admission, intravenous injection of edrophonium chloride (2 mg) greatly improved ptosis and muscular weakness of the neck and extremities. The evo-

Theca Lutein Cysts with Maternal Virilization and Elevated Serum Testosterone in Pregnancy

A clinicopathological study was performed on a pregnant patient with bilateral multiple ovarian cysts, who presented with pre‐eclampsia, marked virilization and exceedingly high levels of serum testosterone. The female fetus showed no evidence of virilization. Microscopic examination of the ovaries revealed theca lutein cysts with granulosa cells which showed the existence of testosterone by immunoperoxidase staining.

Pseudomyxoma Peritonei: Effect of Chronic Continuous Immunotherapy with a Streptococcal Preparation, OK-432 after Surgery

Three cases of pseudomyxoma peritonei with ovarian neoplasma were treated by adjunctive immunother‐apy with OK‐432 after surgery. in 2 of the 3 cases, the periods of intramuscular injection of OK‐432 were 11 and 16 months, respectively, and the 2 patients remain clinically free from evidence of disease, 7 and 6 years after surgery. the third patient is still undergoing treatment, with no evidence of recurrence at 4 months after surgery. These results, although for a small number of patients, clearly suggest that adjunctive immunotherapy with OK‐432 may be suitable for treating pseudomyxoma peritonei of ovarian tumor origin.

Vasopressor activity in incubated plasma of normal and hypertensive pregnant women

The pressor activity generated in incubated plasma of nonpregnant, normal pregnant, and hypertensive pregnant women was measured by means of a sensitive bioassay technique. It was found that the plasma of normal pregnant women generated significantly higher amounts of active pressor principle than the plasma of nonpregnant women. The plasma of hypertensive pregnant women generated significantly lower amounts of active pressor principle than the plasma of normal pregnant women. Plasma obtained from the antecubital vein revealed no difference in pressor activity compared to plasma collected from the uterine vein at the time of cesarean section. These data suggest that active pressor principle is not involved in the pathogenesis of pregnancy-induced hypertension and that the pregnant uterus is not the source of active pressor principle.