Tadashi Sugawa

Transcervical amnioinfusion of antibiotics: A basic study for managing premature rupture of membranes☆

To determine the best method of preventing ascending infection in the management of premature rupture of membranes, antibiotics such as latamoxef sodium, cefoperazone sodium, and cefotaxime sodium were infused directly into the amniotic cavity in 64 patients undergoing induction of labor at term. A single infusion of 100 or 500 mg of each drug resulted in a concentration of 200 to 1000 micrograms/ml immediately after infusion, and the concentration remained above 10 micrograms/ml for about 24 hours without significant increase in fetal or maternal blood levels. Consequently, a daily single dose of 100 mg or more is probably effective prophylaxis in cases of premature rupture of membranes. When intrauterine infection is suspected, the dose can be increased to 500 mg or more, and transplacental administration may be added to achieve a higher concentration in fetal blood. The present study simulates well premature rupture of membranes, and an amnioinfusion of antibiotics will be reliable and effective in managing premature rupture of membranes.

Saline solution amnioinfusion for oligohydramnios after premature rupture of the membranes

In the conservative management of premature rupture of the membranes, most patients have oligohydramnios caused by continuous leakage of amniotic fluid. To avoid unfavorable effects of oligohydramnios on fetal development and well-being, we infused physiologic saline solution continuously into the amniotic cavity at a flow rate of 10 to 20 ml/hr with a new cervical indwelling catheter (PROM-fence). As a result the average pocket size of amniotic cavity was 2.7 cm before amnioinfusion, 5.9 cm 1 day after, 5.8 cm 5 days after, and 5.0 cm 10 days after amnioinfusion. The saline solution amnioinfusion made it possible to keep the amniotic cavity fluid level adequate. Variable deceleration disappeared in one case. No side effects such as uterine contractions were observed. We recommend the method of saline solution amnioinfusion for its favorable effects on fetal environment during management of premature rupture of membranes.

Prenatal diagnosis of osteogenesis imperfecta congenita by means of fetography.

By means of fetography, prenatal diagnosis of osteogenesis imperfecta congenita was performed on two pregnant women in the 34th week of gestation with familial histories of the disease.In 1 of the 2 cases, the fetogram revealed abnormal twisting of the torso, shortening, and severe angulation deformities of the extremities with callus formation and parchmentlike skull despite clear-cut outline of the scalp. On the basis of these findings, the fetus was diagnosed as osteogenesis imperfecta congenita and subsequently confirmed.Thus, the excellent fetal resolving power of fetography permitted successful prenatal diagnosis of the disease far more easily and precisely than plain roentgenography.

Differentiation of amylase isozyme in amniotic fluid with fetal age

Composition of the amylase isozymes in the amniotic fluid and their transition with fetal age were studied by means of thin-layer acrylamide gel electrophoresis. The results indicate that amylase isozymes in the amniotic fluid were composed of a pancreatic type faint major isozyme and several salivary type isozymes consisting of an intense major and a few less intense minor bands. Characteristic changes in the pattern of these isozymes with fetal age consisted of a marked increase of the salivary type isozymes rather than of the pancreatic type isozyme. A densitometric analysis of the isozyme patterns proved that the ratio of the pancreatic type isozyme to the salivary type major isozyme was highly correlated with fetal age regardless of levels of amylase activity.

Hemolytic pattern of erythrocytes in the newborn measured by the coil planet centrifuge system and its relationship to neonatal jaundice

Dynamic osmotic fragility of erythrocytes in cord blood and its changes during the neonatal period were studied by means of a coil planet centrifuge system. The starting-point for hemolysis in the newborn become similar to that of adult blood after approximately a week, while the shift of the end-point to the adult range required one month or more.The percentage of fragile cord blood cells with a hemolysis starting-point above 110 m osmol and the maximum bilirubin level during neonatal period were examined. A high percentage of fragile cells was associated with high bilirubin levels, and when fragile cells comprised more than 7.0% of the total cord blood erythrocytes, the bilirubin level tended to rise above 15 mg/dl.

Estimation of fetal weight by fetography

The present studies were designed to estimate fetal weight on the basis of the thesis that the factors which determine body weight include the fetal bone and the amount of fetal soft tissue, i.e., fetal corpulence. Scalp thickness on the fetogram in the vertex presentation was measured, and the ratio of the minimal femur diameter to the thickness of soft tissue on the extensor side in the same region was calculated as an index of fetal corpulence. The scalp thickness and the ratio obtained proved to be highly correlated with fetal weight.

Effect of fetal thymic extract on maturation of precursor lymphocytes from cancer patients with various stages

Abstract Thymus humoral factor seems to have an ability of differentiating the precursor T cells (PTC) into cells bearing T-cell (thymus-dependent lymphocyte) characteristics. Human fetal thymic extract (hFTE) was examined for in vitro effect on the concanavalin A (Con A) responsiveness of peripheral blood lymphocytes in 28 patients with uterine cervical cancer and 9 healthy volunteers. The result was expressed as percentage increase of Con A response of the hFTE-treated group to that of the nontreated group. The effect of hFTE was found to be pronounced in patients in Stages 0 and I, in spite of the small difference in T-cell count in unit volume of peripheral blood. Meanwhile, the effect of hFTE was no longer observed in patients with advanced cancer (Stages III and IV). The present study has suggested that some of PTC, which are prevented from differentiating into mature T cells in vivo due to presumably depressed thymic hormone production, accumulates in peripheral blood of patients with early cancer. And it was also suggested that decrease of both PTC and T-cell count in patients with advanced cancer is due to general immunodeficiency.

IMMUNOSUPPRESSIVE EFFECT OF SERUM IN PATIENTS WITH OVARIAN CARCINOMA

Cell-mediated immune response was measured in 23 patients with ovarian cystadenocarcinoma, 38 patients with benign ovarian tumor, and 44 healthy volunteers. The method used two indexes: the lymphocyte response per unit volume of peripheral blood to phytohemaggluttnin (PHA) and the immunosuppressive effect of serum on the response of normal lymphocytes to PHA stimulation. The lymphocyte response per 50 μl peripheral blood did not differ significantly between patients with ovarian cancer and healthy volunteers. The serum effect, in contrast, differed significantly between malignant and benign ovarian tumors, and was found to increase significantly even when the cancer masses were as small as about 5 X 5 X 5 cm in size, ie, in FIGO Stage 1. It is our belief that the measurement of the serum effect in patients with any ovarian tumor enables the early detection of ovarian cancer.

A case of Acute Fatty Liver of Pregnancy with Disseminated Intravascular Coagulation

妊娠末期にみられる急性妊娠脂肪肝の臨床経過および肝組織像については既に多くの報告があゐが生存例は極めて少ない.本症患者にDICを合併したことを凝血学的に証明し,腹膜潅流を施行し生存しえた1症例を経験したので,DIC合併の面より,本症の死因並びに治療に関して文献的考察を加えて筆者らの見解を述べる.症例:25歳,経産婦.妊娠33週で胎盤早期剥離を伴って分娩し,分娩後急激に黄疸,出血傾向,意識障害が増強し,急性腎不全を合併した.凝血学的検査値でDICの合併と診断し,新鮮血輸血と共に,腹膜潅流を9目間施行したところ,全身状態の改善,BUN値の正常化が認められ生存しえた.第30病日に施行した肝生検組織像で,本症に特徴的な脂肪沈着を認め,肝細胞壊死や炎症像はほとんどみられなかった.本症にみられる重篤な合併症状がDICに起因する可能性が示唆され,DICに対する注意と治療の重要性を強調した.