Gifu University Hospital Research Articles

Expression of sex hormone-binding globulin exon VII splicing variant messenger ribonucleic acid in human ovarian endometriosis

Objective: To investigate the expression of sex hormone-binding globulin (SHBG) exon VII splicing variant messenger RNA (mRNA) in human ovarian endometriosis. Design: The expression of SHBG variant mRNA in normal uterine endometrium and endometriotic tissue was determined. Setting: Department of Obstetrics and Gynecology, Gifu University Hospital. Patient(s): Fourteen women with endometriosis and 18 women without endometriosis. Intervention(s): Normal uterine endometria and ovarian endometriotic tissues from patients who had undergone gynecological surgery were studied. Main Outcome Measure(s): Levels of SHBG wild-type and variant mRNAs were determined using the quantitative reverse transcription-polymerase chain reaction. Result(s): Analysis of the missing base pairs proved that they corresponded to the entire exon VII. There was no significant difference between the levels of SHBG wild-type mRNA in normal endometria and in endometriotic endometria, although the levels of SHBG variant mRNA in endometriotic endometria were significantly higher than that in normal endometria. The ratio of SHBG variant to wild-type mRNA levels was significantly higher in endometriotic endometria than in normal endometria. Conclusion(s): This study demonstrates the coexpression of SHBG exon VII splicing variant mRNA with its wild-type and the dominant expression of the variant in ovarian endometriosis. These results might be involved in the cellular estrogenic interaction, plausibly assisting in the development and growth of ovarian endometriosis.

成人および高齢者における咽後膿瘍の2症例

Retropharyngeal abscess is reported to be decreasing in frequency in recent years. We report two cases of retropharyngeal abscess that were diagnosed within four years in Department of Otorhinolaryngology, Gifu University Hospital. Case 1 was a 36-year-old male who was suggested to have an abscess as primary infection and case 2 was a 71-year-old female whose abscess seemed to be a secondary infection following unknown primary infection. Endoscopic or open neck drainage as well as antibacterial chemotherapy mainly with combinations of flomoxef and clindamycin in the case 1 and piperacillin and clindamycin in the case 2 was successfully carried out. They were discharged an 15-day and 24-day after operation in the cases 1 and 2, respectively. A 30 min. culture after sample collection on operation demonstrated aerobe-anaerobe mixed infection in both cases; three aerobes and four anaerobes in the case 1 and three aerobes and two anaerobes in the case 2. These results suggest that retropharyngeal abscess may be a complicated infection involving more bacterial species than has been commonly believed. Measuring susceptibility of isolates to antimicrobial agents, a strain of Capnocytophaga sp. and a strain of anaerobic gram-negative rod were highly resistant to piperacillin, cefroxine and ofloxacin. It is important for adequate antibacterial chemotherapy to grasp the bacteriology of retropharyngeal abscess and analyze susceptibility of antimicrobial agents.

前庭型メニエール病の検討

Recurrent attacks of vertigo without cochlear symptoms are called vestibular Meniere's disease (VMD), but the etiology has not yet been defined. VMD was diagnosed in 30 patients in Gifu University Hospital between 1987 and 1993. We reviewed the course of vertigo including cochlear symptoms. Hearing tests, electrocochleography and the furosemide VOR test were performed to investigate the etiology.1. The patients were divided into four groups according to the course of vertigo. Less frequent attacks were observed in eight patients, while seven patients had periodic attacks. Fourteen patients had frequent attacks with in a few years. One patient had sporadic attacks but the frequency had increased recently. Fourteen of 30 patients had repeated attacks over a long period (6-40 years) without cochlear symptoms.2. Electrocochleography and the furosemide VOR test were performed on 16 patients with VMD. Seven patients were positive for furosemide VOR test and negative for electrocochleography. There were four patients who were positive for both tests, while two patients were negative for the furosemide VOR test but positive for electrococ-hleography. Five of seven patients who had recurrent attacks over a long period without cochlear symptoms were positive for either test. These findings suggested that the etiology was endolymphatic hydrops.3. In two patients, fluctuating hearing loss was noted on hearing tests. Therefore, they were diagnosed with Meniere's disease.4. In one patients, tumor of the fourth ventricle was detected after 15 years.

含そう用アロプリノール液に使用する保存剤の検討

For the prevention or treatment of stomatitis caused by anticancer agents, allopurinol gargle has been used at Gifu University Hospital. The allopurinol gargle has been prepared by dispersing powdered allopurinol tablets and sodium carboxymethylcellulose into water for injection. As the result of examination of microbial contamination of the allopurinol gargle administered to a patient, Acinetobacter calcoaceticus var. anitratus, Burkholderia pickettii or Candida albicans were isolated. Benzoic acid (BA), sodium dehydroacetate (DA) and ethyl-p-hydroxybenzoate (EP) were used as preservatives for allopurinol gargle. Allopurinol gargles containing 0.05% of BA, 0.1 % of BA, 0.05% of DA, 0.1 % of DA or 0.05% of EP were prepared and antimicrobial activities against strains isolated from allopurinol gargles and those from clinical specimens were assessed based on the criteria for topical preparations in British Pharmacopoeia. Among the alloprinol gargles prepared, only alloprinol gargle containing 0.1% of BA had antimicrobial activity against all strains at storage conditions of 25°C and 37°C. The alloprinol gargle containing 0.1 % of BA did not demonstrate sufficient antimicrobial activity at 4°C. The BA added to allopurinol gargles had no influence on either the stability of allopurinol or on the inhibition of xanthine oxidase by allopurinol. No growth of organisms appeared in the remaining allopurinol gargle containing 0.1 % of BA used by the patient.These findings suggest that the addition of BA at the concentration of 0.1 % is suitable for allopurinol gargle.

Bacteriology of chronic otitis media, chronic sinusitis, and paranasal mucopyocele in Japan.

A bacteriologic study of cases of chronic otitis media, chronic sinusitis, and paranasal mucopyocele diagnosed at Gifu University Hospital was performed between 1989 and 1992. Bacteria were isolated from all of 13 samples of discharge from the ears of patients with chronic otitis media, all of 14 mucosal biopsy specimens from patients with chronic sinusitis, 8 of 10 aspirate samples from patients with chronic sinusitis, and 9 of 15 aspirates samples from patients with mucopyocele. Cultures often yielded polymicrobial growth, with an average of 3.1, 3.8, and 4.2 species per positive specimen from chronic otitis media, chronic sinusitis, and mucopyocele, respectively. The most commonly encountered anaerobes were Peptostreptococcus, Propionibacterium, and Prevotella species; the most common aerobes were Staphylococcus and Streptococcus species. One strain of Prevotella melaninogenica highly resistant to ampicillin and two strains of Peptostreptococcus resistant to cefaclor were found.

Effectiveness of intraoperative radiation therapy for recurrent supratentorial low grade glioma

Twelve adult patients in the records of 38 patients with histologically verified supratentorial low grade glioma showed recurrence at the Gifu University Hospital between 1980 and 1992. A mean period to recurrence from the initial surgery and postoperative radiation was 38 months. Six of these patients underwent intraoperative radiation therapy. The other six patients received chemotherapy with conventional cytoreductive surgery in three cases and additional external irradiation in three cases. The 2-year survival rate of the former patients was 83.8% and significantly higher than that of the latter ones, 16.7% (p < 0.05). Most cases showing recurrence of supratentorial low grade glioma were occurred locally, and dissemination or remote metastasis of the lesion were rare. The results revealed that the local control is important for recurrent tumors of supratentorial low grade gliomas. The effectiveness of the intraoperative radiation therapy as the second operation for the recurrent supratentorial benign glioma is discussed.

入院患者における相互作用の組合わせ処方に関する検討

Patients who received pharmacist-conducted counseling in the medical ward of the Second Department of Internal Medicine, Gifu University Hospital, were monitored for drug use from August 1992 to May 1994. The average number of drugs received by patients who were administered digitalis, theophylline, warfarin or adrenocorticoids was 8.0, and the average number of drugs received by patients who were administered the other drugs without these 4 drugs was 5.8. It was shown that 71.4% of patients given digitalis, theophylline, warfarin or adrenocorticoids were concomitantly administered drugs which were suspected the drug interactions, whereas this condition arose in 33.3% of patients given other drugs. This finding suggests that the risk of incurring on adverse drug reaction was increased in patients receiving these drugs.

複数科受診患者の重複・相互作用処方に関する検討

A support system for prescriptions was added to the Gifu University Hospital prescription ordering system in July 1994. The information on other prescriptions for patientswho were consulting multiple clinical departments in our hospital was printed on the prescription sheet to support the dispensing process. These prescriptions are indicated on a computer display using the printed information (e.g., department and prescription date). Drug duplications and drug interactions including the medications which were prescribed by other department are subsequently checked by pharmacists.The rate of prescriptions on drug duplications decreased significantly from 14.0% in June to 2.6% in October (p<0.05) since the support system was introduced. The rate of prescriptions generating drug interactions did not significantly decrease. However, some doctors modified the medication order or carefully maintained the medication order to prevent the occurrence of undesirable drug interactions as a result of the pharmacist's advice. These findings suggest that this support system is useful for preventing overdosing and adverse reactions that may be induced by drug duplications or drug interactions

最近１４年間の岐阜大学皮膚科におけるケルスス禿そう

1979年1月から1993年4月までの約14年間に岐阜大学皮膚科を受診したケルスス禿瘡について統計的観察を行った。1)症例数は22例, 年平均1.5例であり, 明らかな増加傾向はみられなかった。2)男女比は13:9で男性が女性の約1.5倍みられた。15歳以下の小児が19例と全体の86%を占め, とくに10歳以下の症例が18例あった。成人発症例は全例女性で60歳以上の患者であった。3)原因菌種はTrichophyton rubrum 10例, Microsporum canis 9例, M. gypseum 1例, T. violaceum 1例, 不明1例であり, T. rubrum, M. canisが多かった。4)発症時期は冬期が11例と最も多く, 罹患部位は頭頂部を含む症例が17例と全体の約3/4を占めた。5)感染源としてイヌ1例, ネコ5例が疑われた。6)半数の11例にステロイド剤の外用の既往を認めた。7)家族内発症は7例(31.8%)にみられ, 兄弟間発症が5例, 親子間, 夫婦間発症が1例づつであった。8)治療は抗真菌剤(グリセオフルビン)の内服を行い, 二次感染に対しては抗生剤の内服を併用した。

小児のめまい・平衡障害の検討

A study was conducted of children complaining of vertigo, dizziness and equilibrium disturbance who were examined at the Department of Otorhinolaryngology of Gifu University Hospital from January, 1985 to December, 1992.1. Of the 3, 626 patients who visited our clinic with complaints of vertigo, dizziness and equilibrium disturbances, 98 (2.7%) were under 15 years of age. Their equilibrium and neurological status were evaluated.2. Of the 98 patients, 26 (26.5%) had labyrinthine disturbances, 17 (17.3%) central nervous system disturbances, 2 (2.0%) both labyrinthine and central nervous system disturbances, and 42 (42.9%) vertigo or dizziness due to systemic diseases. In 11 patients (11.2%), the vertigo and dizziness were of unknown etiology.3. Among the 26 patients with labyrinthine disturbances, 3 had Meniere's disease, 5 had vertigo with sudden deafness, 4 delayed hydrops and 4 circulatory insufficiency of the labyrinth.4. Among the 17 patients with central nervous system disturbances, 4 had post-traumatic disorders, and the others had equilibrium disturbance due to brain tumor, hemorrhage, epilepsy, etc.5. Eleven patients with dizziness of unknown etiology were almost free of symptoms shortly after the examinations, and none of them thereafter showed any abnormality of the central nervous system.

Outcome of Vestibular Ménière's Disease

Vestibular Meniere's disease was diagnosed in 18 patients in Gifu University Hospital from January 1987 to October 1989. We review here the electrocochleograms, the course of vertigo, the course of cochlear symptoms and hearing tests, and the incidence of central nervous system disease.1 . Three patients had increased -SP. The side of increased -SP corresponded with the side of canal paresis in all cases.2. The patients were divided into five groups according to the course of vertigo ; 1 patient had sporadic attacks. 8 patients had periodic attacks. 3 patients had frequent attacks in a short period of time. 2 patients had sporadic attacks but recently the frequency increased. In 3 patients, the outcome was unclear, because the periods of observation were short.3. In 2 patients, fluctuating hearing loss was noted in hearing tests. The side of hearing loss was the same as the side of canal paresis. We diagnosed pre-Meniere's disease, but they were not aware of fluctuating hearing loss. Therefore, periodical hearing tests are necessary for observations of vestibular Meniere's disease.4. In one patient, tumor of the fourth ventricle was detected.5. Seven patients had repeated attacks of vertigo in a long time without cochlear signs and disease of the central nervous system.

Tumor of the Fourth Ventricle with Vertigo Similar to Vestibular Ménière's Disease; A Case Report

Vertigo in vestibular Meniere's disease is similar to that in Meniere's disease, but in the former there are no cochlear symptoms.A 58-year-old woman visited Gifu University Hospital on August 31, 1987, complaining of recurrent attacks of vertigo. She had no cochlear symptoms. Caloric tests indicated left canal paresis, but no abnormalities were detected on CT scan. We diagnosed vestibular Meniere's disease. She later complained of positional vertigo with severe nausea and visited our hospital again on February 15, 1990.Neurological findings : Lateral gaze directional nystagmus and down beat head shaking nystagmus were seen. In voluntary OKN, smooth pursuit was abnormal but saccadic eye movement was not. We speculated that disorders of eye movements were caused by a lesion of the flocculus or its connection to the vestibular nuclei.MRI findings : MRI showed a tumor of the fourth ventricle, compressing the right cerebellar peduncle.Neurological findings corresponded with MRI findings.We conclude that the vertigo was due to vertebrobasilar insufficiency or endolymphatic hydrops caused by disturbance of CSF flow.