Nagoya Journal of Medical Science

Using sixty-four cases of bladder cancer, the distribution of carcinomatous lesions, carcinoma in situ, and atypism were observed by step section of the entire urothelium. Carcinoma of the bladder was divided into four tumor types in accordance with the mapping of the disease foci, the patterns of tumor growth, and the DNA distribution pattern in the tumor cells. Type 1 was localized consisting mainly of papillary non-invastive tumors. Atypia was mild around the tumor, and neither atypia nor carcinoma in situ was seen in sites distant from the tumors. Type 2 was multifocal, non-invasive, and consisted mainly of papillary tumors. Type 3 was multifocal, invasive and multiple carcinomata in situ were present at sites distant from the tumors. Type 4 was localized and invasive with no findings suggestive of precancerous lesions in the bladder mucosa. Type 4 tumors grew very rapidly and were highly malignant.
According to the retrospective analysis of the clinical course of each type, a plan for reasonable treatment of the bladder cancer was proposed as follows. Type 1; This type of tumor may be controlled sufficiently by transurethral resection. In cases of T₂ (B₁ or more, dissection of the lymph node is necessary. Type 2; This type may basically be controlled by transurethral resection, but careful follow-up is required because of high incidence of recurrence. When T₂ (B₁ or more are diagnosed, total cystectomy is indicated. Type 3; Total cystectomy including the urethra and dissections of the lymph node are necessary. Type 4; Partial. sometimes total, cystectomy and dissection of the regional lymph node at an early stage are necessary.

Closed intramedullary nailing is becoming a safer and more popular operative method. To this end, an original extension-apparatus has been developed, and the shape of the intramedullary nail and operative techniques have also been improved. Eighty-six femur fractures and 106 tibia fractures of adults have been examined and excellent clinical results have been reported.

A collagenase inhibitor was identified in the culture medium of mouse calvaria after separation from mouse bone collagenase by Sephadex G-200 gel filtration equilibrated with 6M urea in Tris buffer. The simultaneous synthesis of both collagenase and inhibitor by mouse calvaria in tissue culture was consistent with the resuls of our previous study using achick bone culture system and otehr recent studies.

To investigate whether different types of neurons have a different threshold for seizure activity, the thresholds of two types of neurons in the hippocampal formation of a guinea pig, i.e., the CA3 cells in the hippocampus proper, and the granule cells in the dentate gyrus, were compared for penicillin-induced seizure activity using slice preparation. A change in the evoked population spikes recorded from the cell body layers in the slice was observed following perfusion of penicillin-containing medium. All of the CA3 cell body layers showed seizure activity at a penicillin concentration of 200 I.U./ml. The granule cell body layers did not show seizure acitvity even at the higher concentration of 500 I.U./ml.

We have been sterilizing the operating microscope and flexible fiber-optic illuminator on a mobile stand by formaldehyde gas at ambient temperature for the past four years. The instruments were wrapped in two polyvinyl bags and 60 g of formaldehyde-adsorbed plaster were placed in the bottom of the bags. The efficiency of this sterilizing procedure has been periodically tested by examination with spores of Bacillus subtilis and Bacillus stearothermophilus. Of the 245 tests 17 (6.9%) showed positive growth of bacterial spores, the exposure time of the positive growth ranging from 10 hrs and 30 min to 68 hrs and 15 min. The positive growth rate was markedly higher in the operating microscope than in the flexible fiber-optic illuminator. However, after January of 1980 the exchange interval of the formaldehyde-adsorbed plaster was shortened from 4 to 2 weeks, and as a result, all tests longer than a 25-hr exposure time showed negative growth. Therefore, we concluded that a 24-hr exposure time is satisfactory to obtain sterility of the instruments with this method.

A specific collagenase inhibitor was isolated by Sephadex G-200 gel filtration in 6M urea from the culture medium of mouse bone, which simultaneously produced collagenase. The mouse bone collagenase inhibitor apparently blocked collagenases prepared from mouse bone, chick bone, and rabbit cornea. As the result of gel electrophoresis, the molecular weight of the inhibitor was estimated to be approx. 40,000 daltons. This inhibitor appeared to be similar to collagenase inhibitors isolated from other tissues of various species.

Formaldehyde cabinets at ambient temperature have been used to sterilize heat-sensitive operating instruments in our operating rooms. The instruments were placed in formaldehyde cabinets with a capacity of 0.4 m³ either wrapped in linen cloth or not wrapped. To generate the formaldehyde gas, 240g of formaldehyde-adsorbed plaster was deposited in the boltom of the cabinet. The efficiency of the sterilizing process was periodically examined using the spores of B. subtilis and B. stearothermophilus. During the past four years and two months, a total of 224 tests were performed, and 58 tests (25.9%) showed positive bacterial growth. Of 63 tests performed in the year of 1978 and 1979, no positive bacterial growth was observed at the exposure time of over 97 hrs. However, in January of 1980, the exchange inte'rval of formaldehyde-adsorbed plaster was shortened from 4 to 2 weeks; thereafter, among 161 tests no bacterial growth was observed at the exposure time of over 73 hrs.