Adenomatous hyperplasia of the liver as a precancerous lesion

Adenomatous hyperplasia (AH), a hyperplastic parenchymal nodule, is detected most often through radiological and pathological observations in chronic advanced liver disease. AH can be classified into two categories: ordinary type or macroregenerative nodule (MRN) type I, and atypical type or MRN type II. Characteristically, both types contain portal tracts with portal veins and biliary elements. Ordinary AH may represent a large regenerative nodule with limited growth potential. Atypical AH shows slightly cellular and structural atypia, altered phenotypic expression, and increased proliferative activity compared to the surrounding liver. Histologic differentiation of atypical AH from well-differentiated hepatocellular carcinoma (HCC) is controversial, and generally accepted diagnostic criteria are still lacking. Atypical AH occasionally contains overt malignant foci. Histological observations and portography show that nodules of AH are supplied by portal venous blood. While AH nodules appear to be hypoperfused according to arteriographic studies, atypical AH contains small arterial branches which are abundant in contrast to the surrounding liver. The data obtained so far indicate that atypical AH may be a hepatocellular neoplasm which belongs nosologically to a gray area of neoplasm, in which overt HCC is likely to develop. It is clinically recommended that atypical AH is treated as "malignant" because of the occasional inclusion of HCC foci. For its treatment, percutaneous ethanol injection is becoming popular.

Peripheral expansion of gamma delta T cell receptor-positive cells in a patient with Crohn's disease

A 13 year old boy with Crohn's disease had a prominent expansion (over 40%) of gamma delta T cell receptor-positive cells (gamma delta T cells) in the peripheral blood. The gamma delta T cells were gradually decreased from 48 to 22% in 18 months. Anti-gamma delta T cell receptor-triggered cytotoxicity was evident at onset and after 1 year. The significance of peripheral expansion of gamma delta T cells in a patient with Crohn's disease is discussed.

An ultrastructural study of cutaneous hemangioma in two chickens

Cutaneous hemangioma in two laying hens was examined by light and electron microscopy. In close association with capillary and cavernous hemangioma there was a solid cell mass. Ultrastructurally, the cell mass consisted of undifferentiated mesenchymal cells and had an alveolar structure. There were transitional cell types from the alveolar structure to the capillary and cavernous hemangiomas. Hemangiomatous structure may develop from the undifferentiated mesenchymal cells in the solid cell mass.

[Clinical study of recombinant human granulocyte-colony stimulating factor (KW-2228) in pediatric field. 2. Effectiveness on neutropenia associated with administration of anticancer agent and safety]

The effect of KW-2228, a derivative of recombinant human granulocyte colony stimulating factor, on neutropenia associated with chemotherapy was studied in pediatric patients with malignant tumor. To patients repeatedly treated with the same chemotherapy, KW-2228 was administered subcutaneously at 1 microgram/kg or intravenously at 2 micrograms/kg once a day in the 2nd course of the chemotherapy. During the administration term of KW-2228, the nadir of neutrophils went up, and the duration of neutrophil count under 500/microliters as well as the interval for recovery of the count to 500/microliters were remarkably shortened, compared with those during the observation term. Further, the duration of fever in patients and the administration days of antibacterial agent were also reduced. The effective rate judged by attending doctors was as high as 78.9%, consisting of 83.3% in 42 cases of subcutaneous administration and 73.5% in 34 cases of intravenous administration. Side effects such as slight skeletal pain and slight fever in one case each (2.3% in total) were improved without treatment. It is concluded that KW-2228 may be a useful drug for treatment of neutropenia associated with chemotherapy in pediatric patients with malignant tumor.

[Clinical study of recombinant human granulocyte-colony stimulating factor (KW-2228) in pediatric field. 1. Effectiveness on neutropenia by various causes and safety]

The effect of KW-2228, a derivative of recombinant human granulocyte colony stimulating factor, on neutropenia in children was studied in 23 cases of aplastic anemia, 13 cases of chronic benign neutropenia, 6 cases of congenital neutropenia (Kostmann type), 2 cases of cyclic neutropenia, 2 cases associated with glycogenosis type Ib and 1 cases associated with immune deficiency. KW-2228 was administered at 1-8 micrograms/kg subcutaneously and at 2-16 micrograms/kg intravenously. As a principle, the administration was started at low doses and continued for 7-28 days increasing the doses in the cases who didn't respond to the treatment well. The response rate of all the cases by the physicians in charge was 81. 8% (36/44). The mean absolute neutrophil count was increased from 304 to 1,300/microliters in aplastic anemia, from 204 to 3,027/microliters in chronic benign type, from 125 to 2,193/microliters in Kostmann type, and from 360 to 2,007 microliters in others. KW-2228 did not induce any noteworthy serious side effects. These results indicated that KW-2228 is a useful drug to treat neutropenia in children.

Neuropathologic study of newborns with prenatal-onset leukomalacia

The distribution of leukomalacia and glial fibrillary acidic protein (GFAP)-positive glial cells in prenatal- and postnatal-onset leukomalacia were compared and diagnosed histologically in 128 autopsied infants and the different pathogeneses were examined. Prenatal-onset leukomalacia was diagnosed in 12 of 71 still-births and neonates surviving less than 3 days (16.9%). All 4 preterm infants of less than 32 gestational weeks had widespread white matter necrosis and 4 of 5 term infants had focal necrosis. GFAP-positive glial cells were more increased in the deep and intermediate white matter in both forms of leukomalacia than in the controls, although in the subcortical white matter they were less increased in prenatal- than postnatal-onset leukomalacia. These differences may indicate different pathogeneses, including vascular maturity and causal factors, in prenatal- and postnatal-onset leukomalacia.

Single-shot UV autocorrelator that uses a two-photon-induced photoacoustic signal in water

A single-shot autocorrelation of an ultrashort UV pulse is measured by detecting a two-photon-induced photoacoustic signal in water. A supersonic wave representing the autocorrelation function is detected by a polyvinylidene fluoride piezoelectric film with a spatial resolution of less than 60 microm. The detection sensitivity is higher than that of a multiphoton-induced fluorescence method by approximately 2 orders of magnitude.

Abnormal behavioral patterns in the human fetus at term: correlation with lesion sites in the central nervous system after birth

We describe three fetuses at term that demonstrated abnormal behavioral patterns in utero when observed using real-time ultrasound. The abnormal patterns turned out to have neurologic correlations after birth. In case 1, despite a normal breathing pattern, no movement in any of the four extremities was observed, thus suggesting the existence of a spinal cord lesion at the rostral end, located at C4 or C5. In case 2 a lack of breathing movement was noted repeatedly, together with the abnormal finding that alternation of periods of rapid eye movement (REM) sleep with those of non-rapid eye movement (NREM) sleep was not present. These findings implied a lesion involving the pons and/or medulla oblongata. In case 3 movement of the four extremities, breathing movement, and alternating periods of REM sleep and NREM sleep were found to be within the normal range. The concurrence of regular mouthing and the NREM sleep period was not observed, however, suggesting impairment in the brain function responsible for NREM sleep located from the pons through the thalamocortical connection to the cerebral hemisphere.

Enzyme immunoassay for plasma 25-hydroxyvitamin D3 employing immunoaffinity chromatography as a pretreatment method

An enzyme immunoassay (EIA) of 25-hydroxyvitamin D3 [25(OH)D3] has been developed as a new methodology for measuring its plasma levels. Three anti-25(OH)D3 antibodies elicited against 25(OH)D3 3-hemisuccinate or -hemiglutarate conjugated with bovine serum albumin were used for this purpose. Two enzyme-labeled antigens were prepared by linking these haptens to beta-galactosidase employing the N-succinimidyl ester method. An EIA system, selected from several combinations of the antibodies and labeled antigens, exhibited higher sensitivity and specificity than those of the conventional competitive protein binding assay. However, direct measurement of plasma specimens gave lower values than those obtained from the ones which were pretreated with a Sephadex LH-20 column followed by a normal-phase high-performance liquid chromatography. This problem has been overcome by employing immunoaffinity chromatography (IAC). In IAC the homologous anti-25(OH)D3 antibody with that used in the EIA was immobilized as a pretreatment method. The IAC/EIA system developed in this study afforded reliable plasma 25(OH)D3 levels which were confirmed by serial dilution study and the recovery test. The 25(OH)D3 levels of healthy volunteers in the summer measured by this method were 25.2 +/- 6.2 ng/ml (n = 10).

One-shot intravesical instillation of the mucous adhesive anticancer agent hydroxypropylcellulose-doxorubicin for the treatment of superficial bladder carcinoma is sufficient to determine antitumor effects

A 20 mg/20 ml dose of the membrane adhesive anticancer preparation, hydroxypropylcellulose-doxorubicin (HPC-doxorubicin), was instilled into urinary bladders through a catheter for the treatment of superficial bladder carcinomas (Ta-T1). After 14-30 days, the effects of the drug on tumors was examined by cystoscopy, and the residual tumor tissue where reduction in size was observed was resected by transurethral resection (TUR). Therapeutic effects were as follows: a complete response (CR) was found in 6 cases (37.5%), a reduction in size of more than 50% (partial response = PR) in 4 cases (25%), and a less than 25% reduction (no change = NC) in 6 cases (37.5%). In no case was progression of the disease noted. In CR cases, cold cup punch biopsy revealed no tumor cells remaining at the site where the tumor was present before the instillation. Side effects such as bladder irritation were found in 4 cases, but they were only temporary in nature. The one-dose HPC-doxorubicin approach developed by ourselves allowed detection of antitumor effects between 14 and 30 days after the instillation and therefore determination of sensitivities at an earlier stage than with instillation of the conventional water-soluble type of doxorubicin hydrochloride.

Immunization of institutionalized asthmatic children and patients with psychomotor retardation using live attenuated cold-adapted reassortment influenza A H1N1, H3N2 and B vaccines

Live attenuated cold-adapted reassortant (CR) influenza virus vaccines were evaluated in institutionalized asthmatic children and severe psychomotor-retarded (SPR) patients. Almost all the vaccinees were seropositive to the vaccine strains before immunization. Trivalent CR vaccine (containing A H1N1 (CR-125), A H3N2 (CR-149) and B (CRB-117)), bivalent CR vaccine (CR-125 and CR-149) and monovalent CRB-117 were inoculated to 19 asthmatic children and 36 and 16 SPR patients, respectively. Overall 49, 22, and 11% of vaccinees were infected by A H1N1, A H3N2 or B vaccine viruses, respectively, as indicated by significant haemagglutination-inhibition (HI) antibody titre rises 4 weeks after inoculation. No severe adverse reactions associated with CR vaccination were observed in the handicapped patients. A nosocomial outbreak of influenza A H1N1 occurred in the ward with asthmatic children, but none of the 19 CR-trivalent vaccinees became infected. However, five of 20 non-vaccinees in the same ward, and ten of 30 vaccinees in another ward that received inactivated split vaccine became infected. The CR vaccines demonstrated significant protective effects against natural exposure to the A H1N1 virus, and were well tolerated and safe when given to patients with bronchial asthma and severe psychomotor retardation.

An experimental study of delay of flow-through venous flaps

A delayed procedure was performed in flow-through venous flaps made in rabbits' ears. Compared with undelayed venous flaps, the delayed flaps at 7, 14 and 21 days after delay showed a distinct increase of survival area. This effect increased with the delay period.

Human P-glycoprotein transports cortisol, aldosterone, and dexamethasone, but not progesterone

We expressed human MDR1 cDNA isolated from the human adrenal gland in porcine LLC-PK1 cells. A highly polarized epithelium formed by LLC-GA5-COL300 cells that expressed human P-glycoprotein specifically on the apical surface showed a multidrug-resistant phenotype and had 8.3-, 3.4-, and 6.5-fold higher net basal to apical transport of 3H-labeled cortisol, aldosterone, and dexamethasone, respectively, compared with host cells. But progesterone was not transported, although it inhibited azidopine photoaffinity labeling of human P-glycoprotein and increased the sensitivity of multidrug-resistant cells to vinblastine. An excess of progesterone inhibited the transepithelial transport of cortisol by P-glycoprotein. These results suggest that cortisol and aldosterone are physiological substrates for P-glycoprotein in the human adrenal cortex and that substances that efficiently bind to P-glycoprotein are not necessarily transported by P-glycoprotein.

Disseminated intravascular coagulation (DIC) in rabbit haemorrhagic disease

Seven rabbits experimentally infected with rabbit haemorrhagic disease virus were examined haematologically and histologically. Haematologically, activated partial thromboplastin time and prothrombin time were markedly prolonged in the terminal phase of the disease, just prior to death (all the animals died between 27 and 40 hr after inoculation with rabbit haemorrhagic disease virus). There was an increase in the titre of fibrin degradation products and a decrease in antithrombin III activity during the same interval. Acute necrotic hepatitis and disseminated intravascular coagulation (DIC) in many organs, including the lung, kidney, spleen and heart were the characteristic histopathological changes. Thus, the haematological and histological changes suggested that DIC was induced by rabbit haemorrhagic disease virus infection. Severe liver necrosis was considered to be a factor causing DIC by inducing a hypercoagulable condition in the systemic blood circulation.

Modulation of C2 and C3 gene expression of human peripheral blood monocytes by interleukin 1 beta, interferon gamma, tumor necrosis factor alpha and lipopolysaccharide

The effect of interleukin 1 beta (IL-1 beta), interferon gamma (IFN-gamma), tumor necrosis factor alpha (TNF alpha) and lipopolysaccharide (LPS) on the expression of the C2 and C3 genes in human adherent monocytes was studied. Stimulation of monocytes with IFN-gamma increased both C2 and C3 mRNA. IL-1 beta also increased C2 mRNA level, whereas C3 gene expression was not enhanced. TNF alpha failed to increase either C2 or C3 mRNA. LPS increased C2 mRNA, but suppressed C3 gene expression. These results suggest that C2 and C3 production by monocytes is regulated by IL-1 beta and IFN-gamma in the local tissues.

Determination of thiocyanate in human saliva and urine by ion chromatography

A simple ion-chromatographic method has been developed for the determination of trace amounts of thiocyanate in human saliva and urine. Thiocyanate separation and detection were carried out on an ODS column coated with cetyldimethylamine and by an ultraviolet detector, respectively. Citrate solution (1 mmol l-1) was used as the mobile phase. Thiocyanate was clearly separated from many organic and inorganic anions found in saliva and urine samples. The analytical results obtained by the proposed method agreed with those of the Fe(3+)-thiocyanate spectrophotometric method. Thiocyanate concentrations in the saliva and urine of smokers were found to be significantly higher than those of non-smokers.

[Liver transplantation and functions of the graft liver]

Partial liver transplantation from living donors is a new surgical operation on patients in the final stage of liver dysfunction. Among about 90 operations so far done in the world, 34 were performed at the Second Department of Surgery in Kyoto University Hospital (as of June, 1992). Good but limited cooperation between surgeons and clinical laboratories has contributed to saving the lives of as many as 28 patients. Analysis of laboratory data and clinical course of patients indicated that pre-, mid-, and postoperational examinations of blood flow through the graft liver by the use of Doppler echography and the monitoring of the liver capacity to generate ATP by the aid of the arterial ketone body ratio are most important for early detection of dysfunctioning liver grafts. An unusually high incidence of the transient hyperphosphatasemia-like elevation of alkaline phosphatase and a frequent appearance of liver-type arginase in serum during the postoperative stage seemed to indicate some pathological changes of the liver.

[A comparison of community-acquired lung infection and nosocomial infection--review of autopsy cases in Hisayama town]

All people in Hisayama town who died either at home or in hospital are autopsied in Kyushu University Hospital. We examined the incidence and the pathogen of community-acquired lung infection and nosocomial infection from the records of 463 autopsy cases from 1977 to 1988. Of these cases, 243 died at home. Among them, pulmonary infections were present in 122 cases (50.2%), and pulmonary infection was the cause of death in 87 cases (35.8%). Of 220 cases that died in hospital, pulmonary infections were present in 133 cases (60.5%) and were the cause of death in 83 cases (37.7%). In the cases that died at home, the incidence of pulmonary infections during the first 6-year period of the study was almost the same as that during the last 6 years. In the case that died in hospital, the incidence of pulmonary infections during the last 6-year period was higher than that during the first 6-year period. Regarding the pathogenic organisms of the fungal infections, only Candida was detected in case that died at home, while Candida, Aspergillus and Cryptococcus were detected in the case that died in hospital.

Dura and cranial base reconstruction by external oblique fascia and rectus abdominis muscle flap

The rectus abdominis muscle flap, combined with the external oblique fascia, were utilized in cranial-base reconstruction. In a wide defect caused by resection of a giant meningioma, the dura was reconstructed with the external oblique fascia and anterior sheath, and the cranial-base defect was reconstructed with the rectus abdominis muscle flap.