Recurrent melanotic neuroectodermal tumour of infancy. Case report and survey of 16 cases

A case of melanotic neuroectodermal tumour of infancy (MNTI) with rapid recurrence is described, together with a survey of 16 reported recurrent cases. The recurrent lesion was successfully treated by wide excision of the maxilla. The recurrent tumour had two lesions of different natures, one consisting of a lobular mass indistinguishable from the primary tumour but located remote from the original site and the other showing diffuse infiltration of tumour cells deep in the medulla of the maxilla. A survey of the recurrent cases indicated that, although incomplete removal of the primary tumour, dissemination of tumour cells during surgery and a multicentric origin could be the causes of a recurrence, the presence of a silent lesion which may express an aggressive growth on stimulation may also explain the complex behaviour of the tumour.

Changes in pituitary-adrenal function under continuous exposure to hypoxia in male rats

The plasma corticosterone concentration and incorporation of 14C-1-acetate into adrenocortical hormones were measured in male rats exposed to hypoxia (12.5% O2 in N2 balance) for periods of 30 min--14 days. Hypoxia significantly increased the weight of the adrenal and pituitary glands in early stages of exposure. However, weight returned to the control level on the 14th day of exposure. Hypoxia consistently decreased the weight of the thymus. Hypoxia elevated the plasma corticosterone concentration in the early stages of exposure. However, the elevated corticosterone level gradually decreased by the 7th day. The corticosterone level at this stage was lower than in the control. The corticosterone concentration returned to the control level on the 14th day. Hypoxia significantly facilitated incorporation of 14C-1-acetate into corticosterone and cortisol in the adrenal homogenate. The elevated incorporation was maintained until the 7th day and gradually decreased to the control level there after. Body weight was decreased by hypoxia (12 gram in 24 hours). On the 5th day, the weight returned to the control level. Hematocrit increased gradually during 14 days of hypoxia exposure. These results suggest that pituitary-adrenal function is greatly facilitated by 1-6 hours of hypoxia exposure, and hypoxia acclimatization is accomplished humorally within 14 days of exposure in rats.

Evidence for involvement of mast cells in tumor suppression in mice

Mast cell-deficient W/Wv mice had an increased tumor incidence after subcutaneous treatment with 3-methylcholanthrene, compared with that in normal congenic mice treated in the same way. This increased tumor incidence was suppressed to the normal level when the carcinogen was given after the mast cell deficiency had been overcome by transplantation of bone marrow cells from normal congenic mice. The W/Wv mice, however, were not defective in natural killer and T-cell-mediated cytotoxic activities. These results support the hypothesis that mast cells are involved in tumor suppression.

Diurnal variation of urinary potassium excretion in chronic renal insufficiency

Diurnal variation of urinary potassium excretion was examined on 10 adult patients with chronic renal insufficiency and 24 control subjects without cardiorenal functional disturbances. The daily cycle of potassium excretion, similar to that in controls, was present but less obvious in chronic renal insufficiency. In the controls, urinary potassium excretion reached a peak in the early morning (5.30 to 7.30) with a minimum in the night (21.00 to 5.30). The morning rise in potassium excretion was associated with increases in urinary sodium excretion, arterial blood pH, and plasma potassium and aldosterone concentrations. Creatinine clearance rate did not change significantly. In renal insufficiency, plasma potassium level and potassium excretion increased in the morning as compared with the night, whereas sodium excretion, the creatinine clearance rate, arterial blood pH and plasma aldosterone concentration did not change. 9 alpha-Fluorohydrocortisone gave rise to markedly enhanced potassium excretion. The findings suggest that the blunted cycle of potassium excretion in renal insufficiency is due, in part, to suppressed diurnal variations of sodium delivery to the distal tubule, acid-base balance and/or aldosterone secretion.

Renal handling of salt and water in the early stage of obstructive jaundice in rabbits

Renal handling of salt and water in the early stage of obstructive jaundice was studied in rabbits 10 days after the ligation of the common bile duct (BDL). Sham-operated (SO) animals served as controls. No sodium retention was found in BDL rabbits, despite reduced renal perfusion and elevated plasma aldosterone level. A redistribution of intrarenal blood flow was not found. The filtration fraction did not change. A saline load resulted in decreases in arterial hematocrit and total serum proteins, and increases in urine output, urinary sodium excretion and osmolal clearance. Blood pressure, glomerular filtration rate (GFR), RPF, the filtration fraction and the intrarenal flow distribution were not significantly affected by the saline load. No significant difference was found in the natriuretic response to the saline load between the BDL and SO groups. After 60 h of water deprivation, there was no significant difference in urine-to-plasma osmolality ratios or renal tissue fluid osmolality between the BDL and SO animals. The findings indicate that renal handling of salt and water was well maintained in the early phase of obstructive jaundice in rabbits. The data also suggest the critical role of the redistribution of intrarenal blood flow rather than of GFR or aldosterone in determining sodium retention in obstructive jaundice.

Involvement of ovarian innervation in steroid secretion

The effects of electrical stimulation of the brain on the ovarian venous plasma concentrations of estradiol (E2) and progesterone (P) were investigated in female rats hypophysectomized and adrenalectomized at 1000 h on the day of proestrus. Stimulation was applied during the proestrous critical period under pentobarbital anesthesia, and contralateral ovarian venous blood was collected from 105-120 min after the stimulation E2 and P concentrations, estimated by RIA, were significantly increased by stimulation of the medial basal prechiasmatic area (PVA), ventromedial hypothalamus, and areas in the mesencephalon and decreased by stimulation of the dorsal hippocampus, lateral amygdala, and mesencephalic areas. Ovarian blood flow was not affected by these stimulations. Ovarian nervotomy in the proestrous rats abolished E2 secretion induced by PVA stimulation. In intact proestrous rats, electrochemical stimulation of the PVA but not the preoptic suprachiasmatic area increased E2 and P concentrations, although stimulation of both areas commonly potentiated gonadotropin secretion. Present findings suggest that the efferent neural system from the brain to the ovaries is supplementary to the brain-pituitary-ovarian hormonal mechanisms in the regulation of ovarian steroid secretion, and the system may be required for the adjustment of ovarian responsiveness and sensitivity to gonadotropins. In addition, evidence for neural feedback on basal FSH secretion in the ovarian-denervated proestrous rats is presented in this study.

Surgical significance of dilatation of the common bile duct--with special reference to choledocholithiasis

Diameter of the common bile duct was measured in 3,119 patients who underwent primary operation for gallstones, during the period from 1975 to 1978. Although dilatation of the common bile duct was most marked in patients with bilirubin stones in the bile duct alone, dilatation was also observed in patients with cholesterol stones in the gallbladder alone. Drip infusion cholangiograms of 84 healthy patients showed that the common bile duct dilated in parallel with aging. A review of patients with congenital choledochal cysts reported in the literature in Japan revealed that few had gallstones. Thus, it was difficult to determine whether common bile duct dilatation was the cause or result of gallstones, and it was suggested that the so-called drainage operation such as choledochoenterostomy should be done only under strict indications.

Primary carcinoma of the remnant stomach--report of three cases

Among the 318 patients operated on for gastric carcinoma during the last six years in our department, three patients were operated on for carcinoma which developed in the remnant stomach 25, 22 and 12 years respectively after partial gastrectomy for peptic ulcers. Their surgical results were uniformly poor because of far advanced malignant lesions. Another patient who developed adenomatous polyps near the stoma 23 years after gastrectomy for duodenal ulcer was treated by polypectomy through gastrotomy. Both from our experiences and from review of literatures, it was concluded that patients gastrectomized for benign lesions should be followed up regularly ten or more years after the surgery, especially by gastroscopy, in order to detect remnant stomach carcinoma as early as possible. And any physicians should always be aware of this disease and should not attribute any late appearing abdominal complaints to gastrectomy itself.

Experimental radiation therapy and apparent radioresistance of autochthonous tumors subcutaneously induced with 3-methylcholanthrene in mice

The radiation response of autochthonous tumors induced by s.c. injection of 3-methylcholanthrene in ICR/JCL mice was studied. The tumors were mostly fibrosarcomas and grew with an average volume-doubling time of 2.6 days, independently of the time tumor appearance or dose of the chemical used. The tumors were locally and singly irradiated with 6-MV X-rays through a filter. Autochthonous tumors were similar to their transplants in postirradiation regression and gross cellular radiosensitivity (Do, 400 rads), as estimated from regrowth time. However, most of the autochthonous tumors irradiated with single doses of up to 7.4 kilorads recurred within 120 days, whie in identically irradiated tumor transplants a complete cure was obtained with doses of 6.5 kilorads or more. The 50% tumor control dose with no recurrence within 120 days was 4.4 kilorads for the transplants. Transplantation of 26 irradiated autochthonous fibrosarcomas produced only a few tumors in autochthonous hosts, and they were completely rejected in other, previously tumor-free mice; a 48% recurrence was noted even after resection of the irradiated tumor. Two possibilities for the apparent radioresistance of autochthonous tumors were suggested: (a) existence of radioresistant cells in autochthonous tumors; and (b) induction of a second new tumor by the additive effect of the chemical and radiation. Although our results are preliminary, the second possibility is not favored since autochthonous tumors induced with low doses of 3-methylcholanthrene recurred with high frequency after irradiation. Moreover, irradiation of tumor-free mouse skin that had been treated with the carcinogen produced tumors at a very low frequency.

Pathologic fracture of the mandible resulting from osteomyelitis: report of cases

Two cases of pathologic fracture of the mandible resulting from chronic osteomyelitis are described. The first case was treated successfully by antibiotic therapy followed by resection of the affected bone and iliac bone grafting after six months of follow-up care. In the second case, a patient with a history of diabetes mellitus, a fracture of the condyloid process occurred because of extension of the Actinomyces infection after extraction of the third molar. Because antibiotics failed to prevent exacerbation of the disease, the patient was given human gamma globulin. Then, all the signs of inflammation disappeared gradually with no evidence of recurrence for more than a year. There was no spontaneous bony healing of the fractured site.

Gallstones in Western Japan. Factors affecting the prevalence of intrahepatic gallstones

In a study from 40 hospitals in Western Japan between 1975 and 1978, intrahepatic gallstones were identified at the first biliary tract operation in 106 patients (a 3.03% prevalence). These were predominantly bilirubin stones. The occurrence rate for patients with intrahepatic stones was the same as for patients with bilirubin stones solely in the common bile duct suggesting the pathogenetic similarity of these two conditions. The prevalence of intrahepatic stones was 1.5% at urban and 4.97% at rural hospitals (P less than 0.005). Rural patients were significantly older than urban patients (P less than 0.005), but both groups showed an increasing prevalence with age. However, patients with intrahepatic stones were younger than those with bilirubin stones solely in the common bile duct, reflecting the increase likelihood that stones obstructing the biliary tree in this location would cause hepatic damage, pain, and, fever or the possibility that congenital anomalies of the bile ducts migt lead to stone formation at an earlier age. Among the 106 patients, only 12% had stones in the intrahepatic ducts alone. The majority of patients with both bilirubin and cholesterol intrahepatic stones had stones throughout the biliary tree simultaneously. The decreasing prevalence of bilirubin stones in Japan may be related to multiple factors including eradication of parasites and westernization of the diet.

Mechanisms of altered renal perfusion in the early stage of obstructive jaundice

Mechanisms responsible for renal hemodynamic alterations were studied in jaundiced (by bile-duct ligation) rabbits (BDL) 10 days after ligation of the biliary tract, in comparison with sham-operated rabbits (SO). Arterial hematocrit, plasma volume, blood pressure, abdominal inferior vena cava pressure, and heart rate were not significantly different between the BDL and SO groups. Cardiac output in BDL rabbits decreased to approximately 73% of the value for SO rabbits. Renal blood flow and GFR were reduced to 64 and 61%, respectively. Reductions in blood pressure and renal blood flow, caused by bleeding (8 ml/kg of body wt), were more marked in the BDL group than they were in the SO group. In the BDL group, the recovery of blood pressure following blood infusion was slower and the mortality was higher, There was no significant increase in the renovascular sensitivity to exogenous noradrenaline or angiotensin II in the BDL group. The findings indicate that the early stage of obstructive jaundice in rabbits was characterized by altered renal perfusion partly due to reduced cardiac output and by incrased liability to hemorrhagic hypotension.

Renal hemodynamics in oliguric and nonoliguric acute renal failure of rabbits

The role of renal hemodynamic alterations in the curtailment of renal functions was studied in uranyl acetate-induced oliguric (ORF) and nonoliguric (NORF) renal failures of rabbits. 5 days after drug injection, renal functional and morphological changes were most remarkable. A depression of Cin and elevation of serum creatinine concentration were more marked in ORF than in NORF. Renal blood flow was high as compared to controls. Cortical blood flow redistributed to the inner cortex. There was no significant difference in renal blood flow or cortical flow distribution between renal failure models. The findings suggest the minor roles of renal blood flow and cortical flow distribution in maintaining renal failure in these nephrotoxic models. Prominent tubular necrosis was found in ORF but not in NORF. Arterial inulin concentration during retrograde ureteral infusion of 14C-inulin solution was significantly high in ORF as compared to controls and NORF. However, this inulin leakage was too small to explain severely curtailed inulin clearance.

Protein permeability and immune complex deposition in glomerular capillary walls of rats

The effect of reduced glomerular anionic charge on immune complex deposition in the glomerular basement membrane was studied in rats with Heymann nephritis. A reduction of the anionic charge was induced by lysozyme administration. The animals were divided into the following four groups: normal controls (group A), group B treated with lysozyme, group C treated with lysozyme and immunized with autologous tubular antigen, and group D immunized with the antigen. Proteinuria was marked in groups B, C and D as compared with group A, especially in group D. Development of Heymann nephritis by the tubular antigen was suppressed in group C. Stainings of anionic substances in the glomerular capillary walls by cationic probes were weakened in groups B, C and D. Immune complex deposited in the subepithelial area of the capillary wall was also stained by cationic probes. The findings suggest that reduced glomerular anionic charge by polycations results in suppressed immune complex deposition in the basement membrane, partially due to increased permeation of macromolecules across the glomerular capillary walls in rats.

Concurrent feline immune-complex nephritis. Tubular antigen-positive and renal amyloidosis

We describe tubular antigen-positive immune-complex nephritis in a case of feline renal amyloidosis. Amyloid deposition was observed in mesangial area, and thickening of capillary walls was shown in the majority of the glomeruli. This case was also characterized with typical fluorescent granular depositions of cat IgG and C3 along the glomerular capillary walls as seen in human membranous glomerulonephritis. The fluorescent pattern of tubular antigen was identical with that of IgG and C3. Electron micrograph showed the thickening and irregularity of glomerular basement membranes, fusion of foot processes, and deposits of electron-dense or sometimes translucent materials, mostly in the intramembranous location. The causal sequence of the coincidental deposition of amyloid and immune complexes is discussed.

Lipoprotein like antigen on rat renal tubular epithelium

Three lipoprotein fractions were obtained from rat serum by density gradient ultracentrifugation; Fraction A (Fr. A, d less than 1.019), Fraction B (Fr B, 1.019 less than d less than 1.063), and Fraction C (Fr. C., 1.063 less than d less than 1.21). Kidney, liver and heart of rats were investigated by immunofluorescence using fluorescein isothiocyanate (FITC) conjugated rabbit anti-rat Fr. A and anti-rat Fr. C sera. Significant fluorescence was observed only in rat renal tubular epithelium (RTE) suggesting the presence of identical antigenic determinants in it as rat serum lipoproteins. Relatively small doses of each fraction of serum lipoproteins were injected with Freund's complete adjuvant (FCA) in rear foot pads. Two to four weeks after the injection, very mild proteinuria appeared in all rats immunized with Fr. B and Fr. C and three months later serum cholesterol was elevated in 3 of 8 rats. But no deposition of immunoglobulins (IgG, IgM) were observed in glomeruli of all rats examined, and any histological changes could not be found in renal tissue by light or electron microscopic observation.

Etiology of cholesterol gallstones

Formation of pure cholesterol stones is initiated by an excessive intake of highly purified carbohydrates, a large intake of animal fats and a restricted intake of vegetable fibers. When the protein content of the lithogenic diet was reduced, mixed or combined stones were formed in golden hamsters. These experimentally, dietarily produced gallstones had compositions and fine structures similar to those of human gallstones. Some mentions were made on black stones which were found in the aged golden hamsters fed with lithogenic diets.

Recurrent common duct stones, with special reference to primary common duct stones

A series of 1,358 cholelithic patients operated on at 32 affiliated hospitals during the last year and 492 patients operated on at authors' hospital during the last 21 years were reviewed with special reference to the cases of recurrent common duct stones. Of the former series 15 patients and of the latter series 12 patients respectively were reoperated on for recurrent, but not for residual, common duct stones, and all of them had in the markedly dilated common duct bilirubin stones showing characteristics of stasis stone-primary in common duct. Two representative cases are presented briefly. Congenital hypotonia of the common duct and inflammatory choledochitis are condemned and bilioenterostomy is recommended for preventing stone recurrences.

Present features of gallstones in Japan. A collective review of 2,144 cases

A collective review of 2,144 patients operated on for cholelithiasis during the last twenty-two months has shown that younger Japanese adults have predominantly cholesterol stones in their gallbladders and that elderly persons still frequently have bilirubin stones not only in their gallbladders but also in their common bile ducts. Recent westernization of dietary habits in Japan is considered to be the most probable factor causing the increased incidence of cholesterol stones. The decreased incidence of bilirubin stones is considered to be caused by the decreased incidence of biliary infection and increased intake of proteins in food.

Pathogenesis and treatment of pancreatitis due to essential fatty acid deficiency

Pathogenesis of pancreatitis was studied in experimental animals and essential fatty acid deficiency was condemned as an etiological factor, since it caused pathological changes in permeability of cell membrane of the pancreatic acinar cells. Favorable effects of intravenous fat emulsion was clearly demonstrated in treatment for acute and chronic pancreatitis.

Decreased plasma postheparin lipolytic activity in systemic lupus erythematosus

Plasma postheparin lipolytic activity (PHLA) was measured on 50 patients with systemic lupus erythematosus (SLE). Plasma PHLA was significantly decreased in SLE patients. This decrease was most striking in the acute phase of the disease. There was a close relationship between decreased PHLA and immunologic factors indicative of the acute phase of SLE. These immunologic factors included shaggy antinuclear antibody pattern, low serum complement titer, high DNA antibody titer, mixed cryoglobulin and lumpy glomerular pattern by immunofluorescent staining.