Analysis of False-negative Findings of the Incomparable Accuracy and Swiftness of Flow Cytometric Diagnosis of Primary Central Nervous System Lymphoma

Primary central nervous system lymphoma (PCNSL), a relatively rare brain tumor, bears a dire prognosis. On occasion, the rapid progression of the tumor makes immediate diagnosis and initiation of therapy imperative. To achieve swift diagnosis, we adopt flow cytometry (FCM) in addition to conventional histopathology. This study aimed to reveal the utility of FCM diagnosis for PCNSL and the cause of false-negative results of FCM diagnosis. We investigated 33 patients with suspected PCNSL on neuroradiological findings and received both FCM and histological diagnosis. The patients' electronic medical records were investigated, and histological findings, results of FCM, and other clinical data were evaluated. Overall, 27 patients (14 males and 13 females) were diagnosed with PCNSL by histological confirmation. The median age at diagnosis was 68 years. FCM analysis showed lymphoma pattern in 24 cases; however, FCM results did not show lymphoma pattern (sensitivity: 88.9%, specificity: 100%) in the other three lymphoma cases (FCM discordant: FCM-D) and six nonlymphomatous tumor cases. Analysis of FCM-D cases showed the infiltration of T lymphocytes or astrocytes into the tumor tissue, indicating tumor microenvironmental reaction; it is assumed that these reactions deceived FCM diagnosis. The survival of FCM-D patients was superior to FCM concordant counterpart, although the difference was not significant (p = 0.459). The diagnosis of PCNSL by FCM is rapid and highly reliable. Some FCM-D cases are PCNSLs with strong tumor microenvironmental reactions.

PEDT-5 PREOPERATIVE MAGNETIC RESONANCE IMAGING AND INTRAOPERATIVE BLOOD LOSS IN CHILDHOOD POSTERIOR FOSSA TUMORS

Background and Purpose

For removal of childhood posterior fossa tumors, it is important to control bleeding while internally decompressing the tumor. Evaluation of tumor vascularity by preoperative magnetic resonance imaging (MRI) is thought to be effective in predicting and controlling blood loss. In this study, we evaluated the relationship between imaging features, mainly susceptibility-weighted imaging (SWI), and the amount of intraoperative blood loss.

Methods

Among childhood posterior fossa tumors operated on by the same surgeon between January 2016 and March 2022, 9 cases in which preoperative MRI data could be analyzed and total or subtotal resection was achieved were included. The SWI: intratumoral susceptibility signals (ITSS) grade, an index of tumor vascularity, was used to evaluate the association between the degree of vascularity (ITSS: 0-2 vs. ITSS: 3) and multiple factors, including intraoperative blood loss, in a univariate analysis. In addition, the intraoperative blood loss was analyzed by multivariate analysis.

Results

There were 3 males and 6 females with a median age of 6 years (5-11). Seven medulloblastomas, one atypical teratoid/rhabdoid tumor, and one ependymoma were included. Univariate analysis showed that patients with higher vascularity (ITSS: 3) had significantly higher intraoperative blood loss (p=0.016) and larger tumor volume (p=0.032). In multivariate analysis with age, degree of contrast enhancement, degree of vascularity, tumor volume, and degree of tumor resection as independent variables, the degree of vascularity was not significantly associated with intraoperative blood loss (p=0.477), but only with tumor volume (p=0.036).

Conclusion

Although the degree of tumor vascularity may be related to intraoperative blood loss, there was a strong correlation between the degree of vascularity and tumor volume, and multivariate analysis of intraoperative blood loss showed that only tumor volume was a significant factor. Higher tumor vascularity was associated with larger tumor volume, which may result in increased intraoperative bleeding.

Stat5b inhibition blocks proliferation and tumorigenicity of glioblastoma stem cells derived from a de novo murine brain cancer model

Glioblastoma (GBM) is the most common and malignant type of brain cancer in adults with poor prognosis. GBM stem cells (GSCs) reside within niches in GBM tissues and contribute to recurrence and therapy resistance. Previous studies have shown that expression of leucine-rich repeat-containing G-protein coupled receptor 5 (Lgr5), a Wnt pathway-related stem cell marker, correlates with a poor prognosis in GBM, and its knockdown in GSCs induces apoptosis accompanied with downregulation of signal transducer and activator of transcription 5b (Stat5b). Here, we show that Stat5b co-localizes with Lgr5 in hypoxia-inducible factor 2α (Hif2α)-positive regions in GBM tissues. Functional analyses using GSCs derived from a murine de novo GBM model induced by oncogenic genes transduction using the Sleeping-Beauty transposon system revealed that expression of Stat5b was induced by culturing under hypoxia together with Lgr5, repressed by Hif2α knockdown, and reduced by Lgr5 knockdown or a Wnt/β-catenin signaling inhibitor ICG-001 treatment. Stat5b inhibition in the GSCs induced apoptosis and caused downregulation of Cyclin E2 resulted in blockade of entry into S-phase in the cell cycle. Disruption of Stat5b in an orthotopic transplantation model significantly prolongs event-free survival. These results suggest that Stat5b, regulated by hypoxia and the Wnt pathway, plays an important role in the maintenance and tumorigenicity of GSCs and may be a promising therapeutic molecular target to attack GSCs.

MPC-2 Clinical course and prognosis of lower-grade glioma, IDH wildtype and pTERT mutant

Background and Purpose: In the cIMPACT-Now update 3, it was proposed that grade 2 astrocytic gliomas without IDH-mutations and grade 3 astrocytic gliomas with TERT promoter mutations should be designated as diffuse IDH wildtype astrocytic glioma with molecular features of WHO grade IV glioblastoma. Therefore, we investigated whether this group of tumors actually corresponds to grade IV prognostically in cases that we encountered ourselves. Cases and Methods: Among the 65 patients having primary astrocytic glioma who were operated in our hospital from January 2016 to March 2021, the prognostic values of seven patients with lower-grade glioma, IDH wildtype, and pTERT mutant were investigated. Results: Among the seven patients, the median age was 59 years (50–66 years). Four of them had anaplastic astrocytoma, two had diffuse astrocytoma, and no tumor lesion could be identified upon histological examination for one patient. The male-to-female ratio was 1:6. MGMT methylation was observed in two patients (29%). The median survival was 20 months, with a significantly worse prognosis when compared with lower-grade glioma without the TERT promoter mutation (13 patients: median survival 40 months), but a better prognosis when compared with glioblastoma (45 patients: median survival 13 months) (Log-rank p = 0.0051). Conclusion: Although EGFR amplification, combined whole chromosome 7 gain, and whole chromosome 10 loss were not examined, the prognostic value of lower-grade glioma, IDH wildtype, and pTERT mutant was not as poor as that of glioblastoma. Further investigation is required to confirm whether these groups of tumors should be treated in the same way as grade IV glioblastoma.

Inhibition of Gli2 suppresses tumorigenicity in glioblastoma stem cells derived from a de novo murine brain cancer model

The prognosis of glioblastoma remains poor despite intensive research efforts. Glioblastoma stem cells (GSCs) contribute to tumorigenesis, invasive capacity, and therapy resistance. Leucine-rich repeat-containing G-protein coupled receptor 5 (Lgr5), a stem cell marker, is involved in the maintenance of GSCs, although the properties of Lgr5-positive GSCs remain unclear. Here, the Sleeping-Beauty transposon-induced glioblastoma model was used in Lgr5-GFP knock-in mice identify GFP-positive cells in neurosphere cultures from mouse glioblastoma tissues. Global gene expression analysis showed that Gli2 was highly expressed in GFP-positive GSCs. Gli2 knockdown using lentiviral-mediated shRNA downregulated Hedgehog-related and Wnt signaling pathway-related genes, including Lgr5; suppressed tumor cell proliferation and invasion capacity; and induced apoptosis. Pharmacological Gli inhibition with GANT61 suppressed tumor cell proliferation. Silencing Gli2 suppressed the tumorigenicity of GSCs in an orthotopic transplantation model in vivo. These findings suggest that Gli2 affects the Hedgehog and Wnt pathways and plays an important role in GSC maintenance, suggesting Gli2 as a therapeutic target for glioblastoma treatment.

DIPG-04. THERAPEUTIC STRATEGY FOR DIFFUSE MIDLINE GLIOMAS. A SINGLE CENTER EXPERIENCE

INTRODUCTION

Diffuse midline gliomas have unfavorable prognoses due to the difficulty of surgery and chemo-radiation resistances. The purpose of this study is to overview our surgical experiences and prognoses of this challenging neoplasm.

MATERIALS AND METHODS

Five patients of diffuse midline gliomas who were treated between 2016 and 2019 were enrolled. Tumor locations, surgical procedures, molecular diagnoses, and prognoses were retrospectively reviewed.

RESULTS

There were 3 male and 2 female patients, and the median age was 15 years ranged from 7 to 21 years. Tumors were located at the basal ganglia in 1 patient, thalamus in 1, brain stem in 2, and cervical spine in 1. Mutations of H3 K27M genes were detected in 4 surgically treated patients, except for 1 patient, who were radiologically diagnosed as diffuse intrinsic pontine glioma (DIPG). Focal irradiation of ranged 35 to 54Gy were administered in all cases along with temozolomide in 2 cases and bevacizumab in 2 cases. The median survival time was 13 months ranged from 4 to 18 months.

DISCUSSION

Supratentorial tumors were maximumly resected, whereas just biopsies were performed in cases of exophytic brain stem and spinal tumors. Diagnosis of DIPG was made without using surgical specimens. Therapeutic strategies should be discussed with a concern to the patients’ qualities of life for this tumor entity with dismal prognosis.

Periprocedural Outcomes of Carotid Artery Stenting in Elderly Patients

BACKGROUND

Carotid artery stenting has emerged as an alternative to carotid endarterectomy especially in patients with high risk of carotid endarterectomy. Older age (≥80 years old) was recognized as one of the high risk factors of carotid endarterectomy. However, the association between older age and increased risk of adverse events for carotid artery stenting has been reported. The purpose of this study was to evaluate the association between age and periprocedural outcomes after carotid artery stenting.

METHODS

A total of 126 symptomatic and asymptomatic cases of carotid artery stenosis were treated with tailored carotid artery stenting. The type of stents and embolic protection devices were chosen according to clinical and morphologic characteristics of the patients. Procedural, imaging, and clinical outcomes were retrospectively assessed and compared between the elderly patients group (≥80 years old) and the non-elderly patients group (<80 years old).

RESULTS

Clinical and morphologic characteristics except for dyslipidemia were not significantly different between the 2 groups. Periprocedural neurologic complications were not significantly different between the 2 groups (P = .095). Minor stroke occurred more frequently in the elderly patients group (P = .021). However, the frequency of major stroke was not significantly different between the 2 groups (P = 1). Presence of new ischemic lesions on postprocedural examination was not significantly different between the 2 groups (P = .84). Myocardial infarction and death did not occur in either group.

CONCLUSIONS

Carotid artery stenting can be performed safely in elderly patients, comparable with non-elderly patients.

Complications and Predictors of Hypotension Requiring Vasopressor after Carotid Artery Stenting

A significant controversy exists regarding the clinical impact of hemodynamic depression on major adverse events after carotid artery stenting (CAS). The purpose of this study was to evaluate the incidence, predictors, and clinical significance of hypotension after CAS. A total of 118 cases of carotid artery stenosis were treated with CAS. Hypotension was defined as sustained systolic blood pressure <80 mmHg and requiring intravenous administration of vasopressor to maintain adequate systolic blood pressure after the procedure. Baseline characteristics, procedural characteristics, and periprocedural major adverse events were retrospectively compared between postprocedural hypotension group and non-hypotension group. Morphological and procedural characteristics were not significantly different between the two groups. Periprocedural major adverse events, presence of new ischemic lesions, and number of new ischemic lesions were not significantly different between the two groups (P = 1, P = 0.36, P = 0.68). Hypertension was an independent protective factor (P = 0.037), and use of proximal protection and the distance from carotid bifurcation to maximum stenotic lesion ≤ 10 mm were independent risk factors for developing hypotension after CAS (P = 0.034, P = 0.027). There was no significant relationship between hypotension after CAS and major adverse events in this study. Maintenance of periprocedural adequate cerebral perfusion is thought to be important to prevent ischemic complications due to hypotension after CAS, especially in these cases.

Factors for Achieving Safe and Complete Treatment for Unruptured Saccular Aneurysm Smaller Than 10 mm by Simple Clipping or Simple Coil Embolization

OBJECTIVE

Reducing complications from unruptured aneurysms (UAs) treatment is important. We clarify the criteria for achieving safe and complete treatment for UAs ≤10 mm by clipping or coil embolization.

METHODS

This study included 59 newly treated UAs in the past 2 years. We prospectively decided on criteria to recommend active treatment. UAs ≤10 mm and in ≤75 year-olds, located at in the internal carotid artery at the paraclinoid portion and the posterior circulation aneurysms except for a vertebral artery-inferior posterior cerebellar artery aneurysm were mainly treated by coil embolization, and those in the internal carotid artery except at the paraclinoid portion, in the anterior or middle cerebral artery, and in the vertebral artery-inferior posterior cerebellar artery were treated preferably by clipping. UAs with a height/neck ratio or a dome/neck ratio ≤1.4 were treated preferentially by clipping. Specific preoperative imaging and careful manipulation were adopted for clipping.

RESULTS

Fifty-seven (96.6%) achieved modified Rankin scale (mRS) 0-1, 2 (3.4%) mRS 2-5, and 0 had mRS 6. Fifty-three UAs (89.8%) achieved complete occlusion (CO) and 7 (10.1%) had neck remnants (NR). Forty-one UAs (100%) within the criteria achieved mRS 0-1, 40 (98%) achieved CO, and 1 (2%) NR. The odds ratio of NR for those outside the criteria was 18.5 (95% confidence interval, 1.83-186.6) (P < 0.05). CO treated within the criteria was 39 and NR was 1. CO treated outside the criteria was 14 and NR was 5 (P < 0.05). The mRS 0-1 with age ≤75 years was 55 and the mRS 2-6 was 0. The mRS 0-1 with age ≥76 years was 2 and the mRS 2-6 was 2 (P < 0.01).

CONCLUSIONS

The treatment for UAs within the criteria, with the most recent points of concern, can lead to safe and complete results.

Progress in the treatment of unruptured aneurysms

Recent technological progress has reduced the complication rate of unruptured aneurysm. We treated 128 unruptured aneurysms between April 2006 and March 2012. Seventy-six aneurysms (59 %) were clipped and 52 (41 %) were coil embolized. After 2010, we applied new instruments, i.e., near-infrared indocyanine-green videoangiography (ICG), an intraoperative endoscope, preoperative detailed MRI, and a stent-assisted coil embolization. In the results: (1) In 60 aneurysms treated before 2009, three patients showed a deterioration of more than two points in mRS (5 %). In 68 aneurysms treated after 2010, no patients showed deterioration (0 %) (p: n.s.). (2) No patients died and 126 patients (98 %) were discharged to home directly. (3) No patients showed rupture after treatment. In conclusion, the appropriate selection of treatment and recent technological progress have facilitated sophisticated treatment of unruptured aneurysms. Recently, the complication rate in surgery and endovascular surgery for unruptured aneurysms has become acceptably low.

Extra-strong graduated compression stocking reduces usage of vasopressor agents during spinal anesthesia for cesarean section

Because a standard type of graduated compression stocking is not effective for the prevention of spinal anesthesia hypothension during cesarean section, we have used an extra-strong type of graduated compression stocking. This study examined whether the extra-strong stocking reduces usage of vasopressor agents. Forty-eight and 47 full term parturients were fitted with the standard stocking and the extra-strong stocking, respectively. Spinal anesthesia was performed by injecting 2.0 ml 0.3% dibucaine hyperbaric solution. When systolic blood pressure decreased to 90-100 mmHg or to less than 70% of the pre-anesthesia value, ephedrine was injected. There was no significant difference in systolic blood pressure or heart rate during spinal anesthesia between the groups. The mean dose of ephedrine injected during anesthesia was 12.2 and 4.3 mg, and the incidence of ephedrine injected was 85 and 49%, in the standard and extra-strong stocking groups, respectively. The extra-strong stocking group showed significantly lower values. Fitting the extra-strong stocking on both legs for cesarean sections undergoing spinal anesthesia reduced usage of vasopressor agents, suggesting a promising use of this stocking for non-invasive prophylaxis.

Increase of peak expiratory flow by atropine is dependent on circadian rhythm

PURPOSE

To examine whether the bronchodilatory effect of atropine differs in the evening from the morning.

METHODS

Thirteen adult healthy volunteers with no oral medication intake were studied. At 1600, peak expiratory flow (PEF) was measured three times, and the highest value recorded. Subsequently, the volunteer received 0.01 mg(-1) x kg(-1) atropine im, and the PEF was measured every 30 min for 180 min. On a different day, at 0400, the effect of atropine on the PEF was measured again in the same way.

RESULTS

The PEF values before atropine at 1600 and 0400 were 485 +/- 92 (350-730) and 458 +/- 76 (340-600) 1 min(-1),(P < 0.05). There was no difference in PEF values between the 1600 and 0400 time courses after atropine. The PEF value was increased only at 90 min at 1600 (P = 0.0012), but at 30, 60, 90 and 120 min at 0400 (P = 0.0001).

CONCLUSION

Atropine administration has a weak bronchodilatory effect in the evening, but a stronger effect in the morning. Airways are narrower in the morning than in the evening, and this change is inhibited by atropine such that the PEF values are restored to those observed in the evening.

[Clinical evaluation of fiberoptic bronchoscopy for the diagnosis of solitary pulmonary nodules 2 cm or less in diameter of chest roentgenogram]

The value of fiberoptic bronchoscopy in the diagnosis of solitary pulmonary nodules was studied. The subjects were 59 patients with chest-roentgenographic evidence of a solitary pulmonary nodule 2 cm or less in diameter. Definitive diagnoses were made in 34 patients (57.6%). Primary lung care was diagnosed 21 of 32 patients (65.6%), pulmonary tuberculosis in 7 of 12 (58.3%), metastatic lung cancer in 3 of 5 (60%), old lesions in 3 of 5 (60%), and pulmonary filariasis in 0 of 1 (0%). The diagnostic sensitivity of transbronchial biopsy was superior to that of curettage, and combining the two techniques further improved the diagnostic yield. Bronchial lavage was not effective for diagnosis of lung cancer, but was effective for diagnosis of pulmonary tuberculosis. Diagnostic yield was less for nodules in upper lobes than for those in other lobes, and most malignant tumors that were not diagnosed from the results of fiberoptic bronchoscopy were in upper lobes. We conclude that combining various fiberoptic bronchoscopic procedures can improve the diagnostic yield in patients with small pulmonary nodules. CT-guided needle biopsy and video-assisted thoracoscopic biopsy are two such procedures. Early diagnosis of small pulmonary nodules requires a skilled bronchoscopist who can choose the most appropriate method for biopsy.

A phase III randomized trial of cisplatin plus vindesine versus cisplatin plus vindesine plus mitomycin C versus cisplatin plus vindesine plus ifosfamide for advanced non-small-cell lung cancer

A randomized trial of chemotherapy in 105 patients with advanced and metastatic non-small-cell lung cancer (NCSLC) was conducted in order to compare the effect of the additional drug mitomycin C (PVM) or ifosfamide (PVI), to the combination of cisplatin plus vindesine (PV). An objective response rate was observed in 42.8% of the patients treated with PVM, 42.4% with PVI and 28.6% with PV and these response rates were not statistically significant (P > 0.20). No patient achieved the complete response with either of the three regimens. Comparison of the median response durations among the three regimens showed an advantage of PVI over PVM (P < 0.02) and PV (P < 0.05). The median survival times (MST) were similar for all three regimens (PVM, 33.5; PVI, 40.0 and PV, 36.5 weeks); moreover, the difference in survival time between the three regimens of responders was not statistically significant. The univariate analysis showed that significant predictors of survival were performance status (PS) zero (P = 0.0002), limited disease (P = 0.004), no previous weight loss (P = 0.01) and normal serum albumin (P = 0.016), and in multivariate analysis by a stepwise Cox proportional hazard model, these were PS zero (a hazard ratio of 2.3, P = 0.0001) and limited disease (a hazard ratio of 1.9, P = 0.048). Toxicity did not differ among the three treatment regimens.

[The variation of Japanese urinary excretion of iodine in different decades of age]

In order to evaluate whether or not iodine intake in Japanese is variable among different aged subjects and also whether this variation is concordant with the age distribution in patients with chronic thyroiditis, we tried to examine the urinary iodine excretion of euthyroid people in various decades of age. One hundred and twenty outpatients without thyroid disorders, aged 22 to 77 y.o., were selected at random and were divided into 6 groups according to age. Mean total urinary iodine excretion (UIT) and concentration (UIC) were 336.1 micrograms/day and 31.4 micrograms/dl/cr, respectively, and they were in good correlation (r = +0.82, p < 0.001). A straight line on log normal probability was recognized between the ratio of cumulative frequency and values of UIT. UIT and UIC were significantly correlated with serum nonhormonal iodine, respectively (r = +0.21, p < 0.01; r = +0.28, p < 0.01). These indicators in the 3rd decade were lower than those in the 6th decade (p < 0.01, p < 0.05). UIT increased with age up to the 6th decade and then decreased gradually to the 8th decade. Therefore, UIT in all the subjects formed a bell-shaped distribution with a significant peak in the 6th decade (H = 12.1, p < 0.05). Rates of renal iodine clearance (UIC/SNI) in the 6th decade increased significantly more than those in the 4th decade (p < 0.01), and the distribution of those rates in the 6 groups were similar to that of UIT.(ABSTRACT TRUNCATED AT 250 WORDS)

[The prevalence of antithyroid antibodies and long term follow-up in patients with lipiodol iodine-induced goiter]

We have carried out a follow-up study on iodine-induced goiter to clarify whether or not iodine could be a factor in the progression as well as the promotion of thyroid autoimmunity. We selected 143 women of child-bearing age without any previous thyroid disorders who had received hysterosalpingography (H.S.G.). 45 Sex and age-matched healthy subjects were chosen as controls. Serum nonhormonal iodine (S.N.I.) levels, frequency of goiter and antimicrosomal antibody (MCHA) in all the Lipiodol-cases were significantly higher than those in the controls (p < 0.001, < 0.01 and < 0.01), respectively. When the subjects were divided into 9 groups according to the duration of each 5 months after H.S.G., serum TSH and S.N.I. levels, incidence of goiter and MCHA in the initial group were significantly higher than those in the other groups (p < 0.05). The S.N.I. levels became normalized in 30 months after H.S.G. and the goiters disappeared in almost the same duration, while the incidence of higher MCHA titers declined gradually but significantly around 40 months after H.S.G. compared with that in the first 5 months after H.S.G. (p < 0.05). The frequency of goiter and MCHA in 44 cases after a 6-39 month follow-up decreased significantly compared to that in the initial group (p < 0.05). Therefore, we tried an individual longitudinal follow-up study on MCHA titer in 12 cases for 35-103 months, resulting in a significant reduction or negativeness of the titer in 6 cases. Likewise, MCHA titers in all cases decreased significantly (p < 0.05) on later evaluation. The present data suggest that iodine in Lipiodol administered via the vagina will act not only as the promoting factor, but as an aggravating agent for thyroid autoimmunity.

[A case of giant bulla which ruptured and disappeared on chest roentgenogram]

We experienced a case of progressive giant bulla which ruptured and disappeared on chest roentgenogram. The patient was a 60-year-old male who had been treated with home oxygen therapy for chronic pulmonary emphysema. One year after initiating home oxygen, emphysematous bulla occurred and expanded to become giant bulla which occupied 3/4 of the right hemithorax. Although we attempted to persuade him to undergo surgery for bullectomy, he refused. While being followed as an outpatient, sudden right anterior chest pain occurred, and dyspnea was markedly alleviated at the same time. Chest roentgenogram revealed right pneumothorax and pleural effusion, and the giant bulla subsequently receded. The patient has been stable for the approximately one year period since, without evidence of recurrence. It is rare for giant bullae to cause a pneumothorax. In addition, there are no previous reports in the literature with a clinical course such as that experienced by our patient.

[A case of piperacillin-induced pneumonitis]

A 43-year-old woman was treated with piperacillin (PIPC) for spiking fever. Although she was afebrile, fever recurred on the 18th day of PIPC administration with progressive dyspnea and diffuse ground glass shadows on the chest X-ray. Bronchoalveolar lavage fluid (BALF) showed marked increase of total cell number and percentage of lymphocytes and a reduction of the ratio of CD4/CD8. Transbronchial lung biopsy (TBLB) specimen revealed interstitial infiltration of lymphocytes and histiocytes with granulomatous lesions. The drug lymphocyte stimulation test (DLST) was positive for PIPC. Based on these findings, the diagnosis of PIPC-induced pneumonitis was made. Recently, the incidence of drug-induced pneumonitis has increased, but to our knowledge this is a rare case report of PIPC-induced pneumonitis.

[A case of chronic thyroiditis with transient painful thyroiditis occurring after the administration of lipiodol]

We reported a female case of painful thyroiditis occurring after hysterosalpingography and investigated whether the destructive thyroiditis was iodine-induced. The patient, aged 28, had TBG deficiency and the previous episode of thyrotoxicosis caused by Graves' disease. Lipiodol (containing 4.8g of iodide in 10ml solution) was administered via vagina for hysterosalpingography. One month after the radiography, serum inorganic iodide and Tg were elevated abnormally, but she was asymptomatic. After the subsequent 3 months she developed a painful and 3rd grade-sized goiter with concomitant marked elevation of thyroid hormones and inorganic iodide and also high titer of MCHA (320(2)X). A dramatic response was obtained with steroid. Thereafter she was treated with acupuncture on the thyroid gland, resulting in a sudden reappearance of tender goiter. This traumatic thyroiditis disappeared successfully in 2 weeks with steroid treatment. The painful thyroiditis subsided in 5 months throughout the course and she remained euthyroid for the ensuing 2 years. Aspiration biopsy was performed twice and revealed lymphocytic thyroiditis. Values of serum Tg varied in good correlation with those of serum inorganic iodide or rT3 throughout the course, respectively (P < 0.01, P < 0.05). Significant correlations between FT4 and FT3, and also T4 and T3 were observed, respectively (P < 0.01, P < 0.05). Serum inorganic iodide was elevated to 316 micrograms/dl at the symptomatic stage of the thyroiditis and decreased to 170 micrograms/dl at the resolving phase 2 months after the inflammation. Iodide disappearance curve showed a diphasic slope. The BHL was calculated as 60.3 days during the symptomatic stage and 6.9 months in euthyroid state.(ABSTRACT TRUNCATED AT 250 WORDS)

[Influence of the anti-T4 autoantibody cross-reacting with T3 on serum T3 level determined by RIA]

We encountered a patient who showed remarkably high binding capacities of both 125I-T4 and 125I-T3, which suggests the presence of antithyroid hormone autoantibody. However, the serum level of T3 in the patient was not abnormal. Study of the specificity of anti-thyroid autoantibody revealed that the antibody present in the patient was the anti T4 antibody, which cross-reacted with T3. In addition, the binding capacity of the T4 autoantibody with T3 was inhibited by T4. Endogenous T4 is always present when T3 is determined by radioimmunoassay. Our findings indicate that the normal T3 level in the patient was because endogenous T4 inhibited the autoantibody binding with T3.

[Precision measurements of the Doppler broadening of positron annihilation radiations using a simultaneous and comparative detection technique]

The precision measurement system of the Doppler broadening profiles of positron annihilation radiations using a simultaneous and comparative detection technique has been developed and was applied to the study of grown-in defects in indium phosphide (InP). Annihilation energy spectra in the specimen to be examined and in a standard one were simultaneously measured by a single pure Ge detector. Each specimen incorporated a 22Na positron source in a sandwiched form between two identical samples. The colinear directional correlation of two photon annihilation allows us to route the output of ADC (analogue to digital converter) to different memory sections. For the purpose of discrimination which source emitted the analysed gamma ray, two auxiliary NaI(Tl) detectors were used. Such a simultaneous and comparative measurement was found to be free of drift in electronics during the course of experiments over 10 weeks. Furthermore, the coincidence measurement reduced the background due to 1.28 MeV prompt gamma rays. This technique was applied to the detection of a positional distribution of grown-in defects in an InP wafer, which was slivered along a plane involving growth axis from the single crystal ingot grown by a liquid encapsulated Czochralski technique. The narrowing of Doppler broadening profiles was observed at the center and at the periphery of the wafer. This result well resembles the positional distribution of dislocations observed by the etch pit counting.

[In vitro sensitivity test of anti-neoplastic agents and their enhancement by biscoclaurine alkaloid]

We tried an in vitro sensitivity test for the purpose of examining the effect of anti-neoplastic agents and their enhancement by Biscolaurine Alkaloid (Cepharanthin). Methods, HeLa cells were synchronized by excess of thymidine and hydroxyurea, and resuspended in Eagle's MEM with 10% FCS. The cells were mixed with Mitomycin C or Bleomycin and added to the wells of a microtiter plate. When required, Cepharanthin (the effect of this drug is considered to change the plasma membrane liquidity) was added to the medium, and then cultured for 24 hours in a CO2 incubator. After culture, each well received 3H-thymidine, and was incubated for 8 hours. The cells were harvested for the assay of 3H-thymidine.

RESULTS

MMC or BLM suppressed the uptake of 3H-thymidine in relation to its concentration. MMC or BLM with various concentrations of Cepharanthin showed strong suppression compared with the same concentrations of MMC or BLM alone. From the above results, this experimental method is regarded as an useful model for selecting sensitive anti-neoplastic agents. In addition, Cepharanthin showed enhancing effects on anti-neoplastic agents.