The feline fictive startle response and its related potential in the pedunculopontine nucleus

The human P1/P50 midlatency auditory evoked potential and the auditory startle response (SR) have been used for investigating sensory gating and sensorimotor modulation which is impaired in various psychiatric diseases. In the present study, we demonstrated that auditory stimulation was capable of eliciting excitation of flexor and extensor neurograms from the hindlimb nerves in the paralyzed decerebrate cat, a phenomenon which corresponds to a "fictive" startle response (FSR). Previous studies have shown that the SR consists of distinct excitatory components, "early" and "late", separated by an inhibitory phase. However, in the FSR, unlike the SR in the intact preparation, the "late" excitatory phase never occurred. Recordings from the pedunculopontine nucleus (PPN) simultaneously with the FSR revealed the presence of an auditory evoked potential at a 20-25 ms latency, presumably the depth-recorded equivalent of the vertex-recorded wave A, which has been shown to be the feline equivalent of the human P1 potential. The depth-recorded wave A appeared to share neurological substrates with the excitatory phase of the FSR, since both responses were facilitated in a similar manner by increasing stimulus duration. We previously reported that, in the intact rat, the vertex-recorded P13 potential, the putative rodent equivalent of the human P1 potential, is generated, at least in part, by outputs of the PPN, and that the P13 potential shares neurological substrates with the "early" excitatory phase of the SR. Taken together, the results of the present study indicate that, along with the SR and the P13 potential in the intact rat, the FSR and the depth-recorded wave A in the paralyzed cat may be unique animal models for further examining, in the absence of neural structures rostral to the precollicular decerebration, the cellular basis of startle behavior.

Serum KL-6 levels in patients with pulmonary complications after allogeneic bone marrow transplantation

KL-6, a mucinous high-molecular weight glycoprotein expressed on type 2 pneumocytes, has been shown to be elevated in the serum and bronchoalveolar lavage fluid of patients with interstitial pneumonitis (IP). We measured the serum levels of KL-6 in patients after they had undergone allogeneic bone marrow transplantation (BMT) to determine whether KL-6 could be a clinically useful indicator for the development of IP. The serum concentrations of KL-6 were determined by a sandwich-type enzyme-linked immunosorbent assay using an anti-KL-6 monoclonal antibody. A total of 1028 samples were tested from 76 patients (78 transplantations) who received BMTs. The KL-6 values were markedly elevated in patients with pulmonary complications, but not in those with acute and chronic graft-versus-host disease, hemorrhagic cystitis, herpes encephalitis, sepsis, and veno-occlusive disease. The serum levels of KL-6 from patients with pulmonary complications were significantly higher than from those without pulmonary complications (P < .001) and those with other complications (P < .001). Of the 12 patients with pulmonary complications, 6 had idiopathic IP (IIP). The levels were not high at the onset of IIP. Four of 6 IIP patients showed marked elevations of KL-6 levels in parallel with the severity of IP and died of respiratory failure without response to treatment. Assessment of serum KL-6 levels might not be useful for the early diagnosis of IP, but may be a useful indicator for monitoring the severity of IP after BMT.

Pedunculopontine stimulation induces prolonged activation of pontine reticular neurons

Extracellular and intracellular recordings were carried out from neurons in the region of the pontine reticular formation at the transition between the nucleus reticularis pontis oralis and caudalis, and in the pontis caudalis. Responses were studied after stimulation of the mesopontine cholinergic pedunculopontine nucleus in precollicular-postmammillary transected, paralyzed preparations. Recordings of neurographic activity in hindlimb flexor and extensor nerves served to detect changes in fictive locomotion and muscle tone induced by pedunculopontine nucleus stimulation or occurring spontaneously. Short duration trains of pedunculopontine nucleus stimulation induced long lasting responses, on average over 12s in duration, in one-third of pontine reticular neurons. These prolonged responses were stimulation frequency-dependent such that the longest durations were induced by stimulation at 20-60Hz. In some cells, stimulation at lower (10Hz) or higher (100Hz) frequencies induced responses of shorter duration or were absent, while in others, higher frequencies prolonged the excitatory effects of pedunculopontine nucleus stimulation. We conclude that these stimulation frequency-dependent effects may be related to the modulation of postural muscle tone and locomotion by the pedunculopontine nucleus.

Fundic adenomyomatosis bulged with the subserosal excessive fat of the gallbladder mimicking polypoid carcinoma: a case report with unusual imaging and morphological features

This report describes a 41-year-old female who presented with adenomyomatosis of the gallbladder mimicking polypoid carcinoma, on the diagnostic imaging findings and revealing unusual histologic features for such a localized adenomyomatosis. The mass was located on the gallbladder liver-side wall at the fundus and papillary hyperechoic growth showed no clear ultrasonographic features of adenomyomatosis. The patient underwent a laparoscopic cholecystectomy with a tentative diagnosis of superficial polypoid carcinoma. Histologically, the tumor bulged due to subserosal excessive fat tissue.

Successful resection for advanced hepatoblastoma, combined with perioperative chemotherapy

The aim of this study was to evaluate our results of surgical treatment with intensive perioperative chemotherapy for hepatoblastoma in infants and children. Seven patients (mean age, 30 months; range 1 month to 6 years) with hepatoblastoma who were followed-up for more than 3 years were reviewed. All patients underwent hepatectomy, performed using a microwave tissue coagulator, after they had received neoadjuvant chemotherapy comprising up to four cycles of cisplatinum and doxorubicin. The main outcome criteria were the clinical response rates to neoadjuvant chemotherapy and the overall survival. Neoadjuvant chemotherapy markedly reduced the tumor volume on computed tomography (mean regression rate, 73%). Alpha-fetoprotein (AFP) levels also decreased, from a mean value of 138 x 104 to 990 ng/ml (excluding values for one patient with tumor thrombus in the portal vein). The surgical procedures included extended right lobectomy in one patient, extended left lobectomy in two patients, hepatic left trisegmentectomy in one patient, and hepatic subsegmentectomy in three patients. The postoperative clinical courses in all seven patients were good, and no serious complications were observed. No relationship was observed between the DNA ploidy pattern and the histopathological findings of the resected specimens regarding survival. Six patients (excluding the patient with a tumor thrombus in the portal vein) who underwent complete resections survived without any signs of recurrence during a follow-up period ranging from 47 to 150 months. In conclusion, the perioperative chemotherapy greatly improved both the resection rate and overall survival in patients with hepatoblastoma. DNA ploidy pattern analysis may be useful when predicting the prognosis of patients with hepatoblastoma. The use of the microwave coagulator was safe for performing hepatectomy, even in infants.

Expression of p53, bcl-2, and bax as predictors of response to radiotherapy in esophageal cancer

The sensitivity of cancers to radiotherapy or chemotherapy may be influenced by susceptibility to apoptosis. We evaluated whether expression of three proteins regulating apoptosis, p53, bcl-2, and bax, could predict the effect of radiotherapy in esophageal cancers. We used immunohistochemical staining for these protein regulators of apoptosis to study biopsy specimens obtained from 25 patients with esophageal squamous cell carcinoma before they underwent preoperative radiotherapy. Effectiveness of radiotherapy was assessed by barium esophagography, esophagoscopy, and computed tomography. Radiotherapy was effective in 12 patients and ineffective in 13 patients. Biopsy specimens from the 25 patients showed expression of p53, bcl-2, and bax to be 48.0%, 32.0%, and 76.0% respectively. Effectiveness of radiotherapy was correlated with p53 expression (p = 0.047), but bcl-2 and bax expression showed no relationship to effectiveness of radiotherapy. Expression of p53 protein in biopsy specimens may predict effectiveness of preoperative radiotherapy in esophageal cancers.

Granular cell tumor of the rectum: a case report and review of the literature

A 47-year-old Japanese woman with a 5-year history of alcoholism was admitted to the Ryukyu University Hospital for the treatment of the alcoholism. For evaluation of observed changes in her bowel habits, she underwent colonoscopy, which revealed seven small polyps spread throughout the entire large intestine. Six of the polyps were in the colon; one was an adenoma and five were hyperplastic polyps. The remaining polyp, in the rectum, was an 8-mm submucosal tumor. Pathological analysis of a biopsy of the lesion in the rectum indicated a possible diagnosis of adenocarcinoma. Endoscopic ultrasonography (EUS) demonstrated a submucosal hypoechoic nodule, involving the mucosa and the muscularis propria. Subsequently, the patient underwent a radical low anterior resection of rectum. The lesion was a submucosal tumor with ulceration. The tumor consisted of granular tumor cells which were positive for S-100 protein, neuron-specific enolase, and periodic acid schiff (PAS) stain, but negative for desmin and vimentin. Granular cell tumor is rare in the gastrointestinal tract. As a result, such tumors can be misinterpreted to indicate a possible malignancy on either a biopsy or EUS.

A case of adult-onset Still's disease complicated by non-Hodgkin's lymphoma

Left cervical lymphadenopathy developed in a 50-year-old male who had a history of adult-onset Still's disease for the preceding 18 months. Still's disease is characterized by rash, fever, and leukocytosis. Lymphadenopathy has been reported in about 60% of the patients, and most histopathologic studies have shown non-specific reactive hyperplasia. However, in this case, an open biopsy of the cervical node revealed a histology of diffuse large B-cell lymphoma. The B-cell malignant lymphoma that developed may have resulted from a sequential progression of a previous stage of benign lymphoproliferative lesion. Our case suggests that the pathophysiology of adult-onset Still's disease involves the stimulation of lymphoid systems to the point of progression towards lymphoma. Malignant lymphoma should be added to the list of life-threatening complications which, although rare, are associated with this disease.

Combined endoscopic and surgical treatment for multiple polyps of the small intestine in Peutz-Jeghers syndrome: a case report

Combined endoscopic and surgical treatment in a 14-year-old girl with Peutz-Jeghers syndrome is reported herein. The patient was diagnosed with Peutz-Jeghers syndrome because of mucocutaneous pigmentation and hamartomas of the small intestine at 10 years of age, when she underwent an emergency laparotomy for an intussusception of the small intestine. Since this diagnosis, she has undergone follow-up, and barium radiologic and endoscopic studies have shown multiple polyps of various sizes from the stomach throughout the small intestine and to the colon. This time, with the use of combined endoscopic and surgical treatment for polyps of the small intestine, 26 polyps were removed endoscopically by performing only one enterotomy. This combined technique may allow for a longer interval between laparotomies, therefore reducing the complications associated with multiple laparotomies and resections.

Cholinergic modulation of the sleep state-dependent P13 midlatency auditory evoked potential in the rat

Injections into the pedunculopontine nucleus (PPN) of the cholinergic receptor agonist, carbachol (CAR), were found to reduce the amplitude of the vertex-recorded, sleep state-dependent P13 midlatency evoked potential in a dose- and time-dependent manner. This effect was blocked or reduced by pretreatment with the muscarinic receptor antagonist, scopolamine, injected into the PPN.

Locus coeruleus involvement in the effects of immobilization stress on the p13 midlatency auditory evoked potential in the rat

1. Adult male rats were prepared for recording midlatency auditory evoked responses from the vertex (Vx, P13 potential) and auditory cortex (ACx, P7 potential). 2. The P13 potential is the rodent equivalent of the human P1 or P50 potential, which exhibits decreased sensory gating in posttraumatic stress disorder. 3. Immobilization (IMB) stress for 60 min led to a significant decrease in P13 potential amplitude and sensory gating of the potential for the first 30-40 min of IMB. 4. The effects of IMB on the P13 potential were reduced by pre-treatment with the alpha-2 adrenergic receptor blocker yohimbine (YOH). 5. Injections of corticotropin releasing factor (CRF) into the locus coeruleus (LC), but not injections dorsal or ventral to the LC, induced a dose-dependent decrease in P13 potential amplitude and sensory gating. 6. The effects of CRF were blocked by cotreatment with the CRF receptor antagonist alpha-helical CRF (alpha-h CRF). 7. The effects of IMB on the P13 potential were mimicked by injections of the alpha-2 adrenergic receptor agonist dexmedetomidine (DEX) into the pedunculopontine nucleus (PPN). 8. The effects of DEX injections into PPN were reduced by pre-treatment with the alpha-2 adrenergic receptor blocker YOH. 9. The effects of IMB on P13 potential amplitude and sensory gating may be mediated in part via CRF activation of LC, which sends inhibitory alpha-2 adrenergic projections to PPN, a major source of the P13 potential.

Radiation-associated rectal cancer: report of four cases

BACKGROUND/AIMS

Radiation-associated rectal cancer is a remarkable clinical entity. We demonstrate 4 patients (mean age 68 years, range 63-74) who had undergone pelvic radiotherapy for cervical cancer. We indicate some characteristics of radiation-associated rectal cancer.

RESULTS

Two patients had received intracavitary and external pelvic radiotherapy, while the remaining 2 had external pelvic radiotherapy following hysterectomy. The mean total radiation dose was 63 Gy, though radiation dose information was not available for 1 patient. Colorectal cancer developed at a mean time of 20.7 years (range 11-30) after radiation therapy. All patients presented with chronic radiation colitis, and 3 demonstrated abnormal tumor markers. Colonoscopy revealed an ulcerative, localized well-differentiated adenocarcinoma of the rectosigmoid colon in 1 patient, and diffusely infiltrating cancers of the lower rectum, one signet-ring cell carcinoma and two mucinous carcinomas in the remaining 3. One case was stage I, 2 were stage IIIa, and the remaining case was stage IV. Three patients underwent abdominoperineal resection. The remaining patient was felt to be inoperable. The colorectal wall demonstrated the changes of chronic radiation injury. Two patients died within a short time because of their advanced cancers.

CONCLUSION

Radiation-associated rectal cancer has a tendency to be diagnosed in the advanced stage and to have a poor prognosis. A literature review and our case report suggest that since there are no reliable clinical or laboratory indicators of the presence of a curable colorectal cancer in the setting of chronic radiation proctocolitis, surveillance with a colonoscope should be done 10 years after irradiation in patients with previous pelvic radiotherapy.

Serotonergic modulation of the P13 midlatency auditory evoked potential in the rat

The vertex-recorded, sleep state-dependent P13 midlatency auditory evoked potential in the rat may be generated, in part, by pedunculopontine nucleus (PPN) projections. Injections into the PPN of the 5-HT(1A) serotonin receptor agonist, 8-hydroxy-2-di-n-propylaminotetralin hydrobromide (DPAT), were found to reduce the amplitude of the P13 potential in a dose- and time-dependent manner. The suppressive effect of DPAT was blocked or reduced by pretreatment with the 5-HT(1A) serotonin receptor antagonist, Pindobind. These results show that the P13 potential can be modulated by known inhibitory serotonergic inputs to the PPN.

An extraosseous aneurysmal cyst in the pelvic cavity: report of a case

A 51-year-old Japanese female was referred to us with a left lower quadrant pain and palpable mass. The CT and MRI study showed a 10x8x8 cm of well-circumscribed, multicystic mass adjacent to the left iliac bone. The mass was excised and consisted of multiple cysts containing bloody viscous material surrounded by thin-ring of eggshell-like tissue. The histological findings correlated with those of an aneurysmal bone cyst. This extraosseous case might be the first reported case observed in the pelvic cavity.

Course and outcome of tubulointerstitial nephritis and uveitis syndrome

We report here the clinical features and outcomes of 10 patients, aged 11 to 21 years (median, 13.0), with idiopathic tubulointerstitial nephritis (TIN) and uveitis syndrome (TINU syndrome). The initial symptoms were visual impairment in 7 patients and prolonged fever, anemia, or asthenia in 4 patients. An increase in urinary beta(2)-microglobulin was noticed at the initial checkup in all patients, including 2 patients who showed the normal ranges of 24-hour protein excretion. Creatinine clearance was decreased in 8 patients. TIN was found simultaneously with ocular symptoms in 7 patients and preceded these symptoms in the remaining 3 patients. Percutaneous renal biopsy indicated tubulointerstitial lesions in varying degrees. The histological grade of TIN was correlated with urinary beta(2)-microglobulin levels. Systemic steroid therapy was performed in 7 patients because of the progression of uveitis. The 10 patients were followed-up for 16 to 94 months (median, 31.0 months). In all patients, creatinine clearance recovered to the normal ranges (>/=70 mL/min/1.73 m(2)) mostly within 1 year. Urinary beta(2)-microglobulin excretion gradually declined but was slightly elevated in 4 patients at the latest checkup. Uveitis recurred in all 10 patients, which did not affect the renal status. Our findings indicate that early referral of patients from ophthalmologists and determination of beta(2)-microglobulin in the urine is helpful for the early discovery of TINU syndrome. In children and adolescents with this syndrome, TIN spontaneously resolves and its long-term prognosis is good, but uveitis often relapses. Systemic steroids may be required for uveitis, but not for TIN.

Analyses of microsatellite instability and the transforming growth factor-beta receptor type II gene mutation in sporadic human gastrointestinal cancer

Microsatellite instability (MSI) and transforming growth factor-beta receptor type II (RII) gene mutation have been reported in many types of tumors and their instance seem to vary among the tumors investigated. To determine the relation between MSI and RII gene mutation in sporadic gastrointestinal cancer development, 21 esophageal, 19 gastric, and 27 colorectal cancers were investigated. The presence of MSI was screened by single strand conformation polymorphism (SSCP) method using six microsatellite markers. RII gene mutations were detected by SSCP method and direct sequencing. MSI was detected in seven of 21 (33.3%) esophageal cancers, three of 19 (15.8%) gastric cancers and seven of 27 (25.9%) colorectal cancers. However, RII gene mutations were observed in only two of seven (28.6%) MSI-positive colorectal cancers. Our data suggest that among sporadic gastrointestinal cancers, colorectal cancers seem to be the most frequent target organ involved in carcinogenesis through RII gene mutation, which thus appears to be related to organ specificity.

Familial skeletal myopathy with atrioventricular block

OBJECTIVE

We studied familial cases of skeletal myopathy with atrial fibrillation (Af) and atrioventricular (AV) block to compare the clinical features to other myopathies associated with cardiac abnormalities.

METHODS

Neurologic, cardiologic, electrophysiologic, muscle pathology, and genetic studies were performed on the patients showing muscle weakness.

PATIENTS

Four patients (a 63-year-old mother, 30 and 32-year-old sisters, and their maternal grandmother) and three healthy family members from three generations were studied. The mode of inheritance was suspected as autosomal dominant.

RESULTS

Two sisters with congenital myopathy without rigid spine developed Af and AV block at the age of 28 and 18, respectively. The mother showed AV block, and underwent pacemaker implantation at the age of 63. The maternal grandmother had dilated cardiomyopathy, Af and severe lordosis. She died of stroke attacks and congestive heart failure at the age of 78. Muscle biopsy obtained from the mother and sisters showed myopathic changes without characteristic abnormalities. No mitochondrial DNA mutations were found. Other inherited myopathies with cardiac complications were not suspected in this family.

CONCLUSION

This Japanese family appears to belong to a new genetically heterogeneous group of autosomal dominant skeletal myopathy with severe AV block and Af.

Results of retrograde transhepatic biliary drainage after a common bile duct exploration for choledocholithiasis

BACKGROUND/AIMS

The purpose of this study is to assess the benefits of retrograde transhepatic biliary drainage (RTBD) and a primary closure after a common bile duct (CBD) exploration for patients with choledocholithiasis.

METHODOLOGY

We analyzed 143 patients with choledocholithiasis who had been managed by RTBD after undergoing a CBD exploration retrospectively over a 12-year period. The main outcome criteria were frequency of occurrence of post-operative complications which needed a relaparotomy and the clinical long-term results. In addition, the radiographic diameter changes of the CBD at the site of the primary closure and liver function tests after RTBD were also evaluated.

RESULTS

The frequency of bile peritonitis in the patients undergoing the RTBD procedure was only 0.7% (1 out of 143 cases). Cholangiography via the RTBD tube revealed no severe stenosis at the site of primary closure. Liver function returned to normal on day 3 after RTBD (p<0.05). Recurrence of common bile duct stones developed in 2 patients in this series during the follow-up (1-12 years).

CONCLUSIONS

RTBD and a primary closure of the CBD after CBD exploration appears to be a clinically safe and effective method for such patients with choledocholithiasis who had undergone a complete stone removal intra-operatively.

Microsatellite instability in double cancers of the esophagus and head and neck

It is generally accepted that patients with squamous cancers of the esophagus are known to have a high risk of concomitant head and neck cancer. However, there have been only a few reports describing microsatellite instability (MSI) in patients with both esophageal squamous cell carcinoma and head and neck cancers. To evaluate the role of genetic instability in carcinogenesis in such patients, we analyzed six microsatellite loci in 21 tumors from 10 patients who had developed primary cancers of both the esophagus and the head and neck. MSI was detected in 6 out of 10 patients. In five patients with double cancer, MSI was observed at the same microsatellite loci in both the esophageal and the head and neck tumors obtained from the same individuals. These data suggest that such patients may have the same underlying defect in the mismatch repair system, providing insight into possible mechanisms for field carcinogenesis.

Neurochemical modulation of the P13 midlatency auditory evoked potential in the rat

Previous studies have shown that the vertex-recorded P13 auditory evoked potential in the rat appears to be the rodent equivalent of the human P1 (or P50) potential. This sleep state-dependent potential appears to be generated, at least in part, by cholinergic pedunculopontine nucleus projections. The present studies used localized microinjections of neuroactive compounds into the region of the pedunculopontine nucleus in order to modulate the vertex-recorded P13 potential. Both the GABAergic agonist, muscimol, and the noradrenergic alpha2 receptor agonist, clonidine, were found to reduce the amplitude of the P13 potential in a dose-dependent manner. The suppressive effect of clonidine on P13 potential amplitude was blocked by pretreatment with the noradrenergic alpha2 receptor antagonist, yohimbine. In addition, habituation of the P13 potential, measured using a paired stimulus paradigm, was increased by micro-injection of a dose of muscimol or clonidine which did not change the amplitude of the P13 potential induced by the first stimulus of a pair. In contrast, microinjection of yohimbine decreased habituation of the P13 potential. These results show that the vertex-recorded P13 potential and its habituation can be modulated by activation of known inhibitory synapses, both GABAergic and noradrenergic, at the level of the pedunculopontine nucleus. This provides further evidence that the P13 potential is generated, at least in part, by pedunculopontine nucleus outputs.

Vascular reconstruction of the hepatic artery using the gastroepiploic artery: a case report

A 59 year-old woman with obstructive jaundice secondary to proximal bile duct carcinoma underwent percutaneous transhepatic biliary drainage (PTDB). This revealed complete obstruction of the bifurcation of the hilar hepatic duct and encasement of the right hepatic artery. Wedged hilar hepatectomy with combined resection of the extrahepatic bile duct, gallbladder, and the encased right hepatic artery was performed. The hepatic artery was reconstructed using an in situ right gastroepiploic artery (GEA) pedicle graft. The anastomosis was protected with fatty tissue from the greater omentum. This technique can be used to reconstruct the hepatic artery after radical surgery for malignant hepatobiliary and pancreatic disease.

Percutaneous transhepatic cholangioscopic lithotripsy and change of biliary manometry patterns

BACKGROUND/AIMS

Percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) is used to remove bile duct stones. This work aims to evaluate the clinical usefulness of PTCSL and the reversibility of the terminal bile duct dysfunctions after PTCSL.

METHODOLOGY

Thirty patients who underwent PTCSL using mechanical and/or electrohydraulic lithotripsy over the past 10 years (20 patients with common bile duct stones and 10 with intrahepatic bile duct stones) were evaluated. Terminal bile ductal pressure was measured using the percutaneous transhepatic biliary drainage (PTBD) tube prior to and after lithotripsy by means of variable-load cholangiomanometry.

RESULTS

Complete stone extraction was possible in 26 patients (86.7%). The other 4 patients had intrahepatic stones. Complications included 2 cases of hemobilia, one of pneumonia, and 3 of localized peritonitis. Of 26 patients without residual stones, only 4 patients had a linear pressure flow (P-F) pattern which indicates normal biliary tract function prior to lithotripsy. In 17 of 22 patients with other type P-F patterns, however, these types also changed to a linear pattern after complete removal of stones. The P-F pattern of the other 5 patients remained unchanged.

CONCLUSIONS

PTCSL is a safe and efficient method treating biliary tract lesions while preserving the function of the sphincter of Oddi. The terminal biliary tract function normalized after stone removal. Thus, PTCSL was useful for patients with complicated bile duct stones not accessible to endoscopic retrograde management.

Extracorporeal bypass using a centrifugal pump during resection of malignant liver tumors

BACKGROUND/AIMS

Total hepatic vascular exclusion (THVE) during extracorporeal bypass is used for hepatic resection in patients with malignant liver tumors. The aim of this study was to determine the efficacy of hepatectomy during total hepatic vascular exclusion using a centrifugal pump (Bio-pump).

METHODOLOGY

Fourteen patients with malignant liver tumors who underwent hepatectomy during total hepatic vascular exclusion using the Bio-pump were studied retrospectively.

RESULTS

In 3 of 14 patients, insufficient hepatic vascular exclusion was achieved. Six patients underwent tumor resection during total hepatic vascular exclusion, without extracorporeal bypass. In the remaining 5 patients, flow exclusion averaging 1500 ml was achieved with the Bio-pump, and hepatectomy was performed during the procedure. In these 5 patients, the mean operative time and blood loss were 11 hours 38 minutes and 6850 +/- 2451 ml. The Bio-pump bypass time, the excluded blood flow and the mean blood pressure were 82 minutes, 1650 ml and 108/53 mmHg, respectively. The arterial ketone body ratio (AKBR) decreased from a pre-operative value of 1.85-0.32 during total hepatic vascular exclusion.

CONCLUSIONS

Total hepatic vascular exclusion was useful for hepatectomy in patients with tumor invasion into the hepatic vein and inferior vena cava, or tumor thrombus in the inferior vena cava and right atrium. However, this technique did not decrease blood loss or improve outcome in patients undergoing hepatectomy.

Mucosa-associated lymphoid tissue (MALT) of the gallbladder: a clinicopathological correlation

OBJECTIVE

Lymph follicles are frequently found on histological examination of a surgically removed gallbladder. The significance of these lymph follicles is not clearly understood. The aim of this study was to examine the clinicopathological correlation between the lymph follicles in the gallbladder morphologically and the mucosa-associated lymphoid tissue (MALT) in the gut.

METHODS

The gallbladders were fixed and cut serially. The tissue slices were processed in the routine manner for a histological examination. The histological criteria for MALT in this study was defined as the presence of lymph follicles with germinal centers in the lamina propria mucosae in approximately equal numbers in all portions of the gallbladders from the neck to the fundus. Biliary bile obtained at surgery was cultured for a bacteriological examination in the hospital laboratory. The types of gallstones were classified according to the Classification of Gallstones by the Japanese Society of Gastroenterology.

RESULTS

Of the 1341 patients, 158 (11.8%) patients fulfilled the histological criteria, including 64 men and 94 women with an average age of 64.2 years. Gallstones were present in 89.2% of the patients, and 74.5% of these were calcium bilirubinate gallstones. Cultures of the bile were positive in 95.4% of the patients. A variety of bacterial species were thus found, most commonly Escherichia coli and Klebsiella spp. Grossly, the gallbladders usually showed a granular appearance of the mucosa.

CONCLUSION

The MALT in the gallbladder is not a rare condition and is frequently encountered in clinical practice. This lymphoid tissue may represent a mucosal and morphological immune phenomenon for infection rather than a substrate for the development of low-grade B-cell lymphoma.

Sensory gating of the P13 midlatency auditory evoked potential and the startle response in the rat

The human P1/P50 midlatency auditory evoked potential and the startle response (SR) have been used as measures of sensory and sensorimotor gating, respectively. In the present study, both prepulse and paired stimulus paradigms were used in order to investigate the relationship between sensory gating mechanisms of the P13 potential, the putative rodent equivalent of the P1 potential, and those of the SR. In addition, these were compared to the properties of the N40 potential, another measure of sensory gating. Simultaneous recordings from the vertex (P13 potential and N40 potential) and neck musculature (SR) showed that (1) in a prepulse paradigm, increasing the intensity of the prepulse or decreasing the interstimulus interval resulted in increased inhibition of the P13 potential, N40 potential (to a lesser degree) and the SR (to a greater degree), (2) when using a low signal-to-noise ratio between the prepulse intensity and the background level, prepulse inhibition of the SR was reduced or absent while that of the P13 potential was present, (3) the amplitude of the 'prepulse evoked' P13 potential was significantly correlated with prepulse inhibition of the P13 potential, the N40 potential and the SR, (4) in a paired identical stimulus paradigm, decreasing the interstimulus interval resulted in increased habituation of the P13 potential, N40 potential (to a lesser degree) and the SR, and (5) increasing the intensity of the paired stimulation resulted in increased habituation of the P13 potential and the N40 potential (to a lesser degree), but not of the SR. These results demonstrate the presence of prepulse inhibition of the P13 potential, the N40 potential and the SR in a parallel manner, but show certain specific differences in their responses to parametric changes.

Midlatency auditory-evoked potentials in the rat: effects of interventions that modulate arousal

The vertex-recorded P13 midlatency auditory-evoked potential in the rat shows the same characteristics as the P1 potential in the human, namely, sleep-state dependence, rapid habituation and blockade by the cholinergic antagonist scopolamine. The P13 potential appears to be generated, at least in part, by projections of the pedunculopontine nucleus, the cholinergic arm of the reticular activating system. On the other hand, the auditory cortex-recorded P7 potential appears to be of primary cortical origin. Simultaneous recordings from the vertex and the auditory cortex showed that (1) the P13 potential was suppressed by administration of the anesthetics ketamine, pentobarbital or halothane in a dose-dependent manner, but the P7 potential was not; (2) the P13 potential was suppressed by intragastric injections of ethanol in a dose-dependent manner, but the P7 potential was not; (3) the amplitude of the P13 potential was negatively correlated with blood ethanol levels; (4) both the P13 and P7 potentials were still present following injections of the neuromuscular blocker pancuronium bromide; and (5) both the P13 and P7 potentials were decreased by diffuse brain injury induced by a weight-drop device in a weight-dependent manner. These findings suggest that the P13 potential is more sensitive than the P7 potential to changes in arousal and that the P13 and P7 potentials are not of myogenic but of neural origin.

Pedunculated exogastric leiomyosarcoma: case report and brief literature review

A case report and review of the literature on pedunculated exogastric leiomyosarcomas are presented. Although about one-fourth of the stromal tumors (common leiomyomas and leiomyosarcomas) of the stomach grow in an exogastric configuration, pedunculated exogastric leiomyosarcomas are extremely rare. At present there is no evidence of intraperitoneal seeding from exogastric leiomyosarcomas. Consequently, a local resection with an adequate margin is sufficient when no invasion to the adjacent structures, is observed.

Revision of ventriculo-peritoneal shunt under laparoscopic guidance in patients with hydrocephalus

Ventriculo-peritoneal (V-P) shunt is a common treatment for hydrocephalus. However, shunt insufficiency due to obstruction, dislocation, and detachment of the peritoneal tube is frequently encountered. We designed a new technique in which the peritoneal tube is inserted into a target site of the abdominal cavity under laparoscopic guidance. We operated on 9 patients with hydrocephalus using this technique. Shunt insufficiency of the peritoneal tube had been observed in all patients, and 7 patients had undergone repeated revision of the peritoneal tube before this procedure. Our laparoscopic-assisted method ensured tube insertion into the appropriate site, and minimized the abdominal wound and postoperative adhesions. This method also made it possible to differentiate abdominal pain induced by shunt failure from pain caused by other diseases, including appendicitis. In conclusion, we consider this new technique for V-P shunt performed under laparoscopic guidance to be very useful.

Surgical treatment for proximal bile duct carcinoma

BACKGROUND

The surgical management of proximal bile duct carcinoma is controversial. There is no consensus among surgeons as to the indications for radical resection. This article described personal experience with the different surgical procedures for patients with proximal bile duct carcinoma.

METHODS

The medical records of fifty-two consecutive patients undergoing surgical resection over a 20-year period were retrospectively analysed in terms of pathology, perioperative mortality, clinical course, and overall survival.

RESULTS

The 1-, 3- and 5-year survivals for the entire group were 63.3%, 24.5%, and 21.0%, respectively. The results for local resection of the extrahepatic bile duct in 35 cases were unsatisfactory. Radical resection that included the right extended hepatic lobe, caudate lobe, and extrahepatic bile duct was performed in 9 patients and demonstrated an excellent 5 year survival rate of 44.4%. However, hospital mortality was 22.2%. There was no significant difference among the operative procedures for patients with advanced disease.

CONCLUSION

Radical resection remains the procedure of choice in proximal bile duct carcinoma. However, results with surgical therapy alone remain unsatisfactory. Multimodality treatment that also includes radiotherapy and/or chemotherapy is recommended.

[Pagetoid spread of intratubular germ cell neoplasia into rete testis forming tumor-like mass]

Intratubular germ cell neoplasia (ITGCN) is the preinvasive phase of testicular germ cell tumors. ITGCN can spread into the rete testis in a pagetoid manner, but there are very few published data about this phenomenon. Furthermore, the tumor-like mass formed by ITGCN with pagetoid spread into the rete testis has not been documented to date, and the present case is the first to be reported. A tumor-like mass was found close to the superior pole of the left testis in a 39-year-old male and was unrelated to the epididymis. Three other nodules of seminoma surrounded by fibroconnective tissue existed next to the mass. Histological sections revealed ITGCN which was characterized by the presence of large and polygonal germ cells exhibiting clear cytoplasm with distinct cell borders. The cytoplasm was rich in glycogen and the cell membrane was immunohistochemically positive for placental alkaline phosphatase. The nuclei had less coarse chromatin than that of seminoma. ITGCN cells spread in between the lining epithelium of the rete and the basement membrane. This characteristic spread was consistent with pagetoid spread into the rete testis.

Morphologic and mucin histochemical analysis of transitional zones in advanced ulcerated colorectal carcinomas: potential prognostic indicators

BACKGROUND AND OBJECTIVES

The transitional zone, which is normal-appearing mucosa that surrounds a primary colorectal carcinoma, has characteristic histologic features, and an increased amount of sialomucin in the transitional zone have been associated with a poorer prognosis. To clarify the prognostic effects of changes in the transitional zone we studied the transitional zone in cancers of the colon and rectum.

METHODS

A total of 105 specimens resected for advanced colorectal carcinoma were studied to identify the effectiveness of evaluating morphologic types (polypoid or nonpolypoid growth type) and mucin expression (sulfomucin or sialomucin type) of the transitional zone as a prognostic indicator.

RESULTS AND CONCLUSIONS

Nonpolypoid carcinomas were likely to have invaded the deeper layers and lymphatic vessels and go on to develop advanced disease. Sulfomucin-type tumors were predominantly found in the right side colon and followed a relatively favorable course. Our results indicate that the morphologic and mucin components of the transitional zone may be prognostic indicators for advanced colorectal carcinoma.

Esophageal cancer in patients with head and neck cancers

Nine male patients with separate primary cancers of the esophagus and head and neck (pharynx, larynx) presented with a mean age of 56 years (41-69). They included 7 pharyngeal cancer patients and 2 laryngeal ones. Esophageal cancer was discovered synchronously in 6 patients and metachronously in 3 (1, 4, and 11 years later, respectively). The head and neck cancer was stage-I in one patient, stage-II in 4 and stage-IV in 4. The esophageal cancer was cervical in 2, thoracic in 6 and abdominal in 1. It was early cancer (stage-0) in 6 patients and advanced (stage-IV) in 3. The esophageal cancer was more advanced in the metachronous group, while it was early in the synchronous group. Since the head and neck cancer was advanced, all patients underwent a total laryngectomy for their head and neck cancers. As for esophageal surgery, a transhiatal esophagectomy was, in principle, performed for early cancers while a total thoracic esophagectomy was done for advanced cancers. For the reconstruction of the esophagus, a gastric tube was used. Four patients are still alive with a mean survival time of 25 months, whereas five died of cancer recurrence of either type a mean of 19 months after surgery. As compared with the survival rates of the patients with esophageal cancer alone, the 5-year survival rate was 18.2% for patients with double cancers in this series and 27.9% for those with esophageal cancer alone.

Thoracoscopic thoracic splanchnicectomy for chronic pancreatitis with intractable abdominal pain

The therapeutic advantages of a thoracoscopic thoracic splanchnicectomy (TTS) to relieve the pain of chronic pancreatitis patients was evaluated. The TTS procedure (four bilateral and five unilateral TTS), was performed on nine patients from April 1993 to October 1995. Based on radiographic images, the pancreatic duct of seven cases were diagnosed as being "nondilated" (<3 mm), whereas two cases were "dilated" (> or = 3 mm). A 5-mm thoracoscope was introduced through the fifth intercostal space on the anterior axillary line, and an additional two cannulas were introduced under direct thoracoscopic vision. The sympathetic chain, at a level from Th 5 to 9, was then resected and electrocoagulated. We performed a unilateral TTS corresponding to the symptomatic side; however, if pain relief was insufficient, an additional sympathectomy was done on the other side. The early postoperative course was uneventful, and immediate pain-relief was normally possible after TTS except for three patients who demonstrated minor intercostal neuralgia at the site of the trocars inserted for TTS. Six of nine patients were able to return to their preoperative work of lifestyle at a maximum follow-up of 24 months (the median and mean durations were 15.0 and 13.7 months, respectively). In addition, no postoperative deterioration of either the endocrine or exocrine function of the pancreas was observed. In conclusion, TTS proved to be a safe and reliable procedure for the pain relief of the chronic pancreatitis.

Abnormal immunostaining for dystrophin in isoproterenol-induced acute myocardial injury in rats: evidence for change in dystrophin in the absence of genetic defect

Abnormalities in the gene for Duchenne muscular dystrophy produce skeletal and myocardial changes, by impairing dystrophin production in patients with Duchenne and Becker muscular dystrophy. However, it is not known whether myocardial dystrophin may be altered in patients with other heart diseases. To investigate whether changes in myocardial dystrophin may be induced by acute myocardial injury, the immunostaining patterns of myocardial dystrophin were examined, together with those of myocardial actin, in rats with isoproterenol-induced myocardial damage. Hearts were excised at 6, 12, 24 and 48 h, and 1 and 4 weeks after the subcutaneous administration of 100 mg/kg of isoproterenol. Frozen serial sections were prepared for haematoxylin and eosin staining, and for immunostaining for dystrophin and actin. The immunostaining patterns of actin were used as an indicator of cell injury. The myocardial cells observed were classified into four types, according to staining pattern: normal for both actin and dystrophin (Type 1): normal for actin, but abnormal for dystrophin (Type 2); abnormal for actin, but normal for dystrophin (Type 3); and abnormal for both actin and dsytrophin (Type 4). The percentage of myocardial cells with abnormal staining (Types 2, 3 and 4) at 6, 12, 24 and 48 h after isoproterenol injection was 22.4, 12.6, 16.0 and 2.4%, respectively; most cells were Types 3 and 4. One week after injection or later, no Type 3 or 4 cells were detected, while the percentages of Type 2 cells were 2.7% for 1 week and 2.2% for 4 weeks, significantly higher than the corresponding value in the control group. In conclusion, changes in myocardial dystrophin may occur in isoproterenol-induced myocardial injury in rats.

The use of intraoperative ultrasonography for detecting tumor extension in bile duct carcinoma

The purpose of this study was to investigate the clinical feasibility of using intraoperative ultrasonography (IOUS) to detect tumor extension in bile duct carcinoma, especially longitudinal invasion along the bile ducts into either the hepatic parenchyma or adjacent hilar vessels.

MATERIALS AND METHODS

The medical records of 14 patients with bile duct carcinoma who underwent surgical treatment at the First Department of Surgery, University of the Ryukyus, were retrospectively analyzed. All patients were examined by IOUS during the operation. The resected specimens were processed in order to compare the ultrasound images with the histological findings.

RESULTS

The echo level of the primary lesion was not consistent. Specific echo patterns, such as a thickening of the echogenic layer (TEL) adjacent to the main tumor showing cancerous invasion, were observed in ten patients, 71.4% (nodular invasive 7, invasive 3) which were later confirmed by microscopic examinations and ultrasonic findings. The detection rate of TEL was 87.5% in nodular invasive type and 100% in invasive type, respectively. The TEL histologically coincided with a layer of fibrotic hypertrophy around the infiltrating tumor cells. The intramural invasion beyond the edge of TEL was detected in only 2 out of 11 patients. The accurate detection rate of the involvement of the portal vein and the hepatic artery by IOUS was 83.3% and 60%, respectively. Based on the above findings, IOUS is thus considered to be essential for evaluating tumor extension along the bile ducts, and also greatly helps in selection of the most appropriate operative procedure, especially in hilar cholangiocarcinoma.

Squamous cell carcinoma arising from lupus vulgaris on an old burn scar: diagnosis by polymerase chain reaction

A 66-year-old Japanese woman with a squamous cell carcinoma (SCC) arising from lupus vulgaris (LV) on an old burn scar on the left lower extremity is described. Ziel-Neelsen stain of a direct smear from the surface exudate showed acid-fast bacilli. Repeated culture for tubercle bacilli was negative, probably due to a technical error. The diagnosis of LV was successfully made by polymerase chain reaction (PCR). LV and burn scar are common preceding diseases for SCC. The former is rare in the U.S., Europe, and Japan. We were unable to determine whether only one of the two conditions or a combination of both was the true predisposing factor responsible for the development of this SCC. However, this case may be the first report of SCC arising from coexistent LV and a burn scar in which the diagnosis was confirmed by PCR.

Midlatency auditory evoked potentials and the startle response in the rat

The P13 midlatency auditory evoked potential in the rat is (i) sleep state dependent, (ii) undergoes rapid habituation and (iii) is blocked by the cholinergic antagonist scopolamine. As such, the P13 potential in the rat shows the same characteristics as the P1 (or P50) potential in the human. These potentials are thought to be mediated, at least in part, by the cholinergic arm of the reticular activating system. Previous studies have linked the reticular activating system with the startle response. The present study was undertaken to explore this relationship by simultaneously recording the P13 potential and the electromyographically recorded startle response using stimuli designed to elicit each response. Simultaneous recordings from the vertex and neck musculature following auditory click stimuli showed that: (i) the mean threshold of the P13 potential was 69.3 +/- 1.9 dB, while that for the startle response was 87.9 +/- 6.4 dB; (ii) the P13 potential was present during waking and paradoxical sleep, but absent during slow-wave sleep, while the startle response was present reliably only during waking; (iii) both responses habituated in response to paired stimuli, but the startle response was more habituated than the P13 potential; and (iv) both responses were facilitated by trains of stimuli in a similar manner. Recordings carried out from the auditory cortex verified that the primary cortical response had properties different from the P13 potential; i.e. it was present during all sleep-wake states, had a lower threshold and did not habituate rapidly. Finally, different patterns of startle responses were detected in the neck muscles. In every case, the P13 potential occurred during the middle, inhibitory phase of the startle response. These results suggest that the P13 potential and the startle response share response features, but the P13 potential appears to be more sensitive to auditory stimulation and to sleep-wake states. The startle response may be modulating descending systems by priming the spinal cord to respond in a "fight vs flight" fashion. On the other hand, the P13 response may be modulating ascending systems by triggering thalamocortical activity and resetting descending systems to allow novel motor strategies.

Expression of Fas antigen and Bcl-2 in human glomerulonephritis

To understand the regulatory mechanism of apoptosis in human glomerulonephritis, we examined the expression of Fas antigen (CD95) and Bcl-2 in five normal human kidney specimens and 80 tissues from patients with several types of glomerular diseases. These proteins were detected in glomeruli by immunofluorescence. The number of intraglomerular cells positive for Fas antigen was high in Henoch-Schönlein purpura nephritis and lupus nephritis, and that of Bcl-2-positive intraglomerular cells was high in lupus nephritis, focal glomerular sclerosis, and IgA nephritis. Dual-labeling and staining on serial sections indicated that mesangial cells and occasionally infiltrating leukocytes expressed Fas antigen and Bcl-2. In situ hybridization detected Bcl-2 mRNA in glomerular cells. Electron microscopy revealed apoptotic cells and apoptotic bodies in proliferated mesangial areas and within the glomerular capillaries. Fragmented DNA was detected in glomeruli by in situ nick end labeling, the data of which paralleled the number of Fas antigen-positive intraglomerular cells. In mesangial proliferative types of glomerulonephritis, the population of Bcl-2-positive intraglomerular cells, but not that of Fas antigen-positive cells, was significantly correlated with the number of proliferating cell nuclear antigen-positive glomerular cells, the grade of mesangial cell increase, and the magnitude of proteinuria. This study showed that Fas antigen and Bcl-2 are up-regulated in the glomeruli of several types of human renal diseases. Bcl-2 overexpression might play a role in the prolonged proliferation of mesangial cells and glomerular hypercellularity in glomerulonephritis.

[Histopathological analysis of herniated cerebellar tonsils resected from the patients with Chiari type I malformation with syringomyelia]

Cerebellar tonsillectomy is a controversial treatment for Chiari type I malformation combined with syringomyelia. To demonstrate the validity of this procedure, we evaluated the postoperative clinical course, the histopathological finding in the resected cerebellar tonsils and the MR images of four patients. The patients were all women, ranging in age from 27 to 58 years old (mean: 43 years). The postoperative follows-up period lasted from 28 to 51 months (average: 38 mos), and the neurological symptoms and signs improved in all patients. Histopathological examination of the resected tonsils revealed a loss of Purkinje cells and granule cells. Vacuolated degeneration and chromatolysis were also seen, and modified Bielschowsky stain revealed axonal degeneration. These findings appeared to be irreversible. Postoperative T1-weighted MR images of the cervical and thoracic spine demonstrated a decrease in the size of the syrinx and the disappearance of evidence of tonsillar herniation in all patients. Postoperative phase-contrast MR images showed good CSF pulsation in the subarachnoid space at the craniocervical junction in all three patients examined. It was possible to avoid surgical complications by using careful microsurgical techniques. Based on these results, we concluded that cerebellar tonsillectomy is an adequate surgical strategies for treating Chiari type I malformation associated with syringomyelia.

Cardiac dystrophin abnormalities in Becker muscular dystrophy assessed by endomyocardial biopsy

Duchenne and Becker muscular dystrophy (DMD/BMD) are allelic variants caused by mutations in gene-encoding dystrophin. Abnormal expression of dystrophin in skeletal muscle has been shown to correlate with severity of disease. However, in BMD the severity of skeletal and cardiac involvement are not well correlated. We studied the immunostaining pattern of cardiac dystrophin in endomyocardial biopsy specimens from 83 patients with heart disease. Immunohistochemical assessment of dystrophin in four patients with BMD and cardiomyopathy showed a variable distributions of myocytes with continuous, discontinuous, or absent membrane immunostaining patterns. These patterns were obviously different from patterns of other heart diseases. We conclude that the discontinuous immunostaining pattern of cardiac dystrophin is characteristic of BMD and that an absent pattern may be associated with more severe cardiac dysfunction. Because genetic analysis cannot determine the correct diagnosis in 35% of DMD/BMD cases, we recommend routine examination of immunostaining patterns of dystrophin in endomyocardial biopsy specimens in patients with cardiomyopathy suspected to be the result of BMD.

A middle-latency auditory-evoked potential in the rat

Previous studies have established the presence of a middle-latency auditory-evoked potential that is characterized by a) sleep-state dependence, b) low following frequency (i.e., rapid habituation to repetitive stimulation), and c) blockade by the cholinergic antagonist, scopolamine. A vertex-recorded evoked potential having these characteristics was described in humans at a 50-80 ms latency (termed the P1 or.P50 potential) and in the cat at a 20-25 ms latency (termed wave A). These studies were undertaken to determine if a click stimulus-evoked potential having the same characteristics was present in the intact rat. Vertex and auditory cortex recordings in intact rats studied in a sound-attenuating chamber and exposed to free-field click stimuli showed a) the presence of a vertex recorded potential at a 11-15 ms latency, termed P13, and of an auditory cortex recorded potential at a 7-11 ms latency, termed Pa; b) the P13 was present during waking and paradoxical sleep but absent in slow-wave sleep, while Pa was present in all sleep-wake states; c) the P13 habituated markedly at stimulation rates above 1 Hz while Pa did not; and d) the P13 was blocked by low doses of scopolamine while Pa was not. These studies demonstrate the presence of a P1-like potential in the rat at a 13 +/- 2 ms latency.

A case of double cancer: a squamous cell carcinoma arising from a long pierced site on the left earlobe and a solid tubular carcinoma of the left breast

A 43-year-old woman presented with a well differentiated squamous cell carcinoma of the left earlobe where a small hole for pierced type earrings had been made about 20 years earlier. A year after the removal of the tumor, a metastasis of a moderately differentiated squamous cell carcinoma to the left cervical lymph nodes was detected. A month later, a solid tubular carcinoma of the left breast was found. A modified radical neck dissection and a quadrantectomy with an axillary lymph node dissection were performed. A total of 5 courses of peplomycine-mitomycine combinated therapy with 26 Gy of radiotherapy was administered for the cervical lesion. A month of postoperative chemotherapy with tegafur-uracil and medroxyprogesterone acetate and a total of 56 Gy of radiotherapy to the mammary lesion were added. She has been well without recurrence for about a year after the operations. This case is not only a rare double cancer, a combination of a squamous cell carcinoma and a solid tubular carcinoma, but may also be the first case of a squamous cell carcinoma arising at a long pierced site on an earlobe for pierced type earrings.

A case of acquired lymphangioma due to a suspected old filariasis and a review of literature

A 65-year-old man presented in 1992 with multiple papular lesions on the scrotum and foreskin. His medical history revealed that, at the age of 25, he was diagnosed as having filariasis and treated conservatively at a hospital in Hawaii. The histologic study of the scrotal skin showed large, dilated vascular spaces in the upper dermis lined with a single layer of endothelial cells that were negative for Factor 8-related antigen. The diagnosis was acquired lymphangioma due to a suspected old filariasis infestation, although serologic tests for filarial antibodies were negative. The paper also presents a review of the literature of acquired lymphangioma in Japan with a brief discussion of etiology and nomenclature.

[Crossed cerebellar diaschisis in putaminal hemorrhage--evaluation by the Xe-133 clearance method]

Metabolic depression in the contralateral cerebellar hemisphere caused by a supratentorial lesion is called crossed cerebellar diaschisis (CCD). In order to investigate diaschisis based on the location and extension of lesions, time course and prognosis, 31 patients with putaminal hemorrhage were examined by the Xe-133 clearance method (67 studies in all). They consisted of 20 males and 11 females, from 40 to 77 years old (mean: 57.1 +/- 8.9). Small hematomas (mean volume: 16.1 +/- 8.4 ml) in 18 patients were treated nonsurgically, whereas medium and large hematomas (mean volume: 57.5 +/- 29.9 ml) in 13 patients were treated by craniotomy for evacuation. rCBF was measured using a BI 1400 rCBF Analyzer (Valmet, Denmark), and CCD was considered positive when the percentage difference in cerebellar blood flow was 10.1% (mean + 2SD) greater than obtained in 21 normal controls. CCD was observed in 10 patients (55.6%) in the non-surgical group and in 9 patients (69.2%) in the surgical group. In the non-surgical group, CCD was positive in 5 of the 7 cases (71.4%) involving the posterior limb of the internal capsule and in 7 of the 11 cases (63.6%) involving the corona radiata. The surgical group was divided into three types based on the time course of CCD after surgery, i.e., type A: persistent CCD found two months later, type B: postoperative CCD had resolved two months later, and type C: no CCD observed after surgery. Mean hematoma volume was significantly greater in type A (79.0 +/- 19.8 ml) than in type B (44.6 +/- 8.5 ml) or type C (30.7 +/- 3.7 ml) (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

The target antigen of anti-tubular basement membrane antibody-mediated interstitial nephritis

Our previous studies showed that 54 kD and 48 kD tubular basement membrane (TBM) proteins were the major form of the target antigen involved in anti-TBM antibody-mediated tubulo-interstitial nephritis in humans. In those studies, we isolated the 54 kD glycoprotein (named gp54) from collagenase-digested bovine TBM. NH2-terminal amino acid sequencing indicated that gp54 represented a newly defined glycoprotein. In this study, we further characterized the target antigen, using mouse monoclonal antibodies to gp54 and polyclonal anti-gp54 peptide antibody. Two monoclonal antibodies (H79 and H80) were established, and they reacted, by immunofluorescence, predominantly with the proximal TBM of humans, rabbits, and Wistar, Sprague-Dawley, and Brown-Norway rats, but not with that of Lewis rats. They were also fixed by blotting intensely to the 54 kD component and weakly to the 48 kD component of collagenase-digested human TBM. In vivo transfer of H79 to Wistar rats showed extensive linear binding of mouse IgG to the TBM and the basal membrane of the small intestine; however, no pathologic changes were seen by light microscopy. The anti-gp54 peptide antibody reacted with both the 54 kD and 48 kD TBM components of human TBM. mRNA was prepared from rabbit kidneys, and fractionated to enrich mRNA encoding the 54 kD and 48 kD peptides. On in vitro translation experiments with the mRNA fraction, the 54 kD and 48 kD peptides were immunoprecipitated with anti-gp54 antibodies. These findings indicate that the 54 kD and 48 kD components are encoded with different mRNA, but that they share the same antigenic epitope.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined therapy in children and adolescents with IgA nephropathy

We retrospectively evaluated renal outcome in a total of 38 children and adolescents with IgA nephropathy who were selected for 6-month therapy for clinical (proteinuria > 1 g/m2/24 hour) and pathologic (mesangial proliferation, crescent formation, and tubulo-interstitial changes) features suggestive of progressive renal failure. Seventeen patients (group A) were treated with a combination of prednisolone, cyclophosphamide and dipyridamole, and the remaining patients (21; group B) were treated with the same drugs plus warfarin. All the patients were followed-up for more than 2 years (range 2-10 years, mean 4.8). In both groups, the mean urinary protein excretion value was significantly reduced after the therapy, compared with that at entry into the therapy. The significant reduction continued for up to 6 years in group A and up to 5 years in group B. Creatinine clearance was stable until 5-6 years after the trial in both groups, but 4 patients progressed to end-stage renal failure after that period. Post-therapy biopsy was performed in 14 patients, and was compared with the pre-therapy biopsy. The activity score had improved in both groups, but the chronicity score did not. These results indicate that there was a temporary effect and limited benefit with this treatment of combined drugs for children and adolescents with IgA nephropathy. The additive effect of warfarin was not substantiated.