Palisaded neutrophilic and granulomatous dermatitis associated with systemic lupus erythematosus: possible involvement of CD163+ M2 macrophages in two cases, and a review of published works

BACKGROUND

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a commonly occurring condition related to systemic autoimmune disease. It is characterized histopathologically by a distinct pattern of granulomatous inflammation in the presence or absence of leukocytoclastic vasculitis. The properties of granulomatous cells in PNGD are still uncertain.

OBJECTIVE

We sought further investigation on the phenotype of the infiltrated cells in PNGD from two patients with systemic lupus erythematosus (SLE) and reviewed the previous published reports in order to provide a comprehensive summary on the clinical features of PNGD in SLE.

METHODS

The immunohistochemical features of granulomatous cells in PNGD associated with SLE were analyzed. Immunohistochemical studies were performed on sections from our two cases using antibodies against CD68, CD163, CD15, Factor XIIIa, myeloperoxidase and neutrophil elastase. The clinical characteristics of the SLE patients who developed PNGD were also evaluated. We included all cases retrieved through a PubMed search with the key words PNGD and SLE.

RESULTS

Cutaneous lesions consisted of erythematous plaques distributed on the face and upper limbs in both cases. The infiltrated cells were mainly positive for CD68 and CD163, a phenotype suggestive of M2 macrophages. Some mature neutrophils and lymphocytes were also present. A review of the literature of PNGD associated with SLE revealed a predominance in females, high prevalence of lupus nephritis and a good response to systemic steroids, with frequent skin lesions relapses during tapering of the treatment.

LIMITATIONS

This study examined only two cases; the pathogenesis of the disease remains to be clarified.

CONCLUSION

PNGD lesions were abundantly infiltrated by M2 macrophages, suggesting that they may have a role in this condition. SLE accompanied by PNGD might be associated with lupus nephritis and frequent relapses of skin lesions.

Abstract P1-07-13: Obesity is associated with poor prognosis of Japanese breast cancer, especially in ER positive/HER2 negative subtype, which tendency is prominent

Introduction: Body mass index (BMI) is defined as a poor prognostic factor in breast cancer patients in western countries. Since the percentage of the overweight differs between Asian and western breast cancer patients, we do not know if breast cancer prognosis in Asia is related to obesity, the same as in western countries. Therefore, we have investigated the association between BMI and the prognosis of Japanese breast cancer patients.

Patients and Methods: This study is a retrospective analysis of the 1,924 primary Japanese female breast cancer patients with clinical stage I through III disease to have undergone surgery between January 2004 and December 2013 at the Hokkaido Cancer Center. The data of BMI were at the time of diagnosis, and stratified into 2 groups as non-Obese (BMI < 25 kg/m2), Obese (BMI ≥ 25 kg/m2). The overall survival (OS) and disease-free survival (DFS) were compared between two BMI groups using the Kaplan-Meier method and Cox hazards model.

Results: The number of non-Obese group was 1,353 (70.3%) and Obese group was 571 (29.7%) of the 1,924 patients. Six hundred and thirty two patients were in premenopausal (32.8%), 1,289 were in postmenopausal (67.0%) and 3 were unknown. The median follow-up period was 73 months. Breast cancer recurred in 239 patients (12.2%), and 204 patients died. There were 110 cases of breast cancer-related death, 48 cases of non-breast cancer death, and 46 cases of unknown as the cause of death. Patients in Obese group had shown significantly poorer OS (adjusted hazard ratio (HR) = 1.68, 95% confidence interval (CI) = 0.45 to 0.79) and DFS (HR = 1.46, 95% CI = 1.16 to 1.82). As investigating by subtype analysis, a high BMI in ER positive/HER2 negative patients was associated with a significantly worse OS (HR = 2.04, 95% CI = 1.42 to 2.92) and significantly worse DFS (HR = 1.61, 95% CI = 1.23 to 2.11). On the other hand, there was no significant interaction found between the BMI and OS or DFS in ER negative/HER2 negative patients and HER2 positive patients. Subsequently, when analysis was limited to ER positive HER2 negative, there was a difference in the degree of association between obesity and prognosis due to the difference in menopause status. In premenopausal patients with ER positive/HER2 negative cancer, Obese group had significantly poorer OS (HR = 2.83, 95%CI = 1.32 to 5.88) and significantly poorer DFS (HR = 2.41, 95%CI = 1.41 to 3.99). In postmenopausal patients, Obese group patients had significantly poorer OS (HR = 1.71, 95%CI = 1.11 to 2.58) and poorer DFS (HR = 1.35, 95%CI = 0.98 to 1.86), however. The relevance was not so large compared with that in premenopausal patients.

Conclusion: Among Japanese breast cancer patients, Obese (BMI ≥ 25 kg/m2) was one of poor prognostic factors. Specifically, obesity was associated as an extremely strong prognostic factor in ER positive/HER2 negative premenopausal patients. Since hormone therapy has been practiced in almost all ER positive breast cancers, the relationship between hormonal therapy susceptibility and obesity is noticed not only in western patients but also in Asian patients.

Citation Format: Sato M, Terai S, Tachikawa H, Maeda H, Yamamoto M, Tomioka N, Watanabe K, Takahashi M. Obesity is associated with poor prognosis of Japanese breast cancer, especially in ER positive/HER2 negative subtype, which tendency is prominent [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-13.

Full-layer mucosal histology in achalasia: Histological epithelial wave is characteristic in "pinstripe pattern"-positive achalasia

BACKGROUND

Previously, the mucosal histology in achalasia has only been investigated using superficial biopsy or surgically resected esophageal specimens in end-stage cases. We investigated the histology of the full-layer mucosa in early and advanced achalasia.

METHODS

Endoscopy was performed for the pinstripe pattern (PSP) (an early achalasia indicator) and dilation and thickening of the mucosa (advanced achalasia indicators). A mucosal entry site for peroral endoscopic myotomy was created using cap-fitted endoscopic mucosal resection to access the full-layer mucosa and the submucosa.

KEY RESULTS

Mucosal histology was compared between 32 patients with achalasia and 15 controls. Histological esophagitis with findings of inflammatory cell infiltration and dilated intercellular spaces was observed more in patients with achalasia than in controls (87.5% vs 13.3%, P<.001; 84.4% vs 46.7%, P=.049). Muscularis mucosae (MM) atrophy and epithelial wave were only observed in achalasia (40.6% vs 0%, P=.005; 28.1% vs 0%, P=.043). Fibrosis was more common in achalasia, but without statistical significance (31.3% vs 20.0%, P=.503). In achalasia with endoscopic dilation and thickening of the mucosa, MM atrophy was observed histologically, and in cases involving endoscopic PSP, the histological epithelial wave was observed.

CONCLUSIONS & INFERENCES

Histological findings of esophagitis were observed endoscopically even in early achalasia. Pinstripe pattern corresponds to the epithelial wave observed histologically in achalasia, whereas endoscopic findings in advanced achalasia correspond to MM atrophy. Appropriate management is necessary during early achalasia to prevent progression to advanced achalasia with more severe histological changes.

Changes in esophageal motility after endoscopic submucosal dissection for superficial esophageal cancer: a high-resolution manometry study

The effect of endoscopic submucosal dissection (ESD) on esophageal motility remains unknown. Therefore, the aim of this study is to elucidate changes in esophageal motility after ESD along with the cause of dysphagia using high-resolution manometry (HRM). This is a before-and-after trial of the effect of ESD on the esophageal motility. Twenty patients who underwent ESD for superficial esophageal carcinoma were enrolled in this study. Patients filled out a questionnaire about dysphagia and underwent HRM before and after ESD. Results before and after ESD were compared. Data were obtained from 19 patients. The number of patients who complained of dysphagia before and after ESD was 1/19 (5.3%) and 6/19 (31.6%), respectively (P = 0.131). Scores from the five-point Likert scale before and after ESD were 0.1 ± 0.5 and 1.0 ± 1.6, respectively (P = 0.043). The distal contractile integral (DCI) before and after ESD and the number of failed, weak, or fragmented contractions were not significantly different. However, in five patients with circumferential ESD, DCI was remarkably decreased and the frequency of fail, weak, or fragmented contractions increased. Univariate regression analysis showed a relatively strong inverse correlation of ΔDCI with the circumferential mucosal defect ratio {P < 0.01, standardized regression coefficient (r) = -0.65}, the number of stricture preventions (P < 0.01, r = -0.601), and the number of stricture resolutions (P < 0.01, r = -0.77). This HRM study showed that impairment of esophageal motility could be caused by ESD. The impairment of esophageal motility was conspicuous, especially in patients with circumferential ESD and subsequent procedures such as endoscopic triamcinolone injection and endoscopic balloon dilatation. Impaired esophageal motility after ESD might explain dysphagia.

Muscle layer histopathology and manometry pattern of primary esophageal motility disorders including achalasia

BACKGROUND

Histopathology of muscularis externa in primary esophageal motility disorders has been characterized previously. We aimed to correlate the results of high-resolution manometry with those of histopathology.

METHODS

During peroral endoscopic myotomy, peroral esophageal muscle biopsy was performed in patients with primary esophageal motility disorders. Immunohistochemical staining for c-kit was performed to assess the interstitial cells of Cajal (ICCs). Hematoxylin Eosin and Azan-Mallory staining were used to detect muscle atrophy, inflammation, and fibrosis, respectively.

KEY RESULTS

Slides from 30 patients with the following motility disorders were analyzed: achalasia (type I: 14, type II: 5, type III: 3), one diffuse esophageal spasm (DES), two outflow obstruction (OO), four jackhammer esophagus (JE), and one nutcracker esophagus (NE). ICCs were preserved in high numbers in type III achalasia (n=9.4±1.2 cells/high power field [HPF]), compared to types I (n=3.7±0.3 cells/HPF) and II (n=3.5±1.0 cells/HPF). Moreover, severe fibrosis was only observed in type I achalasia and not in other types of achalasia, OO, or DES. Four of five patients with JE and NE had severe inflammation with eosinophilic infiltration of the esophageal muscle layer (73.8±50.3 eosinophils/HPF) with no epithelial eosinophils. One patient with JE showed a visceral myopathy pattern.

CONCLUSIONS & INFERENCES

Compared to types I and II, type III achalasia showed preserved ICCs, with variable data regarding DES and OO. In disorders considered as primary esophageal motility disorders, a disease category exists, which shows eosinophilic infiltration in the esophageal muscle layer with no eosinophils in the epithelium.

Evaluation of quantitative trait loci affecting intramuscular fat and reproductive traits in pigs using marker-assisted introgression

We investigated the effects of previously identified quantitative trait loci (QTL) in an experimental backcross (BC) between Chinese Meishan pigs and commercial Duroc pigs. We performed marker-assisted introgression of two QTL for intramuscular fat (IMF) content (IMF population) and three QTL for reproductive traits (reproduction population) from a donor Meishan pig into a recipient Duroc pig. At the fourth BC generation of the IMF population and third BC generation of the reproduction population, carrier animals were selected for the production of animals homozygous for the QTL. Our previous studies have shown that the presence of a Meishan allele on the IMF QTL is associated with low IMF values, and the Meishan allele on the reproductive QTL is associated with large litters. In this study, the presence of a Duroc allele at the IMF QTL on SSC9 resulted in a 0.27% increase in IMF (additive effect = 0.27 ± 0.08), whereas the presence of a Meishan allele at the IMF QTL on SSC7 resulted in a 0.34% increase in IMF (additive effect = -0.34 ± 0.09). The presence of the Meishan allele at the IMF QTL on SSC7 thus had the opposite effect to our previous studies, that is, increased IMF. In the reproduction population, we observed no differences between the genotypes of the three QTL in regard to number of corpora lutea or litter size. Marker-assisted introgression at these QTL is thus unlikely to result in an associated increase in litter size. These results show that it is possible to introgress alleles from other breeds into a selection population using molecular markers; any unexpected results might be associated with the genetic background.

Quantitative trait loci analysis for growth and carcass traits in a Meishan x Duroc F2 resource population

We constructed a pig F2 resource population by crossing a Meishan sow and a Duroc boar to locate economically important trait loci. The F2 generation was composed of 865 animals (450 males and 415 females) from four F1 males and 24 F1 females and was genotyped for 180 informative microsatellite markers spanning 2,263.6 cM of the whole pig genome. Results of the genome scan showed evidence for significant quantitative trait loci (<1% genomewise error rate) affecting weight at 30 d and average daily gain on Sus scrofa chromosome (SSC) 6, carcass yield on SSC 7, backfat thickness on SSC 7 and SSC X, vertebra number on SSC 1 and SSC 7, loin muscle area on SSC 1 and SSC 7, moisture on SSC 13, intramuscular fat content on SSC 7, and testicular weight on SSC 3 and SSC X. Moreover, 5% genomewise significant QTL were found for birth weight on SSC 7, average daily gain on SSC 4, carcass length on SSC 6, SSC 7, and SSC X and lightness (L value) on SSC 3. We identified 38 QTL for 28 traits at the 5% genomewise level. Of the 38 QTL, 24 QTL for 17 traits were significant at the 1% genomewise level. Analysis of marker genotypes supported the breed of origin results and provided further evidence that a suggestive QTL for circumference of cannon bone also was segregating within the Meishan parent. We identified genomic regions related with growth and meat quality traits. Fine mapping will be required for their application in introgression programs and gene cloning.

Human homologue of maid: A dominant inhibitory helix-loop-helix protein associated with liver-specific gene expression

The helix-loop-helix (HLH) family of transcriptional regulatory proteins are key regulators in numerous developmental processes. The class I HLH proteins, such as E12 are ubiquitously expressed. Class II HLH proteins, such as MyoD, are expressed in a tissue-specific manner. Class I and II heterodimers can bind to E-boxes (CANNTG) and regulate lineage commitments of embryonic cells. In an attempt to identify partners for the E12 protein that may exert control during liver development, we performed the yeast 2-hybrid screen using an expression complementary DNA library from human fetal liver. A novel dominant inhibitory HLH factor, designated HHM (human homologue of maid), was isolated and characterized. HHM is structurally related to the Id family and was highly expressed in brain, pituitary gland, lung, heart, placenta, fetal liver, and bone marrow. HHM physically interacted with E12 in vitro and in mammalian cells. Comparison of the dominant inhibitory effects of HHM and Id2 on the binding of E12/MyoD dimer to an E-box element revealed a weaker inhibition by HHM. However, HHM but not Id2 specifically inhibited the luciferase gene activation induced by hepatic nuclear factor 4 (HNF4) promoter. The HHM was transiently expressed during stem-cell-driven regeneration of the liver at the stage in which the early basophilic foci of hepatocytes started to appear. These results suggest that HHM is a novel type of dominant inhibitory HLH protein that might modulate liver-specific gene expression.

Mechanism in progressive lacunar infarction: a case report with magnetic resonance imaging

BACKGROUND

The mechanism of a progressive lacunar infarction is not well understood, and changes in ischemic tissue after onset have not yet been clarified clinically.

OBJECTIVE

To investigate the pathophysiological characteristics of a case of progressive lacunar infarction using diffusion-weighted and conventional magnetic resonance imaging (MRI) scans.

PATIENT

A 73-year-old woman was hospitalized 18 hours after stroke onset and was diagnosed as having a lacunar infarction in the perforating territory of the left middle cerebral artery. Despite treatment, the hemiparesis worsened, with the peak on the fourth day after onset. Diffusion-weighted and conventional MRI scans provided clues to the pathogenesis.

FINDINGS AND CONCLUSIONS

In the acute stage, gradual enlargement of the hyperintense lesion, reflecting fresh ischemic tissue, and neurological deterioration were observed by serial examination of diffusion-weighted MRI scans. A conventional coronal MRI scan revealed a 2-layered ischemic lesion, suggesting the involvement of perforating arteries. These findings indicated that hemodynamic impairment of the microcirculation in the perforators was the major cause of the lacunar infarction.

[Clinical course of acute deep infarcts in carotid system--pathogenesis of progressing stroke]

We attempted to clarify the temporal profile and the predisposing factors for progressing neurological disorders in the patients with acute cerebral infarction in the territory of the deep perforators of the carotid system. The subjects were 19 patients with mild hemiparesis admitted to our hospital within 24 hours of stoke onset, and their mean age was 59.9 +/- 9.1. Six of those patients (about 32%) had gradual neurological deterioration after admission (progressive cases), and they had poor outcome compared with non-progressing patients. The mean progressing period was 3.7 +/- 1.0 days. Our examination suggest that both the changes in systemic hemodynamics and the risk factors for cerebrovascular disease (hypertension, diabetes mellitus, hyperlipidemia) do not always provide a correlation with the development of progressing stroke. However, we speculate that the impairment of the microcirculation plays a major role in progressing stroke in the territory of penetrating arteries because of the result that the mean infarct size of progressive patients had a tendency to be larger than that of non-progressive patients in the chronic stage.

Long-term haemodynamic effects of octreotide on postprandial splanchnic hyperemia in humans: a placebo-controlled echo-doppler study

BACKGROUND

Octreotide is a potent splanchnic hypotensive somatostatin analogue effective in the treatment of acute variceal bleeding.

AIM

To study the effects of octreotide on basal and postprandial splanchnic and systemic haemodynamics, and hormonal changes in humans.

METHODS

Twenty-four healthy volunteers were randomized to receive a liquid meal and either octreotide (OCT, 100 microg bolus) or placebo repeatedly every 4 h for 48 h. Splanchnic (Doppler ultrasound) and systemic haemodynamics (non-invasive cardiac monitoring) were assessed for 2 h on four consecutive days: one control day and after doses 1 (0 h), 7 (24 h) and 13 (48 h).

RESULTS

The maximum postprandial increases in mean blood velocity of the superior mesenteric artery (SMA-Vmean +72%), portal (PBF +52%) and total hepatic blood flow (HBF +50%) observed in the placebo group, were abolished after the first dose of octreotide (SMA-Vmean -23%, P<0.01; PBF -22%, P<0.01; HBF -21%, P<0.01). Postprandial hyperemia was restored at the end of the 48-h study period, but baseline SMA-Vmean (placebo 40+/-12, OCT 29+/-11 cm/s, P<0.05) and PBF (placebo 1200+/-971, OCT 743+/-449 mL/min, P<0.05) remained significantly lower in the octreotide group. The postprandial decrease of systemic vascular resistance and increase of cardiac index were prevented by octreotide for 48 h.

CONCLUSIONS

Repeated 4-hourly bolus injections of octreotide reduce splanchnic blood flow for at least 48 h, but the prevention of food-induced splanchnic hyperemia is short-lasting.

[Diffusion MRI for evaluating TIA--a case of reversible ischemic injury in the territory of the deep perforators]

A 61-year-old man was admitted to our hospital because of left pure motor hemiparesis. Neuroradiological examination was performed after three hours of onset, but no apparent lesion responsible for the hemiparesis was detected by CT and MRI. Diffusion weighted MRI (DWI), however, demonstrated a high signal area with good contrast in the posterior limb of right internal capsule. This lesion was compatible with patient's clinical symptoms. Apparent diffusion coefficient (ADC) of the lesion was lower than that of normal control at the timing of admission. On the following day within 24 hours after the onset, it was revealed that both left hemiparesis and high signal area on DWI had disappeared, and the ADC on the ischemic lesion was restored to normal level. Changes in the intensity on DWI corresponded well with reversion of ischemic injury, which suggested that DWI was very useful for diagnosis of TIA.

Antitumor effect of vesnarinone on human hepatocellular carcinoma cell lines

Vesnarinone, a quinolinone derivative, induces apoptosis and differentiation in some tumor cell lines. We examined the antitumor effect of vesnarinone on three human hepatocellular carcinoma (HCC) cell lines. Vesnarinone suppressed the proliferation of all three HCC cell lines, but did not induce apoptosis and differentiation. Vesnarinone has also been reported to inhibit both nucleoside and nucleobase transport. Concomitant administration of vesnarinone and a de novo nucleotide synthesis inhibitor potentiated the growth-inhibitory effect of vesnarinone on HCC cells. Vesnarinone may be useful as a new biochemical modulator of anticancer agents.

An osteometrical study of the cranium and mandible of the lesser mouse deer (Chevrotain), Tragulus javanicus

The lesser mouse deer (Tragulus javanicus) is one of the most primitive ruminants. Skulls of lesser mouse deer were measured to evaluate their growth. The age was estimated from the eruption and attrition of molars on the mandible. A total of 95 specimens was divided into five age groups, and the growth pattern in each sex was established for some measurements. The relative growth coefficients were calculated for the head and body length and several parts of the cranium and mandible against the profile length. Sexual dimorphism could not be found on the skull in any age group except for measurements related to the upper canine. However, females showed a higher value in head and body length in the oldest group. This feature was consistent with an interpretation of mouse deer society as monogamous. Growth was more rapid in length than in width. Various statistical analyses showed that the visceral cranium related to masticatory facility was much better developed than the neurocranium. However, observations on the shape of the mandible ramus and of the premolars implied that the masticatory function was not suitable for taking roughage. This speculation agreed with previous reports on the feeding habits and digestive organs of the mouse deer.

[Exercise capacity and cardiovascular responses to exercise in hemiplegic patients]

We studied how the severity of hemiparesis was related to cardiovascular and metabolic responses to exercise. Eleven clinically stable patients who had had strokes were studied two to four weeks after they began walking as rehabilitation. After motor function of the lower limbs was assessed, the patients were divided into two groups according to Brunnstrom stage: one group comprised patients at stages III, IV, and V of lower limb function (n = 5), and the other comprised patients at stage VI (n = 6). A control group of 6 patients who had been hospitalized because of benign paroxysmal postural vertigo was also studied. Exercise consisted of 3-minute walks at speeds of 1.6, 3.2, and 4.8 km/hr. Blood pressure, heart rate, and the concentrations of catecholamines and of lactic acid in blood were measured before and after each stage of exercise. The double product (systolic blood pressure x heart rate) was also calculated. Changes in these variables were compared among the three groups. Increases in walking speed were associated with increases in systolic blood pressure and heart rate in hemiparetic patients, but no such changes occurred in the control group. In the patients at Brunnstrom stages III, IV, and V, the double product and the lactic acid level increased, and after the patients walked at the highest speed these were significantly higher than in the other two groups. Serum catecholamine levels did not differ among the three groups during exercise. Low intensity exercise can increase cardiovascular responses, and anaerobic metabolism can become dominant in patients with poor motor function.

Wild-type p53 gene-induced morphological changes and growth suppression in hepatoma cells

The human hepatocellular carcinoma (HCC) cell line, HLF, expresses only mutant-type p53 (mt-p53), which has an amino acid substitution at the 244th residue from glycine to alanine. HLF cells were transfected with wild-type p53 (wt-p53) cDNA construct pC53-SN3, mt-p53 cDNA construct pC53-SCX [which differs by a single nucleotide, resulting in alanine instead of valine at the 143rd residue in p53 (p53-143)], or pCMV-Neo-Bam, as a control, by a liposome method. After G418 selection, three wt-p53 stable transformants (WT), four mt-p53 transformants (MT), and three control vector transformants (VT) were obtained. We analyzed the cell growth and morphological changes of these transformants under different culture conditions [fetal calf serum (FCS), 10%, 1%, and 0%]. Whereas no difference from control in the growth rate and morphology was observed under the 10% FCS conditions, serum starvation induced remarkable phenotypical changes in all three WTs, but not in the other transformant. Corresponding to these phenotypical changes, the transcriptional activity of wt-p53 was increased more than nine fold. These results indicated that serum starvation would induce wt-p53 biological function, which is tightly linked to morphological changes and growth suppression. To induce these changes, the introduction of the wt-p53 gene itself was not sufficient, and additional triggering, i.e., serum starvation, was indispensable.

Inhibition of tumor necrosis factor-alpha production retards liver regeneration after partial hepatectomy in rats

We studied the effects of a tumor necrosis factor-alpha (TNF-alpha) production inhibitor E3330, [(2E)-3-[5-(2,3-dimethoxy-6-methyl-1,4-benzoquinolyl)]-2-nonyl-2-+ ++propenoic acid] on liver regeneration in rats subjected to 70% partial hepatectomy. The BrdU labeling index was 53.5 +/- 3.8% 24 h after partial hepatectomy alone and was significantly inhibited by E3330 (25 and 50 mg/ kg) in a dose-dependent manner (43.3 +/- 2.1% and 19.0 +/- 10.3%, respectively; p < 0.05, p < 0.01). In these 3 groups, TNF-alpha protein levels in liver tissue were 187 +/- 18, 123 +/- 47, and 89 +/- 33 pg/mg total protein, respectively, with a significant decrease by E3330 administration (p < 0.01). TNF-alpha mRNA expression in liver tissue was also reduced by E3330. These results suggest that TNF-alpha promotes liver regeneration after partial hepatectomy.

Clinicopathologic features of early hepatocellular carcinoma

BACKGROUND/AIMS

This study attempts to clarify the clinicopathologic definition of early hepatocellular carcinomas (HCCs).

MATERIALS AND METHODS

We evaluated 57 patients, with HCCs less than 3 cm in diameter, in terms of prognosis, incidence of extrahepatic metastasis, and tumor recurrence rate following treatment.

RESULTS

Survival was related to both tumor number and histologic differentiation, but was not related to tumor size. Furthermore, prognosis appeared to depend on the functional reserve of the liver. The incidence of extrahepatic metastasis was related to histologic differentiation. There was no significant difference in the recurrence rates of patients with uninodular tumors in terms of tumor size.

CONCLUSIONS

Our findings indicate that early HCCs measure 15 mm or less in diameter, are uninodular, and are histologically well-differentiated. Finally, the functional reserve of the liver will likely be an additional parameter that will further characterize early HCCs.

Cell death induced by baicalein in human hepatocellular carcinoma cell lines

We examined the action of baicalein, a flavonoid contained in the herbal medicine sho-saiko-to (TJ-9), on three cell lines of human hepatocellular carcinoma (HCC). Treatment with baicalein strongly inhibited the activity of topoisomerase II and suppressed the proliferation of all three HCC cell lines. But the mode of cell death induced by baicalein differed according to the cell line. Baicalein induced apoptosis in a concentration-dependent manner in only one cell line, and an increased concentration of baicalein produced cell death via necrosis in the other two lines. These results suggest that the inhibition of topoisomerase II is not by itself sufficient for induction of apoptosis, and that there is a more important mechanism which can account for the difference in susceptibility of cells to apoptosis induced by baicalein.

Hepatocyte proliferation induced in rats by lead nitrate is suppressed by several tumor necrosis factor alpha inhibitors

Lead nitrate induces liver cell proliferation in rats without accompanying liver cell necrosis. However, the mechanism of this proliferation and its effect on hepatocytes remain unknown. Therefore, we examined the liver and blood level of hepatocyte growth factor and tumor necrosis factor alpha (TNF-alpha) at various intervals to determine whether lead nitrate modifies hepatocyte proliferation by altering the production of these cytokines. We also administered several TNF-alpha inhibitors, dexamethasone, adenosine, (2E)-3-[5-(2,3-dimethoxy-6-methyl-1,4-benzoquinoyl)]-2-nonyl-2- propenoic acid (E 3330), and pentoxifylline, to rats to clarify whether pretreatment with these inhibitors suppresses the increase of TNF-alpha messenger RNA (mRNA) in the liver and prevents the hepatocyte proliferation induced by lead nitrate. Hepatocyte proliferation occurred by 24 hours and reached a peak 48 hours after a single intravenous injection of lead nitrate (100 mumol/kg). TNF-alpha mRNA expression in the liver was increased 1, 6, and 12 hours after the injection, whereas no alteration was observed in liver or blood level of hepatocyte growth factor. Pretreatment with dexamethasone (4.0 mg/kg), E3330 (100 mg/kg) adenosine (0.3 mmol/kg), and pentoxifylline (100 mg/kg), inhibited both TNF-alpha mRNA expression and hepatocyte proliferation 48 hours after the injection. These experimental results strongly support the hypothesis that TNF-alpha positively regulates the hepatocyte proliferation induced in rats by the mitogen, lead nitrate.

Endoscopic ligation of gastric varices using a detachable snare

A new technique of endoscopic treatment for gastric varices is presented here, which was applied in 10 patients, either electively (n = 9) or as emergency therapy for bleeding (n = 9) or as emergency therapy for bleeding (n = 1). A detachable snare is placed endoscopically, tightened around the varix, and then detached using a similar principle to that of band ligation. Following one or two treatment sessions (one snare applied in seven cases, two snares applied in three cases), eradication of gastric varices was observed in all patients. No significant complications were encountered, and nine of 13 snares passed spontaneously, the remaining ones being removed when found during follow-up endoscopy. Short-term follow-up (4-12 months, mean: 7.2 months) did not show either reappearance of varices or rebleeding in any of the patients. Angiography and endoscopic ultrasonography performed in four patients before and after treatment showed regression or disappearance of intramural vessels. Further studies will show the relative value of this new technique compared to other treatment modalities such as banding or cyanoacrylate injection.

[Bacterial cerebritis developed from purulent meningitis--serial CT and MRI study of a case]

A 54-year-old woman was admitted to our hospital because of purulent meningitis caused by Streptococcus pneumoniae during a long-term administration of prednisolone for the treatment of bronchial asthma. After admission, both antibiotics and steroids were given, which resulted in her good general and neurological condition, and the normal protein and glucose content in her cerebrospinal fluid three weeks later. However, post-contrast computerized tomography (CT) at this time showed various size of multiple irregular high-densities devoid of capsular component in the white matter of the bilateral cerebral hemisphere. MRI examination revealed that the lesions were of low intensity on the T1-weighted sequence whereas high on T2-weighted sequence. Gd-DTPA enhanced the T1-weighted images on these lesions. These findings may indicate that the lesions were at the pre-encapsulation stage of cerebritis, because the lesions were gradually reduced and disappeared after the subsequent antibiotic therapy. It is emphasized that patients with purulent meningitis under steroid therapy require careful observation for the risk of bacterial cerebritis.

[Assessment of factors associated with the outcome in patients with hypertensive putaminal hemorrhage]

A total of 32 patients with hypertensive putaminal hemorrhage, who had been admitted within 24 hours of onset, were reviewed. Patients were divided into three groups on the basis of their outcome at hospital discharge, as follows: Group A, 11 patients who were able to walk independently with good or full recovery from hemiparesis; Group B, 9 patients who were able to walk with a cane and 2 patients in wheel chairs; and Group C, 6 patients who required evacuation of hematoma and 4 who had died. We investigated factors affecting outcome by comparing the clinical features during the acute stage and degrees of hypertensive damage to the retina, heart, and kidney of the above three groups. Furthermore, we examined interrelationships among the volume of the hematoma (as calculated from CT scan), systemic blood pressure, and urinary catecholamine excretion in 10 of these patients. The mean age in groups A, B and C was 61.4 +/- 8.1, 58.0 +/- 11.3, and 52.4 +/- 6.8, respectively. The mean volume of hematoma on admission (Day 1) in Group C (50.2 +/- 28.2 ml) was significantly larger than in the other two groups (p less than 0.01, vs Group A: 19.5 +/- 8.8 ml; p less than 0.05, vs Group B: 25.1 +/- 12.6 ml). In Group C, the mean hematoma volume on Day 2 (98.4 +/- 39.5 ml) was significantly larger than the volume on Day 1 (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of spinal dural arteriovenous malformation associated with the broad lesion within spinal cord--diagnostic value of MRI with Gd-DTPA enhancement]

A 70-year-old man, with slowly progressive gait disturbance, numbness in his lower limbs and dysuria, was admitted to our hospital in July, 1988. Neurological examination revealed flaccid paraparesis, hyperesthesia below the level of Th-10 combined with the disturbance of pain and temperature sensations below the level of Th-11, and neurogenic bladder. Midsagittal Tl-weighed image of MRI did not reveal any abnormal finding except for a mild enlargement of the conus medullaris. With Gadolinium (Gd)-DTPA injection, however, the spinal cord was diffusely enhanced below the level of the 9th thoracic spine. This enhancement effect was particularly remarkable at the periphery of the spinal image showing several high intensity spots in the posterior aspect of the spinal cord, which was thought to be incompatible with the spinal cord neoplasm. The angiographic examination of the selective Th-7 intercostal artery on the left showed vascular malformation lying adjacent to the 7th intervertebral foramen with markedly dilated tortuous spinal veins going upwards and downwards, which was compatible with spinal dural arteriovenous malformation (AVM). After the artificial embolization, draining veins as well the nidus of AVM had completely disappeared on angiogram. There was an improvement on his neurological findings and Gd-DTPA enhancement had been diminished on MRI. It was suggested that Gd-DTPA enhancement on MRI was due to the dilated and remarkably congestive spinal veins, and that both the elevated venous pressure and reduction of intramedullary arteriovenous pressure gradient were the cause of the development of clinical symptoms.