Localization of Satratoxin-G in Stachybotrys chartarum Spores and Spore-Impacted Mouse Lung Using Immunocytochemistry

Satratoxin-G (SG) is the major macrocyclic trichothecene mycotoxin produced by Stachybotrys chartarum ( atra) and has been implicated as a cause of a number of animal and human health problems including pulmonary hemorrhage in infants. However, there is little understanding where this toxin is localized in the spores and mycelial fragments of this species or in the lung impacted by SG-sequestered spores. The purpose of this study was to evaluate the distribution of SG in S. chartarum spores and mycelium in culture, and spore-impacted mouse lung in vivo, using immunocytochemistry. SG was localized predominately in S. chartarum spores with moderate labelling of the phialide-apex walls. Labelling was primarily along the outer plasmalemma surface and in the inner wall layer. Only modest labelling was observed in hyphae. Toxin localization at these sites supports the position that spores contain the highest satratoxin concentrations and that the toxin is constitutively produced. In impacted mouse lung, highest SG labelling was detected in lysosomes, along the inside of the nuclear membrane in nuclear heterochromatin and RER within alveolar macrophages. Alveolar type II cells also showed modest labelling of the nuclear heterochromatin and RER. There was no evidence that the toxin accumulated in the neutrophils, fibroblasts, or other cells associated with the granulomas surrounding spores or mycelial fragments. These observations indicate that SG displays a high degree of cellular specificity with respect to its uptake in mouse lung. They further indicate that the alveolar macrophages play an important role in the sequestration and immobilization of low concentrations of the toxin.

Otoneurological management of petrous apex cholesterol granuloma

OBJECTIVE

The aim of the study is to review the management of petrous apex cholesterol granuloma. The surgical approaches for drainage or total removal and the wait and see policy were analyzed, and outcomes were evaluated.

METHODS

Retrospective charts of 27 patients managed for petrous apex cholesterol granuloma with a minimum follow-up of 12 months were analyzed in a quartenary skull base center. Presenting symptoms and signs were recorded, and radiologic imaging was evaluated. Management options included wait and see policy and surgery by several approaches.

RESULTS

The mean age of patients affected by the lesion was 38.8 years. The mean follow-up was 56.7 months. Patients complained of hearing loss, vertigo, tinnitus, diplopia, hemifacial spasm, trigeminal neuralgia, and facial paresthesia. Twelve patients were managed by wait and see policy, and in this category, only one lesion showed growth during the follow-up. Depending upon size and location, 15 patients were surgically treated by infralabyrinthine approach (9 patients), infratemporal type B approach (3 patients), combined infratemporal type B transotic approach (2 patients), and transotic approach (1 patient). One recurrence was recorded during the follow-up.

CONCLUSIONS

Radiologic evaluation is required for diagnosis and management. Patients with good hearing can be treated by infralabyrinthine approach. Infratemporal fossa type B approach is advocated in patients with extensive disease and internal carotid artery involvement. Wait and see policy is recommended for asymptomatic cases. Drainage and permanent ventilation are the goals of treatment. Complete removal is indicated in selected cases where placement of drainage tube is not feasible.

Huge cholesterol granuloma of the middle ear extending to middle cranial fossa

Cholesterol granuloma (CG) may erode into the middle ear, the mastoid bone and the petrous apex. However, aggressive erosion into the cranial cavity is extremely rare. Here we report a case of huge CG extending to the middle cranial fossa. Temporal bone computerized tomography showed a soft tissue mass which destroyed the bony plate of the posterior and middle cranial fossa. On magnetic resonance imaging, the mass revealed a high signal on both T1 and T2-weighted images. The mass compressed the middle cranial fossa without invasion into the brain. The CG was removed by extended cortical mastoidectomy. The postoperative course was uneventful and there were no neurological complications.

Contralateral ear in chronic otitis media: a histologic study

OBJECTIVE

The objective of this study is to determine the prevalence of the contralateral ear changes in human temporal bones of donors with chronic otitis media.

STUDY DESIGN

Transversal.

MATERIAL AND METHODS

The temporal bones were examined under light microscopy and then described. Chronic otitis media was defined by the presence of irreversible inflammatory alterations in the middle ear cleft. The contralateral ear was defined as the normal or the less affected ear. To compare the qualitative variables, the chi test was used. Spearman's nonparametric test was used for correlations. P values less than or equal to .05 were considered significant.

RESULTS

We studied 85 pairs of temporal bones. Cholesteatoma was observed in 22.4% of the more damaged ears. The prevalence of contralateral ears with alterations was 91.8%. The main alterations were granulation tissue (81%), effusion (58%), and tympanic membrane retractions (35%). There was a direct and moderately strong correlation between the extent of granulation tissue in the more damaged ear and the contralateral ear (r(s) = 0.345, P = .004). A strong correlation was observed between the extent of cholesteatoma in the more damaged ear and in the contralateral ear (rs = 0.617, P < .001).

CONCLUSION

We observed a high prevalence of changes in the contralateral ear. There was a direct correlation between the extent of both granulation tissue and cholesteatoma between the two ears, demonstrating that the more extensive the manifestation of these pathologies in the more damaged ear, the greater they will be in the contralateral ear.

Lesions of the petrous apex: diagnosis and management

Management of petrous apex pathology poses a unique challenge even to the most seasoned skull base surgeons. The central location in the skull base with adjacent critical neurovascular structures makes access to this region more than a trivial matter. Significant advances in diagnostic imaging have greatly facilitated the diagnosis of petrous apex lesions. The introduction of modern skull base surgery techniques also has provided skull base surgeons with numerous avenues to the petrous apex while significantly decreasing morbidity. The latest diagnostic and management strategies are discussed and an update of some of the more common pathologic entities is provided.

Enhancement by PL 14736 of granulation and collagen organization in healing wounds and the potential role of egr-1 expression

Apart from becaplermin (recombinant human platelet-derived growth factor homodimer of B chains, PDGF-BB), for the treatment of lower extremity diabetic ulcers, few agents are available for pharmacological stimulation of wound healing. We have compared the mechanism of action of the potential wound healing agent, PL 14736 (G E P P P G K P A D D A G L V), with that of PDGF-BB on granulation tissue formation following sponge implantation in the normoglycemic rat and in healing full-thickness excisional wounds in db/db genetically diabetic mice. Expression of the immediate response gene, early growth response gene-1 (egr-1) was studied in Caco-2 cells in vitro. While PDGF-BB and PL 14736 had similar selectivity for stimulation of granulation tissue in both sponge granuloma and in healing wounds in db/db mice, PL 14736 was more active in stimulating early collagen organization. It also stimulated expression of egr-1 and its repressor nerve growth factor 1-A binding protein-2 (nab2) in non-differentiated Caco-2 cells more rapidly than PDGF-BB. EGR-1 induces cytokine and growth factor generation and early extracellular matrix (collagen) formation, offering an explanation for the beneficial effects of PL 14736 on wound healing.

A diagnostic trap for the dermatopathologist: granulomatous reactions from cutaneous microimplants for cosmetic purposes

We present a case of late granulomatous reactions from silicone that first appeared in a site different from that of the injection causing an incorrect diagnosis of liposarcoma in the beginning. The histological picture was a cystic-macrophagic granuloma in both the injection site (upper lip) and the migrating site (paranasal regions). We think that the foreign body has undergone an antigravity migration from the upper lip to the right paranasal region. To our knowledge, such a phenomenon has not been yet reported in literature.

Aggressiveness in Cholesterol Granuloma of the Temporal Bone May Be Determined by the Vigor of Its Blood Source

OBJECTIVE

Recently, it has been proposed that the aggressive behavior of cholesterol granuloma (CG) of the petrous apex is explained by its proximity to the richly vascular marrow of the petroclival junction. Most CGs of the lateral temporal bone are indolent. The purpose of the present study is to examine the factors responsible for atypical aggressive behavior in mastoid CG.

STUDY DESIGN

Retrospective case series.

SETTING

: Tertiary academic practice.

PATIENT POPULATION

Four patients with atypically aggressive CG of the mastoid.

RESULTS

In each case, the CG abutted a rich blood source: the sigmoid sinus, carotid artery, a large dural vein, or a rich deposit of vascular marrow in the mastoid tip.

CONCLUSION

These observations lend further support to the theory that aggressiveness of CG is sustained by a robust source of ongoing hemorrhage.

Knee locking due to a single gouty tophus

Knee locking is a highly incapacitating condition attributable to mechanical or functional factors. Pain, mostly of capsuloligamentous or intraosseous origin, is the cause of functional locking. Meniscal injuries are the most frequent arthroscopic finding in the locked knee, due to mechanical factors. We describe a patient experiencing locking during extension whose history and examination suggested a tear of the anterior horn of the lateral meniscus of the right knee; a diagnostic/therapeutic arthroscopy revealed an intraarticular gouty tophus growing from the anterior horn of the lateral meniscus.

Analysis of fifteen positional candidate genes for Schnyder crystalline corneal dystrophy

PURPOSE

To identify the genetic basis of Schnyder crystalline corneal dystrophy (SCCD) through screening of positional candidate genes in affected patients.

METHODS

Mutation screening of fifteen genes (CORT, CLSTN1, CTNNBIP1, DFFA, ENO1, GPR157, H6PD, KIF1B, LOC440559, LZIC, MGC4399, PEX14, PGD, PIK3CD, and SSB1) that lie within the candidate gene region for SCCD was performed in members of two families affected with SCCD.

RESULTS

No presumed disease-causing mutations were identified in affected patients. Seventeen previously described single nucleotide polymorphisms (SNPs) were identified in eight of the candidate genes. Novel SNPs were identified in both affected and unaffected individuals in GPR157 (c.795C>T [Arg218Leu]; c.811C>T [Ala223Val]), MGC4399 (c.1024G>C [Leu277Leu]), and H6PD (c.754A>C [Asp151Ala]).

CONCLUSIONS

No pathogenic mutations were identified in fifteen positional candidate genes in two families with SCCD. As the candidate gene region in each SCCD family previously examined with haplotype analysis has been mapped to the same chromosomal region, the absence of pathogenic mutations in these positional candidates in the families we examined reduces the number of remaining positional candidate genes by half, and the number of remaining candidate genes with a known gene function by two-thirds. We anticipate that screening of the remaining positional candidate genes will lead to the identification of the genetic basis of SCCD.

Antagonism of vascular endothelial growth factor results in microvessel attrition and disorganization of wound tissue

Vascular endothelial growth factor (VEGF) is a potent growth factor that is indispensable for the development of blood vessels in the fetus and for wound healing in adults. VEGF likely plays a role in maintaining the blood vessels once they have been formed. It is not clear, however, whether a low tissue VEGF (caused either by disease or by systemic administration of VEGF antagonists) can cause abnormalities in preexisting blood vessels, especially of wound tissue that requires high local levels of VEGF for healing. The present study investigated the effect of VEGF antagonism on blood vessels of foreign-body granulomas (a model of wound-healing tissue). Granulomas were induced by implanting perforated polyvinyl tubes into the subcutaneous tissue of rats and allowed to develop for 14 days, at which time the implanted tubes were completely encapsulated by the subcutaneous tissue. The encapsulated granulomas consisted of 3 distinct histological layers, of which the middle layer was well perfused by a rich supply of microvessels. Morphologically, the granuloma remained "stable" after developing for 14 days. At 1 week, VEGF levels in the granuloma fluid, which is in equilibrium with the interstitial fluid, were 25 times higher than in the plasma. VEGF levels in the granuloma fluid continued to increase for up to 3 weeks, reflecting the high dependence of the wound tissue on ambient VEGF levels. After injection of the VEGF receptor antagonist in the fully formed granuloma, the preexisting blood vessels in the middle layer regressed and underwent apoptosis, accompanied by expansion of the extracellular matrix (predominately collagen I) into areas normally devoid of matrix. We conclude that wound tissue is sensitive to ambient VEGF levels, and that a low VEGF condition resulting from VEGF receptor antagonism can disrupt the healing of wound tissue.

Morphologic Characteristics of Lamellar Channel Deposits in the Human Eye

OBJECTIVE

To report the histologic characteristics of lamellar channel deposits after polymethyl methacrylate intrastromal corneal ring segments in a human eye.

METHODS

A 34-year-old man previously diagnosed with keratoconus received photorefractive keratectomy in his left eye that exacerbated his corneal ectasia. To delay or possibly prevent corneal transplant, the patient elected to have intrastromal corneal segments implanted in the left eye. One year later the patient underwent corneal transplant. Before transplant, lamellar channel deposits were noted on clinical microscopic examination of the left eye. We performed histologic evaluation to assess changes to the patient's excised corneal tissue and to further characterize the observed lamellar channel deposits.

RESULTS

Lamellar channel deposits in humans are histologically similar to our previous descriptions of deposits in rabbits. These deposits primarily consist of intracellular lipid accumulations that stain positively with oil red O and filipin but not periodic acid Schiff reaction. Immunohistochemistry of cells located in the deposit region stained positively with vimentin, suggesting that these cells were keratocytes. Stains for cytokeratins 3 and 12 and for CD68 were both negative, indicating that epithelial cells and macrophages were not present in the deposit region.

CONCLUSION

Lamellar channel deposits are a common clinical finding after intrastromal corneal implants. This case provides further evidence to support our hypothesis that lamellar channel deposits in humans are a tissue response to corneal implants that consist of intracellular lipid accumulations. We use this case to propose a theoretical construct for the observation of stromal lipid accumulation in response to corneal injury.

Murine macrophages cultured with IL-4 acquire a phenotype similar to that of epithelioid cells from granulomatous inflammation

Epithelioid cells (ECs) found in granulomas are thought to derive from mononuclear phagocytes. Although GM-CSF and/or IL-4 are known to promote cell differentiation their role in the development of ECs has never been demonstrated. Here we showed that mouse macrophages treated exclusively with recombinant IL-4 (rIL-4) differentiate into epithelioid-like cells. Macrophages cultivated with rIL-4 presented a fried-egg shape, and ultrastructural studies revealed membrane interdigitations, cytoplasmic vesicles, prominent Golgi complex, and rough endoplasmic reticulum. Compared with controls, rIL-4 treated cells displayed increased expression of MHC class II molecules and of Migration Inhibitory Factor-Related Protein-14. Whereas mannose receptor-mediated phagocytosis was increased, Fcgamma-receptor mediated phagocytosis and the production of nitric oxide were decreased in treated cultures. All these features overlap those reported for ECs from granulomatous lesions. In conclusion, treatment of mouse peritoneal macrophages with rIL-4 drives their in vitro differentiation to an epithelioid phenotype and provides a tool to investigate the biology of ECs.

Change in location of cytokine-induced neutrophil chemoattractants (CINCs) in pulmonary silicosis

Rat cytokine-induced neutrophil chemoattractants (CINCs), which belong to the interleukin-8 family, are known to be induced by treatment with lipopolysaccharide (LPS). Recently, CINCs were grouped into four subtypes-CINC-1, CINC-2alpha, CINC-2beta, and CINC-3-and CINC-1 was considered to be a major isoform among the four CINCs in LPS-induced acute lung inflammation in rats. The purpose of this study was to investigate the change in location of CINCs with chronic inflammation induced by experimental pulmonary silicosis. Administration of silica particles induced lung granulomas. Immunohistochemical staining for CINCs showed that the number of cells positive for CINC-2alpha, CINC-2beta, and CINC-3 was increased, peaking at 1 day after treatment with silica particles, whereas CINC-1 was almost undetectable. We suggest that CINC-2alpha, CINC-2beta, and CINC-3 are the most important chemoattractants in the formation of granulomas in chronic inflammation.

Oxidized cellulose (Surgicel) granuloma mimicking a primary ovarian tumor

A 37-year-old woman presented with left lower quadrant pain and vaginal spotting 1 month after hysterectomy and right salpingo-oophorectomy, which were performed for hemoperitoneum related to a ruptured corpus luteum. An 8-cm left ovarian mass was removed that had a microcystic, mucoid sectioned surface. Histological examination revealed that the mass consisted of a massive foreign-body granulomatous reaction to oxidized cellulose (Surgicel). To our knowledge, this is only the second report of an ovarian Surgicel granuloma.

Histopathologic study of the temporal bones and Eustachian tubes of children with cholesterol granuloma

Six temporal bone-eustachian tube (ET) specimens with cholesterol granuloma (CG), obtained from 6 children 6 months to 15 years of age, were studied histopathologically to obtain further information about the pathogenesis of CG. We observed CG in the mastoid air cells in 5 ears, the mastoid antrum in 1 ear, the aditus ad antrum in 2 ears, and the epitympanum in 1 ear. All 6 cases exhibited a large amount of remaining mesenchyme that was in continuity with the hematopoietic bone marrow in the locations in which CG was present. All cases demonstrated otitis media with effusion and inflammation of the ET. Apparent morphological abnormalities of the ET and its associated structures, including hypoplastic ET cartilage and an abnormal tensor veli palatini muscle, were noted in 3 of the 6 cases. Furthermore, the posterior cartilaginous portion of the ET that includes its narrowest portion was completely filled with effusion in 2 of the 3 cases with the ET anomaly. The findings obtained were compared with data from age-matched control cases. Our results suggest that the source of erythrocytes in the remaining mesenchyme is the hematopoietic bone marrow. The pathogenesis of CG in children is likely promoted by ET dysfunction resulting in failure of ventilation of the middle ear.

Association between hemosiderin deposition and blood vessel regression during involution of foreign-body granuloma. Histochemical and ultrastructural study

We have characterized the sequence of events resulting in vessel occlusion and stasis of blood flow during involution of a foreign-body granuloma using histochemistry and electron microscopy. In the microvascular bed of the granulation tissue accompanying the progressive resorption of an implanted collagen sponge, endothelial cells protruded into the vascular lumen, resulting in the occlusion of the lumens of venules and capillaries. Examination of sections stained by the TUNEL method showed brown-yellow stained structures in the vascular lumen during regression of blood vessels. However, the ultrastructural profiles of endothelial cells effectively involved in the vessel occlusion showed none of the cardinal morphological features of apoptosis. These endothelial cells which displayed remarkable indentations of their nuclei in the form of nuclear pinches and/or deep pockets bulged conspicuously into the lumen. Such endothelial cells served as effective valves by protruding into the lumens of small blood vessels, and eventually the vessels were completely plugged by red blood cells. However, protruding endothelial cells subsequently shed into the vascular lumen by deviating themselves from the constitution of the vessel wall. The endothelial cells undergoing apoptosis were removed by intraluminal macrophages. Between the 130 and 140 day, the occurrence of small vessels tightly packed with erythrocytes reached a peak value in the granulation tissue and was accompanied by hemosiderin deposits. The plugged vessels were frequently associated with erythrocyte extravasation, leading to openings between degenerated endothelial cells due to the disappearance of endothelial cytoplasmic projections. Extravasated erythrocytes were rapidly eliminated by phagocytic cells such as mononuclear macrophages and multinucleated giant cells, and ended as hemosiderin deposits in granulation and/or scar tissue at the end of the experimental period (130-140 days). The morphological analysis of this regression sequence suggests that the protrusion of endothelial cells with the nuclear deformation is a mechanism contributing to the occlusion of blood vessels and consequently leads to erythrocyte extravasation.

Foreign bodies in sarcoidosis

Sarcoidosis is a multisystem disease of unknown etiology. The demonstration of polarizable foreign bodies in cutaneous granulomas is generally thought to exclude a diagnosis of sarcoidosis. Nevertheless. some investigators have reported systemic sarcoidosis with cutaneous manifestations in which polarizable particles were associated with granuloma formation in the skin. We searched the biopsy specimens of granulomatous lesions from 50 patients with cutaneous sarcoidosis using polarization microscopy to estimate the frequency of polarizable foreign bodies in cutaneous lesions of sarcoidosis. Using electron probe microanalysis, we sought to determine what elements compose these foreign bodies. Polarizable foreign bodies were found in the granulomatous skin lesions of 12 of 50 patients with cutaneous sarcoidosis. All 12 patients also had at least one other granulomatous systemic lesion, and 4 had biopsy specimens of a systemic lesion available for review. Polarizable foreign bodies were found in two cases. The elements identified were calcium, phosphorus, silicon, and aluminum. Polarizable foreign bodies were found in cutaneous sarcoidosis far more often than expected. Foreign bodies were also found in granulomatous systemic lesions. The foreign body may serve as an inciting stimulus for granuloma formation in selected cases of sarcoidosis.

Histologic evidence of foreign body granulation tissue and de novo lesions in patients with coronary stent restenosis

OBJECTIVES

We examined the relative contributions of foreign body granulation and de novo lesions to neointimal hyperplasia in atherectomized specimens of restenosis after coronary stenting.

BACKGROUND

Clinicopathological studies have suggested that smooth muscle cell (SMC) hyperplasia is the most likely cause of restenosis after coronary stenting. It is not yet fully understood how SMC hyperplasia occurs or how SMCs stimulation can lead to intimal hyperplasia. Although inflammation has been postulated to be a major contributor to restenosis after coronary stenting, there is a paucity of data on the relationsip between inflammation and subsequent neointimal formation in humans. Only in a porcine experimental model of stent restenosis, foreign body granulation tissue as a cause of inflammation in stent restenosis was reported.

METHODS

Tissue specimens were retrieved by directional atherectomy from 11 patients in whom stent restenosis developed after percutaneous revascularization of coronary artery disease. For specimens preserved in 10% buffered formalin, analysis of cellular composition was performed quantitatively after cell-specific immunostaining, i.e. CD68, UCHL-1, HLA-DR, smooth muscle actin, vimentin, desmin, PCNA and TGF-beta.

RESULTS

Five of the 11 patients showed granulation tissues 3-6 months after stent implantation, of whom 3 patients revealed foreign body multinucleated giant cells around the stent struts where PCNA- and vimentin-positive SMCs were demonstrated. Calcification and de novo lesions in medial and adventitial tissues were observed in 3 other patients, and fresh and/or organized thrombi were documented in 3 of the 11 patients.

CONCLUSIONS

These findings support the notion that stent restenosis results from SMC hyperplasia and suggest that the foreign body granulation tissue against metals of the stents and de novo lesions could play an important role in chronic inflammation leading to intimal hyperplasia and subsequently to stent restenosis in some patients. Clinicians should thus consider whether a patient may be allergic to stent components with unknown reaction, e.g. haptens.

Visualization of oxygen radical production in mouse liver in response to infection with Schistosoma mansoni

BACKGROUND/AIMS

The tropical parasite S. mansoni induces granulomatous inflammation in the liver, following the lodging of eggs in this organ. In vitro studies suggested that the host's response might involve the production of oxygen radicals.

METHODS

In an attempt to investigate the situation at the site of inflammation, under disease conditions, livers of infected mice were treated with dichlorodihydrofluorescein diacetate which fluoresces after oxidation.

RESULTS

Fluorescence of the oxidized tracer revealed that oxygen radicals were produced by granulomatous inflammatory cells. The phenomenon reached its highest intensity close to the eggs. The membranes of the cells were strongly labelled, probably reflecting membrane-associated NADPH oxidase activity. The cytoplasm of hepatocytes was also fluorescent but with lower intensity; hepatocyte membranes or nuclei were not labelled. Fluorescence was reduced drastically by treatment with catalase and antioxidants, indicating the occurrence of H2O2. Treatment with superoxide dismutase had no effect. Neither the livers of uninfected animals nor those of infected animals before parasite egg deposition were labelled. Eosinophil peroxidase activity was released in the areas of inflammatory cells, but was not found in hepatocytes.

CONCLUSIONS

The H2O2/peroxidase system, which is the cornerstone of the antimicrobial defense associated with inflammation, is activated in close contact with parasite eggs. The process does contribute to egg killing in vivo. Moreover, hepatocytes undergo oxidative stress in the entire organ. This finding is in agreement with the parasite-induced decrease of liver antioxidant defenses demonstrated previously.

Modulation of in vivo granuloma formation related to regulation of in vitro IFN-gamma and IL-4 expressions in experimental schistosomiasis japonica

OBJECTIVE

To find out relationship between the in vitro schistosome egg antigen (SEA) stimulated IFN-gamma and IL-4 mRNA expressions and the in vivo SEA elicited granulomatous responses, the transcriptions of IFN-gamma and IL-4 gene were investigated in the spleen of BALB/c mice infected with Schistosoma japonicum (S. japonicum).

METHODS

Spleens were removed at 0, 3, 5, 8, and 10 and 12 weeks after infection and the spleen cells were incubated in the presence of SEA. The extracted RNA was analyzed for IFN-gamma and IL-4 mRNA by reverse transcription PCR (RT-PCR). Newly-formed liver granulomas were measured.

RESULTS

The study revealed that no detectable IFN-gamma and IL-4 mRNA RT-PCR products were found in SEA treated spleen cells from uninfected, or 3-week infected mice, whereas IL-4 mRNA was found to be expressed in 5- and 8-week infected mice, and an appreciable enhanced expression of IL-4 mRNA was observed in SEA stimulated spleen cells at 8-week infection than at 5-week infections. However, SEA could not induce IFN-gamma and IL-4 mRNA transcription in 10- and 12-week infected mice, indicating the modulated expression of IFN-gamma and IL-4 mRNA.

CONCLUSION

The significant changes of IL-4 mRNA expression in SEA stimulated spleen cells during S. japonicum infection were coincident with SEA elicited granuloma formation and modulation in vivo.

Aluminum silicate-containing psammoma bodies in a cervicovaginal smear (Pap): cytological, ultrastructural, and radiographic microprobe studies

Psammoma body is a rare finding in a cervicovaginal smear and can be associated with either benign or malignant diseases. Here we report a case to illustrate the association of psammoma bodies with benign granulomatous reactions to a foreign material (aluminum silicate).

Expression of NO-synthase in cells of foreign-body and BCG-induced granulomata in mice: influence of L-NAME on the evolution of the lesion

The microbicidal activity of macrophages in an inflammatory milieu has been related to the production of a large number of cytokins and intermediary metabolites of oxygen and nitrogen among them, nitric oxide (NO). Considering that granulomatous inflammation is predominantly composed of macrophages and epithelioid cells, we decided to investigate the participation of NO in this peculiar type of inflammation. Two models were used: glass cover slip implantation into the subcutaneous tissue of mice and, the inoculation of live bacillus Calmette-Guérin (BCG) into the footpad of the animals. Using a histochemical method for the detection of NO synthase and of the concentration of citrulin metabolized by cells obtained from cover slips implanted on different time intervals or BCG-activated peritoneal cells, it was possible to demonstrate that epithelioid cells do not produce NO. Cells from granuloma induced by BCG inoculation express NO synthase, with different degrees of reactivity with a higher intensity in the cytoplasm of cells located in the edge of the lesions. The expression of NO synthase in the cytoplasm of these cells decreases with the age of the lesions. It could also be demonstrated that in mice treated with l-name, an inhibitor of NO metabolism, the lesions induced by BCG lost the granulomatous architecture, were necrotic, and had a significant increase in the bacillary load of the lesion. These data allow us to conclude that NO production by macrophages is a determining factor in the organization of the granulomatous lesion and that it also controls the bacterial load in BCG-induced lesions in mice.

Variations in rat biochemical parameters after buckshot implant

Twenty eight albino Wistar rats were implanted with two 100 mg lead spheres: 14 received the implant in the peritoneum (P) and 14 in the thigh (T). Variations in the activity of delta-aminolevulinic dehydratase (ALAD), of urinary delta-aminolevulinic acid (ALAU), of hematoporphyrins (HP) and of lead blood levels (BPb) were then determined at 30, 60 and 90 days with respect to basal values. Parallel determinations were performed by the same schedule in 7 rats implanted with two glass beads and in 8 sham animals receiving surgical incision alone. Techniques employed for ALAD were Berlin and Schaller; for ALAU, Tomokuni and Ogata; for HP, Piomelli; and for BPb, atomic absorption spectrophotometry. As indicators of lead presence, HP and ALAU proved better, both in P and in T rats. The replacement of lead buckshot for small game hunting by other less toxic elements is recommended.

Mercury content in amalgam tattoos of human oral mucosa and its relation to local tissue reactions

Mucosal biopsies from 48 patients with and 9 without amalgam tattoos were analysed with respect to their mercury content, distribution of mercury in the tissue, and histological tissue reactions. The distribution of mercury was assessed by autometallography (AMG), a silver amplification technique. The mercury content was determined by energy dispersive X-ray fluorescence (EDXRF), a multielemental analysis. Mercury was observed in connective tissue where it was confined to fibroblasts and macrophages, in vessel walls and in structures with the histological character of nerve fibres. A correlation was found between the histopathological tissue reaction, the type of mercury deposition, the intensity of the AMG reaction, and the mercury content. Mercury was also found in patients with amalgam dental fillings but without amalgam tattoos.

The preliminary research on the relationship between TNF- and egg-induced granuloma and hepatic fibrosis of schistosomiasis japonica

The amount and distribution of tumor necrosis factor-alpha (TNF-alpha) in liver at various stages of Schistosomiasis japonicum-infected mice were immunohistochemically determined by SABC method. The results showed that the amount of TNF-alpha in liver began to increase at the 8th-12th week after infection, and reached a peak (9 mice reached 2+ grade or higher) 16 weeks after infection, which was higher than the levels 8 weeks after infection (P = 0.001) and was mainly scattered in and around egg granuloma. At the chronic stage of the infection, the amount of TNF-alpha in liver decrease not increase with an increased secretion of collagen in liver and development of hepatic fibrosis. On the contrary, FN, LN, type I and III collagen in liver began to rise 8-12 weeks after infection, and were linearly scattered around egg granuloma, reaching a peak (more than 70% of infected mice reached 3+(-)4+ grade) at the 20th and 24th week and they became wide, thick and retiform, and deposited around and in egg granuloma. After administration of recombinant TNF-alpha to the infected mice, the amount of FN and LN, the size and the inflammatory response of granuloma in liver showed no significant changes as compared with the untreated group at the same stage. However, the amount of type I collagen in liver increased, among which the amount of type I collagen was significantly higher than that in the untreated group at the same stage (P = 0.01), while similar changes were not observed when recombinant TNF-alpha was administrated to the healthy mice. It is suggested that TNF may play a role in stimulation of fibroblast in liver to proliferate and secrete collagen, but may need to cooperate with some factors.

Significant roles of inducible cyclooxygenase (COX)-2 in angiogenesis in rat sponge implants

Angiogenesis in rat sponge implants, as determined from the concentration of hemoglobin in the sponge granuloma tissues, was gradually increased over a 14-day experimental period. The inducible cyclooxygenase COX-2 was detected in the sponge granuloma tissues at day 4 by Western blot analysis using specific mouse COX-2 antibody. Angiogenesis in the sponge implants was enhanced by daily topical injections of human recombinant basic fibroblast growth factor (bFGF) or human recombinant epidermal growth factor (EGF) (100 or 1000 ng/sponge/day) for 4 days. These treatments clearly enhanced the expression of COX-2 in the sponge granuloma tissues. In immunohistochemical studies, COX-2-positive staining was mainly observed in the endothelial cells of the neovasculature and in the fibroblasts of the granuloma capsule. Administration of the selective COX-2 inhibitor NS-398 (p.o., 3 mg/kg, 3 times a day) for 14 days significantly inhibited the angiogenesis. The angiogenesis enhanced with bFGF or EGF (day 4) was inhibited by administration of indomethacin or NS-398, both in the above regimen, and fell to the level obtained without growth factor treatment. These results suggest that COX-2 induced in the sponge granuloma tissues may participate in neovascularization through prostaglandin formation.

Sequential development of angiotensin receptors and angiotensin I converting enzyme during angiogenesis in the rat subcutaneous sponge granuloma

1. The vasoconstrictor peptide antiotensin II (AII) can stimulate angiogenesis, an important process in wound healing, tumour growth and chronic inflammation. To elucidate mechanisms underlying AII-enhanced angiogenesis, we have studied a subcutaneous sponge granuloma model in the rat by use of 133Xe clearance, morphometry and quantitative in vitro autoradiography. 2. When injected directly into the sponge, AII (1 nmol day-1) increased 133Xe clearance from, and fibrovascular growth in sponge granulomas, indicating enhanced angiogenesis 6 to 12 days after implantation. This AII-enhanced angiogenesis was inhibited by daily doses (100 nmol/sponge) of the specific but subtype non-selective AII receptor antagonist (Sar1, Ile8)AII, and by the selective non-peptide AT1 receptor antagonists losartan and DuP 532. In contrast, AII-enhanced neovascularization was not inhibited by the AT2 receptor antagonist PD123319, nor was it mimicked by the AT2 receptor agonist CGP42112A (each at 100 nmol/sponge day-1). 3. AI (1 nmol/sponge day-1), the angiotensin converting enzyme (ACE) inhibitors captopril (up to 100 micrograms/sponge day-1) and lisinopril (40 micrograms/sponge day-1), or AII receptor antagonists did not affect angiogenesis in the absence of exogenous AII. 4. [125I]-(Sar1, Ile8)AII binding sites with characteristics of AT1 receptors were localized to microvessels and to non-vascular cells within the sponge stroma from 4 days after implantation, and were at higher density than in skin throughout the study. 5. [125I]-(Sar1, Ile8)AII binding sites with characteristics of AT2 receptors were localized to non-vascular stromal cells, were of lower density and appeared later than did AT1 sites. 6. The ACE inhibitor [125I]-351A bound to sites with characteristics of ACE, 14 days after sponge implantation. [125I]-351A bound less densely to sponge stroma than to skin. 7. We propose that AII can stimulate angiogenesis, acting via AT1 receptors within the sponge granuloma. AT1 and AT2 receptors and ACE develop sequentially during microvascular maturation, and the role of the endogenous angiotensin system in angiogenesis will depend on the balanced local expression of its various components. Pharmacological modulation of this balance may provide novel therapeutic approaches in angiogenesis-dependent diseases.

Subcutaneous nodules in a patient hyposensitized with aluminium-containing allergen extracts: a microanalytical study

Electron spectroscopic imaging (ESI) is a recent tool for electron microscopic analysis which permits the recognition of the distribution of elements in a specimen, with a spatial resolution up to 5 nm. The authors performed the ESI together with X-ray microanalysis (EDX) and transmission electron microscopy to study granulomatous subcutaneous nodules in a patient who had undergone a desensitising therapy with an aluminium-containing vaccine. Aluminium was detected both by EDX and ESI, mainly in lysosomes of histiocytes containing needle-shaped material in a lucent matrix. However, ESI provided a better localization of aluminium with respect to EDX. This result suggests that the identification of aluminium-containing structures cannot be obtained only by ultrastructural morphology and underlines the utility of a microanalitycal study for a correct diagnosis in the presence of a needle-shaped deposition of dense material in lysosomes.

Cutaneous sarcoidosis and foreign bodies. An electron probe roentgenographic microanalytic study

A 60-year-old woman had extensive and recurrent foreign-body granulomatous inflammation of her forehead. The granulomata contained double refractile crystalline material. Electron probe roentgenographic microanalysis identified silicon, calcium, aluminum, potassium, and sulphur in the crystalline material. Silicon-rich particles are generally considered exogenous. A diagnosis of sarcoidosis was confirmed by the presence of bilateral hilar and mediastinal lymphadenopathy due to biopsy-proven nodal replacement by noninfectious noncaseating granulomata. We conclude that foreign matter may operate as a nidus for the formation of granuloma in sarcoidosis and that the presence of polarizable matter in a sarcoid granuloma does not rule out sarcoidosis.

The expression of osteoclast markers on foreign body giant cells

The expression of some candidate osteoclast markers, tartrate-resistant acid phosphatase (TRAP), macrophage associated antigens (M phi Ag), and vitronectin receptor (VNR) on foreign body giant cells (FBGCs) was investigated in peri-implant tissues of loosened total joint arthroplasties. Osteoclasts showed distinct staining characteristics. They were strongly TRAP-positive at tartrate concentrations of 50-200 mM and expressed VNR and a restricted range of M phi Ag. In contrast, FBGCs were shown to be significantly heterogeneous. Significant numbers of FBGCs were TRAP-positive at a 100 mM tartrate concentration and some were more intense than osteoclasts. A population of FBGCs did not express M phi Ag such as CD11b, but expressed VNR. It was demonstrated that these candidate osteoclast markers were also positive on FBGCs. These results have highlighted the difficulty in distinguishing these two cell lineages and suggested that there might be some uncertainty in defining osteoclast-like cells in culture studies.

Asteroid bodies: products of unusual microtubule dynamics in monocyte-derived giant cells. An immunohistochemical study

We have studied asteroid bodies (ABs) of multinucleated giant cells (MGCs) in a series of sarcoid and foreign body granulomas with a standard streptavidin-biotin peroxidase technique, using commercial antibodies against collagen, vimentin and tubulin on routinely processed tissue as well as, in one case, on fresh frozen sections (FS). Our findings clearly indicate that ABs are products of the microtubule (MT) system and lack collagen. The tubulin in them stains in fresh FS but is "masked" in formalin-fixed tissue. It can be fully "unmasked" by dephosphorylation and partially by trypsinization. Compared to single microtubule organizing centers (MTOCs) in mononuclear cells serving as internal controls, ABs are obvious replicas of centrosome-nucleated MT assemblies from which they differ principally by the disproportionate size of their components and by the invariable vacuolation of the surrounding cytoplasm. Relying on bits of relevant information gleaned from the literature, our observations support the following preliminary conclusions: 1) spokes are massive bundles of MTs rich in tyrosinated alpha-tubulin coassembled in phosphorylated linkages with yet unidentified microtubule associated proteins (MAPs) and probably microfilament proteins; cores are masses of pericentriolar material including amorphous tubulins, MAPs, phosphoproteins and phospholipids; 2) their size, at least in some ABs, appears to indicate the presence of overlapping centrosome-nucleated MTOCs which in monocyte-derived MGCs are known to be multiple; 3) the cytoplasmic vacuolations around them reflect a collapse and retraction of intermediate filaments (IFs), indicating substantial ongoing MT depolymerization with disruption of MT-IF interactions; 4) ABs are products of unusual MTOC dynamics characterized by simultaneous MT assembly and depolymerization; such a phenomenon, termed "microtubule catastrophe", has been recognized in vitro with centrosome-nucleated MT assemblies under conditions of low tubulin concentrations.

Hyaline ring granuloma: a case report with histochemical and polarized microscopic studies

An unusual case of hyaline ring granuloma arising from the connective tissue wall of a residual apical periodontal cyst is reported. Hyaline rings with foreign-body type giant cell inclusions were a significant feature in the histopathologic diagnosis. Histochemical and polarized light microscopic studies suggested that the introduction of foreign material, possibly cellulose, through the postextraction socket into the cystic wall may have caused the granulomatous reaction and formation of the hyaline ring granuloma. The clinical features of this case and 66 previously reported cases, as well as the pathogenesis of the hyaline rings, are discussed.

[Inhibition of fructus Corni on experimental inflammation]

Fructus Corni (FC) decoction inhibits the increase of peritoneal capillary permeability by ip 0.7% acetic acid in mice, the proliferation of granuloma formed by implanting cotton pellets in rats, the swelling of mouse pinnea with xylene and the edema of hind paw induced by injection of fresh egg white 0.1 ml in rats. FC decreases the contents of ascorbic acid in adrenal, but has no marked effect on the contents of prostaglandin E in inflammatory tissue of rats. These results indicate that the inhibitory effect of FC on the inflammatory process may be related to pituitary-adrenal axis.

[The pharmacokinetics of fluorescein, hematoporphyrin and its derivative during the development of granuloma]

In experiments on rats with granuloma reproduced by subcutaneous implantation of foreign material there was shown a slowing of excretion from the organism as well as a considerable redistribution between the organs of fluorescein, hematoporphyrin and its derivative as compared with intact animals. The noted changes practically did not depend on the time of granuloma development.