Synchronous cancers of the esophagus and the ampulla of Vater after distal gastrectomy: successful removal of the esophagus, gastric remnant, duodenum, and pancreatic head

A case of synchronous squamous cell carcinoma of the esophagus and adenocarcinoma of the ampulla of Vater after previous gastrectomy is presented. The coexistence of these two lesions has never been reported in the English literature. We performed a subtotal esophagectomy, total residual gastrectomy, and pancreaticoduodenectomy with lymph node dissection in a one-stage procedure. An operation of this magnitude could be safely performed with attention to meticulous surgical technique and intensive postoperative care. Histological examination of the ampulla lesion showed adenocarcinoma with Paneth-cell differentiation. This is a rare lesion, and a review of the literature revealed only one other case. Neoplastic Paneth cells were also found in lymph node metastasis that originated from the ampulla tumor. This case confirms that cells with Paneth-cell differentiation can be a significant component in invasive carcinoma.

Serial changes in plasma levels of pancreatic elastase 1 after pancreatic surgeries

The alterations of the plasma level of elastase 1 (Ela) were investigated in 15 patients undergoing total pancreatectomy (TP), 18 patients undergoing pancreatoduodenectomy (PD), 8 patients undergoing distal pancreatectomy (DP) and 10 patients undergoing gastrectomy for gastric cancer (GR). The Ela level decreased rapidly below the normal level after TP. The plasma half-life of Ela was 4.6 +/- 1.2 h (Mean +/- SEM). The Ela levels after PD were abnormally elevated until the 7th postoperative day. The Ela levels after DP and GR were elevated gradually until the 7th postoperative day. From 1 to 6 months after PD, DP and GR, the Ela levels were normal. An additional release of Ela from the remaining pancreas following direct surgical interventions to the pancreas resulted in the elevated of the plasma level of Ela in the early postoperative period. The plasma level of Ela was normalized within 2 weeks after pancreatic surgery.

Non-destructive elemental analysis of vertebral body trabecular bone using muonic X-rays

Non-destructive elemental analysis with muonic X-rays was performed on human vertebral bone and lumbar torso phantoms. It can provide quantitative information on all elements in small deep-seated localized volumes. The experiment was carried out using the superconducting muon channel at TRIUMF in Vancouver, Canada and a lithium drifted germanium detector with an active area of 18.5 cm2. The muon channel produced backward-decayed negative muons with wide kinetic energy range from 0.5 to 54.2 MeV. The muon beam was collimated to a diameter of 18 mm. The number of incoming muons was about 4 x 10(6) approximately 5 x 10(7) per data point. In the measurements with human vertebral bones fixed with neutralized formaldehyde, the correlation coefficient between calcium content measured by muons and by atomic absorption analysis was 0.99 and the level of significance was 0.0003. In the measurements with lumbar torso phantoms, the correlation coefficient between calcium content measured by muons and by atomic absorption analysis was 0.99 and the level of significance was 0.02. The results suggest that elemental analysis in vertebral body trabecular bone using muonic X-rays closely correlates with measurements by atomic absorption analysis.

Messenger RNA expression of heat shock proteins (HSPs) during ocular development

The heat shock proteins (HSPs) are believed to act as molecular chaperones which appear to play some roles in regulation of normal protein folding and also in preventing damage to protein structures under various conditions of environmental stress. We examined the expression of the major HSP families, HSP60, 70 and 90 families and small HSP32, at the mRNA level in ocular development. Expression of HSP32, HSP60, HSP70, HSP84, HSP86 and heat shock cognate protein (HSC)70 mRNAs was examined by in situ hybridization. HSC70, HSP84, HSP86 and HSP60 mRNAs were expressed strongly in all ocular tissues during early stages 3 to 5, corresponding to embryonic day (E)11.5 to E14.5. At stages 6 to 7 (E15.5 to E18.5), the expression of these four mRNA species was decreased markedly in most ocular tissue, while in the retina strong HSC70 and HSP86 mRNA expression was still detected. HSP32 and HSP70 mRNAs were not detected at any stage. These results suggest that the expression of HSPs is developmentally regulated through ocular organogenesis, and the proteins may play some important roles in ocular development.

[Familial amyloidotic polyneuropathy (FAP) type I and the therapies]

Since autonomic dysfunction in familial amyloidotic polyneuropathy (FAP) Type I is recognized in the early stage of FAP patients and restricts their daily life, we developed various therapies for various autonomic manifestations: Loading glucose was often effective for faintness caused by hypoglycemia and erythropoietin was also good therapy for orthostatic hypotension as well as anemia found in the end stage of FAP patients. Stoma and nasal drop of L-threo-DOPS were useful to control diarrhea and orthostatic hypotension. Duplex ultrasonography of the 4 vessels revealed that reverse flow was always recognized in FAP patients with faintness, which was effectively treated by the administration of L-threo-DOPS. Orthotopic liver transplantation revealed effective therapy for autonomic dysfunction in FAP patients. Precise analysis of protein metabolism in FAP patients revealed that among apolipoproteins, only apolipoprotein AII decreased as the progression of the disease and high density lipoprotein gained the negative charge by agarose electrophoresis study. Concerning low density lipoprotein (LDL) study, only variant transthyretin in the circulation associated with LDL in FAP patients, suggesting that LDL may play an important role in the amyloid formation of FAP.

Association of chronic lymphocytic thyroiditis and thyroid papillary carcinoma. A study of surgical cases among Japanese, and white and African Americans

BACKGROUND

An association between lymphocytic thyroiditis and thyroid papillary carcinoma is still controversial. To determine a definite statistical relation, a histopathologic study was performed on tissues from in three races, because there is a racial and age-related difference in the susceptibility to thyroiditis.

METHODS

The prevalence and severity of thyroiditis combined with adenomatous goiter, follicular adenoma, or papillary carcinoma was defined by examination of surgically resected materials from Japanese (626 patients), and white and African Americans (330 and 90 patients, respectively).

RESULTS

The prevalence of lymphocytic infiltrates, which are indicative of autoimmune thyroiditis, was significantly higher in patients with papillary carcinoma than in patients with adenomatous goiter or follicular adenoma among Japanese females (63.0%) and males (50.0%), white females (76.0%), and African American females (46.2%). Lymphocyte infiltration into the follicular adenoma or papillary carcinoma correlated with the severity of combined thyroiditis.

CONCLUSION

An association between chronic lymphocytic thyroiditis and papillary carcinoma was confirmed in the Japanese, and white and African American populations. The possibility of autoimmune thyroiditis as a predisposing factor for papillary thyroid carcinoma, is suggested.

[Biosynthesis, processing, and lysosome targeting of acid phosphatase]

The biosyntheses, processing, and intracellular transport of lysosomal APase were studied using pulse-chase experiments with primary cultured rat hepatocytes and subcellular fractionation techniques of rat liver after pulse-labeling with [35S] methionine in vivo. Apase was transported as a membrane-bound enzyme from the site of synthesis in the ER through the Golgi complex to lysosomes. Unlike many lysosomal enzymes which are translocated into lysosomes through the mediation of the Man-6-P receptors, transport of APase to lysosomes was independent of the Man-6-P receptor system. The transport of APase to lysosomes is dependent on the GY-motif which is located in its cytoplasmic domain. Kinetic experiments combined with subcellular fractionation of rat liver showed that after reaching the lysosomes, the membrane-bound APase (67 kDa) is subsequently released into the lysosomal matrix in the 64 kDa form, which is further processed via the 55 kDa form to the 48 kDa one, the major form of APase in rat liver lysosomal content. Our data from the in vitro experiments further showed that APase is released from lysosomal membranes into the lysosomal matrix by cathepsin D in the 65 kDa form, with release of a 1 kDa peptide, following which the released enzyme is further processed to the 64 kDa form, probably by lysosomal cysteine protease.

[Analysis of 4 cases of intralobar pulmonary sequestration]

Four cases with pulmonary sequestration treated in Tottori university hospital between January 1993 and December 1994 were reported. Case 1 was a 63-year-old male who had lung tumor without inflammatory findings. Differential diagnosis from lung cancer was needed, and aortography showed a aberrant artery from descending aorta. Pulmonary partial resection and division of aberrant artery were performed. Case 2 was a 71-year-old female who diagnosed pulmonary sequestration in other hospital 10 years ago. Tumor shadow did not progress compared with the old X-ray film. Because tumor size was remarkably diminished by aspiration of cystic tumor, conservative follow up was continued. Both case 3 and 4 were a 20-year-old man and 16-year-old female who had typical findings of pulmonary sequestration with inflammation and easily detection of aberrant artery by CT or aortography. Resection of sequestrated lung and division of aberrant arteries were performed in both cases. Pulmonary sequestration was the disease which should be always kept in our mind in differential diagnosis from various lung disease.

Fracture of the tarsal navicular associated with calcaneonavicular coalition: a case report

Fracture of the navicular occurred in a 23-year-old male with unilateral cartilaginous calcaneonavicular coalition. Inversion sprain of the left foot caused the longitudinal navicular fracture next to the coalition. En bloc resection from the beak of the calcaneus to the fracture line of the navicular including the calcaneonavicular coalition was performed, and a short leg cast was applied for 10 days. Four weeks after surgery, he returned to his preinjury level of activity and job as a long-distance truck driver. Two years and 3 months after surgery, he was totally asymptomatic and had gained a full range of subtalar motion. He had no peroneal spasm or recurrence of the coalition.

[Radiotherapy for intracranial meningioma: special reference to malignant and high risk benign meningioma]

Results of radiotherapy in 21 patients who had been treated for intracranial meningioma from April 1975 to March 1993 at Tokyo Metropolitan Komagome Hospital are presented. All patients were treated with 4 MV X-rays using conventional fractionation. The median tumor dose was 54.4 Gy (range 30 Gy to 70 Gy). Radiotherapy was delivered by conformation technique in 11, parallel opposed field in four and three ports technique in two. Of 21 meningiomas, 13 were histologically malignant and 8 were benign. The median follow-up period was 63 months. Overall survival rate at 5 years was 71% for benign and 63% for malignant meningiomas; the 5-year progression-free survival rates were 25% and 30%, respectively. Eight of 21 patients received 60 Gy or more, and the remaining 13 received less than 60 Gy. The 5-year overall survival rates for these two groups were 43% and 83% (p < 0.05), respectively. Ten of 21 patients were treated with post-operative radiotherapy as initial treatment and eleven of 21 patients were treated with salvage therapy with or without surgical excision for recurrent lesions. The 5-year survival rates and progression-free survival rates of these two groups showed no significant differences. From analysis of the clinical course of the salvage therapy group, radiotherapy may prolong survival time and delay further tumor recurrence. According to the present study, radiotherapy (doses of 55 Gy to 60 Gy) after primary resection and at the time of recurrence are equally effective for prolongation of survival and delay of further tumor recurrence.

IL-4 upregulates Fc epsilon RI alpha-chain messenger RNA in eosinophils

By using the reverse transcription polymerase chain reaction and Southern blot hybridization, we demonstrated that Fc epsilon RI alpha-chain (Fc epsilon RI alpha) messenger RNA was expressed in eosinophils purified from the peripheral blood of patients with allergic rhinitis and that this expression was enhanced by IL-4. However, studies in which flow cytometry or immunostaining was used did not reveal the expression of Fc epsilon RI alpha protein on eosinophils from peripheral blood. Neither IL-4 alone nor the combination of IL-4 and other cytokines could induce detectable Fc epsilon RI alpha protein; nevertheless, they do express Fc epsilon RI alpha mRNA. Double-labeling immunostaining on cryostat sections of nasal mucosa clearly demonstrated that some Fc epsilon RI alpha-positive cells were eosinophil cationic protein-positive, which confirms their eosinophilic nature. Not all the eosinophil cationic protein-positive cells express on Fc epsilon RI alpha signal. Considering that Fc epsilon RI alpha mRNA was detectable in four of five samples of eosinophils from those patients with nasal allergy and that only one of five eosinophil samples from normal subjects expressed Fc epsilon RI alpha mRNA, the level of Fc epsilon RI expression may be correlated with the activation of eosinophils. It seems very likely that some other unidentified factors are required for the process from the expression of Fc epsilon RI alpha mRNA to that of Fc epsilon RI as a protein.

Molecular cloning and analysis of the cDNA for an auxin-regulated calmodulin gene

An auxin-regulated calmodulin cDNA (arCaM) were isolated by differential screening from a mung bean (Vigna radiata) cDNA library. The expression of the arCaM transcript in the etiolated mung bean hypocotyl was examined by RNA gel blot analysis. The arCaM transcript was induced depending on indole-3-acetic acid (IAA) concentrations. An increase in level of the arCaM transcript upon treatment of hypocotyl segments with 10 microM IAA was detected after 1 h and a maximum level was detected at 2 h. Induction of the arCaM transcript occurred upon treatment with 10 microM 2,4-dichlorophenoxyacetic acid (2,4-D) or naphthalene-1-acetic acid (NAA) as well as with IAA, while treatment with 10 microM p-chlorophenoxyisobutyric acid (PCIB) as an anti-auxin, prevented the induction. Ethylene did not have any effect. Other stress conditions, such as exposure to salt stress, heavy metal ions and heat shock, also had no effect on the induction. The levels of the arCaM transcript in leaves of light-grown mung bean plants treated with IAA showed steady but small increases with time.

Human esophageal carcinomas frequently express the tumor-rejection antigens of MAGE genes

The human genes MAGE-1 and -3 encode melanoma peptide antigens that are recognized by autologous cytotoxic T lymphocytes. Tumors expressing MAGE genes are potential targets for cancer immunotherapy, because MAGE genes are expressed only in tumor tissue and not in any normal tissue except testis and placenta. However, little is known about MAGE gene expression in human esophageal carcinoma. The purpose of this study was therefore to analyze MAGE gene status in human esophageal carcinoma. We studied the expression status of these genes in 42 surgical samples and in 12 cell lines of human esophageal carcinoma using the reverse transcription polymerase chain reaction (RT-PCR). Various clinicopathological factors were also analyzed. No MAGE gene expression was seen in any of the 42 normal esophageal tissue specimens. In contrast, tumor tissue expressed MAGE-1, -2, and -3 in 26, 18 and 24 specimens, respectively. Thirty-three of 42 tumors expressed at least one MAGE gene. Significant clinicopathologic differences between the tumors were not observed, regardless of the presence or absence of MAGE gene expression. In cell lines, MAGE-1, -2, and -3 gene expression was recognized in 5, 4 and 4 cell lines, respectively. This study demonstrates that MAGE genes are frequently expressed in clinical samples as well as in cell lines of esophageal carcinoma. The identification of MAGE genes, therefore, may open up a new modality of treatment, namely specific immunotherapy, for patients with esophageal carcinoma.

Marked acceleration of the metastatic phenotype of a rat bladder carcinoma cell line by the expression of human gelatinase A

Numerous studies have reported a correlation between the production of gelatinases A and B by cancer cells and invasive and metastatic potential. It has been suggested that the expression of gelatinase A (72-kDa type IV collagenase) is associated more closely with the metastatic phenotype of malignant cells in vitro and in vivo than that of gelatinase B (92-kDa type IV collagenase). We have established a rat bladder carcinoma cell line, MYU3L, which is tumorigenic and locally invasive but is not metastatic to the distal organs in nude mice. The MYU3L cell line secretes pro-gelatinase B but not any detectable level of pro-gelatinase A. We undertook the present study to determine whether over-expression of gelatinase A can affect the metastatic potential of MYU3L cells. We transfected MYU3L cells with an expression vector containing human pro-gelatinase A cDNA under the transcriptional control of the SR alpha promoter. Two stable transfectants over-expressing gelatinase A activity were isolated. We assessed the biological behavior of the transfectants by an orthotopic site (urinary bladder) inoculation and an i.v. injection in nude mice. Our results demonstrate that the induced expression of human gelatinase A enzyme markedly accelerates the metastatic phenotype of the rat bladder carcinoma cell line MYU3L. Our results suggest that gelatinase A produced by tumor cells plays a major role in the metastatic process.

Studies on antiulcer agents. IV. Antiulcer effects of 2-benzylthio5,6,7,8-tetrahydro-4(3H)-quinazolinones and related compounds

With a view to finding more effective antiulcer agents, a series of 2-benzylthio-5,6,7,8-tetrahydro-4(3H)-quinazolinones and related compounds were synthesized and evaluated in a histamine-stimulated gastric secretion model. The sodium salt of the 2-(dimethylamino)benzylthio derivative (8) showed gastric mucosal protection and gastric antisecretion activities, and was also effective against experimental gastric and duodenal ulcers induced by some ulcerogenic agents. Based on a comparison of the antiulcer properties of 8 with those of the lead compounds (1 and 2) and cimetidine, it appears that, for improvement of antiulcer activity, the reduction of gastric acidity is a more important factor than the reduction of gastric volume output or gastric total acid output.

Choroid plexus papilloma of the III ventricle in an infant

A case of choroid plexus papilloma of the III ventricle associated with hydrocephalus in an 1-month-old boy is reported. The tumor was removed after placement of a ventriculoperitoneal shunt; however, the histologically mainly benign tumor grew very rapidly. The cause of this rapid growth may have been a drop in the intraventricular pressure after the shunting procedure.

Increased plasma thrombin-antithrombin III complex levels in non-insulin dependent diabetic patients with albuminuria are reduced by ethyl icosapentatenoate

Hypercoagulability may increase the risk of cardiovascular disease (CVD) in diabetic patients with albuminuria. Plasma thrombin-anti-thrombin III complex (TAT) levels, representing a functional state of clotting system, were studied in one hundred and fifteen non-insulin-dependent diabetic (NIDDM) patients. The patients were divided into three groups according to the urine albumin index (UAI: mg/g Cr): Group A; UAI < 30, Group B; 30 < UAI < 300, Group C; UAI > 300. The effect of albuminuria on plasma TAT levels was significant (p < 0.02). Ethyl icosapentatenoate (EPA: 1800 mg/day) for 4 weeks significantly (p < 0.0005) decreased plasma TAT levels. These data indicate that the degree of diabetic albuminuria is related to plasma TAT levels in NIDDM patients and that treatment with EPA may reduce TAT levels and possibly therefore the rate of development of CVD in patients with NIDDM.

[Electron microscopic studies of retinal pigment epithelial cells incubated with L-dopa in 10% and 20% oxygen]

In order to make clear how the ultrastructure of the bovine second-passage retinal pigment epithelium (RPE) was affected by exposure to L-dopa and oxygen, we compared the toxic effects of melanotic and amelanotic RPE. The oxygen levels in the incubators and the L-dopa concentrations in the media were adjusted to 10% or 20% oxygen by adding nitrogen gas and 100 microM or 250 microM L-dopa, respectively. After 24 hours, melanotic and amelanotic RPE were fixed and embedded in epon. Ultrathin sections were examined by transmission electron microscopy. Rough endoplasmic reticula were found to be dilated and ribosomes were extinguished in both melanotic and amelanotic RPE. The damage by L-dopa in melanotic RPE was less than that in amelanotic RPE and less in 10% oxygen than in 20% oxygen.

[Effect of inhaled vancomycin hydrochloride on elimination of methicillin-resistant Staphylococcus aureus]

Vancomycin hydrochloride (VCM) is one of the most useful drugs in treating methicillin-resistant Staphylococcus aureus (MRSA) infections. Intravenous administration of the drug is, however, not appropriate in patients with impaired renal or liver function. Thus, we studied the effect of inhaled VCM on MRSA. Fifty-one patients with MRSA in their sputum (35 men and 16 women 21, in the "infected" group and 30 in the "colonized" group, mean age 76.4 years) were studied. MRSA was eliminated in 84.3% of the patients (43 of 51 patients), and the average time required for elimination was 14.7 days. MRSA colonization or infection recurred in 46.5% of the patients (20 of 43 patients), and the duration from elimination until recurrence of MRSA averaged 28 days. Eight patients in whom MRSA was not eliminated by inhaled VCM were not clinically distinguishable from other patients, but their performance status was worse. Two hours after VCM was inhaled, serum VCM concentrations were unmeasurable in 7 patients. The VCM level in sputum peaked at 262.5 micrograms/g just after inhalation, and then gradually decreased. No side effects of this treatment were observed. These results suggest that inhaled VCM can be used to eliminate MRSA.

Histopathology and pathophysiology of secondary hyperparathyroidism due to chronic renal failure

Between 1973 and 1992, 300 patients underwent parathyroidectomy for secondary hyperparathyroidism due to chronic renal failure in our departments. Using parathyroid glands obtained at operation, histopathological studies were performed, and to estimate pathophysiology DNA analysis of parathyroid cell nuclei and calcium-regulated parathyroid hormone (PTH) secretion in vitro were estimated. PTH mRNA expression was evaluated by in situ hybridization. The typical histopathological findings were asymmetric enlargement, nodularities and increased number of oxyphil cells. Secondary hyperplasia was divided into 2 types: diffuse and nodular type hyperplasia. In the histopathological study nodular hyperplasia indicated more aggressive proliferation. In DNA analysis the relative number of scattered cells in the DNA synthesis phase was significantly greater in nodular than in diffuse hyperplasia. The half of the maximal inhibition of PTH secretion for calcium (the set-point) in the cells from nodular hyperplasia was higher than in the cells obtained from diffuse hyperplasia. However, there was no difference in expression of PTH mRNA in nodular and diffuse hyperplasia. These data suggested that nodular hyperplasia was more progressively hyperplastic, had more aggressive proliferative activities and showed more abnormal regulation of PTH secretion. These results imply that to prevent graft-dependent recurrent hyperparathyroidism after parathyroidectomy, the nodular hyperplastic tissue should not be autografted.

Involvement of human interleukin 6 in experimental cachexia induced by a human uterine cervical carcinoma xenograft

A human tumor xenograft model for cancer cachexia was established by growing a uterine cervical carcinoma, Yumoto, in nude mice. The tumor transplanted into the mice induced severe body weight loss (30% of body weight) when the tumor weight was only 1 g. In addition, other indicators for cachexia, such as adipose tissue and muscle wasting and hypoglycemia, were also observed in the tumor-bearing mice, suggesting that this is a proper model for experimental cachexia induced by a human tumor. We then examined the association of this model with various cytokines, such as tumor necrosis factor alpha, interleukin (IL)-1alpha, IL-1beta, IFN-gamma, IL-6, and leukemia inhibitory factor, and identified human IL-6, which was produced by the tumor cells, as a mediator of cachexia. A neutralizing antibody against hIL-6 administered to the mice after the development of cachexia symptoms significantly improved body weight loss, adipose tissue wasting, hypoglycemia, acute phase reaction, and leukocytosis, although it did not suppress the tumor growth. These results demonstrate that the hIL-6 produced by the tumor cells is an essential mediator of the cachexia induction in this model.