Histological and immunohistochemical studies on primary gastrointestinal lymphomas

To study the characteristics and histogenesis of the malignant lymphomas derived from the gastrointestinal mucosa, histologic and immunohistochemical analyses were performed on a series of 28 malignant lymphomas of the gastrointestinal tract. By cytomorphologic classification, there were two small lymphocytic lymphomas, one small cleaved cell lymphoma, two mixed small cleaved and large cell lymphomas, 17 large cell lymphomas, one small noncleaved cell lymphoma, three immunoblastic lymphomas, and two lymphoblastic lymphomas. This distribution of histologic types was compatible with that of nodal lymphoma. The lymphomas with poor prognostic histology (23 cases) outnumbered those with favorable prognosis (five cases). Three of 28 cases (one in the stomach and two in the small intestine) had cytologic features consistent with centrocytoid cell lymphoma of the mucosa associated lymphoid tissue and were large cell lymphomas. Immunophenotypically, 23 cases expressed B-cell markers (82.1%) and three cases reacted with T-cell markers. Two cases did not react with either T-cell or B-cell markers. True histiocytic lymphomas were not identified. Gastric lymphomas (nine cases) and colorectal lymphomas (three cases) were of B-lymphocyte origin whereas T-cell lymphomas were noted in the small intestine (two cases) and ileocecal region (one case). Three cases of centrocytoid lymphoma were of B-lymphocyte origin. Histologically B-cell lineage lymphomas were evenly distributed on various histologic subtypes but all T-lineage lymphomas belonged to the large cell type. The two cases with undetermined phenotype were lymphoblastic lymphomas histologically. This study showed that the primary GIT lymphomas, mostly of B-cell lineage, were not cytomorphologically distinctive from the nodal lymphomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Transfer and metabolism of dideoxyinosine by the perfused human placenta

Dideoxyinosine (DDI) has been recently approved for the treatment of AIDS. In anticipation of its use in HIV-infected women during pregnancy, the transfer and metabolism of DDI by the perfused human placenta have been investigated. Transfer characteristics are those of simple diffusion: clearance is the same as that for L-glucose (transfer index of 0.98 +/- 0.09), it is equivalent in both directions across the placenta, and the transfer rate is proportional to the transplacental gradient over a very broad range (1 to 500 microM). Because of extensive placental metabolism, only about one-half of the cleared DDI (51 +/- 21%) is transferred intact to the fetal circulation. No dideoxyadenine triphosphate, the antiviral product of DDI, could be detected in the placenta following perfusion. Comparison of the pharmacological information on DDI and zidovudine (ZDV) indicates that treatment of HIV-infected women during pregnancy with DDI will expose the fetus to much less drug than if ZDV were used. DDI may therefore be less effective than ZDV in the treatment of the infected fetus. However, the uninfected fetus of an HIV-infected woman will gain by reduced exposure to a drug that is known to be toxic.

Malignant lymphomas of the nasal cavity and Waldeyer's ring--clinicopathologic and immunohistochemical study

The clinicopathologic and immunohistochemical finding of 10 cases of nasal non-Hodgkin's lymphoma (NHL) and 23 cases of Waldeyer's ring NHL were studied. Immunohistochemically, nasal NHL expressed T-cell markers exclusively, whereas the NHL of Waldeyer's ring were of both T-cell (56.5%) and B-cell lineages (43.5%). Angioinvasiveness by tumor cells was exclusively noted in the T-lineage lymphomas. Epithelial hyperplasia, epitheliotropism by tumor cells, and extensive invasion of adjacent normal tissue were more prominent in T-cell lymphomas than in B-cell lymphomas. T-lineage lymphomas showed distant extranodal spread pattern involving the skin, soft tissue, stomach, spleen, and the liver, whereas B-lineage lymphomas tended to localize in the lymph nodes. The survival rate of Nasal NHL was similar to that of Waldeyer's ring NHL. Although not statistically significant because of small sample numbers, immunophenotype, histologic groups of monomorphic lymphoma, and stage had prognostic importance. In general, T-lineage lymphomas presented with a higher stage than B-lineage lymphomas (p < 0.05)-and overall survival was poor. Stage I disease showed a much more favorable prognosis than stage II disease. Monomorphic lymphomas had a shorter survival than polymorphic reticulosis (PR) or lymphomas with features of PR. This result in conjunction with the morphologic transition between them suggested that monomorphic lymphoma may represent the most advanced stage in the spectrum of PR, lymphoma with features of PR, and monomorphic lymphoma.

Immunoscintigraphy in the detection of tuberculosis with radiolabelled antibody fragment against Mycobacterium bovis bacillus Calmette-Guérin: a preliminary study in a rabbit model

Immunoscintigraphy with radiolabelled monoclonal antibodies is widely used to detect solid tumours, but only a few trials have been carried out concerning the specific in vivo localization of an inflammatory process. The purpose of this study was to investigate the detectability of tuberculous foci utilizing this method with radiolabelled bacillus Calmette-Guérin (BCG)-specific F(ab')2 in rabbits. All of the tuberculous lesions (n = 8) were clearly visualized on serial scintigraphy for up to 48 h after injection of the antibody. Immunohistochemical and Ziel-Neelson staining of the tuberculous lesions confirmed the presence of the tuberculous antigens and bacilli. It failed to demonstrate any sustained retention of the BCG-specific antibody fragment in the control group with syphilitic orchitis (n = 2). Therefore, the specific in vivo localization of tuberculosis is feasible by immunoscintigraphy.

Participation of lipopolysaccharide-binding protein in lipopolysaccharide-dependent macrophage activation

Only recently has the mechanism for lipopolysaccharide (LPS) recognition by macrophages been elucidated. In contrast to many ligand receptor interactions, the interaction of LPS with its receptor, CD14, on myeloid cells is greatly enhanced by prior complexation of LPS with LPS-binding protein (LBP), a recently discovered plasma glycoprotein. LBP is found in normal serum or plasma in the 5 to 10 micrograms/ml range. In plasma, it reacts rapidly but transiently with LPS. LPS-LBP complexes then react with CD14 bearing cells. Blocking CD14 with monoclonal antibodies or removal of LBP from plasma blocks the ability of the cells to react with LPS-LBP complexes and also blocks release of cytokines and other mediators from the cells. In the normal lung, bronchoalveolar lavage fluid contains low levels of LBP. However, during acute lung injury, LBP levels may rise by transudation and enhance activation of alveolar macrophages to release injurious mediators. Description of this pathway for LPS recognition by macrophages and other leukocytes offers the possibility of developing new reagents to block LPS recognition and prevent the development of endotoxemia.

Choriocarcinoma of the cervix

The incidence of primary cervical choriocarcinoma is extremely low, with only approximately 60 cases reported. We present a case of primary cervical choriocarcinoma, which was originally mis-diagnosed as a cervical pregnancy. After failure of conservative treatment with methotrexate, the patient underwent a hysterectomy, followed by chemotherapy with actinomycin-D. After twenty months of follow-up, the patient is in good condition and her serum beta-hCG levels are normal.

Interleukin-6 production by human melanoma cell lines

We examined the expression of interleukin-6 (IL-6) by 12 established human melanoma cell lines. Two constitutively produced low levels of IL-6 protein, as measured by enzyme-linked immunosorbent assay. Cells from these two lines, as well as those from two non-IL-6-producing cell lines, contained IL-6-specific mRNA as demonstrated by Northern hybridization. Treatment of the two IL-6-producing melanoma cell lines with interleukin-1 beta, tumor necrosis factor-alpha, or phorbol myristate acetate caused a marked increase in IL-6 production. These induction signals failed to stimulate IL-6 production in the nonproducing cells, even those that expressed IL-6 mRNA. IL-6 did not appear to act as an autocrine growth factor since the addition of exogenous human recombinant IL-6 or polyclonal anti-IL-6 antibody did not alter cellular proliferation. The production of this multifunctional cytokine by tumors may play a role in tumor-host interactions and this should be recognized in the design of biologic therapy trials.

Transfection of CD14 into 70Z/3 cells dramatically enhances the sensitivity to complexes of lipopolysaccharide (LPS) and LPS binding protein

Bacterial endotoxin (lipopolysaccharide [LPS]) causes fatal shock in humans and experimental animals. The shock is mediated by cytokines released by direct LPS stimulation of cells of monocytic origin (monocyte/macrophage [MO]). Recent studies have supported the concept that the plasma protein, LPS binding protein (LBP), plays an important role in controlling MO responses to LPS. Specifically, evidence has been presented to suggest that CD14, a membrane protein present in MO, serves as a receptor for complexes of LPS and the plasma protein LPS binding protein (LBP). In this function CD14 mediates attachment of LPS-bearing particles opsonized with LBP and appears to play an important role in regulating cytokine production induced by complexes of LPS and LBP. The CD14-, murine pre-B cell line 70Z/3 responds to LPS by synthesis of kappa light chains and consequent expression of surface IgM. To better understand the role of CD14 in controlling cellular responses to LPS, we investigated the effect of transfection of CD14 into 70Z/3 cells on LPS responsiveness. We report here that transfection of human or rabbit CD14 cDNA into 70Z/3 cells results in membrane expression of a glycosyl-phosphatidylinositol-anchored CD14. When LPS is complexed with LBP, CD14-bearing 70Z/3 cells bind more LPS than do the parental or 70Z/3 cells transfected with vector only. Remarkably, the expression of CD14 lowers the amount of LPS required to stimulate surface IgM expression by up to 10,000-fold when LPS dose-response curves in the CD14-, parental and CD14-bearing, transfected 70Z/3 cells are compared. In contrast, the response of CD14-bearing 70Z/3 cells and the parental 70Z/3 cell line (CD14-) to interferon gamma is indistinguishable. LPS stimulation of the parental and CD14-bearing 70Z/3 cells results in activation of NF-kB. These data provide evidence to support the concept that the LPS receptor in cells that constitutively express CD14 may be a multiprotein complex containing CD14 and membrane protein(s) common to a diverse group of LPS-responsive cells.

Gallium-67 scintiscan in the diagnosis of primary splenic non-Hodgkin's lymphoma after the treatment of Hodgkin's disease

A rare primary non-Hodgkin's lymphoma (diffuse large cell) of the spleen developed in a 72-yr-old man who had successful radiotherapy to the right inguinal region for Hodgkin's disease 23 yr ago. Radiologic findings, particularly the 67Ga scintigraphy finding, were very useful in leading to the correct diagnosis of malignant splenic lymphoma, in this case, preoperatively.

[Five cases of hematological disorders associated with acute myocardial infarction in thrombocytopenia]

Case of hematological disorders associated with acute myocardial infarction had been found in five of forty five autopsy cases which had hematological disorders during the past seven years. The five cases of hematological disorders consisted of two cases of myelodysplastic syndrome, a case of aplastic anemia, a case of primary myelofibrosis in blast transformation, and a case of acute myelogenous leukemia. All the patients were over 60 years old. Four patients had coronary artery stenosis and extensive myocardial infarction. Fibrinogen degradation products were elevated in four patients. DIC was recognized in two and suspected in two others. In all cases, platelet counts markedly decreased to less than 2.5 x 10(10)/L. Since no chest pain was noted by any patient, it was difficult to diagnose acute myocardial infarction without autopsy, except in one case. It is important to recognize the possibility of severe cardiac dysfunction due to myocardial infarction in thrombocytopenia, especially in the aged with DIC.

The effect of Dermatophagoides pteronyssinus allergens on proliferation and CD23 antigen expression of peripheral blood lymphocytes from atopic patients

The low affinity IgE receptor (Fc epsilon RII/CD23) has been proposed to be involved in the regulation of IgE synthesis. The present study was undertaken to investigate the responses to in vitro stimulation by allergen (Dermatophagoides pteronyssinus; D.p) and/or interleukin-4 (IL-4) of peripheral blood lymphocytes (PBLs) isolated from atopic and non-atopic subjects. IL-4 induced up to 5 fold increase in CD23 expression on PBLs from both atopic patients and normal controls, whereas the D.p extract increased CD23 expression on cells from 7 of 8 atopic donors and from 2 of 8 normal controls. The combination of IL-4 and allergen had an additive effect of CD23 expression. PBLs from 6 of 8 atopic patients but 1 of 8 normal controls showed significant proliferative responses to D.p extract whereas IL-4 did not induce any cell proliferation. The dose of D.p extract required for the maximal CD23 expression was 20 fold higher than that for cell proliferation. These results imply that allergen stimulation, presumably through proliferating allergen specific T cells which secrete IL-4, activates B cells from most atopic donors and a few non-atopic donors resulting in increased CD23 expression. This allergen-mediated CD23 expression may play an important role in specific IgE production.

Coronary artery vasoreactivity to intracoronary acetylcholine infusion test in patients with chest pain syndrome

Coronary vasoreactivity of patients with chest pain syndrome (CPS, 18 patients) was examined with intracoronary acetylcholine infusion test (ACh). For comparison, 10 patients with vasospastic angina (VSA) and 17 patients without chest pain (control group) were used. The luminal diameters of coronary arteries were measured before and after ACh, and the maximal value of constriction rate of each segment (MCR) was used as index of vasoreactivity in each patient. By the ACh test, an average MCR of 42 +/- 23% was observed in CPS, 84 +/- 17% in VSA, and 26 +/- 12% in the control group. In CPS, chest pain was induced by ACh in 7 patients (group I), but was not induced in the other 11 patients (group II). The average MCR of group I (66 +/- 18%) was significantly higher than group II (28 +/- 9%, p less than 0.01) and the control group (p less than 0.01), though lower than VSA (p less than 0.05). These findings suggest that increased coronary vasoreactivity may play an important role in the chest pain development in CPS.

Simultaneous bilateral tubal pregnancies after in vitro fertilization and embryo transfer: report of a case

Ectopic pregnancies continue to be a major complication of in vitro fertilization and embryo transfer (IVF-ET). A case of bilateral simultaneous tubal pregnancy after IVF-ET is described. The patient underwent ovum pick-up (OPU) through a laparotomy with concomitant pelvic surgery. Embryo transfer (ET) was performed two days after OPU; this resulted in bilateral tubal pregnancies, diagnosed and treated one month apart. There are several possible causal mechanisms for the increased rate of ectopic pregnancies following IVF-ET. It is important to recognize that care in the transfer technique, with respect to the catheter position and limiting the volume of transfer medium to 20 microL, and an awareness of previous occlusion of the tubal ostia, or of a salpingectomy before IVF-ET, can help to minimize this complication rate. Two important points are the possibility of a simultaneous bilateral tubal pregnancy after IVF-ET, and the necessity of carefully examining both adnexa at the time of surgery for an ectopic pregnancy. Early and accurate diagnosis of a simultaneous bilateral ectopic pregnancy can prevent the necessity of a second operation and reduce maternal morbidity and mortality.

Peripheral T-cell lymphomas--clinicopathologic and immunophenotypic analysis of 25 cases

The clinicopathologic and immunophenotypic findings of 25 cases of peripheral T-cell lymphoma in Korea were analysed. Seventeen cases (68%) of the 25 T-cell lymphomas presented in the extranodal sites including the nasal mucosa, tonsil, oral cavity, skin and rarely bone, mediastinum and breast. Immunologic studies showed that 12 cases (48%) of the lymphomas were of T-helper phenotype, 5 cases (20%) were of cytotoxic/suppressor phenotype, 1 case (4%) expressed both helper and cytotoxic/suppressor markers, and 7 cases (28%) lacked detectable markers for subsets. Histologically, fourteen cases (56%) showed histologic features suggestive of peripheral T-cell lymphoma. The more frequently seen histologic types by Working Formulation (WF) included large cell type and immunoblastic type. Classification by WF was straightforward in most cases of large cell, immunoblastic type. However, with some cases of small cell, large cell and mixed types, there were problems fitting the morphology seen into the WF category. We hope that the establishment of a world wide immunologic and clinicopathologic classification for peripheral T-cell lymphoma will be made in the near future.

The survival and development rates in mouse embryo cryopreservation

A research of mouse embryo cryopreservation was carried out in our department in order to establish the clinical service of human embryo cryopreservation. Mouse embryos were stored in glass vials using 1.5M propanediol (PROH) or 1.5M dimethyl sulfoxide (DMSO) as cryoprotectants and we used a modified four-step equilibration method to minimize osmolarity shock. We divided the 1490 embryos into two phases and compared phase 1 to phase 2. After achieving more sophisticated handling techniques and more accurate timing of each procedure, the survival rate (25% vs 59.8%) and stage advancing rate (5.2% vs 33.5%) were all improved in phase 2. The proportion of frozen embryos developing to hatched blastocysts was significantly increased from 14.5% to 56.7% in the 4-cell embryo groups compared to the 2-cell embryo groups. Two kinds of cryoprotectants were used in the 4-cell embryos and the results showed no difference in the post thaw survival rate but a better blastocystic development in the propanediol group (64.0% vs 41.5%). The results obtained from this study have encouraged us to initiate a major clinical trial of the technique in our IVF programs. Two pregnancies have been established upon the transfer of cryopreserved embryo and two normal healthy infants have already delivered at our hospital.

Familial Bartter's syndrome--a study of free water clearance

Three siblings in one family were found to have Bartter's syndrome. All of them had persistent hypokalemia, metabolic alkalosis, hyperreninemia and normal blood pressure. Patient 1 also had hyponatremia and hyperaldosteronism. Free water clearance studies during a maximal water diuresis showed that all of them had mild decrease in distal fractional chloride reabsorption. Patient 1 had normal proximal sodium reabsorption, however, patient 2 and patient 3 had enhanced proximal sodium reabsorption. These data suggest that the defect in chloride reabsorption at the Henle's loop may contribute to the pathogenesis of Bartter's syndrome, and compensatory proximal sodium reabsorption is very important in maintaining normal plasma sodium in Bartter's syndrome.

Adult chicken alpha-globin gene expression in transfected QT6 quail cells: evidence for a negative regulatory element in the alpha D gene region

The chicken adult alpha-globin genes, alpha A and alpha D, are closely linked in chromosomal DNA and are coordinately expressed in vivo in an approximate 3:1 ratio, respectively. When subcloned DNAs containing one or the other gene are stably transfected into QT6 quail fibroblasts, the alpha A-globin gene is expressed at measurable RNA levels, but the alpha D gene is not. The alpha A gene expression can be considerably increased by the presence of a linked Rous sarcoma virus long terminal repeat enhancer, but that of the alpha D gene remains undetectable. Transfection with subclones containing both genes, either in cis or in trans, leads to considerably reduced alpha A RNA levels and still no observable alpha D gene expression. Transfection with deleted subclones suggests that maximal expression levels in this system require the alpha A-globin gene promoter, as opposed to that of the alpha D gene, but that such expression is greatly reduced by one or more DNA sequences which lie approximately 2,000 base pairs upstream of the alpha A gene, within the body of the alpha D gene.

Refractory variant angina relieved by denopamine--a case report

A 48-year-old man with severe variant angina refractory to conventional treatment with calcium antagonists and nitrates, or prazosin, or trihexyphenidyl hydrochloride, became symptom free rapidly when treated with denopamine, a adrenergic beta-1 agonist. Denopamine may prove to be an additional therapeutic agent in the management of severe variant angina. Therefore the response to denopamine and the lack of response to prazosin in this patient suggests that not only the adrenergic alpha receptor but also the adrenergic beta-1 receptor plays an important role in the production of coronary spasm, at least in some patients.

[Clinical value of thallium-201 reinjection after delayed imaging in patient showing incomplete or no redistribution]

To asses clinical value of Tl-201 (Tl) reinjection after delayed imaging, 30 patients who showed incomplete or no redistribution in stress-delayed Tl myocardial scintigraphy were studied. Of 76 myocardial segments with incomplete or no redistribution on the delayed images, 29 segments (38%) showed improvement of Tl uptake after Tl reinjection. Reinjection was considered effective in 24 segments (32%) where no or little redistribution were observed on the delayed images but improved after reinjection. The contrast ventriculography showed less wall motion abnormality in the segments with improvement after reinjection than that without improvement after reinjection (regional wall motion score: 2.55 +/- 0.50 vs. 0.59 +/- 0.97 p less than 0.01). History of myocardial infarction was also significantly less in the former (p less than 0.05). We conclude that Tl reinjection is useful in cases showing no or equivocal redistribution on the delayed images.

CT findings in primary thymic carcinoma

Computed tomography of five cases of thymic carcinoma was reviewed. The subtypes of thymic carcinoma were squamous (two cases), lymphoepithelioma-like (one case), undifferentiated (one case), and basaloid (one case). The patients ranged from 52 to 72 years of age. Computed tomography showed anterior mediastinal tumors infiltrating along the pleura or mediastinum with frequent internal necrosis or calcifications. The three nonsquamous cell cases developed extrathymic metastases to the mediastinal lymph nodes, lung, or chest wall. Although the CT features of thymic carcinomas were similar to those of invasive thymoma, the former showed more aggressive behavior. Among the four variants of thymic carcinoma, squamous carcinomas were less aggressive and had less tendency to develop necrosis than the others.

Acute effects of oral pyridostigmine bromide on conditioned operant performance in rats

Pyridostigmine bromide (Pyr), the current drug of choice in the management of myasthenia gravis, has been suggested for use in Alzheimer's dementia, and as a prophylactic treatment for intoxication with organophosphate cholinesterase inhibitors. The present study was undertaken to evaluate the dose-response and time-course effects of acute oral administration of Pyr over a broad dose range (3-40 mg/kg) on the lever pressing of rats maintained under a multiple fixed-ratio (FR-20) time-out schedule of reinforcement for water reward. The drug produced a dose-dependent biphasic response depression in the overall rate of FR responding. Low doses of Pyr (less than or equal to 12 mg/kg) that caused no gross signs of toxicity only moderately decreased rates of responding, primarily due to a decrease in response rates. Whereas high doses of Pyr (greater than 24 mg/kg) which produced overt signs of peripheral cholinergic intoxication markedly suppressed overall responding, primarily due to cessation of responding. The lowest effective dose of performance disruption was 6 mg/kg, and the ED50 was calculated as 23.3 (17.9-28.7) mg/kg. The time-course data of performance disruption showed that low doses of Pyr (less than or equal to 12 mg/kg) had an onset latency within 40-80 min and a duration of 20-80 min, whereas high doses (greater than or equal to 24 mg/kg) had an onset latency of 20-40 min and a duration greater than 80 min. These results suggest the recommended human therapeutic or prophylactic regimen of 30-120.mg Pyr, orally taken each 8 hours, might adversely affect behavioral performance.

Giant malignant schwannoma of the diaphragm: CT and ultrasound findings

A rare case of malignant schwannoma of the diaphragm is presented. The CT and ultrasound findings are described, correlated with the pathologic findings. During surgery, the tumor presented as a dumbbell shaped mass with central disruption of the right diaphragm.

[A case of vasospastic angina: development of transient collateral circulation lessen the degree of myocardial ischemia during coronary artery spasm]

A 57-year-old man was admitted to our hospital because he had had attacks of chest pain at rest for more than a year, in spite of daily oral diltiazem (90 mg/day) and isosorbide dinitrate (15 m/day). The diagnosis of variant angina was made for him based on ST elevation in chest leads of the electrocardiogram during his first attack. However, one year later, the electrocardiograms during attacks showed only ST depression or T wave inversion in chest leads. The coronary arteriogram during spontaneous chest pain revealed that the left anterior descending artery was totally occluded at its middle portion, and that its peripheral portion was perfused by collateral circulation from the right coronary artery. The coronary arteriograms after administration of nitroglycerin were apparently normal, and no signs of collateral circulation were observed. These findings indicated that the transient collateral circulation could develop after repetitive coronary artery spasms even in the absence of significant coronary stenosis, and that it could lessen the degree of myocardial ischemia during coronary artery spasm.