Conditions favoring long-term survival after hepatectomy for hepatocellular carcinomas

The present study was aimed at answering the question of what patients with hepatocellular carcinomas could obtain long-term benefits from resectional therapy. The 239 patients hepatectomized from 1973 through 1986, with 33 tumor-free, 3-year survivors, were the subjects of the study. The following criteria for long-term survival were determined. (a) It is essential that there are no macroscopic tumor thrombi in any of the vessels. (b) It is desirable that there is no daughter lesion and a tumor size of less than 5 cm. (c) When there are daughter lesions, they should be confined to the region adjacent to the main tumor and only few in number. (d) Resection should be performed on a large scale within the limit of safety, especially for the tumors with daughter lesions. (e) The surgical margin should be free of tumor though the exposure of the tumor capsule is not always incompatible with long survival.

[Surgical treatment of hepatocellular carcinoma]

The surgical treatment for hepatocellular carcinoma must be chosen by considering some factors such as liver function, position and involved area of the tumor. This article reports our guide line for surgical treatment based on liver function and long term survival. In severe cirrhotic patient with ICG retention rate ranging 30 to 40%, hepatectomy can be indicated only when they mach several conditions as follows; KICG from 0.06 to 0.08, superficially located tumor removal by resection of small area with curability. In patients with ICG retention rate lower then 30%, resection range is determined by the multiple regression equation indicating safety limit of hepatectomy. The predictability of the equation has been as high as 93%, the long term survival depends on following factor, i.e.; tumor size, VP factor, and IM factor. Hepatectomy should be first option when the tumor is less than 5 cm in size, VPO, IMO, and can be safely removable with segmentectomy or larger resection.

[Intrathecal immunoactivation in the patients with myasthenia gravis--autoantibodies in the cerebrospinal fluid]

We examined the cerebrospinal fluid (CSF) of 17 myasthenia gravis (MG) patients for certain immunological parameters in order to assess signs of intrathecal immunoactivation. We have found oligoclonal IgG bands in the CSF of 6 of 17 by the agarose gel electrophoresis and enlarged lymphoid cells in CSF of 8 of 17 patients of MG. We measured anti-nicotinic acetylcholine receptor (AChR) antibody and anti-striational muscle antibody (AMA) in serum and CSF from MG patients and compared the serum: CSF ratio with total IgG. No evidence of intrathecal anti-AChR antibody synthesis was demonstrated while AMA was partly (50%) synthesized in myasthenic CSF. This difference suggested that there is either different immunological regulation in synthesis between anti-AChR antibody and AMA in the CSF or the different behavior after transfer to CSF.

Soluble immune complexes and squamous cell carcinoma-related antigens in patients with head and neck cancer

Sera from 85 patients with head and neck cancer including laryngeal cancer, hypopharyngeal cancer, nasopharyngeal cancer, and maxillary cancer were assayed for immune complexes (IC) by solid-phase anti-C3 enzyme immunoassay and for squamous cell carcinoma-related (SCC) antigen by radioimmunoassay. The positive rates of IC and SCC antigen in head and neck cancer patients were 29.4% and 34.1%, respectively. Their serum levels and positive rates were found to be elevated according to the degree of advancement of the disease stage, showing their good clinical correlations. With individual patients there was no significant relationship between IC and SCC antigen.

Immunosuppressive substance in the sera of head and neck cancer patients

Serum levels of immunosuppressive substance (IS) and immunosuppressive acidic protein (IAP) were studied by single radial immunodiffusion in 108 patients with head and neck cancer. Mean values of serum IS and IAP in patients with head and neck cancers were as follows: laryngeal carcinoma, 955 +/- 447 micrograms/ml (IS), 604 +/- 324 micrograms/ml (IAP); maxillary carcinoma, 896 +/- 384 micrograms/ml (IS), 568 +/- 246 micrograms/ml (IAP); nasopharyngeal carcinoma, 871 +/- 313 micrograms/ml (IS), 673 +/- 395 micrograms/ml (IAP); hypopharyngeal carcinoma, 1034 +/- 495 micrograms/ml (IS), 669 +/- 335 micrograms/ml (IAP). Except for IAP in hypopharyngeal carcinoma, these values were significantly higher than those of controls (IS, P less than 0.01; IAP, P less than 0.05). The overall positive rates of IS and IAP in the patient group were 46% and 37%, respectively. In patients with laryngeal carcinoma the positive rates of serum IS and IAP were found to be elevated as the disease stage advanced. The IS showed a higher positive rate than IAP in the advanced disease stage. Serial studies revealed that all patients who had recurrent disease after the treatment exhibited marked elevation of serum IS levels; in addition, patients with recurrent cancer showed significantly higher IS levels (1507 +/- 464 micrograms/ml) compared to patients who had remained free of disease in the follow-up period (640 +/- 143 micrograms/ml) (P less than 0.001). These data strongly suggests that serum IS and IAP levels are useful parameters for monitoring the disease stage of head and neck cancer patients.

Suppression of glomerular IgA deposition in ddY mice through periodic injections of lipopolysaccharides

We investigated the role of lipopolysaccharides (LPS) in glomerular IgA deposition of ddY mice. The incidence of IgA deposition was lower in the LPS-injected mice at 10 and 13 months of age as compared with that of their age-matched controls (10 months, LPS 20% vs control 60%; 13 months, LPS 14% vs control 100%). Serum levels of IgA were lower in the LPS-injected mice than in the control mice. There were no appreciable differences in the percentage value of Thy-1+ cells, the ratio of Lyt-1+/Lyt-2+ cells, mitogenic responses, or IL-1 activities between the LPS-injected and the control mice. On the other hand, the IgA responses of spleen and Peyer's patch cells in the LPS-injected mice were lower than those observed in the control mice. These results suggest that the persistent use of LPS directly suppresses gut-associated lymphoreticular tissue (GALT), and that the lower IgA response in GALT induced by LPS causes suppression of glomerular IgA deposition in ddY mice.

[Hepato-portal-splenic dynamics after hepatectomies]

The present study was performed to clarify the regeneration and splenic changes following hepatectomy. The processes were compared between the three classes (L greater than 50%, 30 less than M less than 50%, S less than 30%) categorized by the resection rate (%) calculated by CT scan in the 26 cirrhotics (LC) and 22 non-cirrhotics (N). Hepato-splenic volumes were serially measured by CT scan. The regenerative speed (cm3/day) of the remaining liver were significantly higher in the N group than LC and in the larger resection class. Liver functions tended to return to the initial levels behind the time of restoration of the liver volumes. The delay was partially caused by the posttransfusion hepatitis (PTH), which developed more frequently with an increase of fresh frozen plasma transfusion given. The changing pattern of splenic size was strongly regulated by the massiveness of hepatectomy. Newly developed posthepatectomy esophageal variceal ruptures were endoscopically determined in the 10% of the 129 late deaths after hepatectomies for hepatomas (1973-1987) with or without recurrences and its occurrence was found to be enhanced in the massive resection in the LC group ended with the poor regeneration of the liver and persistent postoperative splenic enlargement.

Flow cytometric analysis of Epstein-Barr virus receptor among the different B-cell subpopulations using simultaneous two-color immunofluorescence

The distribution of Epstein-Barr virus receptor (EBVR) among the different B-cell subpopulations was analyzed by flow cytometry, using simultaneous two-color immunofluorescence of EBVR and cell-surface markers. The expression of EBVR was established by the binding of fluorescein isothiocyanate (FITC)-labeled EBV to the cells, while surface markers were stained by phycoerythrin (PE)-indirect immunofluorescence, using monoclonal antibodies. All cells of both the resting B-cell subpopulation defined by L30 and the B-cell subpopulations expressing surface IgM, IgD, IgA, and IgG were EBVR-positive. In contrast, EBVR was absent from about 10% cells of the activated B-cell subpopulation recognized by OKT9, as well as from about 10% cells of the highly differentiated B-cell subpopulation which reacted with OKT10. These results suggest that the expression of EBVR on the B-cell lineage varies with the maturation stage and with the state of activation. This postulation was further supported by analyses based on in vitro B-cell activation.

Development of the glomerular mesangium

The development of the glomerular mesangium was studied in fetal and newborn rat kidneys by using a widefield electron microscope which can cover a whole glomerulus within one low-power viewfield. A three-dimensional observation of the immature glomeruli was done by performing ultrathin serial sectionings of the specimen for electron microscopy. Scanning electron microscopic observation of the developing glomeruli was also performed. The developmental distribution of contractile protein (actin) in mesangial cells and the main intrinsic component of the extracellular matrix protein (type IV collagen) of the mesangium were examined by immunohistological techniques. The widefield electron micrograph revealed a precise relationship between the mesangium and other components of the glomerulus. The results confirmed that the capillary extends into the S-shaped body from the surrounding vascular system at the initiation of nephronogenesis. The mesangial cells are always continuous to the vascular pericyte-smooth muscle cell system during the whole course of glomerular development and they participate in the subdivision of the capillary network during glomerulogenesis. Morphological findings and the changing distribution of intra- and extracellular proteins of the mesangium during development suggest that the mesangial cell differentiates from the primitive pericyte of the immature capillary.

Immunologic and cytologic studies in otitis media with effusion

Detection of immune complexes (ICs) of IgG, IgM, or IgA isotypes in middle ear effusions (MEEs) by the solid-phase anti-C3 ELISA and cytologic analyses of MEEs were done in 245 patients with otitis media with effusion (OME). In 320 ears, the clinical classification was acute, 10.3%; subacute, 16.6%; chronic, 73.1%. In the cytologic analyses, the predominant types in each clinical stage were as follows: neutrophil dominant (N) type (63%) in acute cases; neutrophils and lymphocytic (Mixed) type (37%) in subacute cases; and cellular remnant (CR) type (37.8%) in chronic cases. In all the clinical stages IgG-ICs were positive in over 50% of cases and acute cases showed the highest positive rate (64%). IgA)ICs were found in all clinical stages and the highest positive rate was found in subacute cases (67%). In chronic cases, MEEs of N type showed the highest IgG-ICs level and positive rate (75%). These results suggested that immune complexes formed in the middle ear cavity might play an important role in the prolonged inflammatory process of OME through the complement activation following chemotaxis of neutrophils.

[A case of vesical malacoplakia diagnosed by randomized biopsy of the urinary bladder]

Vesical malacoplakia is a relatively rare disease and commonly diagnosed by characteristic cystoscopical findings and histological determination using biopsy specimen. We report here a case of a 53-year-old housewife, with atypical cystoscopical findings, which looked like carcinoma in situ, and in which randomized biopsy helped to make the final diagnosis. This case was successfully controlled by anti-bacterial agents.

[Cholesteatoma of the ureter: a case report]

A 68-year-old woman was hospitalized complaining of right flank pain. The excretory pyelogram revealed that the right kidney was hydronephrosis, and a retrograde pyelogram showed stringy filling defects in the middle portion of the right ureter. Suspecting a right ureter tumor, a right ureteronephrectomy was performed. The pathological diagnosis was ureteral cholesteatoma which is a rare condition with reports of only 9 cases in the Japanese literature. Although the possibilities of malignant change has been debatable, long term follow up would be mandatory.

Renal lesions in a strain of spontaneously diabetic WBN/Kob rats

In WBN/Kob strain rats, only males spontaneously develop hyperglycemia, glycosuria, hypoinsulinemia and glucose intolerance from about nine months of age. The kidneys of male rats of this strain were histopathologically studied to evaluate the changes which appeared as complications of diabetes mellitus. Thickening of the basement membrane, increase of the mesangial matrix and fibrin-cap lesions were noted in the glomeruli. Armanni-Ebstein degeneration was occasionally found in the tubules. Linear deposition of plasma components such as IgG and albumin in the basement membrane of the glomeruli, tubules and Bowman's capsule characterized the immunohistological pattern. These findings are similar to the findings in diabetic nephropathy in humans. Since the onset of diabetes mellitus in the strain is slow and symptoms are generally mild, insulin administration is usually not necessary for survival. This strain, therefore, appears to be an important animal model for the study of complications of diabetes in humans.

Experimental mesangioproliferative glomerulonephritis in rats induced by intravenous administration of anti-thymocyte serum

Focal glomerulonephritis was induced in rats, by a single intravenous injection of anti-Thy-1.1 antibody (ATS). One hour after the administration, the glomeruli of affected rats developed necrotic changes of the mesangial cells while after two hours, mesangiolytic changes appeared. From six days onwards, focal segmental mesangial proliferation which persisted until 30 days, occurred. This is thought to be the first report of experimental nephritis induced by pure anti-mesangial antibody.

[A case of metastatic urinary bladder tumor from a gastric remnant carcinoma]

We report a case of a metastatic urinary bladder tumor from gastric remnant carcinoma. On August 23, 1984, a 70-year-old-woman visited us with the complaint of dysuria. She had undergone gastrectomy for gastric ulcer 25 years earlier. Cystoscopy revealed a non-stalk tumor in the dome of the bladder and the examination of the upper gastro-intestinal tract revealed gastric remnant carcinoma. We treated her with adriamycin, cis-diamminedichloroplatinum and mitomycin C but unfortunately she died of cachexia two weeks later. An autopsy revealed that the urinary bladder tumor was a signet ring cell carcinoma, metastasized from gastric remnant carcinoma.