[Embolization of multiple pulmonary arteriovenous fistula in a case of Rendu-Osler-Weber syndrome with brain abscess]

A forty-year-old woman who developed brain abscess was found to Rendu-Osler-weber syndrome with multiple arteriovenous fistulas of the left lung. Therapeutic embolization of pulmonary arteriovenous fistulas was performed for the prevention against brain abscess and improvement of hypoxia.

Sequential malignant transformation of cardiac myxoma

We describe a case of cardiac myxoma in a 44-year-old Japanese man, who died after developing metastases in the skin, brain and muscle. A satellite tumor which was attached to the wall of the abdominal aorta induced marked hypertension due to obstruction of the renal arteries. Although the primary heart tumor had typical histological features of benign cardiac myxoma, the recurrent heart tumor, which was partly resected three months before the patient's death, showed apparently malignant characteristics resembling malignant fibrous histiocytoma (MFH). Since the histological features of the initial and recurrent tumors were different, the grade of malignancy was investigated using the cellularity of the tumor as an arbitrary criterion. A gradual but significant increase in the cellularity was observed over the course of five years. Immunohistochemically, tumor cells in the muscle metastasis contained vimentin and factor VIII-related antigen, and multinucleated giant cells in the recurrent heart tumor contained desmin, which is rarely detectable in MFH. Therefore, we considered that the present case represented malignant transformation of benign cardiac myxoma.

[A case of interstitial pneumonia after hepatic arterial infusion of lipiodol-anticancer drug emulsion for hepatocellular carcinoma]

We reported a case of interstitial pneumonia immediately after hepatic arterial infusion of Lipiodol anticancer drug emulsion for hepatocellular carcinoma. The reason was considered that Lipiodol-anticancer drug emulsion ran through an A-V shunt to alveolar septum resulting in alveolitis.

Differences in irradiation susceptibility and turnover between mucosal and connective tissue-type mast cells of mice

Although precursors of mast cells are derived from the bone marrow, phenotypes of mast cells are influenced by the tissues in which final differentiation occurs. Connective tissue-type mast cells (CTMC) and mucosal mast cells (MMC) are different in morphological, biochemical, immunological, and functional criteria. The purpose of the present study was to obtain information about the differentiation process of MMC. First, we compared changes in irradiation susceptibility in mice during the differentiation process of CTMC and MMC. The decrease in irradiation susceptibility was remarkable in the CTMC differentiation process, but it was moderate in that of MMC. Some morphologically identifiable CTMC in the peritoneal cavity had proliferative potential and were highly radioresistant, whereas such a radioresistant population of MMC was not detectable in the gastric mucosa. Second, we estimated the turnover of CTMC and MMC by determining the proportion of mast cells that were labeled with continuously administered bromodeoxyuridine. The turnover of MMC was significantly faster than that of CTMC. The absence of the radioresistant mast cell population in the gastric mucosa appeared to be related to the short life span of MMC.

[Clinical study of preoperative radiotherapy of bladder cancer]

From May 1982 to Nov. 1987, 33 patients with bladder carcinoma were treated with preoperative radiotherapy (20 Gy/5fr) and total cystectomy. The over all 3-year survival rate was 70%. For T1 and T2, 3-year survival rate was 100%, but only 55% and 0% for T3 and T4 respectively. In 23 out of 33 patients, preoperative T-stage was confirmed by TUR-BT. Down-Staging was recognized in 7 out of 23 patients (30%). They were 0 out of 1 patients for Tcis (0%), 2 of 3 for T1 (67%), 3 of 6 for T2 (50%), 2 of 11 for T3 (18%) and 0 of 2 for T4 (0%). This protocol of preoperative radiotherapy is thought to be favorable for T1 and T2 bladder carcinoma, but inadequate for T3 and T4 tumors. Consequently, it is considered that higher dose radiotherapy and postoperative chemotherapy are necessary for T3 and T4 bladder carcinoma.

[A case of extramedullary plasmacytoma in the radix linguae treated with radiation and chemotherapy]

A case of extramedullary plasmacytoma in the radix linguae was reported. Although immunological parameters rapidly normalized during the treatment, tumor size slowly reduced to minimal lesion 11 months after radiotherapy combined with chemotherapy. The management and the availability of MRI for this tumor was discussed reviewing the literature.

[A case of candida endocarditis with consecutive measurement of serum mannan and D-arabinitol concentrations]

We encountered a case of an 83-year-old patient with candida endocarditis. He had been diagnosed as having aortic regurgitation with moderately calcified aortic valve 5 years previously, and had received medication. He was admitted to our hospital because of pancreatic cancer. He had high fever from the time of his admission and antibiotics produced no effect. Candida albicans was detected in arterial blood culture. We also detected antibody against Candida albicans, and investigated serum mannan and the D-arabinitol creatinine ratio several times. We performed echo-cardiographic examination and recorded a vegetation at the aortic valve. Rising antibody titers against Candida albicans, mannan antigenemia and an elevated creatinine ratio were also observed. So we concluded that these examinations were also effective in the diagnosis of candida infection. Finally, this patient died of cerebral hemorrhage and was autopsied. Macroscopic findings showed mass-like vegetation involving the aortic valve, and microscopic findings showed candida organisms scattered within the vegetation.

Crystalline light-chain deposition and amyloidosis in the thyroid gland and kidneys of a patient with myeloma

A 48-year-old Japanese woman died of multiple myeloma (lambda light-chain type) with chronic renal failure. Histological examination revealed deposition of a homogeneous substance and crystals in the kidneys and thyroid gland. The homogeneous substance was stained with Congo red after permanganate treatment but did not stain with antibody to amyloid A protein, and it was recognized as AL-type amyloid. Crystals were not stained with Congo red, but crystals were stained with antibody to the lambda light chain. Since AL-type amyloid is considered to be derived from a myeloma light chain, the present case showed two different types of deposition, both of which were derived from the same myeloma protein.

Necessity of IgE antibodies and mast cells for manifestation of resistance against larval Haemaphysalis longicornis ticks in mice

Genetically mast cell-deficient WBB6F1-W/Wv mice showed an apparent defect in manifestation of the resistance against larval Haemaphysalis longicornis ticks, but their serum IgE levels increased more than 100-fold after the second tick infestation. Immune sera obtained from the WBB6F1-W/Wv mice were adoptively transferred to the other WBB6F1-W/Wv mice which had received intracutaneous injections of WBB6F1-+/+ mouse-derived cultured mast cells. Because the resistance against ticks was detectable only when both mast cells and IgE antibodies were available, immediate hypersensitivity reaction appeared to have a physiologic role in the manifestation of the resistance against H. longicornis ticks.

Necessity of IgE antibodies and mast cells for manifestation of resistance against larval Haemaphysalis longicornis ticks in mice

Genetically mast cell-deficient WBB6F1-W/Wv mice showed an apparent defect in manifestation of the resistance against larval Haemaphysalis longicornis ticks, but their serum IgE levels increased more than 100-fold after the second tick infestation. Immune sera obtained from the WBB6F1-W/Wv mice were adoptively transferred to the other WBB6F1-W/Wv mice which had received intracutaneous injections of WBB6F1-+/+ mouse-derived cultured mast cells. Because the resistance against ticks was detectable only when both mast cells and IgE antibodies were available, immediate hypersensitivity reaction appeared to have a physiologic role in the manifestation of the resistance against H. longicornis ticks.

[Experimental study of arterial damage induced by anti-cancer drug infusion]

In order to clarify the cause of arterial changes after intra-arterial infusion of anti-cancer drugs (AI-AD) experiments were made on the arteries of rabbits. Histopathologic sections, 7 days after AI-AD revealed endothelial damage characterized by pyknosis, hyalinization with edematous change of the intimal layer. Proliferation of the endothelial cells was also observed. The cause of narrowing or occlusion of the arteries was considered to occur with thrombus formation surrounded by the proliferated endothelial cells and this suggested that thrombolytic agents would be effective to prevent these arterial changes.

[Experimental study of embolo-hyperthermia for treatment of liver tumor--induction heating to ferromagnetic particles injected into tumor tissue]

Hepatic arterial embolization was performed on VX2 liver tumor of rabbit with subsequent induction heating to the tumor. Prior to the heating, iron particle suspension was injected into tumor tissue as a target of induction heating (500 KHZ, 9 KW). The temperatures of the tumor and liver parenchyma were measured with fluoroptic thermometer. Elevation of the tumor temperature during initial heating for 6 minutes were well correlated to the dose of iron particles injected; 1.4 degrees C with 1 g, 3.0 degrees C with 2 g, and 4.9 degrees C with 3 g. The temperature of liver parenchyma were below 39 degrees C even with 3 g injection.

[Three cases of hepatocellular carcinoma with remarkable fatty metamorphosis]

Three cases of hepatocellular carcinoma with remarkable fatty metamorphosis were reported. When we encounter lipomatous tumor with liver cirrhosis on CT and MRI, further examination is necessary because of its high possibility of hepatocellular carcinoma.

Relationship of the effects of interferon on chronic hepatitis B and the induction of 2',5'-oligoadenylate synthetase

Two years or more after 35 patients (29 men and six women) with chronic hepatitis B were treated by interferon, we studied relationships of age, ALT activity, activity of serum DNA polymerase associated with the hepatitis B virus, serum levels of hepatitis B e antigen and activity of 2',5'-oligoadenylate synthetase in peripheral blood mononuclear cells when treatment started in comparison with treatment results. Seventeen patients were given human lymphoblastoid interferon-alpha; the other 18 patients were given interferon-beta. We measured the activity of 2',5'-oligoadenylate synthetase in these mononuclear cells and found the rate of increase in vivo and in vitro; the correlation between the two was r = 0.68. This enzyme activity in the patients who became negative for DNA polymerase after interferon treatment increased more both in vivo and in vitro than in patients who did not became negative. Also, both the in vivo and in vitro activity increased more in patients who became negative for the e antigen after interferon therapy than in those who remained positive. In the first group, interferon was considered to be effective; in the second, ineffective. Of the patients who became negative, some developed e antibodies and some did not; the increase in this enzyme activity in the two groups was not significantly different. The increase in the activity of 2',5'-oligoadenylate synthetase activity could be used to predict the results of interferon treatment and is an index that can be used before treatment to predict the response.

Anterior communicating artery aneurysm associated with bilateral occlusion of the middle cerebral artery--case report

A female who had had no previous cerebrovascular events suffered a subarachnoid hemorrhage and was referred to our hospital. Angiography revealed an anterior communicating artery aneurysm and bilateral occlusion of the middle cerebral artery at its origin. She exhibited mild ischemic symptoms after clipping of the aneurysm, possibly as a consequence of disturbance of the collateral blood flow during surgery. This is the third such case reported in the literature.

[A comparative study of CT and plain X-ray film in the diagnosis of interstitial pulmonary disease in patients with rheumatoid arthritis]

In order to detect the interstitial pulmonary disease of rheumatoid arthritis (RA), we studied 91 patients with RA and compared the appearances of high resolution CT with those of plain chest X-ray film. We found 43 cases of interstitial pneumonitis on CT. We classified the CT and X-ray appearances as 4 groups (0-3) based on the degrees of pulmonary lesions. The both classifications accorded only in 46 cases (51%). In 46 cases who were not detected any changes by plain X-ray film, 17 were detected interstitial changes by CT. As to the early interstitial changes, the detectability of CT was superior to that of plain X-ray film.

[Application of the immunohistochemical method as predictive assay in radiotherapy of squamous cell carcinoma]

We analysed various subsets of lymphocytes infiltrated into cancer tissues from 15 patients (10 cases of oropharyngeal cancer and 5 of hypopharyngeal cancer) at pretreatment and at about 10 Gy and 30 Gy of irradiation by the method of biotin-avidin-horseradish peroxidase using mouse monoclonal antibodies. In 3 cases, tumor infiltrating lymphocytes were remarkably increased at the delivery of small dose of irradiation: Two of them showed remarkable radiosensitivity, and the lymphocyte subpopulation of the cancer tissue was mainly composed of Leu3a + 3b positive, Leu-8 negative and Leu-HLA-DR positive lymphocytes (activated helper inducer T lymphocytes). On the other hand, the third one proved to be rather radioresistant and the lymphocyte subpopulation was mainly composed of Leu-14 positive lymphocytes (B lymphocytes). These findings indicate that the analysis of the lymphocyte subpopulation infiltrating into cancer tissues at the delivery of small dose of irradiation is applicable as a predictive assay in radiotherapy of squamous cell carcinoma of oropharynx and hypopharynx.

A family with pseudodeficiency of acid alpha-glucosidase

A unique family is presented which consists of a patient with the juvenile muscular dystrophy form of glycogenosis type II and four healthy individuals, both parents and sisters, with low acid alpha-glucosidase activity. It was almost impossible to distinguish the homozygote from the heterozygous members by lymphocyte assay alone. In cultured skin fibroblasts, acid alpha-glucosidase activity measured with a synthetic substrate was less than 1% of the normal mean value in the patient and about 15% in the parents. The activity toward glycogen was not detectable in the patient and was about 30% of the normal mean value in the parents. These values are also lower than expected in heterozygotes. To explain these results properly, a new mutant allele of acid alpha-glucosidase is proposed. Both parents could be compound heterozygotes for the pseudodeficiency allele and the juvenile form of glycogenosis type II allele.