Malignant hemangioendothelioma of the skin

Three cases of malignant hemangioendotheliomas in elderly individuals are recounted. All of them died shortly after onset of the malignancies in spite of radical surgery in one; radical surgery, chemotherapy, and radiotherapy in another; and chemotherapy and radiotherapy in the third. Findings from studies of specimens of the malignancies by conventional microscopy, histochemistry, and electron microscopy are described.

Proatlantal intersegmental artery with absence of bilateral vertebral arteries. Case report

A case of proatlantal intersegmental artery with absence of bilateral vertebral arteries is presented. This rare anomaly was accidentally encountered on angiography in a patient with a ruptured aneurysm of the anterior communicating artery.

Finger replantation

From May 1965 to December 1979, finger replantation were performed on 157 patients (229 digits). Of these 205 fingers were successfully replanted with an overall success rate of 89.5%. In most cases, sensation was recovered to more than protective sensation and approximately 50% of the cases showed 2-point-dicrimination of less than 15 mm. Restricted joint motion was a problem in the replantation at "no-man's-land" in fingers. However, most of the patients gained useful pinch or grasp in their daily living activities and were very satisfied with their successfully replanted fingers. Operative indications, replantation technique, postoperative management and clinical results are reported.

Microvascular anastomosis with absorbable and nonabsorbable sutures—A comparative study in rats

Polyglycolic acid, polypropylene, and nylon sutures were used to anastomose the aortas of 40 rats. Comparative studies of the healing process at the suture sites were performed. The long-term observations, by means of light and scanning electron microscopy, revealed that the regeneration of endothelium was more rapid and the endothelium had a smoother surface in the aortas that received the polyglycolic acid sutures than in the aortas receiving polypropylene or nylon sutures because the polyglycolic acid sutures were absorbed after 6 weeks. It was concluded that polyglycolic acid suture material may be more desirable than nonabsorbable suture material in microvascular anastomoses.

Suppression of allergic contact dermatitis by alpha-L-fucose

We observed that L-fucose could suppress the skin reaction of allergic contact dermatitis induced by dinitrochlorobenzene. This observation was ascertained by histological examination as well as by visual inspection. The degrees of the acanthosis and the spongiosis were significantly slighter in the skin lesions of guinea pigs that received L-fucose injection, than in those of control animals. The number of infiltrated mononuclear cells in epidermis and dermis in the skin lesions as much less in the animals received L-fucose injection than that in the skin lesions of control animals. On the other hand, L-fucose had no suppressive effect on irritant contact dermatitis induced by high concentration (4%) of dinitrochlorobenzene.

Large-scale purification of prothoracicotropic hormone of the silkworm (Bombyx mori)

Prothoracicotropic hormone has been successfully extracted from as many as 2,800,000 silkworm male adult heads and purified partially through an 8-step procedure. Approximately 7 microgram of the crude preparation ("crude PTTH") shows activity in the debrained Samia pupa test. A further 4-step chromatographic purification of the "crude PTTH" derived from 100,000 Bombyx heads yields 3.4 mg of purified preparation ("highly purified PTTH"), of which 7 ng causes adult development in a debrained Samia pupa.

Mechanism of renal distribution of aminoglycoside antibotics

The renal accumulation of dibekacin, one of the aminoglycoside antibiotics, was pharmacokinetically analyzed and the mechanism of the renal accumulation of these antibiotics was investigated. The remaining amounts of dibekacin in the kidneys were adequately expressed by the bi-exponential equation. There was no possibility of a covalent bond between dibekacin and the renal tissue components. The renal accumulation of the aminoglycoside antibiotics was explained in terms of the two successive processes, renal tubular reabsorption and electrostatic interaction between these antibiotics and the tissue components. In other words, these antibiotics were reabsorbed at the renal tubules and transported into renal tubular epithelial cells and bound to the tissue components by electrostatic force. The electrostatic interaction also played an important role in increasing the acute toxicities of aminoglycoside antibiotics.

Blood vessel transplantation to bone

In dogs an artery, a vein, and a vascular bundle were transplanted into intact bone, isolated bone segments, necrotized bone, and homografts of bone. Active proliferation of new blood vessels and formation of new bone occurred in all instances where the vascular bundle was used, when the vein was implanted into the intact bone and isolated bone, and only when the artery was implanted into intact bone. As a result of these experiments, vascular bundle transplantation has been performed in patients with Kienboeck's disease, and avascular necrosis of the scaphoid, the femoral head, the talus, and other conditions.

Multicentric bowen's disease of the genitalia: spontaneous regression of lesions

The phenomenon of multiple lesions of Bowen's disease appearing on the genitalia of young adults is becoming increasingly recognized. We have seen two patients who had genital lesions with histologic features of squamous carcinoma in situ, but with an entirely different clinical appearance. In both patients, varying degrees of spontaneous regression occurred. A conservative approach to management of these lesions is suggested.

Microvascular anastomosis and its application on the replantation of amputated digits and hands

Successful microvascular anastomosis depends upon the applications of magnifications, special instruments and fine suture materials, and the surgeon's skill in the technique. The key points of one millimeter vessel anastomosis are the wall-to-wall coaptation of the vessel ends, the fewer number of interrupted stitches with relatively loose knot. To gain good coaptation, an oblique insertion of a needle through the vessel wall must be used. In a thin-walled vein repair, the lumen should always be kept open with frequent irrigations. Between July 1965 and December 1976, 150 digits out of 168 in 111 cases and 11 hands in 11 patients were successfully replanted. All tissues must be repaired primarily. The repair of artery is performed first, recirculation is allowed with systemic heparinization, followed by vein anastomosis. The rehabilitation is commenced from the first day. To gain good function, several reconstructive surgeries may be necessary on the replanted digit or hand.

Neuroradiologic evaluation of the subdural pathogenesis in infants with small heads

A marginal low density area is often revealed by CT scan in infants with microcephalia. However, it is difficult to assess precisely the main pathologic state of the marginal low density area and also whether such a lesion exists in the subdural-epiarachnoid space or in the subarachnoid space. A carotid angiographic evaluation of cortical vessels in the marginal avascular area was made and suggestive results were obtained. When there is acute subdural effusion or subdural hematoma, cortical arteries in the marginal avascular area will have a straightened and attenuated figure. But when such a pathologic state persists for a long period, it induces secondary cortical atrophy and the subarachnoid space becomes enlarged. The cortical artery appears as if it is flying in the enlarged subarachnoid space because it is detached from the gyrus and the sulcus following the cortical atrophy. This is why we named it the 'flying artery.' Angiographic findings allow more precise interpretation of the marginal low density area in the CT scan.

Traumatic amputation of digits: the fate of remaining blood. An experimental and clinical study

Experimental studies on rabbit ears amputated by either a clean sharp division or severed by a crushing blow showed that twice as much blood remained in the crush group. Microthrombi and tissue thrombi were seen in this group only. A review of 142 digital replantations performed over a 10 year period showed 126 survivals. Ninety-three were complete amputations and 80 of these survived; 49 were incomplete amputations and 46 survived after revascularization attemps. Of 74 clear amputations, 68 survived; of 68 crush-type amputations, 58 survived. Circulatory disturbances occurred in 36 replanted digits; 16 could not be salvaged. The primary cause of complications was venous obstruction. In 80 digital replantations done from January, 1974, to December, 1975, success was obtained in 75 (93.75 percent). Irrigation of vessels of the severed part is done only in cases of double level amputation, severely crushed or those due to avulsion. Heparin, low molecular weight dextran, urokinase, and antibiotics are given for several days after operation.

Characterization of the temperature-dependent inactivating factor of the thermostable direct hemolysin in Vibrio parahaemolyticus

The termostable direct hemolysin of Vibrio parahaemolyticus is inactivated by heating at around 55 C with an inactivating factor isolated from culture filtrates of V. parahaemolyticus. The characteristics of the temperature-dependent inactivating factor were studied by using polyacrylamide gel disc electrophoresis. It was found that when heated with the hemolysin, the inactivating factor destroyed the hemolysin and thus inactivated the hemolytic activity, suggesting that the inactivating factor has proteolytic activity. It was also demonstrated that the inactivating factor itself is heat labile, losing its activity on heating with the hemolysin at 95 C for 15 min. The inactivating factor was stimulated by the presence of NaCl or MgCl2 and showed maximal activity at around pH 8.0. The results support our previous hypothesis that the Arrhenius effect observed with crude hemolysin of V. parahaemolyticus is due to the presence of a temperature-dependent inactivating factor. The fact that the factor is activated on heating at 50 to 60 C but is inactivated on heating at 70 to 100 C explains the Arrheius effect of crude hemolysin of V. parahaemolyticus.

The late effects of selected immunosuppressants on immunocompetence, disease incidence, and mean life-span. II. Cell-mediated immune activity

The late effects of various immunosuppressive insults on cell-mediated immunity in mice were studied in an attempt to assess the role of immune surveillance in the aging process. Results were obtained using susceptibility to allogeneic tumor cell challenge, graft-versus-host reaction (GVHR), blastogenic response to PHA, a thymus derived T cell-specific plant mitogen, and cytolytic activity against allogeneic tumor cells as measures of immunologic activity. In vivo studies late in life show that resistance to allogeneic tumor cells is significantly decreased in thymectomized mice, whereas those treated with cortisone, cyclophosphamide and sublethal X-ray remain unchanged. Spleen cells from only the thymectomized and the sublethally irradiated mice show reduced activity in the GVHR. No difference is seen in the activity of bone marrow cells. Results consistent with these findings were obtained in in vitro studies. Thus spleen cells from thymectomized or sublethally irradiated mice show decreased activity is response to PHA, whereas no change is seen in spleen cells from other treated groups. Hence, surgical and physical insults are more likely to induce long-lasting immunosuppression in those immunocompetent tissues whose activity normally diminishes with advancing age. Furthermore, the degree of immunosuppression seen in this study is not of the order of magnitude that one could reasonably predict a significant decrease in mean life-span.

Congenital circumscribed hypomelanosis: a characterization based on electron microscopic study of tuberous sclerosis, nevus depigmentosus, and piebaldism

Subcellular defects of hypomelanosis in tuberous sclerosis (TS) (28 subjects) were compared by light and electron microscopy with oThere forms of congenital circumscribed hypomelanosis that occur in nevus depigmentosus (ND) (8 subjects) and in piebaldism (PB) (4 subjects), respectively. On the light microscopic level in both TS and ND, the population density of functioning melanocytes was normal but each perikaryon was small, and dopa activity was decreased. On the ultrastructural level, the hypomelanotic skin and hair of TS were associated with a decrease in the synthesis, melanization, and size of melanosomes; the decrease in the size of melanosomes resulted in the aggregation of melanosomes (i.e., a melanosome complex) in the keratinocytes in all the specimens examined. In ND, ther were no obvious changes in the size and melanocytes. the hypomelanosis of ND is related to the decreased synthesis and also, perhaps, abnormal transfer of melanosomes. In PB the hypomelanosis of the skin and hair results from the absence of functional melanocytes. The hypermelanotic areas of PB, however, characteristically contain melanocytes that synthesize abnormal (sperical and granular) as well as normal (ellipsoidal and lamellar) melanosomes.

Demonstration of a temperature-dependent inactivating factor of the thermostable direct hemolysin in Vibrio parahaemolyticus

A factor was found in Vibrio parahaemolyticus which inactivated the hemolytic activity of a purified, thermostable direct hemolysin. The inactivating factor was associated with the hemolysin but could be separated from it by diethylaminoethyl-cellulose column chromatography. The inactivating factor was activated by heating at 50 to 60 C, but was itself thermolabile and lost activity on heating to 70 to 100 C. The mechanism of the Arrhenius effect, observed with crude hemolysin of V. parahaemolyticus, is as follows. At 50 to 60 C, the temperature-dependent inactivating factor associated with hemolysin inactivates the hemolysin, whereas at 80 to 100 C the crude hemolysin retains activity because at this temperature the factor is inactivated.