Tumor necrosis factor alpha production by peripheral blood mononuclear cells of patients with chronic liver disease

We investigated the production of tumor necrosis factor alpha by peripheral blood mononuclear cells of patients with chronic liver disease and its association with hepatitis activity. Tumor necrosis factor alpha production was measured with an enzyme-linked immunosorbent assay. Tumor necrosis factor alpha production by peripheral blood mononuclear cells stimulated with recombinant gamma-interferon of patients with chronic active hepatitis (5.8 +/- 4.0 units per ml, p less than 0.05) and patients with cirrhosis (4.1 +/- 2.1 units per ml, p less than 0.05) was significantly increased when compared with controls (2.5 +/- 1.6 units per ml). Tumor necrosis factor alpha production by peripheral blood mononuclear cells stimulated with a combination of recombinant gamma-interferon and recombinant interleukin 2 of patients with chronic persistent hepatitis (5.8 +/- 3.8 units per ml, p less than 0.05), patients with chronic active hepatitis (8.9 +/- 3.0 units per ml, p less than 0.001) and patients with cirrhosis (6.7 +/- 3.2 units per ml, p less than 0.05) was significantly increased in comparison with controls (3.3 +/- 1.8 units per ml). Tumor necrosis factor alpha production of patients with chronic active hepatitis was significantly higher than that of patients with chronic persistent hepatitis (p less than 0.05). There was a significant correlation (r = 0.5699, p less than 0.005) between tumor necrosis factor alpha production and histologic activity index in patients with chronic persistent hepatitis or chronic active hepatitis. These findings show that tumor necrosis factor alpha production is increased in chronic liver disease and that the increased tumor necrosis factor alpha production is related to hepatitis activity.

Immunohistochemical analysis of calcitonin and calcitonin gene-related peptide in human lung

Calcitonin and calcitonin gene-related peptide (CGRP) have been localized immunohistochemically in neuroendocrine cells of normal and diseased human lungs. Cells immunoreactive for calcitonin and CGRP first appeared in immature bronchi in the 27th gestational week. Thereafter, both peptides were found in the same bronchial neuroendocrine cells throughout fetal and neonatal life. In adult lungs with or without neuroendocrine cell hyperplasia, only calcitonin was present. In 17 of 18 (94%) pulmonary tumorlets, variable numbers of calcitonin-positive cells were identified. A few CGRP immunoreactive cells, as a subset of calcitonin-containing cells, were found in only three (17%) lesions. Of 37 bronchial carcinoids, calcitonin was detected in 14 and CGRP was detected in 16 (38% and 43%, respectively), and both peptides were predominantly localized in the same cells. Ten of 45 (22%) small cell lung carcinomas were calcitonin-immunoreactive. CGRP was noted in only one (2%) of these tumors, and both peptides coexisted in single cells. These findings indicate that the patterns of calcitonin/CGRP expression in hyperplastic bronchial neuroendocrine cells, pulmonary tumorlets, and, to some extent, small cell lung carcinomas are similar to those of normal adult lungs. On the other hand, calcitonin/CGRP expression in bronchial carcinoids is similar to that of late fetal and neonatal lungs.

Expression of the alpha subunit of human chorionic gonadotropin in normal and neoplastic neuroendocrine cells. An immunohistochemical study

The alpha subunit of human chorionic gonadotropin (HCG) was localized Immunohistochemically in paraffin sections of normal human tissues and neuroendocrine tumors. A small subset of dispersed neuroendocrine cells was positive in normal adult tissues, including gastric antrum, urachal remnant, anal glands and prostate. Positive cells were consistently present in perinatal lung but rare in adult lung. In contrast, the beta subunit was absent from these cells. Seventy-two of 151 extrapituitary neuroendocrine tumors (48%) were alpha subunit-positive. Thirty-three of 37 bronchial carcinoids (92%) were immunoreactive, with a high percentage of the tumors (54%) containing moderate to large numbers of positive cells. The alpha subunit was further demonstrated in 9 of 45 small cell lung carcinomas (20%), 19 of 35 extrapulmonary carcinoids (54%), 3 of 11 islet cell tumors (27%) and 8 of 13 medullary thyroid carcinomas (62%). Two of three malignant islet cell tumors were positive. Positive cells were usually few in number, except for two small cell lung carcinomas, two rectal carcinoids, one thymic carcinoid and one malignant islet cell tumor. Pheochromocytomas (n = 10) were negative. Eleven of 19 pulmonary tumorlets (58%) were alpha subunit-immunoreactive. A few beta subunit-positive cells were detected in only 6 lung lesions. The physiological significance of the imbalance of expression of HCG subunits by certain neuroendocrine cells and their tumors remains unknown.

Hepatitis B core antigen-specific IFN-gamma production of peripheral blood mononuclear cells in patients with chronic hepatitis B virus infection

To evaluate the specificity of cellular immune response to hepatitis B virus (HBV) Ag in patients with chronic HBV infection, we have measured IFN-gamma production and proliferation of PBMC of 16 patients with chronic active hepatitis (CAH), 17 asymptomatic carriers of HBV (ASC), 6 anti-hepatitis B surface (HBs)-positive subjects, and 6 control individuals with ELISA procedure and [3H]thymidine incorporation. There was no significant increase in the mean proliferative response to recombinant HB surface and core Ag (rHBsAg and rHBcAg), nor was IFN-gamma production elicited with rHBsAg in any group. In contrast, PBMC of HBeAg-positive and anti-HBe-positive CAH patients, and anti-hepatitis B "e" Ag (HBe)-positive ASC showed significantly enhanced IFN-gamma production in response to HBcAg, whereas those of HBeAg-positive ASC and anti-HBs-positive subjects did not respond to HBcAg. The maximal response was observed in a 5-day culture with 500 ng/ml of rHBcAg when assessed by stimulation index value. Monocytes did not demonstrate an increased suppressor or helper activity for IFN-gamma production in these patients. T cell subset fractionation revealed that CD4+ cells were main population of IFN-gamma production specific for HBcAg and CD8+ cells did not suppress IFN-gamma production of CD4+ cells. Furthermore, CD4+ cells of HBeAg-positive ASC generated lesser amounts of IFN-gamma than HBeAg-positive CAH patients did. These results show that the measurement of IFN-gamma production is useful to determine cellular immune response to HBV Ag and suggest that IFN-gamma production depends on the helper activity of CD4+ T cells sensitized to HBcAg.

Hepatitis B core antigen-specific IFN-gamma production of peripheral blood mononuclear cells in patients with chronic hepatitis B virus infection

To evaluate the specificity of cellular immune response to hepatitis B virus (HBV) Ag in patients with chronic HBV infection, we have measured IFN-gamma production and proliferation of PBMC of 16 patients with chronic active hepatitis (CAH), 17 asymptomatic carriers of HBV (ASC), 6 anti-hepatitis B surface (HBs)-positive subjects, and 6 control individuals with ELISA procedure and [3H]thymidine incorporation. There was no significant increase in the mean proliferative response to recombinant HB surface and core Ag (rHBsAg and rHBcAg), nor was IFN-gamma production elicited with rHBsAg in any group. In contrast, PBMC of HBeAg-positive and anti-HBe-positive CAH patients, and anti-hepatitis B "e" Ag (HBe)-positive ASC showed significantly enhanced IFN-gamma production in response to HBcAg, whereas those of HBeAg-positive ASC and anti-HBs-positive subjects did not respond to HBcAg. The maximal response was observed in a 5-day culture with 500 ng/ml of rHBcAg when assessed by stimulation index value. Monocytes did not demonstrate an increased suppressor or helper activity for IFN-gamma production in these patients. T cell subset fractionation revealed that CD4+ cells were main population of IFN-gamma production specific for HBcAg and CD8+ cells did not suppress IFN-gamma production of CD4+ cells. Furthermore, CD4+ cells of HBeAg-positive ASC generated lesser amounts of IFN-gamma than HBeAg-positive CAH patients did. These results show that the measurement of IFN-gamma production is useful to determine cellular immune response to HBV Ag and suggest that IFN-gamma production depends on the helper activity of CD4+ T cells sensitized to HBcAg.

Recurrent lupus pneumonitis with pulmonary hemorrhage in systemic lupus erythematosus associated with chronic thyroiditis and antithyroid hormone autoantibodies

We describe a SLE patient with repeated lupus pneumonitis and pulmonary hemorrhage. The hemorrhagic episodes were considered to be related to thrombocytopenia and lupus pneumonitis, which have responded well to treatment with moderate doses of steroids and immunosuppressant. She was also found to be suffering from chronic thyroiditis (hypothyroidism) and was positive for anti-thyroid hormone antibodies, which have not been reported before in the SLE patients with thyroid diseases.

[Antiplatelet effects of combination therapy with low-dose aspirin and ticlopidine in cerebral ischemia]

Antiplatelet effects of combination therapy with aspirin and ticlopidine were investigated in comparison with single aspirin or ticlopidine therapy in 62 patients with cerebral thrombosis or transient ischemic attack. The 14, 21 and 27 patients were given orally daily aspirin 300mg, ticlopidine 200mg and aspirin 81mg with ticlopidine 100mg, respectively. Various platelet function tests were performed before and a week after medication. They included platelet aggregation (PA) to adenosine diphosphate (ADP), arachidonic acid (AA) and platelet activating factor (PAF) with turbidimetry, plasma beta-thromboglobulin (beta TG), platelet factor 4(PF4), thromboxane B2(TXB2) and 6keto-prostaglandin-F1 alpha(6keto PGF1 alpha) with radioimmunoassay, bleeding time with Simplate device, and platelet survival and lysis with Indium-111-tropolone-labelled platelets. Aspirin inhibited PA to ADP and AA but not to PAF, while ticlopidine inhibited PA to ADP and PAF but not to AA. In contrast, aspirin with ticlopidine inhibited PA to all of these agonists despite their smaller doses used. Aspirin reduced plasma TXB2 but not beta TG or PF4, while ticlopidine reduced beta TG and PF4 but not TXB2. On the contrary, aspirin with ticlopidine reduced TXB2 as well as beta TG and PF4. 6keto PGF1 alpha tended to be reduced by aspirin 300mg alone but not by ticlopidine with or without aspirin 81mg. Bleeding time was significantly prolonged by aspirin or ticlopidine alone, although most prolongation was produced by combination of aspirin and ticlopidine. Platelet survival and lysis remained unaltered in 4 patients treated with aspirin or ticlopidine alone, whereas platelet survival was prolonged and platelet lysis was reduced in 4 patients treated with both aspirin and ticlopidine.(ABSTRACT TRUNCATED AT 250 WORDS)

Sclerosing stromal tumor of the ovary. Immunohistochemical and electron-microscopic demonstration of smooth-muscle differentiation

Two cases of sclerosing stromal tumor of the ovary (SST) are described. Immunohistochemical analysis of SSTs was performed using formalin-fixed and paraffin-embedded materials in comparison with thecofibromas and normal ovaries. The existence of desmin- and smooth-muscle actin-positive isolated spindle cells in SSTs and also in cortical stroma of the normal ovary was characteristically demonstrated, whereas such smooth-muscle-like cells were absent from six thecofibromas. Immunohistochemistry of desmin and smooth-muscle actin is useful in distinguishing SST from thecofibroma. Ultrastructural study further evidenced the presence of smooth-muscle-like cells in SSTs. In addition, we histochemically demonstrated heterogeneous cellular components in SSTs, including fibroblastic, thecalike, smooth muscle and endothelial cells. Hence, it is suggested that SST is derived from pluripotent immature stromal cells of the ovarian cortex.

Distribution of HBcAg in hepatitis B detected by immunoperoxidase staining with three different preparations of anti-HBc antibodies

To evaluate the role of the expression of hepatitis B core antigen (HBcAg) in liver cell damage the immunoperoxidase staining pattern of cryostat liver biopsy specimens from 16 chronic carriers of hepatitis B surface antigen (HBsAg) was investigated using three different kinds of anti-HBc antibodies. Polyclonal antibody prepared from recombinant HBcAg seemed to be more sensitive in detecting HBcAg than did monoclonal antibody from the same antigen. The topographical distribution of HBcAg detected by these two antibodies was similar, showing a close correlation to the histological activity of disease. Furthermore, the predominant localisation of cytoplasmic HBcAg usually reflected an active and severe ongoing hepatitis. On the other hand, monoclonal antibody prepared from purified Dane particles resulted in the prominent cytoplasmic staining for HBcAg regardless of histological severity of the hepatitis. The quantitative expression and topographical distribution of HBcAg depended on the type of anti-HBc antibodies used.

A new ultrasound-guided brain biopsy technique through a burr hole. Technical note

There is a disadvantage in brain biopsy by ultrasonic guidance comparing it with the CT guided approach. It is the fact that the ultrasonic method requires a small craniotomy or multiple trephinations because the size of the transducer exceeds the diameter of the burr hole and the echographic information from the trocar which houses the biopsy forceps, becomes poor when the sound beams run nearly parallel with the site of its insertion. The authors devised a brain biopsy technique through only one burr hole under real time monitoring, using a small foot-print transducer, 12 mm in diameter, and a special trocar with engraved scales on its surface. We believe that this new biopsy technique surpasses the traditional CT directed and ultrasound-guided methods in many respects. A representation case biopsied by this technique is presented.

High incidence of pulmonary tuberculosis in pathologists at Tokai University Hospital: an epidemiological study

Between 1935 and 1950 tuberculosis was the most common cause of death in Japan. Subsequently, the mortality rate, incidence, and prevalence of tuberculosis have decreased remarkably due to socioeconomic improvements and development of specific chemotherapy. It has been suspected that the incidence and prevalence of pulmonary tuberculosis in hospital workers, particularly those employed in pathology divisions, may be higher than those for other health care workers. However, there have been no reports on this subject. We conducted a questionnaire survey to assess and compare the incidence of pulmonary tuberculosis in pathologists at Tokai University Hospital with that in other employees of the University. Data on history of treatment for tuberculosis were obtained. The incidence of pulmonary tuberculosis in pathologists was significantly higher than that in other university employees, including clinical doctors who see patients with tuberculosis. These findings suggest that specific environmental conditions in the Pathology Division represent an occupational hazard although the infection might be contracted from other hospital staff.

Gastric carcinoma with lymphoid stroma. Analysis using mucin histochemistry and immunohistochemistry

A total of 626 surgically resected gastric carcinomas were reviewed, and 24 cases (3.8%) of "gastric carcinoma with lymphoid stroma" were identified. The tumour cells were consistently arranged in an anastomosing trabecular or alveolar pattern and were densely infiltrated by lymphoid cells. The specimens were studied using mucin histochemistry and the indirect immunoperoxidase method to determine the histochemical properties of this form of gastric carcinoma. The tumour cells were consistently positive for concanavalin A paradoxical staining, class III and almost devoid of acidic mucins, features demonstrating preferential differentiation toward pyloric glands or pseudopyloric glands. Immunohistochemically, positive reactions for Leu M1 and lysozyme, marker substances of (pseudo)pyloric gland cells, were often observed. Carcinoembryonic antigen was positive in focal areas without (pseudo)pyloric glandular patterns. Secretory component was focally positive. HLA-DR was strongly expressed in most cancer cells and 17 tumours (71%) showed positivity for interleukin 1 (IL-1). The lymphoid stroma contained a high percentage of UCHL1-reactive T cells both within and around the cancer cell nests, while SL26-reactive B cells clustered in lymphoid follicles. A considerable number of T-lymphoid cells were also reactive for IL-1. A number of plasma cells with a predominance of IgG-type were distributed around the cancer cell nests. S-100 protein-positive dendritic cells were not identified. We speculate that the prominent lymphoid stroma including intraepithelial lymphocyte-like T cells with IL-1 receptors is possibly induced by IL-1 related mediators released from the HLA-DR-positive gastric cancer cells of the (pseudo)pyloric gland-type.

Effects of various cytokines on collagen synthesis by normal rat hepatocytes in primary cultures and fibroblasts

Collagen formation is an important function of liver parenchymal and nonparenchymal cells that may be relevant to the pathogenesis of hepatic fibrosis. In the present study, the effect of various kinds of cytokines and prednisolone on collagen synthesis by hepatocytes obtained from perfused rat livers and confluent human skin fibroblasts were investigated. The cells were cultured in serum-free medium for 24 h with [3H]proline and various additives. The amounts of collagen and noncollagen protein synthesis were calculated from the incorporation of [3H]proline into collagen-sensitive and collagen-resistant proteins. The additions of interleukin 1 alpha, interleukin 1 beta and transforming growth factor alpha enhanced both collagen and noncollagen protein synthesis by hepatocytes as well as by fibroblasts. Transforming growth factor beta also increased both collagen and noncollagen protein synthesis by fibroblasts while it selectively inhibited collagen synthesis by hepatocytes. Interferon preparations and prednisolone showed a selective suppression of collagen synthesis by both cells, indicating that these additives did not affect either cell viability or proliferation during the observed period. These results suggest that collagen synthesis by liver parenchymal cells is either positively or negatively modulated by various kinds of cytokines and hormone.

Recurrent primary leptomeningeal astrocytoma of the lumbosacral spinal cord resembling schwannoma. A case report

Primary leptomeningeal astrocytoma has been considered to be derived from ectopic glial cells in the leptomeninges. A case of recurrent primary leptomeningeal astrocytoma of the lumbosacral spinal cord is described. The original tumor was localized in the extramedullary space at the level of the 12th thoracic vertebra, and was solely composed of interlacing bundles of monomorphous spindle-shaped cells. The tumor was therefore diagnosed as schwannoma. The recurrent tumor removed one year after the first operation showed two distinct histologic patterns with increased nuclear atypia and mitosis. Namely, both schwannoma-like areas and astrocytomatous areas were observed. Silver impregnation clearly demonstrated an alveolar pattern in the schwannoma-like area. Immunohistochemically, the tumor cells revealed a positive reaction for glial fibrillary acidic protein. This case particularly emphasizes the usefulness of silver impregnation in differential diagnosis from schwannoma.

Peripheral neuroepithelioma in childhood. Immunohistochemical demonstration of epithelial differentiation

Peripheral neuroepithelioma arising from the chest wall of a 4-year-old girl is described. She died of local recurrence 15 months after surgery. Light- and electron-microscopic as well as immunohistochemical findings confirmed the neuroectodermal nature of the tumor. A distinctive histologic feature was the presence of clustered epitheliallike cells, which immunohistochemically stained positive for both keratin and carcinoembryonic antigen. The epithelial nature of these peculiar cells is presented.

Gastric metaplasia in duodenal ulcer. Histochemical considerations of its pathophysiological significance

Gastric metaplasia of the duodenal mucosa in biopsy specimens of healed duodenal ulcer and in surgical specimens of perforated duodenal ulcer was investigated using mucin histochemistry and the indirect immunoperoxidase method. Endoscopic methylene blue test was performed prior to biopsy. All specimens from areas showing no dye absorption revealed varying degrees of gastric metaplasia characterized by heterotopic occurrence of gastric-type foveolar cells mainly at the tips of stunted intestinal villi. On average, 31.8% of the total surface length of duodenal mucosa taken from areas showing no dye absorption was occupied by the metaplastic cells. They showed strong reactivities for periodic acid-Schiff (PAS) and galactose oxidase-Schiff sequences, while alcian blue and paradoxical concanavalin A staining, class III, were negative. Immunoperoxidase-PAS double staining revealed a few gastrin and somatostatin cells in foci of gastric metaplasia, but almost no cells containing motilin, secretin, cholecystokinin and gastric inhibitory peptide. Such endocrine cells were scattered in nonmetaplastic mucosa. While such metaplastic change has been regarded as a self-defence mechanism or adaptation of the duodenal mucosa against acid, a local decrease of normal endocrine cells, which allegedly function as acid receptors, may lead to alterations of gastroduodenal interaction. It is suggested that gastric metaplasia is important as one of the pathophysiological mechanisms involved in the recurrence of duodenal ulcer.

Paget's extension of esophageal carcinoma. Immunohistochemical and mucin histochemical evidence of Paget's cells in the esophageal mucosa

A 68-year-old male with Paget's disease of the esophagus is reported. The underlying primary esophageal carcinoma was diagnosed as adenosquamous cell carcinoma on the basis of the presence of both adenocarcinoma and epidermoid carcinoma components. There was invasive growth of clear Paget's cells in the esophageal epithelium. Mucin histochemistry disclosed common characteristics of mucin between Paget's cells and adenosquamous cell carcinoma. It was histochemically confirmed that the existence of mucin was a general feature of extramammary Paget's disease. In 13 control esophageal carcinomas including three with adenocarcinomatous elements, Paget's cells were not found in the epithelium. To date only one case of Paget's disease of the esophagus has been described in the literature.

Immunohistochemistry of desmin and vimentin in smooth muscle tumors of the digestive tract

The expression of desmin and vimentin in 35 "smooth muscle tumors" of the digestive tract was investigated using formalin-fixed and paraffin-embedded materials and the indirect immunoperoxidase method. Fourteen of 15 esophageal tumors and two of 15 gastric tumors were categorized as benign leiomyoma with low cellularity, and immunohistochemically were desmin-positive and vimentin-negative as were normal muscle layers of the digestive tract. The remaining tumors showed moderate to high cellularity: Six tumors seemed to be malignant on the basis of frequent mitosis and/or nuclear atypia, while 11 were considered to be of borderline malignancy. This cellular tumor group exhibited consistent vimentin immunoreactivity, but desmin was negative or only weakly and/or focally positive. S-100 protein was fundamentally negative in these tumors. The pitfalls of studying desmin immunohistochemistry as a routine diagnostic tool in surgical pathology are discussed.