Double adenomas with different pathological and hormonal features in the left adrenal gland of a patient with Cushing's syndrome

We report a 52-year-old women with Cushing's syndrome who presented with two adenomas in the left adrenal gland. One tumour appeared dark brown and the other appeared yellow on the cut surface. The non-neoplastic adrenal demonstrated marked cortical atrophy. Upon histological examination, the brown tumour was found to be composed of both compact and clear cells. In contrast, the yellow tumour was composed of clear cells associated with pseudoglandular formation and marked degeneration. Immunohistochemical studies demonstrated positive immunostaining of cytochrome P-450 specific for 17 alpha-hydroxylation (P-450c17) in the brown but not the yellow tumour. Other steroidogenic enzymes except for dehydroepiandrosterone sulphotransferase were detected in both tumours. The biochemical activities of 21-hydroxylase, 17-hydroxylase and 11 beta-hydroxylase in the brown tumour (6.10 nmol/mg protein/4 minutes, 1.87 nmol/mg protein/2 minutes and 5.71 mumol 11-OHCS formed/g protein/10 minutes, respectively) were much greater than those in the yellow tumour. Gel-supported three-dimensional native-state primary culture of the tumours demonstrated a much higher concentration of cortisol in the culture medium for the brown tumour (5750 nmol/l on 4th day). Vimentin expression was detected in both tumours but cytokeratin expression was detected only in the yellow tumour. The Ki67 labelling index in the brown tumour was greater than that in the yellow tumour. These results indicated that these two adenomas had different biological characteristics and the brown tumour was primarily involved in over-production of cortisol in this patient. When analysing unilateral multiple adrenocortical lesions, approaches using immunohistochemical studies for steroidogenic enzymes, enzyme activity assays and cell culture can help to define the steroidogenesis of individual adrenocortical lesions.

Angiographically unrecognized microaneurysms: intraoperative observation and operative technique

Twenty operated cases of angiographically unrecognized microaneurysm (AUM) have been analysed with special reference to intra-operative observations and clipping-technique. Among the patients with intracranial aneurysms that the authors' facility has operated upon, the incidence of asymptomatic incidental AUM that was 2 mm or smaller amounted to 3.7%. Thirteen cases of AUM were found on the middle cerebral artery; four AUMs arose from the M1 portion, four from the bifurcation, and five from the second bifurcation. Sixty percent of AUMs were recognized on the parent arteries of ruptured aneurysms. In 90% of cases the AUMs were broad based in shape and in 70% of cases exhibited a thin-walled neck and a thin-walled fundus. Intra-operative findings revealed four reasons why AUMs were not visible in the pre-operative angiograms: (1) the AUM was sandwiched between two arteries; (2) the AUM was completely hidden by a contiguous large or giant aneurysm; (3) the AUM was diagnosed by pre-operative angiogram as a bleb of the contiguous aneurysm; (4) the AUM was not visible on angiograms because the height of the AUM was extremely low. Twelve cases of AUM were successfully clipped using four different clipping techniques; (1) clipping parallel to the bifurcation in four, (2) clipping parallel to the parent artery in four, (3) pinch-clipping in two of the cases, and (4) cross clipping in two of the cases. The other eight cases were wrapped and coated. AUMs may be present during the direct operation of intracranial aneurysms and in intravascular surgery. Neurosurgeons and neuroradiologists need to explain the possible existence of AUMs to patients and their families.

Leydig cell tumor of the testis: analysis of testosterone production and secretion by three-dimensional histoculture

We treated an 11-year-old boy with a testicular Leydig cell tumor. We analyzed the testosterone production of this tumor by immunolocalization of steroidogenic enzymes and in vitro three-dimensional histoculture. Spermatic venous blood from the tumor bearing testis had noticeably high concentrations of testosterone and androstenedione. The tumor had the characteristic ultrastructural features of steroid producing cells and was immunoreactive for P450scc (side chain cleavage), 3 beta HSD (hydroxysteroid dehydrogenase) and P450c17 (17 alpha-hydroxylase). Three-dimensional collagengel-supported histoculture demonstrated that the tumor tissue in the culture maintained its histologic architecture, expression of steroidogenic enzymes, and secretion of testosterone into the medium for up to 7 days in culture. Histoculture preserved in vitro testosterone production in this case of testicular Leydig cell tumor.

Ectopic gastric mucosa in the upper esophagus: prevalence and radiologic findings

OBJECTIVE

Ectopic gastric mucosa of the upper esophagus is an asymptomatic benign lesion that may simulate a more serious lesion on radiographs. We studied the radiographic findings and prevalence of this abnormality.

SUBJECTS AND METHODS

During a 1-year period, 1142 consecutive patients (817 men, 325 women) who had an upper gastrointestinal series as part of an annual health checkup were prospectively studied. Routine examination of the esophagus consisted only of fluoroscopy. Radiographs were obtained if any localized irregularities were found in the upper esophageal wall at fluoroscopy. The findings were subsequently confirmed by endoscopy and biopsy.

RESULTS

Ectopic gastric mucosa in the upper esophagus was seen in 27 (25 men, two women) of the 1142 patients. Forty-three localized ectopic gastric mucosal patches varying in size from 5 mm to 32 mm were detected at the level of the thoracic inlet in the 27 patients. The most common radiographic finding was a pair of small indentations on the wall of the esophagus (18 patches). Other findings included a rimlike shadow (three patches), a pair of somewhat large indentations with a shallowly depressed area between them (two patches), one indentation (five patches), a small flat elevation (one patch), a serrated irregular outline (five radiologic lesions consisted of 11 patches), other various irregular outlines (two patches), and a polypoid area (one patch).

CONCLUSION

Prevalence of radiographic evidence of ectopic gastric mucosa in the upper esophagus is 2.4%. The lesion was found more commonly in men (3.1%) than in women (0.6%). Radiographic findings include a pair of indentations along the lateral margin of the esophagus and a rimlike shadow on the anterior or posterior wall. Recognition of the characteristic radiographic features of this abnormality makes endoscopy and follow-up unnecessary.

[Three-dimensional longitudinal dissection view of hollow viscus]

To visualize the pathologies of hollow viscus and their extension three-dimensionally, volume data of the larynx, trachea, stomach, rectum, and urinary bladder were obtained using helical CT with moderately thin slices. Longitudinal cut sections were made as in a simulated surgical cut, and the interior morphology was displayed along with the pathology. A cylindrical projection profile was made by making a longitudinal incision on one wall and pulling apart the flaps to reveal the interior, providing better visual perception. The detailed outline from the 3D profile and the cylindrical projection views constituted an added advantage over the existing procedures.

Ectopic gastric mucosa in the upper esophagus: detection and radiographic findings

PURPOSE

To detect and characterize the appearance of islands of ectopic gastric mucosa in the upper esophagus at routine examination of the upper gastrointestinal (GI) tract.

MATERIALS AND METHODS

Well-distended upper esophagus was documented with spot radiographs obtained with routine double-contrast examination performed after administration of high-density barium in nine patients. Detected lesions were confirmed by means of endoscopy and biopsy.

RESULTS

Twelve lesions were detected. Radiographic findings were characterized by either a discrete, shallow depression surrounded by a subtle, rimlike elevation on double-contrast images or by a pair of small indentations on the same wall on full-column, single-contrast images at the level of the thoracic inlet. Endoscopic examination revealed well-circumscribed areas of reddish mucosa located 15-26 cm from the incisors.

CONCLUSION

Ectopic gastric mucosa in the upper esophagus is easily demonstrated at routine examination of the upper GI tract. Diagnosis can be based on location and characteristic radiographic appearance.

Enhancing effects of fluorescein on beta-lactam rash. II: Enhancing effects of fluorescein on generalized rash induced by beta-lactam antibiotics in guinea pigs

Healthy volunteers, who were receiving intravenous injections of cefclidin (CFCL) with frequent concomitant use of fluorescein (F) and oxybuprocain (O) in the eyes for measurement of ocular tension, developed drug eruptions at the high frequency of 66.7%. The injection of CFCL alone induced the eruptions at an incidence of 2.8%. The cause of this high eruption rate was thought to be the simultaneous treatment with F and/or O. Therefore, we conducted experiments with CFCL-induced generalized rash (GR) in guinea pigs. Guinea pigs treated with F and O during both the phases of immunization and intraperitoneal elicitation developed CFCL rashes at a high frequency. This CFCL-rash was augmented by the treatment with F during either phase, but not by the treatment with O. Skin testing induced delayed type hypersensitivity (DTH) reaction to O in some animals, but the DTH to F was not induced in animals immunized with F in complete Freund's adjuvant. Furthermore, F augmented rashes induced not only by CFCL but also by other beta-lactam antibiotics such as cefsulodin and sulbenicillin. Accordingly, it is likely that F played a dominant role in the high incidence of drug eruptions during the volunteer trials with measurement of ocular tension.

[Effect of cefclidin and E1077, new cephalosporins, on the alcohol-metabolizing system in rats]

Administration of latamoxef and cefoperazone, reported to act like disulfiram in humans, caused a depression of mitochondrial low Km aldehyde dehydrogenase (low Km ALDH) activity in rats. In addition, a marked increase of blood acetaldehyde concentration was observed when rats were given alcohol orally at 18 hours after administration of these cephalosporins. However, mitochondrial low Km ALDH activity and blood acetaldehyde level were not altered by repeated administration of 300 mg and 1,000 mg of cefclidin (CFCL, E1040) or E1077 per kg. From these results, it was concluded that neither CFCLn or E1077 affected the alcohol metabolizing-system.

Ultrasonographic appearance of the endometrium in natural and stimulated in-vitro fertilization cycles and its correlation with outcome

Ultrasonographic evaluation of the endometrium in 56 IVF patients was performed prospectively. Endometrial thickness and pattern were analysed in 18 natural-cycle and 38 stimulated-cycle patients. Thickness was measured from the echogenic interface of the endometrium-myometrium junction on a transverse section at the level of the fundus. Patterns were classified as A (homogeneous, hyperechogenic), B (mixed, with an outer hyperechogenic and inner hypoechogenic layer) or C (fluid-filled cavum with ring configuration). The thickness and pattern distributions were similar in natural- and stimulated-cycle patients. There was no correlation between thickness and serum oestradiol levels, the diameter of the largest follicle or the pregnancy outcome in either group. However, the occurrence of endometrial pattern A on the day prior to oocyte retrieval had a predictive value of 100% for a non-conceptional cycle. In contrast, pattern B occurred in a significantly greater proportion of pregnant than non-pregnant patients.

[Atrioventricular delay and diastolic mitral regurgitation in patient with DDD pacemaker implantation, and cardiac function]

We examined the mitral valve motion, the mitral valve flow pattern, and changing atrioventricular (AV) delay in 34 patients with DDD pacemaker implantation, using M-mode echocardiography and pulse Doppler echocardiography. In 28 patients, B-B' step and diastolic mitral regurgitation (DMR) were induced by extending the AV delay. 8 of 12 patients who showed B-B' step and DMR with the AV delay less than or equal to 165 mS had heart failures. In such patients, P-B-B' step (DMR) interval was 174 +/- 31 mS shorter than the other patients (216 +/- 26 mS, p less than 0.001), and Q-C interval was 131 +/- 26 mS longer than the other patients (63 +/- 31 mS, p less than 0.001). The minimal value of the AV delay that induces B-B' step and DMR can be decided under the influence of cardiac functions, and this echocardiographic examination is useful, giving us information about the cardiac function of the patients with DDD-PM. B-B' step is the mitral valve motion that corresponds with the DMR, so we can check the DMR through the B-B' step easily.

[Usefulness of dual-energy digital radiography in detecting atlas and axis]

Cranial dual-energy digital radiography was applied to three patients. The anatomy of the atlas and axis was clearly recognized without utilizing the open-mouth view. We consider it a very effective technique when applied to the patient who experiences difficulty in opening the mouth, like severe traumatic or infantile patients. In addition, it is a useful examination for patients with suspected anomalies of cranio-vertebral junction.

Pollen morphology of Ginkgo biloba and Cycas revoluta

Morphological studies on pollen grains of Ginkgo biloba L. and Cycas revoluta Thunb. were carried out by scanning electron microscopy. The pollen grains of both species are generally oblong with 1-sulcate apertures which are shrunken as a result of dryness. However, the swollen grains show an almost spherical form with a large and rounded germinal aperture. This aperture may not correspond to any aperture type so far known, although the term "anaporate" can be fitted to the swollen pollen grains. Auricular projections, which may be derived from protrusions of the ectosexine, can be seen sometimes on the surface of the pollen grains. These projections remind us of degraded versions of the bladders that may have been present on the pollen grains of the fossil ancestor. The inner side of the exine, which can be seen in thin sections obtained with the freezing microtome, is ornamented with reticulumlike sculptures. These endosculptures may be the first reported among gymnosperm pollen grains.

The effect of immunoglobulin G1 structure on macrophage binding to supported planar lipid monolayers

We have studied the antibody-dependent binding of macrophages to supported planar lipid monolayers containing haptenated phospholipids (Tnp-Cap-DPPE). Eight monoclonal anti-TNP IgG1s, which had similar affinities to the TNP residues in solution and in the membranes, were used in the experiment. The results showed that mouse macrophages (P388D1 and J774.1) bound with different affinities to these IgG1-coated lipid monolayers. The monoclonal antibody shown to be deficient in macrophage binding was also relatively ineffective in activating complement. These results indicated that individual monoclonal antibodies of a given subclass may prove deficient in terms of the biological activities associated with the group as a whole.

Brugia pahangi: stage-specific antigens on microfilariae detected by serum from infected jirds or by monoclonal antibodies

Experiments were carried out to determine whether there are stage-specific antigens on microfilariae of Brugia pahangi, using sera from Mongolian jirds infected with B. pahangi and monoclonal antibodies against microfilariae of B. pahangi. These studies showed that microfilariae have both stage-specific and nonspecific antigens. The nonspecific antigens were also present on adult worms and on infective larvae. Among monoclonal antibodies, 6 out of 14 clones produced antibodies against the microfilarial stage-specific antigens, and 8 clones produced antibodies against nonspecific antigens. These monoclonal antibodies could not distinguish between adults, microfilariae, or infective larvae of B. malayi and B. pahangi.

Effect of priming with antigen on the expression of C3 receptors on murine B cells and the responses to TI-2 antigens

The effect of priming with DNP-Ficoll on the expression of receptors for the third component of complement (CR) on B cells was studied. B cells from mice primed with antigen were separated into CR- and CR+ populations by rosetting and density gradient centrifugation, and they were examined for antibody responses to TI-2 antigens in vitro. CR- B cells in spleen cells from mice primed with antigen responded well in contrast with the low responsiveness of CR- B cells from unprimed mice. These CR- B cells from primed mice reached their peak responses 1 day earlier than CR+ B cells from primed or unprimed mice. The response of these CR- B cells was specific for the hapten used for priming, and the priming effect was most conspicuous in spleen cells from mice primed with antigen 3 days previously, and it decreased thereafter. The CR- B cells from primed mice also showed better responses than CR+ B cells to all polyclonal B cell activators (PBA) tested. When CR+ B cells were primed in vitro with DNP-Ficoll for 3 days, the major cell population responsive to the antigen in secondary culture was found to be CR- B cells. On the other hand, CR- B cells in spleens could not respond to DNP-Ficoll challenge after in vitro priming with the antigen for 3 days. These results indicate that B cells lose CR by priming with antigen, although they retain their responsiveness to antigens and PBA. The role of CR on B cells in the antibody response is discussed.

Effect of priming with antigen on the expression of C3 receptors on murine B cells and the responses to TI-2 antigens

The effect of priming with DNP-Ficoll on the expression of receptors for the third component of complement (CR) on B cells was studied. B cells from mice primed with antigen were separated into CR- and CR+ populations by rosetting and density gradient centrifugation, and they were examined for antibody responses to TI-2 antigens in vitro. CR- B cells in spleen cells from mice primed with antigen responded well in contrast with the low responsiveness of CR- B cells from unprimed mice. These CR- B cells from primed mice reached their peak responses 1 day earlier than CR+ B cells from primed or unprimed mice. The response of these CR- B cells was specific for the hapten used for priming, and the priming effect was most conspicuous in spleen cells from mice primed with antigen 3 days previously, and it decreased thereafter. The CR- B cells from primed mice also showed better responses than CR+ B cells to all polyclonal B cell activators (PBA) tested. When CR+ B cells were primed in vitro with DNP-Ficoll for 3 days, the major cell population responsive to the antigen in secondary culture was found to be CR- B cells. On the other hand, CR- B cells in spleens could not respond to DNP-Ficoll challenge after in vitro priming with the antigen for 3 days. These results indicate that B cells lose CR by priming with antigen, although they retain their responsiveness to antigens and PBA. The role of CR on B cells in the antibody response is discussed.