[A case of muscle metastasis of renal cell carcinoma treated by local resection and tensor fascia lata myocutaneous flaps]

A 44-year-old male with a little finger tip-sized tumor palpable on the left epigastric wall and a left renal tumor detected on computerized tomography (CT) was referred to this hospital in June 1991. Nephrectomy was performed in July 1991 under the diagnosis of a left renal tumor. Histologically, the tumor was a renal cell carcinoma, grade 2, clear and granular cell type. The tumor in the left abdominal wall was not extracted. As a tumor also developed in the scapular tunica muscularis, tumors in the left musculus rectus abdominis and the scapular tunica muscularis were extracted to the extent possible in July of 1992. Histologically, these tumors were metastatic clear cell carcinomas. The tumor in the left musculus rectus abdominis recurred and another was palpable in the left lateral femur. In August of 1993, the tumors in the left musculus vastus lateralis and the left musculus abdominis were extracted together with the tunica muscularis, and the defective region on the abdominal wall was closed with a left musculus tensor fascia lata flap. No evidence of recurrence has been observed to date.

3 beta-Hydroxysteroid dehydrogenase activity and gestagen concentrations in bovine cotyledons and caruncles during gestation and parturition

3 beta-Hydroxysteroid dehydrogenase (3 beta-HSD) activity in bovine cotyledons was much higher than in caruncles throughout the gestation period. The activity of this enzyme in cotyledons increased greatly to 150.6 +/- 5.8 pmol min-1 mg-1 protein during the seventh month of gestation, reached a peak of 221.0 +/- 34.9 pmol min-1 mg-1 protein during the eighth month, and decreased at parturition. Progesterone and 20 alpha-hydroxyprogesterone concentrations in cotyledons also increased sharply to 2.69 +/- 0.30 and 2.15 +/- 0.42 ng mg-1 protein, respectively, during the seventh month of gestation, reaching peaks of 2.86 +/- 0.47 and 2.51 +/- 0.36 ng mg-1 protein, respectively, during the eighth month and decreasing at parturition, in a manner similar to the activity of 3 beta-hydroxysteroid dehydrogenase. The fluctuation of 17 alpha-hydroxyprogesterone concentration in cotyledons was different from that of progesterone and 20 alpha-hydroxyprogesterone. These findings indicate that the activity of 3 beta-hydroxysteroid dehydrogenase in the placenta is enhanced during the third trimester, and progesterone synthesized in the cotyledons is converted concurrently to 20 alpha-hydroxyprogesterone before progesterone is transferred to the fetal blood.

Experimental study of cryopreserved allogeneic transfer of vessel: preliminary report

It has long been known that the antigenicity of tissues is depressed when they are kept at a very low temperature. In this study, Lewis rats and Brown Norway (B.N.) rats were used because these species are significantly dissimilar at the major histocompatibility complex (MHC) Femoral arteries were harvested from Lewis rats, frozen while lowering the temperature in a stepwise fashion to -70 degrees C. After three weeks of cryogenic storage, the arteries were transplanted into Lewis and B.N. rats. At various times from the first to the twelfth week after surgery, grafted vessels were observed, and pathological and electron microscopic studies were carried out. The vessels were found to be in good condition at the end of the 12 week observation period. These results strongly suggest that prolonged cryopreservation of vessels makes allotransplantation without immunosuppression possible.

Aromatase activity and oestrogen concentrations in bovine cotyledons and caruncles during gestation and parturition

Two peaks of aromatase activities were detected in bovine cotyledons, 2.76 +/- 0.96 pmol min-1 mg-1 protein at month five of gestation and 3.62 +/- 0.78 pmol min-1 mg-1 protein immediately after parturition, but aromatase activity in caruncles was very low throughout gestation. Oestrone concentrations in the cotyledons and caruncles were 0.93 +/- 0.50 and 1.51 +/- 0.69 ng mg-1 protein at month five of gestation, but 4.31 +/- 1.66 and 3.36 +/- 0.98 ng mg-1 protein immediately after parturition, indicating a biphasic pattern. Our findings suggest that oestrogen synthesis in the bovine placenta increased to a maximum at least twice during the period from gestation to parturition; at month five of gestation and at parturition the changes in aromatase activity may only be partially explained by changes in oestrogen production.

Contact microradiographic analysis of feline tooth resorptive lesions

Feline tooth resorptive lesions were studied using contact microradiographic analysis of ground sections. Contact microdiagram films were developed with a PIAS-imaging device, and decalcification patterns were evaluated, revealing a clear boundary between normal tissue and the resorptive area, which was different from the image of dental caries in humans. By contrasting analysis, decalcification signs appearing in human caries were not observed in feline resorptive lesions.

Transplantation of long-term cryopreserved allocutaneous tissue by skin graft or microsurgical anastomosis: experimental studies in the rat

A step-wise method of freezing cutaneous soft tissue containing vessels to -196 degrees C for permanent preservation was developed. The methods of embryo cryopreservation were modified for soft-tissue preservation. Cutaneous tissue obtained from the abdominal wall of a Lewis rat was preserved for more than 3 weeks by this method and was then transplanted to a Brown Norway rat with the largest difference in major histocompatibility complex. Rejection reaction against the epidermal layer was markedly delayed, followed by a decrease in antigenicity of the dermis, with survival of the majority of the tissue for more than 6 months. A concept of artificial skin was formed based on these experimental results. A skin flap from the abdominal wall with a vascular pedicle consisting of the femoral artery and vein was similarly preserved and transplanted by vascular anastomosis. This transplant was made viable over a long period through the additional use of an immunosuppressant. Replantation of a rat hindleg also was successfully accomplished by using a skin flap from the abdominal wall with a vascular pedicle consisting of the femoral artery and vein, which had been cryopreserved for more than 3 weeks. These results with 65 pieces in five different treatment groups indicate the reliability of this method of preservation in maintaining the tissue in a state adequate for transfer without loss of viability over a long period. The applicability of this method of allograft preservation to the field of free-tissue transfer combined with microsurgical technique may introduce a new concept to the field of reconstructive surgery in the future. According to the results of the present experiment, the great potential for clinical application is described for the deepithelialized cryopreserved allocutaneous flap transfer.

Cryopreserved allogeneic vessel and nerve grafts: hind-limb replantation model in the rat

The authors have previously reported the permanent storage of skin and cutaneous flaps using cryopreservation. In this study, replantation of the hind limb was performed in rats, using an allogeneic femoral artery, vein, and sciatic nerve which had been cryopreserved for more than 3 weeks. Femoral arteries, veins of 2 cm in length, and sciatic nerves of 1.5 cm in length from Lewis rats were cryopreserved for more than 3 weeks to decrease antigenicity. The hind limb of a Brown Norway rat was completely amputated at its mid-length and the cryopreserved artery, vein, and nerve were interposed in the anastomosis of the femoral artery, vein, and sciatic nerve. Immunosuppressants were not used. Hind limbs were replanted in six rats, and all cases survived. Toe spread and gait-foot analysis revealed good results at 3 months postoperatively. Excellent axonal regeneration was observed in the pathologic examination of the sciatic nerve 1 cm distal to the transfer. This report introduces a long-term storage method for vessels and nerves and extends the possibilities for clinical use of cryopreserved vessels and nerves, using replantation in a rat model.

Combination of patch test and IgE for dust mite antigens differentiates 130 patients with atopic dermatitis into four groups

BACKGROUND

Patients with atopic dermatitis sometimes have positive responses to patch testing (PT) with dust mite antigens, which is believed to correlate with the elevated levels of specific IgE for those antigens.

OBJECTIVE

The purpose of this study is to identify the correlation between the PT and serum IgE concerning the mite antigens.

METHODS

We studied 130 patients with atopic dermatitis by the PT reaction and the serum level of specific IgE for Dermatophagoides pteronyssinus antigens.

RESULTS

Fifty-one of the 130 patients assessed as PT-positive had either high (32 of 130 patients; 24.6%) or low or no (19 of 130 patients; 14.6%) levels of mite-specific IgE; there was a significant difference between the groups with elevated and low IgE. Similarly, a total of 79 PT-negative patients also showed an elevated or low mite-specific IgE (42 of 130 patients [32.3%] or 37 of 130 patients [28.5%], respectively). It was noted that clinical morphologic findings were peculiar to three of the four groups; however, the patients who were PT-negative with a low IgE (37 of 130 patients) showed no particular clinical lesions.

CONCLUSION

Comparing the results from our 130 patients, there was no correlation between the serum IgE level and the PT reaction for dust mite antigens. Conversely, the results of PT and mite-specific IgE could be used to divide these patients into four distinct groups, each with its own particular clinical morphology, suggesting the heterogeneity of this disease.

Microsurgical use of polydioxanone (PDS) suture: an experimental report

Although many technological advances have been made in surgical materials, nylon is still the main suture material use for microvascular surgery. This study sought to evaluate polydioxanone (PDS) sutures for use in microvascular anastomoses. Twenty-eight male Sprague-Dawley rats were used in this experiment. Spatula-type needles with 9-0 PDS suture were used to anastomose the right femoral arteries, with 9-0 nylon used on the left side. The arteries were observed for 1, 2, 3, 4, 8, 12, and 16 weeks after surgery to determine arterial patency and to evaluate vascular pathology. Results were comparable between PDS and nylon. We suggest that if the suture material is redesigned to allow smooth passage through the tissue, and if the needle used in conjunction with the suture is improved, PDS may offer an excellent material for microvascular anastomosis.

Changes of plasma concentrations of steroid hormones, prostaglandin F2 alpha-metabolite and pregnant mare serum gonadotropin during pregnancy in thoroughbred mares

Plasma concentrations of estrogens, gestagens, cortisol (F), 13, 14-dihydro, 15-keto PGF2 alpha (PGFM) and pregnant mare serum gonadotropin (PMSG) in 10 Thoroughbred mares were measured for a 11-month pregnancy period. Estrone (E1) and estradiol-17 beta (E2) levels gradually increased as the pregnancy advanced, showing a peak around Month 8 and decreased thereafter. Progesterone (P) levels increased on Months 3 and 11, and 17 alpha-OH-progesterone (17 alpha-OHP) levels peaked on Month 3, whereas 20 alpha-OH-progesterone (20 alpha-OHP) levels increased sharply after Month 6. PGFM indicated peaks on Months 2 and 11. F and PMSG levels peaked on Months 2 and 3. From factor analysis, Month, E1, E2 and 20 alpha-OHP were discriminated as Factor 1, increasing with the progress of pregnancy, PMSG, 17 alpha-OHP and P as Factor 2, showing a relation with the secondary corpus luteum, and PGFM and F as Factor 3, affecting PGFM change on Month 2 by F. P also related to both Factors 1 and 3, showing an inverse relation against PGFM. In conclusion E1, E2 and 20 alpha-OHP contained in Factor 1 were suggested to be important especially as parameters of placental function after Month 6.

Clinical and pathologic studies on contraction band lesion: relation to acute myocardial infarction and unexplained sudden death

The relation between contraction band lesion (CBL) and major cause of death was investigated through the use of hearts from 500 serialized autopsy cases. Acute myocardial infarction (AMI), unexplained sudden death (USD), cardiac surgery death, cancer, infection, cerebrovascular disease, and ruptured aortic aneurysm were examined with respect to age, sex, heart weight, and CBL localization patterns. CBL was observed frequently with AMI, USD, and cardiac surgery death, but virtually unseen with cancer or in the remaining disease categories. In a comparison of average heart weight among the various groups, there appeared to be a correlation between heavy heart weight and increased frequency of CBL. In a second investigational phase, the relation between CBL and application of cardiopulmonary resuscitation techniques was investigated in 100 separate autopsy cases. There was no significant difference between treated and untreated patients regarding frequency and pathology of CBL. We hypothesize that CBL-AMI and CBL-USD belong to the same disease group and that CBL develops before the onset of death with no connection to the mechanical and pharmacologic effects of cardiopulmonary resuscitation.

An autopsy case of human T lymphotropic virus type I-associated myelopathy (HAM) with a duration of 28 years

An autopsy case of human T lymphotropic virus I-associated myelopathy (HAM) of a duration of 28 years in a 61-year-old man with serological confirmation of HTLV-I infection was reported. The spinal cord was grossly atrophic. There was severe symmetrical degeneration of the lateral funiculi, particularly of the bilateral pyramidal tracts, involving all levels of the spinal cord, but anterior horn cells were relatively well preserved. In the most severely damaged middle and lower thoracic segments, the white matter degeneration also involved the anterior funiculi. In the degenerated white matter, both the myelin and axons were equally lost and had been replaced by glial scars. Marked adventitial fibrosis was commonly seen in small parenchymal vessels in both the white and gray matter. Although there was no evidence of inflammation in the spinal cord, mild lymphocytic infiltration was occasionally observed in the subarachnoid and perivascular spaces in the brain stem, cerebellum and cerebrum. This case was considered as a burnt-out case of HAM.

Ultrastructure of swollen proximal axons of anterior horn neurons in motor neuron disease

We have investigated ultrastructurally swellings of the proximal axons directly connected with the somata of anterior horn cells in a patient with motor neuron disease. In the distal portion of the initial segment, the swellings consisted predominantly of increased amounts of neurofilaments running nearly parallel to the longitudinal axis together with other cytoplasmic organelles. In the first internode of the myelinated axon, as the swellings became larger, the neurofilaments lost their parallel orientation and became intermingled. Most of the cell bodies connected with the swellings and their dendrites showed no particular changes. The abnormal neurofilamentous accumulations in the proximal axons suggest abnormal axonal transport, which may be pathogenetically associated with motor neuron disease.

Two cases of pilomatrix carcinoma

We report two cases of pilomatrix carcinoma. Wide surgical excision, radiation, and chemotherapy were required for the first patient. The tumor eventually revealed the characteristics of a carcinoma, both clinically and histopathologically, as it recurred. In the second case, although the tumor exhibited the histology of pilomatricoma in the central part of the lesion, there were numerous outgrowing irregular nests of basaloid tumor cells with cellular atypia and frequent mitoses; these are the characteristic features of the pilomatrix carcinoma in its early stages.

Observation of the proximal portions of axons of anterior-horn cells in the human spinal cord

The proximal portions of axons of large anterior-horn cells were investigated in the lumbar cords of 10 normal human autopsy cases. Light-microscopically, 81 myelinated axons were observed to be connected with the cell body. Of the 81 axons, 78 emanated from the cell body and 3 others originated in the proximal part of primary dendrites. As for normal-looking neurons (n = 77), the length of the axon hillock plus initial segment was 64.0 +/- 12.3 microns (average +/- SEM), ranging from 47.5 to 110.0 microns, while the diameter of the thinnest portion of the initial segment was 2.40 +/- 0.30 microns (average +/- SEM), ranging from 1.32 to 3.92 microns. Electron-microscopically, the predominant organelles of the axon hillock were mitochondria, neurofilaments which merged into the axon and occasional granular endoplasmic reticulum. A few synaptic boutons were found on the surface of the axon hillock. The cell membrane of the initial segment consisted of a layer of electron-dense material (undercoating). The cytoplasm contained many neurofilaments, running parallel to the longitudinal axis of the initial segment. Among the neurofilaments, lysosomes, smooth endoplasmic reticulum, dense bodies and vesicular profiles as well as mitochondria were seen. At the beginning of the myelin sheath, the axoplasm contained mitochondria, many neurofilaments and occasional lysosomes.

[An autopsied case of insulin dependent diabetes mellitus complicated by chronic thyroiditis and chronic hepatitis]

A deceased 59-year-old woman with insulin dependent diabetes mellitus complicated by chronic thyroiditis and chronic hepatitis was autopsied. She had had diabetes mellitus since she was 30 years old, and insulin therapy was started at 34 years. Laboratory findings were as follows: s-GOT 85, s-GPT 31, gamma-globulin 2.45 g/dl. Immunological tests were positive for anti-smooth muscle antibody and anti-ENA antibody with high titers of antithyroglobulin and anti-microsome antibodies. HLA analysis revealed the presence of DR-4. The thyroid biopsy specimen showed microscopic features characteristic of chronic thyroiditis at 52 years of age. She had been repeatedly admitted for the control of diabetes mellitus. She was admitted for the 9th time in June, 1987 following complaints of abdominal pain. After admission, her general condition became gradually worse, and she died of peritonitis in September, 1987. Pathological examination of the liver revealed an expansion of fibrous tissue on Glisson's capsule accompanied by lymphocytic infiltration and was diagnosed to be chronic inactive hepatitis. As for the thyroid gland, fibrous tissue replaced an extensive area of the thyroid gland, and normal thyroid tissue was not observed. Lymphocytic infiltration was less in comparison with that in the previous biopsy. As for the pancreas, atrophy of exocrine pancreatic tissue and fibrous change in interstitial tissue was observed. Lymphocytic infiltration was also seen in the interstitial exocrine tissue but not in the islet. Immunohistochemical examination of the islets using anti-insulin, glucagon and somatostatin antibodies by ABC peroxidase method showed the selective disappearance of B cells in the islets. The pathological changes in the thyroid gland, liver and pancreas suggest that autoimmune mechanism may be involved in the pathogenesis of chronic thyroiditis, chronic hepatitis and IDDM with exocrine pancreatic impairment in this case.

Efficacy of ivermectin against live mites and eggs of Sarcoptes scabiei in pigs

Sows infested with Sarcoptes scabiei var. suis (ssvs) were treated with 75, 150 and 300 micrograms/kg of ivermectin by a single subcutaneous injection at the neck region. Compared to the numbers of mites and eggs just before injection, those on post treatment weeks (PTW) 1, 2 and 4 showed significant decreases. Especially at 300 micrograms/kg, the counts showed almost all mites and eggs were eradicated on PTW 1, manifesting ivermectin to possess potential effect on ssve without apparent abnormal side effect. Potential mitocide effect of ivermectin on ssvs was revealed.

Adrenocorticotropin and cortisol levels in the plasma of bovine fetuses and neonates

Plasma ACTH and cortisol levels in the bovine fetuses over the period of 5 to 9 months of gestation and in the neonates immediately after birth and at 5 days old were studied. In the bovine fetuses, the plasma ACTH levels ranged from 60.8 +/- 17.8 to 71.3 +/- 19.7 pg/ml over the period of 5 to 7 months of gestation. It increased rapidly to 239.2 +/- 261.5 pg/ml at 8 months and to 406.9 +/- 409.4 pg/ml at 9 months of gestation. In the neonates immediately after birth it decreased to 182.3 +/- 110.7 pg/ml. The plasma cortisol levels ranged from 3.23 +/- 2.12 to 3.85 +/- 2.52 ng/ml over the period of 5 to 8 months of gestation and increased to 8.10 +/- 4.88 ng/ml at 9 months of gestation. It then increased rapidly to 88.35 +/- 42.78 ng/ml in the neonates immediately after birth. The correlation between plasma ACTH and cortisol levels in the fetuses of 5 to 7 months of gestation was not significant, but in the fetuses of 8 and 9 months of gestation and neonates were significant. However, especially immediately after birth, the increase in plasma cortisol occurred without a concomitant rise in plasma ACTH. According to these findings, it is suggested that the pituitary-adrenocortical axis in bovine fetus matures in the later stage of gestation and an increase of sensitivity in the fetal adrenal gland to ACTH may serve as a trigger for the onset of parturition.

Swellings of proximal axons in a case of motor neuron disease

Serial semithin sections of lumbar anterior horn cells from a patient with rapidly progressive sporadic motor neuron disease were searched for direct connections between swellings of neuronal processes and perikarya. Focal swellings of the proximal axons were not uncommonly seen to be connected directly to perikarya. These swellings varied in shape and size and some were identified as spheroids. Most of the cell bodies connected with swellings showed otherwise normal architecture. These observations suggest that the focal swellings of proximal axons, particularly the distal portion of the initial segment and the first internode of the myelinated axon, indicate an early pathological change, and may represent functionally and morphologically vulnerable sites.

Characterization of feline T and B cells

Feline peripheral-blood lymphocyte populations (n = 22) were examined for the following markers: rosette formation with guinea pig erythrocytes (GPE-T cells), rosette formation with human RBC (HRBC-T cells), rosette formation with sheep RBC, mixed rosette formation with GPE-T cells and HRBC-T cells (total T cells), erythrocyte antibody-complement rosettes, and surface immunoglobulin. An average of 28% +/- 7% (range, 16% to 39%) of the feline lymphocytes formed rosettes with GPE-T cells, and 27% +/- 7% (range, 11% to 36%), with HRBC-T cells. An average of 57% +/- 9% (range, 33% to 75%) of the lymphocytes formed mixed rosettes. The erythrocyte antibody-complement rosette-forming cells and surface immunoglobulin-bearing cells were found in peripheral blood lymphocytes (10% +/- 6% and 24% +/- 8%, respectively). The murine monoclonal antibodies OKT 11 and HuLy-m1, specific for a framework determinant of human E-rosette receptor antigens, cross-reacted with feline cell membrane molecules recognizing a bimolecular complex (45,000 to 50,000 daltons) similar to that described in persons. We investigated the distribution of these E-rosette receptor-like antigens on feline lymphocytes. By complement-mediated lymphocytotoxicity, about 30% of the feline lymphocytes expressed the antigens. When lymphocytes were treated with HuLy-m1 antibody, spontaneous rosette formation with HRBC-T cells was significantly inhibited.

Cross-reactivity between human and feline Ia antigens, using a monoclonal antibody HLA-D.m1

A murine monoclonal antibody HLA-D.m1 produced against human Ia antigens which react with 10% to 30% of human peripheral-blood mononuclear cells was found to react with greater than 90% of feline mononuclear cells. The antigen was not expressed on granulocytes. By direct immunofluorescence, 7% to 41% of feline lymphocytes expressed surface immunoglobulins. In mixed-lymphocyte reaction, the addition of antibody HLA-D.m1 to cultures abolished proliferation. These studies indicate that most feline peripheral-blood mononuclear cells express Ia-like antigens.

New theory on the pathogenesis of acute myocardial infarction

Autopsy studies of hearts from 140 patients who had suffered acute myocardial infarction (AMI) and 26 cases of sudden coronary death revealed two distinct types of myocardial cell death: "kinetic cell death" (KD) and "static cell death" (SD). In KD, the predominant type of cell death in AMI-myofibrils disintegrated through alternating overcontraction and overextension. KD was found not only in patients having died after some time had elapsed from the onset of AMI, but also in cases of sudden coronary death. Muscle fibers in SD, which by contrast began to appear at least seven hours after the onset of AMI, characteristically preserved cross striations, while their nuclei were pyknotic or had already disappeared. Such fibers were observed only in territories peripheral to occlusive coronary thrombus, a secondary rather than a primary event that takes place during the course of AMI. As a result of the above observations, we were able to produce a new experimental model of AMI using mongrel dogs. As a preparatory procedure we first injected them intravenously with 2% calcium chloride at a constant rate for 90 or 120 minutes, and then with a sudden injection of caffeine, calcium chloride and catecholamine in order to induce KD. In contrast, ligation of the intraventricular coronary artery near its origin caused SD of myocardial fibers in the dependent territories. Overall results led us to conclude that AMI is initiated by instantaneous overcontraction of myocardial fibers, resulting in their KD, a phenomenon that could be called "myocardial self-destruction."

Dimensional changes of tissues in the course of processing

Dimensional changes of bovine kidney and liver tissues in the course of processing under four different schedules were measured. Shrinkage of tissues at dehydration, substitution with intermedium and paraffin infiltration stages was 1-2%, 2-5% and 5-10% respectively. There was no significant difference in final dimension and morphology among the specimens processed under the different schedules. Any one of the investigated schedules can be employed for practical tissue processing.