[Clinical significance of serum acid soluble glycoproteins (ASP) and immunosuppressive acidic protein (IAP) in inflammatory diseases and liver diseases]

In order to study the clinical significance of ASP and IAP, we have measured serum concentration of ASP and IAP in 259 patients with inflammatory diseases, non-inflammatory diseases, autoimmune diseases and liver diseases. Significantly higher correlation (coefficient of correlation = 0.922) was found between ASP and IAP. There were good correlation between ASP, IAP levels and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP). Coefficient of correlation were 0.705 and 0.673 between ESR and ASP, IAP; 0.621 and 0.623 between CRP and ASP,IAP, respectively. There were food correlations between ASP levels and thrombo test (TT) and hepaplastin test (HPT). The positive rate and mean concentration of ASP, IAP in patients with inflammatory diseases were significantly higher than noninflammatory diseases. It is suggested that serum ASP, IAP could be one of the useful indicator for evaluating the clinical course of patients with inflammatory diseases. Serum concentration of ASP, IAP in patients with chronic liver diseases were lower than normal subjects, especially serum levels in patients with decompensated liver cirrhosis and chronic hepatitis (active) were significantly lower than normal subjects. In patients with hepatoma with cirrhosis, serum levels of ASP, IAP were significantly lower than the hepatoma patients without cirrhosis. The determination of ASP, IAP in liver diseases seems to be useful for evaluating the severity of diseases, the effects of therapy and the forecast of prognosis.

[Clinical evaluation of serum immunosuppressive acidic protein (IAP) and acid soluble glycoproteins (ASP) in patients with malignant tumors]

In order to study the clinical significance of IAP and ASP, we have measured serum concentration of IAP and ASP in patients with different cancer types including digestive organs, head and neck. Significantly higher correlation (coefficient of correlation = 0.924) was found between IAP and ASP. IAP and ASP levels were elevated in about 60-80% of cancer from digestive organs except hepatocellular carcinoma, and in about 56-100% of head and neck tumor. There was no correlation between IAP, ASP and various tumor markers (CEA, CA19-9, AFP) in all malignancies except pancreatic cancer. There was positive correlation between CEA and IAP, ASP in pancreatic cancer. IAP and ASP levels were significantly higher in patients with cancer having evidence of disease than the patients with cancer who had no evidence of disease, and so the determination of IAP and ASP was clinically useful for the diagnosis of tumor existence. At the time of diagnosis of recurrence, the levels of IAP and ASP were elevated in about 70% of patients with cancer recurrence. There was a definite relation between IAP, ASP and the gastric cancer stage. In later state (stage III and IV), serum IAP and ASP levels were significantly higher than the levels of stage I and II. In hepatocellular carcinoma without liver cirrhosis, the levels of IAP and ASP were higher than the patients with cirrhosis. The determination of IAP and ASP seems to be useful for monitoring clinical course, judgement of therapeutic effects.

[Clinico-statistical study of inpatients and autopsied cases in our clinic]

The statistics of clinical observation at Department of Internal Medicine, Nippon Dental University at Niigata from July 1981 to December 1987 (duration 6.5 years) were as follows: Total number of inpatients: 1,238, Total number of death cases: 106. Findings include: 1) Ratio of male patients to female patients 1.34:1.00. Male deceased patients to female deceased patients 1.52:1.00. 2) Average patients number hospitalized per year was 200. The high percentaged of certain advanced aged groups was reflected by the recent demographic changes in the society in general.; in their 60's 46.0%, in their 70's 24.3%, in their 80's 6.7%. In these age groups, female number is tendency to increase the number of male. 3) The diseases of inpatients were mostly due to the digestive tract, which accounted for 60.4% of the total. Of this percentage, 65% was due to hepato-biliary diseases. 4) The death statistics of malignant tumor was 68.9%; Benign diseases being 31.1%. Male patients died from hepatocellar carcinoma, lung cancer, colon cancer and stomach cancer, in descending order. Females died from cancer of the biliary tract, stomach cancer and hepatocellular carcinoma, again, in descending order. 5) 71.7% of all deaths were caused by the digestive tract, in particular, hepatocellular carcinoma, cancer of the biliary tract, liver cirrhosis and primary biliary cirrhosis, all belonging primarily to the hepato-biliary disease group. 6) As a result of 58 autopsies performed for 106 death cases, 32 cases had complete autopsies and 26 cases had partial organ punctures.

[Two cases of thrombosis of an aneurysm in the acute stage]

Thrombus formation within aneurysm is common and has generally been proved to be a slowly progressive phenomenon. We report two cases of acute completely thrombosis of aneurysms. The initial angiogram failed to reveal aneurysm and other etiology of subarachnoid hemorrhage. CT revealed diffuse cisternal blood and acute hydrocephalus. We decided to operate on these patients in the acute stage because of the generally-known strict correlation between the amount of cisternal high density on CT and the subsequent development of vasospasm and ischemic event. Case 1. A 68 year-old female was admitted on Day 1 with neurological deterioration of Grade 3 (H & K). Complete angiographic study was done, including the basal view and stereotechnique, but failed to reveal aneurysm. On Day 2 we operated on this patient and discovered a thrombosed aneurysm of the anterior communicating artery (3 X 7 mm in size). Case 2. A 51 year-old male suffering from subarachnoid hemorrhage was transferred to our hospital on Day 0. Emergency angiography gave no information, but the pattern of cisternal clots on CT was suggested the existence of an aneurysm of the right internal carotid artery. The next day we performed angiography once more, at that time 2 X 5 mm internal carotid bifurcated aneurysm was revealed. Shortly thereafter we operated and found the intra-aneurysmal clot. Through consideration of these we have reached the following conclusions. When CT findings in a patient with subarachnoid hemorrhage show the diffuse cisternal clots due to rupture of aneurysm, we should consider immediate surgery even if the angiogram is negative in order to lessen the risk of delayed vasospasm.(ABSTRACT TRUNCATED AT 250 WORDS)

Crystalloid structure in adrenocortical adenoma

The presence of crystalloid structures was demonstrated in the cytoplasm of a huge adrenocortical adenoma ultrastructurally. The crystalloids were classified into four types, and they differed from those of spironolactone bodies or intramitochondrial bodies in their size and shape. The structures of the crystalloids resembled the crystalloids of Reinke in the Leydig cells of the testis. Reports on intracytoplasmic crystalloids are rare in the tumors of the adrenal cortex.

[A case report of post-traumatic syringomyelia]

A case of posttraumatic syringomyelia which appeared 26 years after the injury was presented. A patient was 61 year old female, who sustained thoraco-lumbar spine injuries rendering her to paraplegic in 1954. Eleven months later she had an operation of T6-T9 and L1-L2 laminectomies and regained motor and sensory functions of the both lower extremities. She was ambulatory with crutches till 1979. In 1980, burning pain was noticed in the left scapular region, and thereafter, extended to the ulnar side of the left forearm. The pain became progressively worse and intractable. Analgesics were ineffective. Two years later muscle atrophies and weakness in the left finger intrinsic muscles appeared. Absent deep tendon reflexes in the left upper extremity, dissociated sensory loss (in the left C2-S1 and right T5-T12 dermatomes) and paraparesis were also documented. Metrizamide CT scan performed 24 hours after the intrathecal injection disclosed an intramedullary syrinx between C2 and L1 vertebral levels. No communication with the fourth ventricle was seen. A syringoperitoneal shunt with low pressure valve was placed. The pain subsided immediately after this procedure. However, no improvement in motor and sensory functions were observed. Pathophysiological mechanisms involved in post-traumatic syrinx formation and its development were discussed. We prefer hypothesis proposed by Ball and Dayan to Gardner's hydrodynamic theory regarding to development of the syrinx secondary to spinal cord injury.

Malignant peritoneal mesothelioma with massive foamy cells. Codfish roe-like mesothelioma

An autopsy case of a 45 years old Japanese female with malignant masothelioma showing peculiar stromal change was presented. The tumor had occupied the abdominal cavity around the uterus and both ovaries, and was diagnosed as a malignant peritoneal mesothelioma of epithelial type. The characteristic feature of the tumor was that the foam cells, which contained abundant amount of lipid droplets in the cytoplasm, and were thought to be histiocytes, massively occupied the stroma of the papillary tumor. Macroscopically, the tumor simulated a codfish roe. To our knowledge, no case of this sort of appearance of mesothelioma has ever been reported.

An ultrastructural study of the morphogenesis of membranocystic lesions in bone marrow

A biopsy case of a man aged 30 years, who was admitted to the hospital for the fracture of his right talus, was reported. The X-ray analysis of his extremities revealed multifocal cystic lesions in bilateral tali, and carpal bones. Pathological examination of the cystic lesions of the bilateral tali showed the membranocystic lesion (MCL), which morphologically resembled that of "membranous lipodystrophy" reported by NASU et al. Minute tubulovesicular structure of the MCL observed in this case was proved to arise at the lipid-cytoplasmic-interface of degenerated fat cells and enter into the interstitium to form MCL, concurrently with collapse of the fat cells. Thus, at least one process responsible for the morphogenesis of MCL could be determined by our electron microscopic examination.

Ultrastructural characteristics of duodenal somatostatinomas. II. Granules and vesicles

Ultrastructural findings of granules and vesicles appearing in tumor cells of somatostatinoma are reported. Except for D granules, one granule and four kinds of vesicles were discerned. Some tumor cells had granules of the exocrine type which were similar to those of the chief cells of the stomach. Very small clear vesicles (YO and KO) had accumulated mainly in the apical region of the somatostatinoma cells. Both vesicles were round, unit-membrane bounded and clear in the center, each measuring about 90 and 30 nm in diameter. The cored vesicles normally seen in the sympathetic system were revealed. Doughnut vesicles characterized by double contour membranes were detected together with the cored vesicles. A mixture of exocrine cells of the chief cell-type in the paraneuroma has not been previously reported. And we have as yet very little information as to the doughnut vesicle.

Ultrastructural characteristics of duodenal somatostatinomas. I. Somatostatinoma cells and Schwann-like cells

This report describes the general ultrastructural characteristics of somatostatinoma cells and Schwann-like cells in two cases of duodenal somatostatinomas. Duodenal somatostatinoma cells had common findings to endodermal cells, i.e. the granules of exocrine type, intracytoplasmic canaliculi, microvilli, small clear vesicles and others. This may suggest that endocrine cells of the gut are of endodermal origin. On the other hand, a few Schwann-like cells were discovered in the tumor nests. Schwann-like cells surrounding the nest of tumor cells were characterized by multilayered piled up cytoplasm, abundant microfilaments and others. This fact suggests that somatostatinoma has some relationship to the nerve.

Duodenal somatostatinoma. Immunohistopathology and review of literature

A case of duodenal somatostatinoma is reported. The patient, a 54-year-old male, had complained of an epigastric pain due to gastric ulcer and a duodenal polyp was unexpectedly found at a gastrectomy. The polyp showed basically tubular adenocarcinoma, with negative argyrophil and argentaffin reactions. By an indirect immunofluorescent examination almost all of the tumor cells were revealed as somatostatin-immunoreactive. Big somatostatin was also positive. Radioimmunoassay of the tumor indicated 6400 pg of somatostatin-like immunoreactivity per milligram of wet tissue. This seems to be the second case of duodenal somatostatinoma, following the case reported by us previously.

Effector cells working for rejection of Ad12 tumors in mice

Immune spleen cells (ISC) capable of inhibiting the growth of adenovirus type 12 (Ad12) tumors were raised in C57BL/6 mice by immunization with Ad12, fractionated according to their affinity for plastic and nylon-wool substrates or treated with various antisera plus complement, and subjected to the tumor-neutralization test (Winn) to define the effector cells for the cell species. Full antitumor activity of ISC was recovered in the cell fractions nonadherent to the two substrates; the antitumor activity of ISC was abrogated entirely by anti-Thy-1,2 serum and almost entirely by anti-Lyt-2.2 ascites fluid plus complement. These results clearly indicate that T-lymphocytes, particularly those bearing Lyt-2.2 antigen, are the principal effectors in ISC against Ad12 tumors in animals.

A breast carcinoid tumor with special reference to ultrastructural study

A case of a carcinoid tumor of the left breast of an 83-year-old male is reported. On light microscopy the tumor showed the classical pattern of a carcinoid tumor. Neurosecretory granules were verified ultrastructurally, membrane-bound, about 180 nm in diameter, and possessing electron-dense contents. Some tumor cells had long slender cytoprocesses with small clear round granules other than neurosecretory ones.

Ultrastructural studies of a thymic carcinoid tumor

A case of a thymic carcinoid tumor is presented. The tumor was a mass measuring 7 by 6 by 5 cm in size. Microscopically, the tumor was composed of a mixture of round, cytoplasm-rich cells in addition to the predominantly spindle-shaped cells. The ultrastructural observation showed many secretory granules, about 120 mmu in size, in almost every cell of the tumor. In the cytoplasm many microfilaments were seen, in places forming large nodules and bundles. Centrioles were often observed in the tumor cells. Sometimes three or even more centrioles were seen in a single cell.