Micrometastatic colorectal cancer lesions in the liver

A surgical resection of metastatic liver lesions from colorectal cancer contributes to an improved prognosis. However, the postoperative recurrence rate remains high, particularly in the residual liver. This is probably the result of the failure to detect small lesions. In the present study, we histologically examined the presence of intrahepatic micrometastases, which are considered to be related to recurrence in the residual liver. Intrahepatic micrometastases were histologically examined in 31 resected specimens of 25 patients undergoing a hepatic resection because of metastasis to the liver from colorectal cancer. Micrometastases were found in 14 of 25 cases (56.0%). They were located in the portal veins, central veins, sinusoid, and bile ducts. The longest distance from the main metastasis was 38.2 (mean 7.5 +/- 8.0) mm. The size of the macrometastases became larger, and the frequency of micrometastases and the distance of micrometastases from macrometastases had a tendency to increase. Continuous invasion of the macrometastases into the micrometastases through the vasculature or bile duct was also observed. These results suggested that some micrometastases observed in the metastatic liver from colorectal cancer were thus seeded from the primary lesions, while other micrometastases originated from the macrometastatic lesions as satellite lesions.

Apocrine Carcinoma of the Breast: Clinicopathological Analysis and Histological Subclassification of 12 Cases

BACKGROUND: Apocrine carcinoma is rare and most of its clinicopathological features are still unknown. The purpose of this study was to identify the clinicopathological characteristics of apocrine carcinoma. METHODS: We clinicopathologically analyzed apocrine breast carcinomas resected from 12 Japanese women and subclassified them histopathologically. RESULTS: The average age of the patients at diagnosis was 60.1 years (range: 38-78). Tumor diameters ranged from 0.5 to 4.5 cm (median 2.4). Mammography revealed tumor shadows without microcalcifications in all patients. Two (17%) of the12 patients were lymph node metastasis-positive, and lymphatic permeation by tumor cells was observed in 3 (25%). Apocrine carcinoma in this study could be classified into three subtypes according to predominant histopathological growth pattern: type I, intraductal spreading type (4 patients); type II, adenosis-associated type (3 patients); and type III, infiltrating type (5 patients). Types I and II showed no lymph node metastasis and had an excellent prognosis, whereas theinfiltrating type was associated with lymph node metastasis and death from cancer. Estrogen receptors and progesterone receptors were positive in 17% (1/6) and 60% (3/5), respectively, of the tumors tested. CONCLUSION: In the present study, apocrine carcinoma of the breast was characterized by higher patient age and tumor shadows without microcalcifications on mammography. However, the tumors were heterogenous with regard to pattern of local spread.

Group B streptococcal metastatic endophthalmitis in an elderly man without predisposing illness

Our patient, an 83-year-old man, suddenly experienced acute lumbago and was prescribed bed rest. Later, pneumonia was diagnosed, even though he had no predisposing illness, and endophthalmitis developed in both eyes. Cultures of anterior chamber and vitreous specimens were positive for group B streptococcus. Treatment with systemic antibiotics, to which this bacteria is sensitive, was begun and his condition gradually improved. Nevertheless, the patient became blind in his right eye and the eye was enucleated. Histopathologic examination showed metastatic endophthalmitis with retinal detachment. Multiple microabscesses were found in the thickened choroid. We speculated that organisms disseminating from the microabscesses had caused the metastatic endophthalmitis.

Influence of inoculation site of combined oil-adjuvanted vaccine on the antibody response in chickens

Inactivated oil-adjuvanted vaccines for ND, IB, and IC serotypes A and C (OILVAX NB2AC) have been marketed from 1993. In the outdoors, various inoculation sites have been used in chickens because to make the inoculation procedure easier. We examined whether differences would be obtained in the antibody response according to the inoculation sites; the subcutaneous inoculation into the back of the neck for OILVAX use, and the thigh, lower thigh, breast and shoulder muscle for the possible application of the inoculation outdoors. The clear order was not found in the NDV-HI titer, IBV-SN titer against Nerima or TM-86 among the inoculation sites used during the examination period. The IC serotypes A and C HI titers did vary among the inoculation sites; the subcutaneous inoculation produced the highest antibody titer, and high antibody titers were observed in the order of lower thigh muscle > or = thigh muscle > breast muscle > or = shoulder muscle inoculation.

Relationship between left ventricular hypertrophy and renal and retinal damage in untreated patients with essential hypertension

We examined the relationship between left ventricular hypertrophy (LVH) and renal and retinal damage in 174 untreated patients with essential hypertension. As an index of renal and retinal damage, we examined proteinuria and retinal vascular change. LVH was diagnosed according to left ventricular mass obtained from echocardiography. Of the hypertensive patients, 111 patients (64%) had LVH. The incidences of proteinuria and advanced retinal vascular change were higher in patients with LVH than in those without LVH. In a multiple regression model, there was a significant positive correlation between left ventricular mass and proteinuria, as well as diastolic blood pressure, sex, age and body mass index. In conclusion, proteinuria is related to elevated left ventricular mass in patients with essential hypertension.

[A case of juvenile muscular atrophy of the upper limb with intraspinal cavity formation]

The patient was a 23-year-old man. He had no history of trauma in the head and neck. When he was 20 years old (in 1992), he noticed muscle atrophy and weakness in the right hand. In a hospital, he had cervical MRI study and other examinations. The diagnosis was juvenile muscular atrophy of the upper limb (Hirayama's disease). After that the symptoms became worse in the bilateral forearms and hands. The neurological examination showed severe atrophy in bilateral C7 to Th1 innervated muscles, right pyramidal sign, mild superficial and deep sensory disturbance in the dermatome of C7-Th1, and right Horner's sign. Cervical MRI and myelography revealed the atrophy of cervical cord and intraspinal cavity formations from C5 to Th1. We concluded that chronic and intermittent compression to cervical cord with flexion position made the cavities during the clinical course because these cavities were not found in the MRI taken in 1992.

Anterior capsule contraction and intraocular lens dislocation after implant surgery in eyes with retinitis pigmentosa

OBJECTIVE

The purpose of the study was to investigate the extent of anterior capsule contraction, intraocular lens (IOL) decentration, and tilt after implant surgery in eyes with retinitis pigmentosa (RP).

DESIGN

A case-control study.

PARTICIPANTS

Forty-seven eyes from 47 patients with typical RP and 47 control eyes from 47 age-matched healthy patients were studied.

INTERVENTION

Phacoemulsification surgery with polymethylmethacrylate IOL implantation with continuous curvilinear capsulorrhexis was performed.

MAIN OUTCOME MEASURES

The area of the anterior capsule opening obtained with capsulorrhexis and the amount of the decentration and tilt of the IOL were measured using a Scheimpflug photography system at 1 week and 1, 3, 6, 9, and 12 months after surgery.

RESULTS

The mean area in the RP group was found to be significantly smaller than that in the control group at 1 month after surgery and later (P < 0.0001). The percent area reduction in the RP group at 6 months was 45.2 +/- 25.8% and 4.6 +/- 13.5% in the control group. Both the decentration length and tilt angle were also greater in the RP group than in the control group. Fourteen (29.8%) of the 47 RP eyes had undergone a neodymium:YAG (Nd:YAG) laser anterior capsulotomy at 12 months after surgery, whereas none of the control eyes had undergone an Nd:YAG.

CONCLUSIONS

Anterior capsule contraction in the RP eyes was more extensive than in the control eyes, leading to a high Nd:YAG laser anterior capsulotomy rate. Both lens decentration and tilt also were greater in the RP eyes than in the control eyes.

Brainstem origin of the efferent components of the cervical vagus nerve in the house musk shrew, Suncus murinus

The brainstem origin of the efferent neurons of the vagus nerve in the house musk shrew, an animal species which has been recently used in researches on emesis, was studied using the retrograde tracing method. The vagus nerve was exposed and cut at the mid-cervical level below the nodose ganglion. Horseradish peroxidase was applied to the proximal end of the cut nerve. The brainstem was sectioned and processed histochemically with the tetramethylbenzidine method. The horseradish peroxidase injection into the vagus nerve resulted in heavy retrograde labelling of neurons in the ipsilateral dorsal motor nucleus of the vagus nerve and ambigual nuclear complex. Labelled neurons in the dorsal motor nucleus of the vagus nerve, constituting approximately 80% of the total labelled neurons, formed a longitudinal column whose length varied from 3.4 to 3.8 mm. Half of labelled neurons in this nucleus were found at the level between the area postrema and 0.6 mm rostral to it. The ambigual nuclear complex was made up of two major longitudinal divisions; the dorsal division corresponded to the ambiguus nucleus and the ventral division was identified as the external formation of the ambiguus nucleus. Our results suggest that in the Suncus murinus the neuroanatomical feature of the dorsal motor nucleus of the vagus nerve is similar to those of other mammals, but ambigual nuclear complex must be somewhat different between mammals.

Early development of Epstein-Barr virus-associated T-cell lymphoma after a living-related renal transplantation

We herein report a case of Epstein-Barr virus (EBV)-associated T-cell lymphoma that developed within a month after a kidney transplantation. The recipient was a 37-year-old man who had evidence of a previous EBV infection. Cyclosporine, methylprednisolone, and azathioprine were used for immunosuppression, and acute rejection was treated with high-dose methylprednisolone. The lactate dehydrogenase level started to increase on day 24 and thereafter peaked on day 37 while also demonstrating progressive jaundice and a bleeding tendency. A transplant nephrectomy was done on day 37; however, the patient could not recover and eventually died of respiratory failure as a result of diffuse pulmonary edema. A pathological examination of the resected kidney revealed a diffuse proliferation of large atypical lymphoid cells in the parenchyma. Immunohistochemically, the tumor cells were positive for CD45 and T-cell marker, CD45RO, but negative for B-cell markers. EBV-encoded RNA was demonstrated within the neoplastic cells by in situ hybridization.

Echocardiographic evaluation in long-term continuous ambulatory peritoneal dialysis compared with the hemodialysis patients

In dialysis patients, the prevalence of severe left ventricular (LV) hypertrophy and systolic failure, important predictors of cardiovascular morbidity and mortality, has been reported to be very high. Therefore, we investigated cardiac function in 17 long-term CAPD patients (dialysis duration: 76.5 +/- 13.2 months; L-CAPD) by echocardiography and pulsed Doppler, and then compared with 16 short-term CAPD patients (dialysis duration: 28.9 +/- 11.9 months; S-CAPD), 21 long-term hemodialysis patients (dialysis duration: 165.1 +/- 52.7 months; L-HD), and 22 short-term hemodialysis patients (dialysis duration: 71.3 +/- 28.9 months; S-HD), except for the cases with diabetes mellitus, ischemic heart disease, cardiac surgery or overt congestive heart failure. We selected 13 normotensive patients with normal kidney function as normal control group matched for sex and age (Control). Concerning with L-CAPD, S-CAPD, L-HD, and S-HD, these four groups were matched for age and original diseases. We examined blood pressure (BP), cardiothoracic rate (CTR), antihypertensive (AHT) drugs and laboratory data. Wall thickness, left atrium, ventricular chamber size, ejection fraction (EF) and left ventricular mass (LV mass) [Devereux et al. 1986] were measured by echocardiograph. Peak early diastolic flow velocity (E), peak atrial filling velocity (A), A/E ratio and deceleration time of peak early diastolic flow velocity (DT) were calculated by analyzing transmitral flow, recorded by pulsed Doppler. BP control, CTR and EF were significantly worse in L-CAPD than in other patient groups. A/E as one of parameters for cardiac diastolic function was significantly higher in L-CAPD than in HD patients. LVMI (LV mass index: LV mass/body surface area) was significantly higher in L-CAPD than in other groups. LVMI in CAPD patients was shown to be significantly worse as time goes. Volume control by itself without AHT drugs could achieve good BP control in the long-term CAPD patients who were changed to maintenance hemodialysis because of peritoneal sclerosis. We concluded that LV hypertrophy and systolic dysfunction tend to progress in CAPD patients as time goes on. Also it is suggested that the cause of cardiac dysfunction in CAPD patients was mainly based on poor BP control probably due to overhydration, and therefore, appropriate volume control in CAPD patients is especially important.

Dynamic changes of 12-lead electrocardiograms in a patient with Brugada syndrome

We present a patient with Brugada syndrome in whom 12-lead ECGs were recorded just before and after an episode of ventricular fibrillation (VF). A progressive elevation of both the RS-T segment and J waves just preceding and following the VF, and a close relationship between the amplitude of the RS-T segment and the preceding R-R intervals during atrial fibrillation, were documented. These findings support the hypothesis that RS-T elevation and a subsequent VF are related to a transient outward current-mediated spike-and-dome morphology of the epicardial action potential.

Human chorionic gonadotropin beta-core fragment is present in the human placenta

The presence of hCG beta-core fragment (beta-core) in the human placenta has been controversial. To clarify its presence in the villous tissue, first, we developed an enzyme immunoassay which is highly specific for beta-core. Then, we investigated the presence of beta-core immunoreactivity in the supernatants of placental organ culture and those of primary culture of trophoblasts as well as in the placental extracts at different stages of gestation. The immunoreactivity of beta-core was demonstrated in each sample, and the amount was at least 5% of intact hCG immunoreactivity. Immunohistochemical analysis of the placental tissue showed localization of beta-core immunoreactivity to the syncytiotrophoblast. Western blot analysis of the supernatants of organ culture as well as urine samples of pregnant women showed two major bands with molecular weight of approximately 15000. On the other hand, beta-core immunoreactivity in the pregnant sera ranged from 0.1 to 0.19% of intact hCG immunoreactivity. These results suggest the presence and possible secretion of beta-core fragment in the human placenta, and its immunoreactivity in the serum is likely to be reduced due to its short half life in the maternal blood.

Improvement of repolarization abnormalities by a K+ channel opener in the LQT1 form of congenital long-QT syndrome

BACKGROUND

This study used monophasic action potential (MAP) to examine the effect of nicorandil, a K+ channel opener, on repolarization abnormalities induced by epinephrine in the LQT1 form of congenital long-QT syndrome in which the KvLQT1 mutation underlies the defect in the channel responsible for the slowly activating component of the delayed rectifier potassium current.

METHODS AND RESULTS

MAPs were recorded simultaneously from two or three sites on the right ventricular and left ventricular endocardium in 6 patients with a congenital form of LQT1 syndrome with KvLQT1 defect (17 sites) and 8 control patients (24 sites). In LQT1 patients, epinephrine infusion prolonged the QT interval and 90% MAP duration (MAPD90) and increased the dispersion of MAPD90. Epinephrine also induced early after depolarizations (EADs) as well as ventricular premature complexes (VPCs) in 2 of the 6 patients. Nicorandil during epinephrine infusion abbreviated the QT interval and MAPD90, decreased the dispersion of MAPD90, and abolished the EADs as well as the VPCs in 1 patient. Addition of propranolol completely reversed the effect of epinephrine in prolonging the QT interval and MAPD90 and increasing the dispersion and eliminated the EADs and VPCs in another patient. In control patients, the effect of epinephrine and that of additional nicorandil and propranolol on repolarization parameters were much less than in the LQT1 patients.

CONCLUSIONS

Our results suggest that nicorandil, a K+ channel opener, improves repolarization abnormalities in the LQT1 form of congenital long-QT syndrome with KvLQT1 defect.

A monoarthritis model in rabbits induced by repeated intra-articular injections of lipopolysaccharide

We attempted to develop a monoarthritis model using repeated intra-articular injections of high-dose Lipopolysaccharide (LPS). Furthermore, the effect of dexamethasone on this arthritis model by intra-articular administration was studied to examine whether the model can be used to screen anti-rheumatic drugs in a short time. Arthritis was induced by one, two or three intra-articular injections of LPS (5-50 micrograms/joint) at 4-day intervals into the knee joint. The rabbits were sacrificed at 7 days following the last injection of LPS. Three intra-articular injections of LPS at 50 micrograms/joint resulted in persistent joint swelling. Hyperplasia of synovium with some discolouration was macroscopically observed. Infiltration of mononuclear cells and lymphoid follicles were histologically observed as the synovial lesions. Concerning the articular bone/cartilage, trabecular destruction of gastrocnemius sesamoid bone and severe loss of safranin-O staining of articular cartilage were observed. Immunohistochemical analysis revealed that inflammatory cells and lymphoid follicles in the synovial lesions consisted predominantly of CD4+ T cells, with few CD8+ T cells. Treatment with dexamethasone markedly reduced the joint swelling and the articular destruction. The results suggest that this arthritis model in rabbits can be utilized to screen anti-rheumatic drugs as a model of rheumatoid arthritis.

Increase in serum vascular endothelial growth factor levels during altitude training

The present study was performed to evaluate the effects of physical exercise at altitudes on serum vascular endothelial growth factor (VEGF) levels. Eight subjects underwent intensive swimming training for 21 days at 1886 m. After altitude training commenced, red blood cell (RBC) counts and erythropoietin levels increased, but both haemoglobin and haematocrit levels did not change significantly. The serum level of VEGF, measured by means of a highly sensitive chemiluminescence (ELISA), showed a transient decrease 10 days after start of the altitude training, thereafter increasing significantly to reach a peak level 19 days later, rising from 23.0 +/- 5.3 to 46.0 +/- 14.6 pg mL-1 (P < 0.05 vs. before). On return to low altitude in Japan, the level of VEGF decreased, and 1 month later had returned to initial levels. Endurance training at altitudes increases serum VEGF levels; this could be an adaptive reaction to hypoxic conditions. This result suggests that VEGF may provide a new physiological parameter for hypoxic stress imposed by high altitude training.

Cloning, mapping, expression, function, and mutation analyses of the human ortholog of the hamster putative tumor suppressor gene Doc-1

doc-1 is a putative tumor suppressor gene isolated and identified from the hamster oral cancer model. Here, we report the molecular cloning and the functional characterization of the human ortholog of the hamster doc-1 gene. Human doc-1 cDNA is 1.6 kilobase pairs in length and encodes for a 115-amino acid polypeptide (12.4 kDa, pI 9. 53). Sequence analysis showed 98% identity between human and hamster doc-1 protein sequences. DOC-1 is expressed in all normal human tissues examined. In oral keratinocytes, expression of DOC-1 is restricted to normal oral keratinocytes. By immunostaining of normal human mucosa, DOC-1 is detected in both the cytoplasm and nuclei of basal oral keratinocytes; while in suprabasilar cells, it is primarily found in the nuclei. Human oral cancers in vivo did not exhibit immunostaining for DOC-1. Like murine DOC-1, human DOC-1 associates with DNA polymerase alpha/primase and mediates the phosphorylation of the large p180 catalytic subunit, suggesting it may be a potential regulator of DNA replication in the S phase of the cell cycle. Using a human doc-1 cosmid as a probe, human doc-1 is mapped to chromosome 12q24. We identified four exons in the entire human doc-1 gene and determined the intron-exon boundaries. By polymerase chain reaction and direct sequencing, we examined premalignant oral lesion and oral cancer cell lines and found no intragenic mutations.