Intraoral minor salivary gland tumors: a retrospective study of 129 cases

From 1970 to 1996, 129 cases of intraoral minor salivary gland tumors were diagnosed at the Department of Pathology, Nihon University School of Dentistry. The diagnosis of each case was based on the 1991 WHO classification. Eighty benign and 49 malignant minor salivary gland tumors were found in the approximately 9,300 oral biopsies submitted during the 27-year period. Pleomorphic adenomas were the most commonly histologic type of the benign tumors identified and 51% of the malignant tumors were diagnosed as mucoepidermoid carcinoma. The most common primary location of the tumors was the palate. Sixty percent of all tumors occurred in females and the peak age for incidences of all tumors was found in the third, fourth, sixth and seventh decades. These results were compared with those of the studies in different world population groups.

Major role of 3',5'-cyclic adenosine monophosphate-dependent protein kinase A pathway in corticotropin-releasing factor gene expression in the rat hypothalamus in vivo

To assess whether the cAMP-dependent protein kinase-A and/or the diacylglycerol-dependent protein kinase C (PKC) pathways play important roles in the activation of CRF neurons in vivo under physiological conditions, we tested the effect of microinjection of 8-bromo-cAMP (8-Br-cAMP) or 12-O-tetradecanoyl phorbol 13-acetate (TPA) into both paraventricular nuclei (PVN) of the hypothalamus in conscious rats. Both 8-Br-cAMP and TPA increased plasma ACTH concentrations and the POMC messenger RNA (mRNA) concentrations in the anterior pituitary. While injection of 8-Br-cAMP also increased CRF mRNA concentrations in hypothalamic tissue containing the PVN, TPA injection had no effect on CRF mRNA concentrations there. During insulin-induced hypoglycemia, which stimulates CRF gene expression and release, c-fos and c-jun mRNA increases in the hypothalamic tissue preceded the increase in the CRF mRNA level after insulin-induced hypoglycemia. Antisense oligodeoxyribonucleotides (oligos) directed against c-fos, c-jun, or the cAMP response element binding protein (CREB) mRNA were injected into both PVN before insulin-induced hypoglycemia to assess whether activator protein-1 or CREB mediates transcriptional activation of CRF during hypoglycemia. Only antisense oligo against CREB mRNA reduced the CRF mRNA level after insulin-induced hypoglycemia. These results suggest that protein kinase A may transduce intracellular signals in CRF neurons under physiological conditions and raises the possibility that CREB may be involved in stress-induced CRF gene expression.

Analysis of circadian variation of blood pressure and heart rate in dexamethasone-induced hypertensive rats

We studied the effect of the chronic oral administration of dexamethasone (dexa) on arterial blood pressure (BP) in conscious rats. Special attention was paid to the effects of dexa on circadian rhythm of BP. As determined by the tail cuff-method, BP in the dexa-treated group was significantly higher than in the control group 24 h after treatment, then increased gradually, reaching a plateau on the 7th day of treatment. At that time, the difference in BP between the two groups was approximately 30 mmHg. When monitored directly and continuously on day 10, mean arterial pressure (MAP) in the dexa-treated group exceeded that of the control group by approximately 15 mmHg throughout the monitoring period. Thus, the circadian rhythm of MAP was sustained in the dexa-treated group, which was in contrast to the previously reported elimination of circadian rhythm in humans. In addition, the increase in BP may have been overestimated by tail-cuff plethysmography, possibly owing to a hightended cardiovascular reactivity to environmental stimuli in dexa-treated animals.

Effect of acetylcholine on corticotropin-releasing factor gene expression in the hypothalamic paraventricular nucleus of conscious rats

To examine the physiological role of cholinergic input in the regulation of CRF neurons in the paraventricular nucleus (PVN) of the hypothalamus, acetylcholine (ACh) was microinjected bilaterally into the dorsolateral border of the PVN of conscious rats. Changes in the levels of POMC messenger RNA (mRNA) in the anterior pituitary, CRF mRNA in hypothalamic tissue containing the PVN, and plasma ACTH were assessed. Plasma ACTH concentrations increased in a dose-dependent manner after ACh injection (1-100 pmol/side), reaching a peak 30 min after ACh injection and returning to baseline within 120 min. The POMC mRNA level in the anterior pituitary and the hypothalamic CRF mRNA level increased in a dose-dependent manner 120 min after ACh (0.1-10 pmol/side) injection. Intracerebroventricular pretreatment with atropine completely abolished the ACh-induced increase in plasma ACTH concentrations, whereas pretreatment with hexamethonium was without significant effect. The intracerebroventricular injection of ACh also increased plasma ACTH concentrations in a dose-dependent manner in conscious rats, but not in pentobarbital-anesthetized animals. Thus, cholinergic hypothalamic input stimulates CRF gene expression in the PVN and CRF secretion into the portal circulation under physiological conditions. The use of conscious animals is essential in elucidating the physiological roles of neurotransmitters and other modulators regulating CRF neurons.

[Recurrent bronchogenic cyst--a case report]

Mediastinal bronchogenic cyst is a benign tumor and occupied about 5% of mediastinal tumor in Japan. As a benign tumor, recurrence of bronchogenic cyst is very rare, and we found only 2 cases were reported. We experienced a recurrent bronchogenic cyst found 14 years after first operation. The patient was 56-year-old male, and admitted to our hospital for further evaluation of his abnormal shadow on chest roentogenogram. He had no symptoms. He was operated an bronchogenic cyst for 14 years ago. Chest X-ray, CT, and MRI demonstrated a paratracheal cystic mass which was suspected of a recurrent bronchogenic cyst. An operation was done, and the tumor was resected. A histopathological study showed that the tumor had thin wall and had a ciliated epithelium, then it was diagnosed bronchogenic cyst. The most likely explanation for the recurrence in our patient is an incomplete resection during the initial operation. It is though that only a very small amount of epithelial tissue need remain for recurrence. For prevention of recurrence, complete resection of cyst is necessary, and long-term follow-up is indicated to detect recurrence.

Further localization of cardiovascular and behavioral actions of substance P in the rat brain

Cardiovascular and behavioral actions of substance P (SP) were examined after microinjection into the medial preoptic area (MPO), anterior hypothalamic area (AH), and ventral tegmental area (VTA) in conscious unrestrained rats. SP elicited marked increases in mean arterial pressure and heart rate as well as stereotyped behaviors of excessive grooming and exploring when injected into the MPO or AH. In the MPO, the latencies to the cardiovascular responses were observed after SP injection into the VTA. These results, together with our previous results, suggest that SP acts as transmitter or modulator in the rostral hypothalamic areas to elicit cardiovascular defense responses. In contrast, SP may not be involved in causing a defense reaction in the more caudal areas of the defense center.

Microinjection of norepinephrine into the paraventricular nucleus of the hypothalamus stimulates corticotropin-releasing factor gene expression in conscious rats

To examine the physiological effects of norepinephrine (NE) in the paraventricular nucleus of the hypothalamus (PVH) on CRF gene expression and CRF release, NE was microinjected bilaterally into the PVH of conscious rats, and kinetic studies were performed on the levels of POMC messenger RNA (mRNA) in the anterior pituitary (AP), CRF mRNA in the PVH-containing hypothalamic fragment, and plasma ACTH. Plasma ACTH levels were increased dose dependently by NE (5-50 nmol/side) injection into the PVH. They reached their peaks after 30 min and returned to the basal values after 90 min. The POMC mRNA level in the AP and hypothalamic CRF mRNA level increased significantly 90 min after NE injection and increased further after 120 min. The POMC mRNA level in the AP and hypothalamic CRF mRNA level were increased dose dependently by NE (5-50 nmol/side) after 120 min. Intracerebroventricular pretreatment with prazosin abolished completely the increase in plasma ACTH levels after intrahypothalamic NE injection, whereas pretreatment with propranolol was without significant effect. These results suggest that NE stimulates CRF gene expression in the PVH and CRF secretion into the portal circulation, thus regulating positively the hypothalamic-pituitary-adrenal axis. alpha 1-Adrenergic receptors may mediate the action of NE on CRF neurons.

[Amebic empyema, a case report]

A 49-year-old man was admitted to our hospital for dyspnea. Chest X-ray examination showed a massive right pleural effusion. Using intrathoracic tube drainage, a large quantity of chocolate-like pleural effusion was removed. Laboratory data demonstrated severe anemia and hypoproteinemia, and TPHA was positive. Antiameba antibody in blood was high, and a liver abscess was demonstrated on abdominal CT scan. Amebic liver abscess and amebic empyema were thus diagnosed. With pleural tube drainage and percutaneous liver abscess drainage, metronidazole (1.5 g/day) was administered. After administering this drug, the high temperature normalized and the patient's general condition improved significantly. Recently, amebic infections have been reported in increased numbers, especially in male homosexuals and immunocompromised patients. Henceforth amebic infection should be considered when pleural effusion and empyema are suspected.

Inhibition by morphine of the cardiovascular and behavioral responses evoked by centrally administered substance P in conscious rats

The effect of endogenous opioid receptor stimulation on the central cardiovascular and behavioral actions of substance P (SP) was examined in conscious rats. SP (55 pmol) injected intracerebroventricularly (i.c.v.) elicited increases in mean arterial pressure, heart rate, and stereotyped behavioral activation such as exploring and grooming, which were considered to be parts of the cardiovascular defense reaction. Intravenous (i.v.) pretreatment with morphine (2.5 and 5.0 mg/kg) attenuated the cardiovascular and behavioral responses produced by SP i.c.v. dose-dependently. The i.v. pretreatment with naloxone (10 mg/kg) had no effect on the central SP-induced response. Pressor responses elicited by i.c.v. injection of corticotropin-releasing factor or angiotensin II were also attenuated by pretreatment with i.v. morphine (5.0 mg/kg). Our results showed that endogenous opioid receptor stimulation antagonizes the central cardiovascular and behavioral actions of SP. Morphine may not influence the primary site of action of SP but does influence the central neural pathway which conveys the SP-induced sympathetic activation signal.

C-type natriuretic peptide in the human central nervous system: distribution and molecular form

The distribution and molecular form of C-type natriuretic peptide (CNP) in the human central nervous system were studied with a specific radioimmunoassay for CNP-22. Immunoreactive (IR-) CNP was detectable in all regions of the brain examined (cerebral cortex, thalamus, hypothalamus, pons, and cerebellum) (0.21-0.81 pmol/g wet tissue, n = 4). The highest concentration of IR-CNP was found in the spinal cord at 1.83 +/- 0.13 pmol/g wet tissue (mean +/- SD, n = 3). Reversed-phase high performance liquid chromatography revealed a major peak migrating at the position corresponding to synthetic human CNP-53 and minor peaks comigrating with synthetic CNP-22 and the methionine-oxidized form of CNP-22, respectively. These findings suggest that IR-CNP is widely present in the human central nervous system mainly in a high molecular weight form as the major component and in the molecular form of CNP-22 as the minor component.

Immunoreactive C-type natriuretic peptide in human adrenal glands and adrenal tumors

C-type natriuretic peptide (CNP) in human adrenal glands and adrenal tumors was measured with a specific radioimmunoassay for CNP. Tissue immunoreactive (IR-) CNP concentrations were 0.54 +/- 0.40 pmol/g wet tissue (gwt) (mean +/- SD) in 14 pheochromocytomas, 0.69 +/- 0.19 pmol/gwt in six adrenocortical tumors, and 0.49 +/- 0.22 pmol/gwt in seven normal adrenal glands (cortex and medulla mixed). These concentrations were comparable to those found in tissues from human brains. Sephadex G-50 superfine column chromatography and reverse-phase high performance liquid chromatography revealed that IR-CNP in normal adrenal glands and pheochromocytoma consisted of at least two components: a component in low molecular weight form chromatographically identical to CNP-22 and the other, a high molecular weight form very similar to human CNP-53. This study has shown that IR-CNP is present in human adrenal glands and adrenal tumors with similar molecular forms and comparable concentrations to those in the human brain.

Effects of tachykinins on phosphoinositide metabolism in the hypothalamus: is the NK1 receptor involved?

Substance P (SP) has been shown to stimulate the hydrolysis of inositol phospholipids in peripheral tissues and in the brain. In mammalian peripheral tissues, three tachykinin receptor subclasses, neurokinin 1 (NK1), neurokinin 2 (NK2) and neurokinin 3 (NK3), have been identified. The purpose of our study was to pharmacologically characterize the SP receptors in the hypothalamus using phosphoinositide breakdown as a functional response. SP, previously described as a NK1 agonist, and Neurokinin A (NKA), previously described as a NK2 agonist, stimulated phosphoinositide breakdown in the hypothalamus in a dose-dependent fashion, with SP being more potent than NKA. The NK2-selective antagonist L-659,877, at a dose of 10(-6) M, abolished the effect of SP (10(-8) M) without affecting basal phosphoinositide breakdown. However, this NK2-selective antagonist did not inhibit the NKA-induced stimulation in phosphoinositide metabolism. The NK1-selective antagonist L-668,169 stimulated phosphoinositide metabolism at a concentration of 10(-6) M, but not at 10(-8) M. This NK1-receptor antagonist did not significantly inhibit the effect of SP on phosphoinositide metabolism. Spantide II, another NK1-selective antagonist, also stimulated phosphoinositide metabolism at a dose of 10(-6) M. Like L-668,169, spantide II failed to inhibit the SP-induced stimulation of phosphoinositide metabolism, and even potentiated the response to SP.(ABSTRACT TRUNCATED AT 250 WORDS)

[TV-assisted thoracoscopic surgery with a lung forceps combined with thoracoscope under local anesthesia for spontaneous pneumothorax with a persistent air leak--a single access port approach]

TV-assisted thoracoscopic surgery was performed under local anesthesia by through a single access port to control a continuing air leak in spontaneous pneumotorax. A 75-year-old man was admitted with severe dyspnea and right-sided chest pain. The chest X-ray film showed right lung collapse. A right spontaneous pneumothorax was diagnosed and was treated by chest tube drainage. However, the lung did not re-expand because of a continuing air leak and subcutaneous emphysema developed. TV-assisted thoracoscopic surgery was performed under local anesthesia to treat the persistent air leak on day 12. By endoscopy, the ruptured bulla was double-ligated with an Endoloop through a single access port using lung forceps combined with endoscope. The air leak subsequently ceased and the lung re-expanded. This method is minimally invasive and is very suitable for controlling a continuing air-leak causing spontaneous pneumothorax in a patient.

Pituitary adenylate cyclase activating polypeptide (PACAP)-like immunoreactivity in ganglioneuroblastoma and neuroblastoma

Pituitary adenylate cyclase activating polypeptide (PACAP) is a 38 amino acid peptide originally isolated from ovine hypothalamus. It has a potent stimulatory action on adenylate cyclase in the rat pituitary. The presence of PACAP was studied in the tumor tissues of ganglioneuroblastoma and neuroblastoma by radioimmunoassay and immunocytochemistry. Immunocytochemical studies showed positive immunostaining in 4 out of 7 ganglioneuroblastomas and 4 out of 6 neuroblastomas. Immunoreactive PACAP concentrations in tissues of 3 ganglioneuroblastomas ranged from 14.5 to 27.8 pmol/g wet weight (20.0 +/- 5.7 pmol/g wet weight, mean +/- S.D.) and the concentration in one neuroblastoma tissue was 111.0 pmol/g wet weight. Reverse phase high performance liquid chromatography of the tumor tissue extract of ganglioneuroblastoma showed a peak eluting in the position of PACAP1-38 and smaller broad peaks eluting later. These results indicated that high concentrations of immunoreactive PACAP were present in the tumor tissues of ganglioneuroblastoma and neuroblastoma, and suggest the possibility that this peptide plays a pathophysiological role in some ganglioneuroblastomas and neuroblastomas.

Substance P and neurokinin A induced desensitization to cardiovascular and behavioral effects: evidence for the involvement of different tachykinin receptors

Desensitization and cross-desensitization to the cardiovascular and behavioral effects elicited by intracerebroventricular (i.c.v.) substance P (SP) and neurokinin A (NKA) injections were examined in conscious, freely moving rats. The cardiovascular responses to equimolar doses of both peptides were identical, however, the pattern of the behavioral responses differed. Relative to SP, NKA was weaker in eliciting hindquarter grooming but more effective in eliciting wet dog shakes. SP pretreatment (50 pmol) desensitized the cardiovascular and behavioral responses to both, subsequent injections of SP (50 pmol) as well as of NKA (50 or 500 pmol) injected 30 or 60 min after SP, indicating cross-desensitization. NKA pretreatment (50 pmol) partly reduced the cardiovascular but not the behavioral responses to subsequent equimolar doses of NKA. The cardiovascular responses to SP (50 pmol) were reduced only 30 min but not 60 min after pretreatment with a 10 times higher dose of NKA (500 pmol). Of all behavioral manifestations to i.c.v. SP, only hindquarter grooming was attenuated by pretreatment with either dose of NKA. The equal potency of SP and NKA in eliciting the cardiovascular effects but different pattern of behavioral responses to these peptides suggest an involvement of different types of tachykinin receptors in mediating the central effects of the two peptides. The fact that NKA induced cross-desensitization selectively to one type of behavioral manifestations elicited by SP, indicates the existence of two subtypes of SP (NK1) receptors in the rat brain.

[A case of pulmonary lymphangiomyomatosis treated with bilateral oophorectomy and methyl-progesterone-acetate]

A case of pulmonary lymphangiomyomatosis is reported. A 37-year-old woman was admitted with hemosputum and dyspnea on exertion. Chest roentgenogram revealed diffuse reticulonodular shadows and arterial hypoxemia was present. Pulmonary function tests showed severe restrictive & obstructive impairment, and pulmonary perfusion scintigraphy with 99mTc-MAA showed non-segmental disproportion. The histological diagnosis of pulmonary lymphangiomyomatosis was made by transbronchial lung biopsy. She underwent bilateral oophorectomy under general anesthesia. However, the arterial hypoxemia advanced gradually, and medroxyprogesterone-acetate (MPA) was commenced (200 mg/day). Her condition remained stable after the description of MPA.

[Local resection of pulmonary lesions by Nd-YAG laser without suturing]

Local excision of 67 pulmonary lesions in 5 patients was performed with the Nd-YAG laser. There were 2 women and 3 men with an average age of 68 years. The patients consisted of three cases of metastatic lung cancer (65 lesions), one hamartoma (One lesion) and one organized pneumonitis (one lesion). The lesion was first enucleated by a contact method using an Nd-YAG laser scalpel, then the crater of the resected lesion in the normal lung tissue was coagulated with a defocused laser beam. The craters of 52 of the 67 resected lesions which were shallow seated in the lung were left open, but the other 15 resected lesions were closed with sutures. Total blood loss was less than 100 ml. There was no bleeding or air leakage (30 cm water pressure) during the post operative days in 4 of the 5 patients, but one patients (one lesion) had to be treated by bronchoscopic endobronchial embolization against a persistent air leak. This lesion was 2.5 cm in diameter and 4 cm deep in the lung on CT. The other lesions were also measured by CT. The tumor size was 1.4 +/- 0.7 cm and the depth was 2.4 +/- 1.0 cm. The Nd-YAG laser is very suitable for local resection of peripheral lung lesions without suturing.

Isolation of trehalamine, the aglycon of trehazolin, from microbial broths and characterization of trehazolin related compounds

Trehalamine, (3aR,4R,5S,6S,6aS)-2-amino-4-(hydroxymethyl)-3a,5,6,6a- tetrahydro-4H-cyclo-pent[d]oxazole-4,5,6-triol (1) and D-glucose were obtained by acid hydrolysis of trehazolin (3), a trehalase inhibitor produced by actinomycetes. More vigorous hydrolytic treatment of trehazolin afforded an aminocyclitol, (1R,2S,3R,4S,5R)-5-amino-1- (hydroxymethyl)cyclopentane-1,2,3,4-tetraol (2). Trehalamine, the aglycon of trehazolin, was also found in the culture broths of two trehazolin producing strains, Micromonospora sp. SANK 62390 and Amycolatopsis sp. SANK 60791. These trehazolin related compounds trehalamine (1) and 2 were poor inhibitors of trehalase (1; IC50 1.8 x 10(-4) M, 2; > 5.0 x 10(-4) M). On the other hand they inhibited more potently rat intestinal sucrase (1; IC50 6.8 x 10(-5) M) and sweet almond beta-glucosidase (2; IC50 5.6 x 10(-6) M) than trehazolin.

Melanin-concentrating hormone in the human brain

The presence of human melanin-concentrating hormone (MCH) was studied in the human brain by radioimmunoassay and immunocytochemistry. Immunoreactive MCH concentrations in the human brain ranged from 0.07 to 19.7 pmol/g wet weight. High performance liquid chromatography of the hypothalamus showed a large immunoreactive peak in the position of human/rat MCH, which was eluted 9 min later than that of salmon MCH. Free-floating sections (40 microns) of the hypothalamus were immunostained. Positive MCH immunostaining was found in perifornical, tuberomammillary, and posterior nuclei. Numerous MCH-immunoreactive nerve fibers were observed throughout the hypothalamus. The presence of high concentrations of MCH in the human brain, in particular in the hypothalamus, suggests that MCH is a neurotransmitter, a neuromodulator, or a neurohormone in man.

Pituitary adenylate cyclase activating polypeptide (PACAP)-like immunoreactivity in pheochromocytomas

Pituitary adenylate cyclase activating polypeptide (PACAP) is a novel hypothalamic peptide consisting of 38 amino acids [PACAP(1-38)] with a potent stimulatory action on adenylate cyclase in rat pituitary. The presence of immunoreactive (IR-) PACAP in the tumor tissue of pheochromocytomas was studied by radioimmunoassay and immunocytochemistry. The antibody to PACAP was raised in a rabbit injected with a peptide containing amino acids 28-38 of PACAP. This antibody showed no significant cross-reactivity with either PACAP(1-27) or vasoactive intestinal polypeptide. The tumor tissue concentrations of IR-PACAP(1-38) were 0.5-57.5 pmol/g wet weight (n = 13) (24.5 +/- 22.4 pmol/g wet weight, mean +/- SD), while those in the normal adrenal glands were 3.58 +/- 2.02 pmol/g wet weight (n = 7) and those in the adrenal cortical tumors were 5.58 +/- 2.02 pmol/g wet weight (n = 6). The IR-PACAP(1-38) concentrations in 7 out of 13 pheochromocytomas exceeded 18 pmol/g wet weight. Sephadex G-50 column chromatography revealed that the IR-PACAP(1-38) in extracts of pheochromocytomas eluted in both the positions of PACAP(1-38) and a larger molecular weight. Reverse-phase high performance liquid chromatography of the tumor extracts revealed a peak in the position of PACAP(1-38) and at least four other peaks. Immunocytochemistry of pheochromocytomas showed numerous immunoreactive cells. The immunostaining was abolished by absorption of the antiserum with synthetic PACAP(1-38). These findings indicate that multiple forms of IR-PACAP(1-38) are present in pheochromocytomas.

An ACTH-secreting bronchial carcinoid: presence of corticotropin-releasing hormone, neuropeptide Y and endothelin-1 in the tumor tissue

The presence of three regulatory peptides, corticotropin-releasing hormone, neuropeptide Y and endothelin-1, was studied by radioimmunoassay in the tumor tissue of an ACTH-secreting bronchial carcinoid. A 36-year-old female was admitted to hospital because of moon face, central obesity and hypertension. High levels of plasma ACTH and cortisol and urinary 17-OHCS and 17-KS were found. One mg dexamethasone did not suppress plasma ACTH and cortisol levels, but 8 mg did so slightly. Corticotropin-releasing hormone (100 micrograms, iv) stimulated plasma ACTH levels (0 min; 34.8 pmol/l; 30 min; 41.1 pmol/l). The computerized tomography showed the presence of a tumor in the right lung. This lung tumor was removed surgically and has been shown by microscopical examination to be a bronchial carcinoid with ACTH-positive cells. The tumor tissue concentrations of corticotropin-releasing hormone, neuropeptide Y and endothelin-1 were 3.34 pmol/g wet weight, 8.07 pmol/g wet weight and 0.92 pmol/g wet weight, respectively, although plasma concentrations of these three peptides were not elevated. Reverse phase high performance liquid chromatography showed that immunoreactive peptides in the tumor tissue were mainly eluted in the position of the standard peptides. These findings indicate that this case of ACTH-secreting bronchial carcinoid had high levels of corticotropin-releasing hormone, neuropeptide Y and endothelin-1 in its tumor tissue and suggested that these peptides may act locally, in a paracrine or autocrine manner, in the tumor.