A study on the mechanism of acute hepatic necrosis following partial resection of the liver

Endotoxin was injected intravenously into rats 48 hours after 70% hepatectomy. The remaining hepatic tissue demonstrated marked hemorrhagic necrosis in high frequency. However, hepatic lesions were slight in other groups such as the group in which heparin was administered simultaneously with injection of endotoxin 48 hours after 70% hepatectomy and the group in which endotoxin was injected 10 days after 70% hepatectomy. Defining of this marked necrosis to be a univisceral Shwartzman reaction in the liver may be justified from (i) conformity of experimental manipulations to those employed in the Shwartzman reaction, (ii) macroscopical as well as histological evidence, (iii) formation of microthrombi in hepatic lesions, (iv) inhibition of occurrence of the reaction by heparin, and (v) absence of any remarkable change in other organs. We concluded that the hepatic regenerative state might correspond theoretically to a state of preparedness for the Shwartzman reaction.

Anti-glucocorticoid effects of melatonin on adult rats

To extend our previous experiment on anti-glucocorticoid effects of melatonin which was performed under a very special condition using young rats, we have carried out another experiment of long term administration of pineal hormone melatonin to adult female rats which were conditioned by overdose glucocorticoid. The results clearly demonstrated significant protection, by melatonin, from the injurious effects of a glucocorticoid, dexamethasone: decrease of body weight gain, atrophy of the thymus and adrenals, and elevation of the level of total cholesterol in blood. Thus, it has been clarified that anti-glucocorticoid effects of melatonin could be shown experimentally not only in young rats but also in adults, and also, could be really seen not only in short term experiment but also in longer ones. Anti-glucocorticoid effects of melatonin seem to be of considerably wide range, not being limited to occur under a special condition, including the age of animals, in experiments.

Postinflammatory mitral and aortic valve prolapse: a clinical and pathological study

In this study we reevaluated whether the sole cause of mitral valve prolapse (MVP) and aortic valve prolapse (AVP) is myxomatous degeneration. Forty-two surgical cases of prolapsed valves with mitral and/or aortic regurgitation were reviewed (AVP in nine, MVP in 27, and combined AVP and MVP [CVP] in six). On microscopic examination, myxomatous degeneration was observed in 20 patients, including six with AVP, 13 with MVP, and one with CVP. In the other 22 patients, including three with AVP, 14 with MVP, and five with CVP, microscopic examination revealed fibrosis with vascularization and scattered infiltration of inflammatory round cells caused by postinflammatory changes with or without chronic inflammation. We coined the term "postinflammatory valve prolapse" (PIVP) to describe these valves. Both postinflammatory and myxomatous degeneration were observed in seven patients with floppy mitral valves attributable to PIVP. Rupture of chordae tendineae was present in six patients with myxomatous mitral valve and three with PIVP. Seven patients with PIVP had a history of rheumatic fever. The results suggest that valvular prolapse is produced not only by myxomatous degeneration but also by postinflammatory changes, including those caused by rheumatic fever.

Pineal gland in old age; quantitative and qualitative morphological study of 168 human autopsy cases

Age-related changes of human pineal gland were studied morphologically on 168 autopsy cases. Pineal weight in the formalin-fixed condition was 99 +/- 56 mg in males (n = 88, mean age 78 years) and 91 +/- 41 mg in females (n = 80, mean age 79 years), which showed no sexual difference (P = 0.290). There was no correlation between pineal weight and age of the patient (r = 0.0678, P = 0.191, n = 168). The pineal volume calculated as a spheroid was directly proportional to the weight (r = 0.904, n = 167, P = 0.000). A significant correlation existed between pineal weight and the degree of calcification (r = 0.231, P = 0.002, n = 156). The density of the pineals decreased with age (r = -0.164, P = 0.017, n = 167). The degree of calcification and cyst formation did not increase with age, but the grade of cyst formation was related to the pineal volume (P = 0.0002). Some pineals of the patients over 90 years old showed no calcification and appeared indistinguishable from the ones of the younger subjects. The weight and volume of the pineals of the patients with hypertension was appreciably greater than those of the non-hypertensive patients. These results indicate that human pineals do not necessarily degenerate progressively after involution.

Acute, massive, haemorrhagic adrenal necrosis experimentally produced by the Shwartzman mechanism in rabbits

Acute and severe haemorrhagic necrosis of the adrenal was produced experimentally in rabbits by means of intravenous injection of endotoxin after pretreatment by adrenocorticotropic hormone (ACTH) administration. The change occurred mainly in the zona fasciculata of the adrenal cortex, and its pathology was quite similar to that of the Shwartzman reaction. Numerous microthrombi were found in and around the lesion, but no marked changes were seen in other parts of the body. Heparin administration was very effective in preventing the necrosis. The pathogenesis of this lesion was postulated to be a univisceral Shwartzman mechanism in the adrenal. This seems to be a good experimental model for massive haemorrhagic necrosis of the adrenal in man, for example in the Waterhouse-Friderichsen syndrome, the pathogenesis of which has been assumed to involve intravascular clotting. It is suggested that hyperfunction of the adrenal cortex caused by ACTH administration could be a preparative condition for the Shwartzman reaction.

Ultrastructural localization of Thorotrast (thorium dioxide) in human liver by analytical scanning electron microscope

The distribution of thorium dioxide (Thorotrast) in the liver from a Thorotrast-administered autopsy case was examined stereographically by analytical scanning electron microscopy. Thorium particles were detected in the macrophages of the portal triad and hepatic sinusoid. These macrophages were irregularly shaped and tended to be aggregated. In the sinusoid, accumulation of the macrophages formed a thrombus-like structure. Furthermore, observed in the sinusoid were free Thorotrast particles that appeared to have been released into the sinusoid as a result of breakdown of the macrophages (Kupffer cells).

Systemic hemangiomatosis

An autopsy case of unusual vasoformative tumor is presented. The distribution of this tumor was restricted to the organ of the hematopoietic system such as the spleen, liver, and whole bone marrow. Although it may be considered as a variant of certain splenic hemangiosarcoma because of widespread dissemination, both the benign-looking histological features and specific distribution of this tumor suggest its hamartomatous nature. Several additional similar cases in the literatures are briefly reviewed from the viewpoint of systemic hemangiomatosis.

Immunohistochemical localization of apolipoprotein E in atherosclerotic lesions of the aorta and coronary arteries

The distribution of apolipoprotein E (apo E) immunoreactive substances (IRS) in atherosclerotic lesions and lesion-free areas of the aorta and coronary arteries obtained from 17 autopsied cases was studied using a specific anti-apo E serum and the unlabeled peroxidase-antiperoxidase (PAP) method. In fatty streak lesions of the aorta, many cells containing apo E-IRS were found in the deeper layer of the intima and diffuse staining of apo E in the extracellular spaces was also noted. In more advanced lesions apo E-positive cells could not be found. Immunohistochemical findings of coronary arteries differed distinctly from those of the aorta in that the apo-E-positive cells were absent in the deeper layer of the intima. The endothelial cells of coronary arteries, but not those of the aorta, showed positive staining for apo E.

Fatal hepatic necrosis after shock

A clinicopathological study was undertaken in 15 cases of massive hepatic necrosis after shock. The GOT and GPT level exceeded 1000 units in 10 cases. The 15 cases consisted of 3 diagnosed as fulminant hepatitis clinically and 12 diagnosed as disseminated intravascular coagulation (DIC) or multiple systemic organ failure (MOF) from the unremarkableness of liver dysfunction. It was noteworthy that sepsis and surgery were closely associated with these lesions. The weight of the liver at autopsy ranged from 800 to 2,700 g. Liver necrosis was macroscopically characterized by clear demarcation of the necrotic areas sharply separated from the surrounding liver parenchyma, showing the appearance of so-called "map-like necrosis". Microscopically, the lesions in these subjects showed mainly the pattern of centrilobular necrosis. As observed in the burn shock case (case 12), the shock which provoked in different phases of time seemed to have repeated its attack. These liver necroses were considered to result from severe systemic circulatory disturbance or intrahepatic circulatory disturbance. The possibility is indicated that the generalized or univisceral Shwartzman reaction, and repeated and combined severe shock participated in the pathogenesis. Fibrin thrombi aggrevate tissue perfusion and accelerate anoxia. Heparin therapy seemed effective in these cases if administered at an appropriate time.

Anti-glucocorticoid effects of melatonin in young rats

Administration of the pineal hormone melatonin to young female rats provided significant prevention of the injurious effects (decrease of body weight gain, atrophy of the thymus and adrenals, glucosuria, elevation of the blood level of glucose, free fatty acid, triglyceride, and total cholesterol) caused by three different glucocorticoids, i.e. dexamethasone, prednisolone, and hydrocortisone. Although these protective effects of melatonin were slightly more remarkable in dexamethasone-treated rats than in prednisolone- or hydrocortisone-treated rats, our hypothesis of melatonin's anti-glucocorticoid effects is said to have been confirmed rather universally and with a considerably wide range through this experiment.

A study on so-called novel inclusion body in human hepatocyte

The so-called novel inclusion body (NIB) is an intrahepatocytic structure which is frequently observed in human cirrhotic liver. It resembles very much to, but definitely differs from Hepatitis B surface antigen (HBsAg) morphologically. The age distribution of liver cirrhosis cases positive for NIB is similar to that positive for HBsAg, except for an existence of a time lag in mean age. One of the best staining methods to demonstrate NIB, for example, is to exhibit it as a reddish body stained by Luna, with a contrast of HBsAg counterstained purple in color by aldehyde fuchsin after thiosulfation. Electron microscopy of the liver obtained from a patient, negative for both HBsAg and Hepatitis B e antigen (HBeAg) but positive for Hepatitis B core antibody (HBcAb) and Hepatitis B surface antigen antibody (HBsAb) clinically, revealed some unfamiliar, tubular and cisternal arrays showing a network pattern and ring-shaped structure at the site exactly corresponding to NIB localization. These are considered to have been induced from the endoplasmic reticulum by an unknown agent, for which non A non B hepatitis virus (NANBV) is rationally postulated as one of the possibilities. A close relation between NIB and NANBV is highly suspected because of much similarities in histology, histochemistry, age distribution, and electron microscopy. The true nature of NANBV should be rescrutinized, especially in relation with Hepatitis B virus infection, since NIB is quite often observed also in cirrhotic liver positive for HBsAg.

Hepatitis B surface antigen in hepatocellular carcinoma

Hepatitis B surface antigen (HBs-Ag) was detected histologically (by victoria blue-nuclear fast red staining) in the liver in 20-40% of liver cirrhosis and/or hepatocellular carcinoma (hepatoma) cases. In hepatoma cases, HBs-Ag was usually found in non-cancerous areas of the liver. However, some HBs-Ag positive cells were also found dispersed in cancerous areas; these were regarded as HBs-Ag-infected non-cancerous hepatic cells remaining undestroyed. There were a few cases where inconsistency was found between the results of the immunofluorescence technique using anti HBs-Ag serum and victoria blue staining in detecting HBs-Ag. This phenomenon was rare in non-cancerous areas, but was relatively frequent in cancerous areas.

A study on pulmonary hemorrhage experimentally produced by the Shwartzman mechanism in rabbits. Possible relationship to pulmonary hemorrhage in man

The lung was chosen as a target organ of the univisceral Shwartzman reaction in this study. Rabbits were selected as the experimental animal, and E. coli endotoxin was used as the Shwartzman reagent. Preparative procedures were applied through the trachea into the lung in several ways; direct injection of the endotoxin solution and inhalation of the atomized endotoxin solution by natural breathing. The provocation was made by intravenous injection of the same endotoxin 24 hours later. The lung showed severe hemorrhage associated with inflammatory cell infiltration, interstitial fibrosis, macrophage accumulation, etc. The severity and extent of these changes varied, to some extent, between groups as well as between individual animals. The fundamental character was, however, common to all, and the incidence of the lesion in the lung was quite high. The relationship of the present results to idiopathic pulmonary hemorrhage and Goodpasture's syndrome is also discussed from the viewpoint of human pathology.

Hepatocellular carcinoma in the Philippines: a clinicopathological study of 150 cases

Clinicopathological features were examined in 150 hepatocellular carcinoma cases autopsied from 1977 to 1983 in the Philippines and were compared to those of cases reported in Japan. The characteristics of hepatocellular carcinoma in the Philippines were as follows. 1. The age of autopsied patients with hepatocellular carcinoma in the Philippines was approximately 10 years younger than in Japan. The Philippines cases included even 10- to 11-year-old patients. 2. The macroscopic type of hepatocellular carcinoma in the Philippines consisted predominantly of the massive type of Eggel's classification. On the other hand, an encapsulated tumor was found in only one case. 3. The histological characteristics of hepatocellular carcinoma in the Philippines were not especially well defined. Hyaline globules and fatty metamorphosis were found in 1 and 12, respectively, of 90 Philippine hepatocellular carcinoma cases. 4. The frequency of HBs antigen in hepatocellular carcinoma in the Philippines was 37%. This is almost equal to that in Japan.

Isoferritins from tumorous and non-tumorous human liver

Human ferritins purified from normal liver (LF) and from hepatocellular carcinoma (HF) showed different biochemical and immunological characteristics. Subunit preparations from the isoferritins showed differences in isoelectric focusing patterns, although both HF and LF were found to be composed of H and L subunits with apparently the same molecular weights. It is postulated that heterogeneities between the two isoferritins are not merely due to different proportions of H and L subunits, but also result from the existence of distinct species of the subunits bearing different surface electric charges.

Protracted histopathological change of the liver necrosis induced by Shwartzman reaction. An experimental animal model of liver cirrhosis?

Severe pathological fibrotic change of rabbits treated with endotoxin was produced. The liver of the rabbits that died within 14 days showed severe architectural distortion through wide fibrotic band which could be called morphologically post necrotic liver cirrhosis. On the other hand, in the liver of the rabbits that remained alive more than 14 days thin septal nodular structures were observed. This experimental model is proposed as a tool for the further study of the pathogenesis of human liver cirrhosis.

Melatonin protects rats from injurious effects of a glucocorticoid, dexamethasone

Administration of the pineal hormone melatonin (1 mg/day) to growing female rats provided significant protection against the injurious effects (decrease of body weight gain and atrophy of the thymus and adrenals) caused by a glucocorticoid, dexamethasone (0.4-0.01 mg/day). The protective effects were greater at lower doses of dexamethasone, and the adrenal/body weight ratio was well maintained. Histological examination of the thymus and adrenals confirmed both the injurious effect of dexamethasone and the protective effect of melatonin. Dexamethasone also increased glutamic pyruvic transaminase, free fatty acid, triglyceride and glucose in the serum, and melatonin significantly reduced the former two changes. It is proposed that the protection afforded by the pineal hormone melatonin against the injurious effects of dexamethasone is due to a direct anti-glucocorticoid action and dose not involve any other endocrine organ.

A study on chronologic change of the relationship between cigarette smoking and lung cancer based on autopsy diagnosis

Human cases autopsied at the Department of Pathology, University of Tokyo, were studied to investigate the chronologic changes in the relationship between cigarette smoking and lung cancer occurrence. The results obtained were as follows: (1) it was confirmed that the incidence of lung cancer was significantly higher among cigarette smokers than among nonsmokers, and that there was a definite dose-response relationship between the quantity of cigarettes smoked and the occurrence of lung cancer; and (2) over the time span studied, the incidence of lung cancer among autopsies showed a remarkable increase. However, this tendency was seen in both cigarette smokers and nonsmokers, and in fact, the increase was comparatively higher in the latter group. It should be stressed that the relative importance of cigarette smoking in human pulmonary carcinogenesis seems to have decreased in the past 40 years or so, and factors other than cigarette smoking seems to have become more important.

Induction of brain tumors by a newly isolated JC virus (Tokyo-1 strain)

A newly isolated virus from a patient with progressive multifocal leukoencephalopathy (PML) (Tokyo-1 strain) was found serologically identical to JC virus (Mad-1 strain) and showed high neurooncogenicity in hamsters. Twenty-one animals inoculated intracerebrally with the virus developed brain tumors during a period that averaged 5 months. The tumors were cerebellar medulloblastoma (n = 20); plexus tumor (n = 2) occurred in 1 animal as a single tumor and in another in combination with a medulloblastoma. Thalamic gliomatosis was also present in 6 animals with medulloblastoma. Five mock-infected animals did not develop tumors. Medulloblastoma cells were shown to contain papovavirus T-antigen. In 20 animals examined the medulloblastoma showed a close resemblance to the human medulloblastoma in its histologic, immunocytochemical, and ultrastructural features. Examination of the incipient tumors indicated that the hamster medulloblastoma originated in cells in the neonatal external granular layer. Following infection the cells apparently migrated into the internal granular layer, carrying integrated virus genes and expressing phenotypical transformation. These findings confirm previous reports on the oncogenicity of virus isolates from PML (ZuRhein and Varakis, 1979), but are novel in that with this new isolate tumors could be induced with comparatively low levels of virus inocula.