Diagnosis of small hepatocellular carcinoma by computed tomography: correlation of CT findings and histopathology

The diagnostic value of computed tomography (CT) scans in small hepatocellular carcinoma (HCC) (less than 5 cm) was studied in 82 patients. Dynamic scan was also made in 66 of them. Combined unenhanced and enhanced scans detected 87% of the lesions greater than 2 cm, but the detection rate was only 25% for lesions less than 1.5 cm. Diagnostic failure was due to isodensity of the mass and to technical artefacts. Diagnosis of the surrounding capsule and internal septa (partition) and demonstration of the typical pattern of density enhancement by dynamic scan proved useful in differentiating HCC from secondary cancers. On unenhanced CT, the density of the interior was subject to the histological changes of tumour such as bleeding, necrosis and fatty metamorphosis. Similarly, enhanced CT showed density changes suggestive of these histological changes. Dynamic scan proved particularly useful for lesions less than 3 cm because the typical density enhancement was frequently demonstrated in the arterial phase. It was concluded that unenhanced CT combined with dynamic scan has a high diagnostic value in small HCC and reflects histological changes.

Test-strip method for measuring lactate in whole blood

We have developed a dry reagent strip system for measuring lactate in whole blood. The test strip contains lactate oxidase (no EC number assigned), horseradish peroxidase (EC 1.11.1.7), and N-ethyl-N-(2-hydroxy-3-sulfopropyl)-m-toluidine. The system is designed to measure with a reflectometer the color that developed in the test strip, although the lactate concentration can be estimated without the reflectometer. The between-run coefficients of variation for controls at three concentrations were 2.9-5.3%. The lactate concentrations in blood samples from healthy subjects before and after exercise correlated well (r = 0.97) with the results measured by the comparison method with the use of lactate oxidase. This dry reagent strip system provides a convenient and rapid test for measuring blood lactate in clinical and sports medicine.

Cloning and expression of the alkaline proteinase gene from Pseudomonas aeruginosa IFO 3455

The alkaline proteinase gene from Pseudomonas aeruginosa IFO 3455 was cloned and expressed in Escherichia coli.

Two patients with hypergonadotropic ovarian failure due to pituitary hyperplasia

Two patients with hypergonadotropic ovarian failure were examined. Plasma levels of LH and FSH were markedly elevated to over 113 mIU/mL (Second International Reference Preparation--human menopausal gonadotropin standard), but the FSH/LH ratio was 1 or less in both women. The plasma estradiol (E2) level was 65 pg/mL in one woman before medication, and in the other increased from below 25 to 130 pg/mL after large doses of clomiphene citrate treatment. The pituitary tissues removed by transsphenoidal surgery showed hyperplasia with numerous cells immuno-histochemically positive for LH and FSH. After surgery, the elevated plasma gonadotropins decreased and plasma E2 levels increased. Human menopausal gonadotropin after clomiphene citrate treatment induced ovulation in one patient, and cyclic administration of estrogen and progesterone induced ovulation in the other. These results suggest that elevated gonadotropins may suppress ovarian function in some cases.

Antimicrobial action of natural substances on oral bacteria

The antimicrobial action of natural substances was investigated in vitro against oral bacteria including Streptococcus sp., Actinomyces sp., Actinobacillus sp., Bacteroides sp., Capnocytophaga sp., Eikenella sp., Fusobacterium sp. and Propionibacterium sp. Among the natural substances tested, hinokitiol was the most inhibitory to oral bacteria. Cinnamon bark oil, papua-mace extracts, and clove bud oil in spice extracts were also inhibitory against many oral bacteria. Egg white lysozyme exhibited antimicrobial action against the periodontitis associated bacteria.

Introduction of phalloidin labelled with fluorescein isothiocyanate into living polymorphonuclear leukocytes by electroporation

To examine the mechanism by which polymorphonuclear leukocytes (PMNs) move, phalloidin labelled with fluorescein isothiocyanate was introduced into freshly sampled cells by use of an electric-cell fusion system. The best conditions for treatment were three pulses of direct current at 100 V for a pulse duration of 3 microseconds. The treated cells retained their usual motility when observed under a microscope, so the method was suitable for the analysis of motile living cells. We used the method to study PMNs during locomotion, spreading and phagocytosis. In locomotion, fluorescence first appeared at the head of the cell and shifted gradually along the cell margin from head to tail. In spreading, diffuse fluorescence around the marginal part of the cytoplasm was strongest near both the attachment sites and the perinuclear area of the cell and spots of fluorescence appeared in the cytoplasm. In phagocytosis, fluorescence developed from the attachment sites, spread to the entire phagocytizing area of the cytoplasm and disappeared when phagocytosis ended. Cells treated with cytochalasin B were randomly spotted with fluorescence. Freshly sampled cells had diffuse and scattered fluorescence, without the lines observed in fixed cells.

Relationship between cirrhosis, liver cancer, and hepatic metastases. An autopsy study

Consecutive autopsies (5241) performed in the Trieste area and consecutive autopsies (6511) performed in the Tokyo-Chiba area were analyzed to study the frequency of liver metastases in cirrhotics. The Italian material included 500 cases and the Japanese material included 529 cases of liver cirrhosis. Both of these groups were matched for sex and age with a control group. The results were similar in both areas and confirmed the widely held but disputed opinion that metastases in cirrhotic liver are rare. These results seem to be clinically important since they agree with the fact that most neoplasms in cirrhotic liver are primary. From a biologic and epidemiologic point of view, these results call for reconsideration of the complex relationship existing between cancer and liver cirrhosis, in relation to major causative factors such as alcohol and hepatitis B virus (HBV) infection.

Hepatocellular carcinoma without cirrhosis in Japanese patients

Hepatocellular carcinoma is closely associated with cirrhosis, but it also develops, although much less frequently, in a noncirrhotic liver. It is suspected, without supporting evidence, that hepatocellular carcinoma has a different etiology when associated and not associated with chronic liver disease. In this study, 66 noncirrhotic cases found among 618 autopsies for hepatocellular carcinoma (10.7%) were analyzed retrospectively. The noncirrhotic liver was histologically unremarkable in 3 cases and in the histologically evaluable 56 cases it had fibrosis of varying degrees or mild cellular infiltrate, or both, in the portal tract. There was one liver that had portal venous changes compatible with those in idiopathic portal hypertension (Banti's syndrome). In these noncirrhotic livers, the parenchymal cells were generally unremarkable except for liver cell dysplasia that was seen in 26.8%. Serum hepatitis B surface antigen was positive in only 7.4% in contrast to 26.6% in cirrhotic cases. Three histologically unremarkable cases had no clinical or histologic evidence of chronic liver disease; two involved painter-plasterers and one a farmer. The liver weight in these cases ranged from 4400 to 6180 g. In contrast, the average liver weight in cirrhotic cases was 1998 g. Noncirrhotic patients when compared with cirrhotic patients had better liver function tests and much less frequent varices. It was concluded that approximately 11% of hepatocellular carcinoma cases in Japan are noncirrhotic, the majority having some histologic changes in the portal tracts suggestive of past or ongoing chronic liver disease, and that there are rare cases that have no histologic changes in the liver.

[Adult T-cell leukemia/lymphoma with OKT4 lack of OKT8 in peripheral blood and with OKT4 and OKT8 in lymph node. Study of two color flow cytometry]

Adult T-cell leukemia (ATL) cells usually express the helper/inducer associated antigen OKT 4 with lack of OKT8. However, there are a few case reports indicating that there are atypical cell phenotypes in ATL including OKT4+/OKT8+. The analysis of surface phenotype of peripheral lymphocytes and abnormal cells in lymph node was done with monoclonal antibodies. ATL cells of peripheral blood and small lymphocytes of lymph node had the usual phenotype, OKT4+/OKT8-, but neoplastic cells of large lymphocytes of lymph node had the unusual phenotype OKT4+/OKT8+. The neoplastic cells were immunophenotyped by two-color flow cytometry analysis. OKT4+/OKT8- cells had a helper cell phenotype. OKT4+/OKT8+ cells had a helper cell and a cytotoxic cell. These findings suggest that in this case ATL cells arise from common thymocyte and one of them mature in peripheral blood other remain in lymph node.

A common antigen of Treponema denticola and other Treponema species detected by monoclonal antibody

Murine monoclonal antibodies against Treponema denticola were produced. One monoclonal antibody (MSA257) reacted with 34,000 dalton antigens of all T. denticola strains, including ATCC strains and our isolates. This monoclonal antibody also reacted with antigens of other treponema strains tested.

Clinical study of malignant lymphoma of head and neck in the nasal cavity and Waldyer's ring

Clinical outcome of fifty-one cases of non-Hodgkin's lymphoma limited to the head and neck were studied for differences with involvement of one of two sites: Waldyer's ring, and the nasal cavity and paranasal sinuses taken together. The median survival for patients with involvement of Waldyer's ring was 58.6 months, and for the other group, 10.3 months. The patients with involvement of the nasal cavity and paranasal sinuses responded poorly to treatment and the lymphoma rapidly progressed. In these patients, the lymphomas were not of the diffuse small cell type, which has a relatively good prognosis: but T cell type. The poor outcome with involvement of the nasal cavity and paranasal sinuses may be due to histological and immunological factors, and to inadequate therapy. Early combination chemotherapy might give better results for this group.

An alternative nonradioactive method for labeling DNA using biotin

An alternative nonradioactive labeling method and a highly sensitive technique for detecting specific DNA sequences are described. The labeling method requires the "Klenow" fragment of DNA polymerase I and random hexanucleotides (synthesized or naturally extracted) as a primer for the production of highly sensitive DNA probes. The system has three main steps: (i) labeling of DNA with biotinylated 11-dUTP; (ii) detection of biotinylated DNA by a one-step procedure with streptavidin-alkaline phosphatase complex; (iii) blocking of background with Tween 20. Twenty attograms (2 X 10(-17) g) of pBR322 plasmid DNA was detected by dot-blot hybridization. Upon Southern blot hybridization, 7.4 fg (7.4 X 10(-15) g) of pBR322 HindIII DNA was detected using the biotinylated pBR322 plasmid DNA probe; 40.8 ag and 7.4 fg of lambda HindIII DNA were detected with the biotinylated whole lambda DNA probe by dot and Southern blot hybridization, respectively. Specific bands were also detected with the biotinylated argininosuccinolyase probe upon Northern blotting of mouse poly(A+) RNA. Further applications for in situ hybridization are also described.

Molecular cloning and nucleotide sequence of rat brain argininosuccinate lyase cDNA with an extremely long 5'-untranslated sequence: evidence for the identity of the brain and liver enzymes

Argininosuccinate lyase (EC 4.3.2.1) is an enzyme present in the brain of ureotelic animals. Using as a probe rat liver argininosuccinate lyase cDNA, already isolated and sequenced (Amaya, Y., Matsubasa, T., Takiguchi, M., Kobayashi, K., Saheki, T., Kawamoto, S. and Mori, M., J. Biochem., 103 (1988) 177-181), we screened a rat brain cDNA library constructed in the lambda gt11 expression vector and obtained a single cDNA clone. This cDNA clone contained an open reading frame encoding a polypeptide of 461 amino acid residues (predicted Mr = 51,390), a 5'-untranslated sequence of 967 bp and a 3'-untranslated sequence of 74 bp. The length of the 5'-non-coding region of the cDNA seems to be one of the longest among the cDNAs heretofore isolated. A comparison of the brain cDNA sequence (2424 bp) with the corresponding region of the liver cDNA (1574 bp) revealed differences in 5 nucleotides. The brain clone contained A----G and C----G base differences from the hepatic sequence, resulting in amino acid changes from Tyr and Arg in the liver clone, to Cys and Gly in the brain clone, respectively. The other 3 nucleotide differences are silent with respect to the amino acid sequence of the protein. Therefore, the amino acid sequence of the brain argininosuccinate lyase, as deduced from the nucleotide sequence of its cDNA clone, was identical with that of the liver protein, except for two amino acid residues. These minor changes may reflect a microheterogeneity of the argininosuccinate lyase gene. The brain and liver enzymes seem to be encoded by the same structural gene.

Neuraminidase-enhanced attachment of Bacteroides intermedius to human erythrocytes and buccal epithelial cells

Bacteroides intermedius strains strongly agglutinated only neuraminidase-treated erythrocytes. The neuraminidase-dependent hemagglutinating activity of B. intermedius was abolished by heating or treating with protease. The adherence of these microorganisms to human buccal epithelial cells was enhanced by neuraminidase pretreatment of the cells (P less than 0.01).

Biopsy diagnosis of well-differentiated hepatocellular carcinoma based on new morphologic criteria

Nodular hepatic lesions detected in 123 patients with chronic liver diseases were subjected to ultrasonically guided needle biopsy. Of these, 94 cases were diagnosed as hepatocellular carcinoma of a moderately or poorly differentiated type with classical histologic features of hepatocellular carcinoma. In 14 cases in whom hepatocytes had minimal atypical changes and were mostly of normotrabecular arrangement (one to two cells thick), a diagnosis of well-differentiated hepatocellular carcinoma was made on the basis of the following three histologic criteria: nuclear crowding, increased cytoplasmic basophilia and microacinar formation. The nodules which showed two or more of these findings were diagnosed as well-differentiated HCC. The diagnoses of these 14 cases were subsequently confirmed by clinical course, histology in the resected specimen and/or autopsy findings. The nodules that presented similar but equivocal changes were arbitrarily categorized as borderline lesions (five cases). The nodules showing the findings almost identical with those of pseudolobules were regarded as benign, large regenerative nodules (nine cases). The remaining one case had a hemangioma. Thus, these three histologic criteria proved to be useful in the biopsy diagnosis of nodular hepatic lesions, with certain limitations. Additionally, the majority of large regenerative nodules, borderline lesions and well-differentiated HCCs were found to be smaller than 2 cm.

[The clinical usefulness of portal venous flow ratio by hepatic angiography with 99mTc-Sn colloid in chronic liver diseases: a comparison with histological finding]

The ratio of portal venous to hepatic blood flow was measured in chronic liver diseases by radionuclide angiography with 99mTc-Sn colloid and its clinical value was discussed. The ratio was proportionally decreased to the progression of the diseases (normal 74.5 +/- 7.3%, chronic hepatitis 58.8 +/- 9.2%, compensated liver cirrhosis 29.3 +/- 19.3%). In alcoholic liver diseases, the standard deviation of the ratio was large as 52.7 +/- 23.7%, and the low ratio in the early period of the disease increased within one or two months as the disease recovered. In comparison with the histological findings of the liver, the ratio in the alcoholic liver diseases was well correlated with the severity of liver fibrosis and liver cell swelling. In conclusion, this noninvasive and simple method is valuable in diagnosing the chronic liver disease, especially alcoholic liver diseases, and also in estimating its clinical course.

[Leukemic Burkitt's lymphoma with an initial symptom of ocular motor disturbance]

A 58-year-old male was admitted to Osaka City University Hospital because of diplopia in May, 1987. Hematological examinations revealed abnormal blastoid cells in his peripheral blood and bone marrow. We found many mitochondria and polysomes in the cytoplasm of the blastoid cells by the electron microscopy. Moreover, left axillary lymph node biopsy specimen disclosed the typical "starry sky" pattern. The blastoid cells in the bone marrow had chromosomal abnormality; 47XY, 8q-, 14q+, 22q-, +mar. Therefore, the diagnosis of Burkitt's lymphoma (leukemic change) was performed. He was treated with chemotherapy, but the blastoid cells resisted many anticancer agents and he died in September 30. On admission left ocular motor disturbance was revealed. Generally, it was reported that meningitis with CNS involvement of lymphoma is accompanied by cranial nerves palsy. However in this case lymphoma cells was not found in the cerebrospinal fluid. The cause of ocular motor disturbance was the adhesion to the medial rectus muscle and compression to the ocular motor nerves of the lymphoma mass.

Structural gene and complete amino acid sequence of Pseudomonas aeruginosa IFO 3455 elastase

The DNA encoding the elastase of Pseudomonas aeruginosa IFO 3455 was cloned, and its complete nucleotide sequence was determined. When the cloned gene was ligated to pUC18, the Escherichia coli expression vector, bacteria carrying the gene exhibited high levels of both elastase activity and elastase antigens. The amino acid sequence, deduced from the nucleotide sequence, revealed that the mature elastase consisted of 301 amino acids with a relative molecular mass of 32,926 daltons. The amino acid composition predicted from the DNA sequence was quite similar to the chemically determined composition of purified elastase reported previously. We also observed nucleotide sequence encoding a signal peptide and "pro" sequence consisting of 197 amino acids upstream from the mature elastase protein gene. The amino acid sequence analysis revealed that both the N-terminal sequence of the purified elastase and the N-terminal side sequences of the C-terminal tryptic peptide as well as the internal lysyl peptide fragment were completely identical to the deduced amino acid sequences. The pattern of identity of amino acid sequences was quite evident in the regions that include structurally and functionally important residues of Bacillus subtilis thermolysin.

Introduction of macromolecules into primary cultured neuronal cells by fusion with erythrocyte ghosts

The macromolecules were injected into primary cultured neuronal cells by fusion with human erythrocyte ghosts containing macromolecules. The injection efficiency was about 30% and 80% of the cells extended neurites like normal neuronal cells. In order to succeed in this method, phytohaemagglutinin E and polyethylene glycol 1000 were essential, and monolayer culture cells were used.

Purification and characterization of cytochrome P-450 induced by benz(a)anthracene in mouse skin microsomes

Topical application of benz(a)anthracene to mouse skin elicited a 2-fold increase in cytochrome P-450 content, with accompanying increases in monooxygenase activities such as benzo(a)pyrene hydroxylation, 7-ethoxycoumarin O-deethylation, and acetanilide 4-hydroxylation, in the microsomes. A major form of cytochrome P-450 was purified from skin microsomes of mice treated with polycyclic aromatic hydrocarbon. A specific content of 1.95 nmol/mg of protein, which corresponded to 48-fold purification from the microsomes, was observed. The purified protein produced a single major band on sodium dodecyl sulfate-polyacrylamide gel electrophoresis having a molecular weight of 55,000. Using Western blotting, the band immunochemically cross-reacted with antibody which had been raised against rat liver cytochrome P-450MC-1. The purified preparation efficiently catalyzed benzo(a)pyrene hydroxylation and 7-ethoxycoumarin O-deethylation when reconstituted with NADPH-cytochrome P-450 reductase. These activities were inhibited by 7,8-benzoflavone as well as anti-cytochrome P-450MC-1 antibody, but not by P-450PB-1 antibody. The results indicate that, in mouse skin microsomes, a cytochrome P-450 induced by benz(a)anthracene is enzymatically and immunochemically similar to rat liver cytochrome P-450MC-1. It is suggested that this enzyme plays an important role in the activation of carcinogenic polycyclic aromatic hydrocarbons.

Drug-induced mononucleosis-like hepatic injury in a patient with systemic lupus erythematosus

A case of systemic lupus erythematosus (SLE) with mononucleosis-like hepatic injury was described. An emergent cesarean section was performed in a 25 yr-old house wife at 34 weeks gestation, followed by administration of several antibiotics. After the surgery she complained of high fever, hepatomegaly and dull right hypochondralgia, and mild liver dysfunction was also found. The liver biopsy showed prominent mononuclear cell infiltration in the sinusoids with minimum hepatocellular necrosis and mild triaditis, resembling hepatic lesion in infectious mononucleosis (mononucleosis-like injury). There were no clinical and serological features suggestive of infectious mononucleosis. This hepatic lesion was thought to be a manifestation of allergic reaction to drugs to which the lymphocyte stimulation test was found to be positive. Immunological abnormalities inherent in SLE might be related to occurrence of such allergic drug reaction.

Angiography in the diagnosis of liver disease

Although necessity for angiography has been reduced somewhat because of the development of newer imaging modalities, such as ultrasound and CT, celiac or hepatic arteriography, portography, and hepatic venography often prove useful in the diagnosis of liver disease. They can be utilized for therapeutic purposes as well in certain vascular abnormalities.

Structural analysis of lipopolysaccharides from Eikenella corrodens by use of murine monoclonal antibodies

The structure of lipopolysaccharides (LPSs) of Eikenella corrodens was analyzed with prepared murine monoclonal antibodies. A common core epitope was found in three of seven LPS preparations from E. corrodens strains and Fusobacterium nucleatum ATCC 25586. Four E. corrodens LPSs were found to possess an O-side-chain epitope which cross-reacted with LPSs from Fusobacterium necrophorum ATCC 25286 and Capnocytophaga ochracea M-12. Lipid A of E. corrodens LPS shared an epitope common among LPSs from various gram-negative rods.