[Therapeutic plasmapheresis in systemic lupus erythematosus]

Nine patients with SLE were treated with plasmapheresis (PP); eight of them having active disease improved rapidly and significantly both in clinical and laboratory parameters. The longest remission period was up to 17 months. The common side effects were hypocalcemia and urticaria but they did not necessitate cessation of therapy. The following treatment course is suggested: PP two to three times a week for two weeks with an exchange amount of 1.5 liters of plasma each time. In order to prevent the patients from antibody rebound phenomenon, administration of steroids and immunosuppressive agents following PP treatment is necessary.

[Analysis of the pathologic diagnoses of 1300 autopsies]

1300 autopsies in this hospital between 1949-1989 were reviewed, and the variation of the autopsy rate was analysed, giving an average rate of 20.7%. In 1258 cases with complete data, the consistency between clinical and pathological diagnoses reached 76.6%. Clinical misdiagnoses and uncertain diagnoses were found to be 19.2% and 4.1% respectively. The statistical figures indicated that infections diseases occupied a dominant position in 1950s, while in recent years cardiovascular diseases and malignant tumors have become the major diseases. Reasons of clinical misdiagnoses and lowering down of autopsy rate are discussed. Furthermore, statistical data cited in this article clearly demonstrate that autopsy is still of extreme importance in investigations of modern medical sciences.

Protein malnutrition predisposes to inflammatory-induced gut-origin septic states

The development of an uncontrolled inflammatory response has been implicated in the pathogenesis of adult respiratory distress syndrome and multiple-organ failure. Because zymosan activates complement and induces a systemic inflammatory response, the effect of zymosan on intestinal structure and barrier function was measured in normally nourished (NN) and protein malnourished (PM) mice. Normally nourished and protein malnourished (up to 21 days) mice challenged intraperitoneally with zymosan (0.1 mg/g body weight) were killed 24 hours after zymosan challenge and their organs cultured for translocating bacteria. Zymosan-induced bacterial translocation was limited to the mesenteric lymph nodes of the NN mice, whereas translocating bacteria spread from the gut to the liver, spleen, and blood stream (p less than 0.05) in the PM mice. Zymosan-induced bacterial translocation appeared to be related primarily to the combination of mucosal injury and a disruption of the gut flora ecology in the PM mice and to mucosal injury in the NN mice. The extent of mucosal injury was greater the longer the mice were protein malnourished before zymosan challenge. The effect of zymosan on survival was measured in separate groups of mice. At a dose of 0.1 mg/g body weight, no deaths occurred in NN mice or in 7-day PM mice. However 20% of the 14-day PM mice and 80% of the 21-day PM mice receiving zymosan died. Thus PM predisposes to mucosal damage and the development of potentially lethal gut origin septic state during periods of systemic inflammation.

Obstructed intestine as a reservoir for systemic infection

Intestinal motility, absorption, and secretion are altered after intestinal obstruction, but at what point the normal bacterial barrier function of the viable gut fails after intestinal obstruction is unclear. Thus, we tested whether after simple intestinal obstruction bacteria would translocate across the viable intestinal wall to cause systemic infection. Within 6 hours of intestinal ligation 1 cm proximal or distal to the ileocecal valve, bacteria had translocated to the mesenteric lymph nodes, and by 24 hours after intestinal obstruction, bacteria had spread to the liver, spleen, and blood stream. Bacterial translocation rarely occurred in the animals undergoing laparotomy and sham intestinal ligation, indicating that bacterial translocation was not due to surgical stress. Based on the results of these studies, bacterial translocation induced by intestinal obstruction appears to be due to disruption of the ecology of the normal gut microflora, leading to intestinal overgrowth with certain enteric bacilli and mucosal damage. Although the exact mechanism(s) by which simple mechanical obstruction injures the intestine is not known, the fact that mucosal injury did not occur in germ-free mice suggests that bacteria may play a role in the pathogenesis of obstruction-induced intestinal injury.

[406 cases of angina pectoris in coronary heart disease treated with saponin of Tribulus terrestris]

Coronary heart disease (CHD) was treated with saponin of Tribulus terrestris. According to 406 cases of clinical observation and a cross test (67 cases treated with Yufen Ningxin Pian as control), the results showed that the total efficacious rate of remission angina pectoris was 82.3%. It was higher than the control group with a total effective rate of 67.2% (P less than 0.05). The total effective rate of ECG improvement (52.7%) was even higher than that of the control group (35.8%). It is shown that saponin of Tribulus terrestris has the action of dilating coronary artery and improving coronary circulation, and thus has better effects on improving ECG of myocardial ischemia. If taken for a long time, it has no adverse reaction on blood system and hepatic and renal functions. Neither does it have side effects. It is one of the ideal medicines to treat angina pectoris.

Myelodysplastic syndrome presenting with generalized cutaneous granulocytic sarcomas

A patient with myelodysplastic syndrome (refractory anemia with excess of blasts in transformation, RAEB-T) presented with generalized granulocytic sarcomas involving the skin. The diagnosis was confirmed by skin and bone marrow biopsies. Partial myeloperoxidase deficiency was noted in the circulating polymorphonuclear leukocytes and the more differentiated tumor cells in the granulocytic sarcoma. This observation suggests that such leukocytes may be derived from the abnormal 'leukemic' clone.

Endotoxin induces bacterial translocation and increases xanthine oxidase activity

Previously, we documented that endotoxin induces bacterial translocation from the gut and that inhibition or inactivation of xanthine oxidase activity reduces endotoxin-induced bacterial translocation. Consequently, experiments were performed to correlate endotoxin-induced bacterial translocation with changes in intestinal mucosal structure and xanthine dehydrogenase and oxidase activity. Segments of the jejunum, ileum, cecum, proximal colon, distal colon, and liver were harvested from ICR mice 24 hr after IP administration of E. coli 0111:B4 endotoxin (0.1 mg). Xanthine dehydrogenase and oxidase activities were measured in these samples and correlated with intestinal morphology. Bacteria translocated from the intestines to extraintestinal organs in 70% of the mice receiving endotoxin, while the organs of control mice were sterile (p less than 0.01). Endotoxin injured primarily the ileal and cecal mucosa and increased ileal and hepatic xanthine dehydrogenase and cecal oxidase activities (p less than 0.05). These results suggest that xanthine oxidase-induced mucosal damage plays a role in endotoxin-induced bacterial translocation.

Lethal burn-induced bacterial translocation: role of genetic resistance

Since genetic factors may influence outcome after trauma or during infection, the current experiments were performed to examine the resistance of three genetically different mouse strains to burn-induced bacterial translocation. Outbred ICR, inbred Balb/c, and inbred C57/B1 mice, with a normal or disrupted (monoassociated with Escherichia coli C25) GI tract microflora, were subjected to sham or actual 25% body burns. In Balb/c, but not ICR mice, replacing the normal intestinal microflora with E. coli C25 converted the thermal injury from a nonlethal (0% mortality) to a lethal (68% mortality) injury. The increased mortality of the burned Balb/c mice monoassociated with E. coli C25 was associated with a higher incidence (p less than 0.05) and magnitude (p less than 0.05) of E. coli C25 translocation from the GI tract. The C57/B1 mice were intermediate between the Balb/c and ICR strains, in that C57/B1 mice monoassociated with E. coli C25 had a higher mortality and greater E. coli C25 translocation than mice with a normal microflora after thermal injury. Thus the composition of the intestinal microflora as well as the genetic background of the host influence the susceptibility of the host to burn-induced bacterial translocation and survival.

Ovarian mucinous tumor with mural nodules of anaplastic carcinoma

A case of mucinous cystic ovarian tumor with mural nodules of anaplastic carcinoma in a 30-year-old woman is described. The carcinomatous components within the nodules showed strong immunopositivity for cytokeratin and carcinoembryonic antigen, and ultrastructurally they displayed epithelial and glandular differentiation. Omental metastasis had already developed in the patient, and she received postoperative adjuvant chemotherapy consisting of cyclophosphamide and cis-platinum. No sign of recurrence was evident 4 months after the operation. The literature is reviewed and the importance of adjuvant chemotherapy in the postoperative management of such patients highlighted. The salient pathologic features differentiating mural nodules of anaplastic carcinoma and true sarcoma from prognostically favorable sarcoma-like nodules are presented.

Electrophysiological measures during acupuncture-induced surgical analgesia

Electrophysiological recordings (electroencephalograms, somatosensory-evoked potentials, cognitive-evoked potentials) were made in five patients during acupuncture-induced analgesia for removal of a thyroid tumor. The electrophysiological measures were unchanged during the operation. Acupuncture's modes of action in producing analgesia are not revealed in this study.

Genetic susceptibility to mucosal damage leads to bacterial translocation in a murine burn model

Since genetic factors may be important in host resistance to infections after thermal injury, we screened the susceptibility of three mouse strains (CD-1, Balb/c, and C57/bl) to thermally induced bacterial translocation from the GI tract. Bacteria translocated to the MLNs of Balb/c but not the CD-1 or C57/bl mice receiving 25% body burns. The increased incidence of bacterial translocation in the burned Balb/c mice appeared to be due to a burn-induced gut mucosal injury, since the intestinal mucosa of the Balb/c but not the CD-1 or C57/bl mice was damaged 24 hr after the thermal injury. The mucosal injury appears to be mediated, at least in part, by xanthine oxidase-generated oxygen-free radicals, since inhibition of xanthine oxidase activity with allopurinol, or inactivation of xanthine oxidase activity by a molybdenum-free tungsten diet, prevented the mucosal injury and reduced the extent of bacterial translocation.

Antihyperlipidemic capsules in the treatment of hyperlipidemia and its clinical effect on hemorheology and aggregation of thrombocytes

The authors treated 54 cases of hyperlipidemia with the antihyperlipidemic capsules and the total short-term effective rate was 77.8%. The capsules also showed obvious effects in improving hemorheology, reducing aggregation of thrombocytes, and lowering the blood pressure. The authors believe they would be useful in the prevention and treatment of ischemic apoplexy and coronary disease.

Endotoxin-induced bacterial translocation: a study of mechanisms

Previously, we documented that nonlethal doses of endotoxin cause the translocation (escape) of bacteria from the gut to systemic organs. The purpose of this study was to determine which portion(s) of the endotoxin molecule induces bacterial translocation and to examine the role of xanthine oxidase activity in the pathogenesis of endotoxin-induced bacterial translocation. Nonlethal doses of Salmonella endotoxin preparations (wild type, Ra, or Rb), containing the terminal portion of the core polysaccharide, induced bacterial translocation, whereas those preparations lacking the terminal-3 sugars (Rc, Rd, Re, or lipid A) did not induce bacterial translocation. Additionally, only those endotoxin preparations that induced bacterial translocation injured the gut mucosa, increased ileal xanthine dehydrogenase and oxidase activity, and disrupted the normal ecology of the gut flora, resulting in overgrowth with enteric bacilli. Inhibition of xanthine oxidase activity by allopurinol prevented endotoxin (Ra)-induced mucosal injury and reduced the incidence of bacterial translocation from 83% to 30% (p less than 0.01). These results suggest that endotoxin-induced bacterial translocation requires the presence of the terminal core lipopolysaccharide moiety and that xanthine oxidase-generated oxidants are important in the pathogenesis of endotoxin-induced mucosal injury and bacterial translocation.

Inhibition of endotoxin-induced bacterial translocation in mice

The primary functions of the gut are to absorb nutrients and exclude bacteria and their products. However, under certain circumstances the gut may lose its barrier function and serve as a reservoir for systemic microbial infections. These experiments were performed to determine the mechanisms whereby endotoxin causes bacteria to escape (translocate) from the gut. Bacteria translocated from the gut to the mesenteric lymph nodes of mice challenged with nonlethal doses of Escherichia coli 026:B6 or E. coli 0111:B4 endotoxin. Physical disruption of the gut mucosal barrier appears to be the primary mechanism whereby endotoxin promotes bacterial translocation. Mucosal injury and endotoxin-induced bacterial translocation were reduced by inhibition (allopurinol) or inactivation (tung-sten diet) of xanthine oxidase activity (P less than 0.01), but were not affected by the platelet-activation factor antagonists, SRI 63-441 or BN 52021. Because the inhibition or inactivation of xanthine oxidase activity reduced both the extent of mucosal injury and endotoxin-induced bacterial translocation, the effect of endotoxin on the gut appears to be mediated, at least to some degree, by xanthine oxidase-generated, oxygen-free radicals.

Clear cell chondrosarcoma: case report and ultrastructural study

A case of clear cell chondrosarcoma in a Chinese patient is described. The clear cells showed strongly positive S-100 protein immunoreactivity. Ultrastructurally 2 types of chondroid cells were demonstrated. One type appeared more primitive with abundant electron-lucent cytoplasm and sparse organelles. The other type of cell was more differentiated with presence of microvilli and numerous dilated cisternae of endoplasmic reticulum. Previous ultrastructural studies on these lesions were reviewed and compared with the present findings.

Hemorrhagic shock-induced bacterial translocation is reduced by xanthine oxidase inhibition or inactivation

Experiments were performed to determine whether bacterial translocation (BT) after hemorrhagic shock is due to a reperfusion injury mediated by xanthine oxidase-derived oxidants. Rats were subjected to 30 minutes of shock (30 mm Hg) followed by reinfusion of shed blood. Twenty-four hours after hemorrhage and reinfusion, the mesenteric lymph node, liver, and spleen were harvested from each animal for bacterial culture, and the ileum and cecum were examined histologically. Sham-shocked (control) rats were instrumented, but blood was not withdrawn. The incidence of BT was higher in the shocked rats (61%) than in the sham-shocked animals (7%) (p less than 0.01). Allopurinol (50 mg/kg, administered orally), a competitive inhibitor of xanthine oxidase, reduced the incidence of shock-induced BT to 14% (p = 0.02). Similarly, rats fed a tungsten-supplemented molybdenum-free diet, which inactivates xanthine oxidase, reduced shock-induced BT to 10% (p = 0.02). The histologic damage cause by hemorrhagic shock was prevented by blocking xanthine oxidase activity. Thus hemorrhagic shock-induced bacterial translocation from the gut appears to be mediated by oxidants generated by activation of the xanthine oxidase system.

[Route and preparation of 5-Fu administration as preoperative adjuvant chemotherapy in rectal cancer. II. Morphologic, ultrastructural and histochemical changes of the cancer cells after intrarectal and intravenous 5-Fu administration]

From March 1981 to October 1985, 5-Fu was preoperatively given to 65 Dukes B and C rectal cancer patients (intrarectal suppository 40 and emulsion 20, intravenous 5). The results indicated that after intrarectal administration, marked changes and destruction of the cancer cells in morphology were observed in 40% of the resected rectal specimens for suppository and in 45% for emulsion; marked retrograde degeneration in ultrastructure was found in 47.5% for suppository and in 50% for emulsion; DNA synthesis was obviously reduced in 63% for suppository and in 75% for emulsion. It is suggested that the emulsion be a better preparation. No obvious changes or destruction in morphology and ultrastructure were observed in cancer cells treated by intravenous drip of high dose 5-Fu though leukopenia below 4000 was found in 2/5. However, it was 0/60 by rectal administration. This implies that the intrarectal route is more rational than the conventional intravenous route. This study presents an alternate supplementary treatment in addition to radiotherapy for the reduction of postoperative local recurrence of Dukes B and C rectal cancers.

Selective immunosuppression with anti-interleukin 2 receptor-targeted therapy: helper and suppressor cell activity in rat recipients of cardiac allografts

(LEW X BN)F1 cardiac allografts are rejected within 8 days in unmodified LEW rats. ART18, a mouse anti-rat IgG1 monoclonal antibody which binds specifically in vitro to the interleukin 2 receptor (IL 2R) molecule expressed primarily on activated T cells, prolongs allograft survival in a dose-dependent fashion to ca. 3 weeks (p less than 0.001) after being administered for 10 days after transplantation. This effect was related to the specificity of the antibody for IL 2R, as therapy with ART62 (a monoclonal antibody recognizing MHC class I antigen but not binding the rat IL 2R) was ineffectual. Suppressor activity was detected in spleen cells of ART18-treated grafted hosts: in vivo, splenic T suppressor/cytotoxic fraction adoptively transferred into normal LEW improved donor-specific but not third-party test graft survival (17 days, vs. 8 days, respectively, p less than 0.001); in vitro, mixed lymphocyte reaction was profoundly but nonspecifically inhibited (less than 5% of test mixed lymphocyte reaction, p less than 0.001 as compared to acutely rejecting controls). In contrast, splenic T helper (Th) cells from ART18-treated hosts were functionally depressed, as noted by their passive transfer into immunologically anergic B recipients of cardiac allografts (rejection in ca. 40 days, vs. ca. 13 days after transfer of Th from specifically sensitized rats). ART18 treatment also resulted in diminished elaboration of IL 2 as compared to normal (p less than 0.005) or acutely rejecting hosts (p less than 0.001); however, a remarkable increase in the production of IL 3 occurred (p less than 0.001). These results demonstrate that IL 2R-targeted therapy of immunocompetent graft recipients produces a selective immune defect in which donor-specific T suppressor cells are spared, but Th cells attenuated or destroyed. Decreased elaboration of IL2 concomitantly augments the release of IL 3, a lymphokine which might play a role in suppressor effect in vivo. In addition, IL 2R-targeted therapy of the immunodeficient graft recipients abrogates the capacity of alloactivated T cells to re-establish acute immune responsiveness.

Local recurrences after subtotal esophagectomy for squamous cell carcinoma

From July 1982 to June 1985, 100 patients with squamous cell carcinoma of the thoracic esophagus had esophageal resection and reconstruction using an abdominal and right thoracotomy approach (Lewis-Tanner operation). Five patients died within 30 days. The remaining 95 patients were studied prospectively for evidence of local recurrences. It was found that anastomotic recurrences occurred in eight patients, and mediastinal recurrences involving the intrathoracic stomach occurred in seven patients over a mean follow-up period of 13 months. The total local recurrence rate was 16% (15 of 95 patients). The incidence of anastomotic recurrence was shown to be related only to the length of the proximal resection margin and not related to tumor differentiation or lymph node metastases. A proximal resection margin of less than 5 cm measured at operation had a 20% risk of developing an anastomotic recurrence, and a margin of between 5 to 10 cm had an 8% risk. Mediastinal recurrences that encroached on the intrathoracic stomach were found to be related more to the extent of lateral spread of the primary tumor in the mediastinum than to the length of the resection margins. Postoperative radiotherapy in patients with palliative resections decreased the incidence of local recurrences. To reduce the incidence and consequences of local recurrence after esophagectomy, it is suggested that in patients with tumors in the upper thorax, a more complete esophagectomy is warranted, postoperative radiotherapy should be given to patients with short resection margins, and in patients with extensive mediastinal spread, use of the retrosternal route for reconstruction is preferred.

Orbital reconstruction with proplast

Proplast was implanted in 15 cases of orbital reconstruction. Seven cases were orbital floor fractures, four cases were phthisical enophthalmos, and four cases were anophthalmic enophthalmos. In orbital floor fracture cases, thin (2-mm) Proplast was placed onto the fractured orbital floor after the incarcerated orbital tissue was released. To correct the enophthalmic socket, Proplast was shaped into small pieces (10 x 5 x 2 mm), then inserted into the subperiosteal space from all directions to fill up the orbital cavity. The results of these 15 cases were satisfactory. The average follow-up period is 13 months. The increased orbital volume seems less than the volume of the implanted Proplast; therefore, we suggest an 80-90% overcorrection rate in accordance with the computer measurements. In sum, Proplast serves as a very good material for orbital floor reconstruction and volume replacement.

Orbital angiosarcoma with subconjunctival presentation. Report of a case and literature review

An otherwise healthy 37-year-old woman had, over the course of 2 years, a recurring subconjunctival lesion associated with blepharoptosis. Computed tomography (CT) demonstrated a large anterior and superior orbital mass. A diagnosis of angiosarcoma (AS) was made from biopsy material. The patient is alive and well 18 months after exenteration and radiation therapy. The clinical and histopathologic features of this tumor are discussed with emphasis on the differential diagnosis of malignant vascular tumors of the orbit.

Localized amyloidosis of the ureter

An unusual case of localized amyloidosis of the ureter is described. Suspicion of the condition was first raised during operation when a frozen section was examined. An unnecessary nephrectomy was thus spared. It is a rare condition and awareness of the entity is required to recognise it clinically, radiologically or pathologically. The pathogenesis of localized amyloidosis is briefly discussed.

Telangiectatic osteosarcoma of the mandible

A telangiectatic variant of osteosarcoma of the mandible was seen in a 15-year-old Chinese girl. It was first diagnosed as an aneurysmal bone cyst both radiologically and pathologically. There were local recurrences despite repeated surgery, and subsequent response to chemotherapy and radiotherapy was poor. The patient died 16 months later with direct cerebral invasion, but no distant metastases. Diagnostic and clinicopathologic correlative aspects of this tumor variant are discussed, but more study of this tumor variant in the jaw is needed because this is probably the first case fully reported.

Propagation of hepatitis A virus in human diploid fibroblast cells

Human hepatitis A virus (HAV) was propagated in human diploid fibroblast cultures (2BS cells) in vitro. Replication of the virus was followed by immunofluorescent staining (IF), indirect ELISA, and by immune electron microscopy. When 2BS cells were inoculated with faecal extracts containing HAV, synthesis of hepatitis A antigen (HAAg) could be detected in the cytoplasm by IF. Its concentration reached a maximum at four weeks post-inoculation. Measured by solid-phase indirect ELISA, the positive/negative (P/N) ratio for HAAg reached values of up to 7.7. The identity of newly synthesized virus particles with HAV was established by immune electron microscopy, IF-blocking, and neutralization with human convalescent serum. Infected cells showed no signs of a specific cytopathic effect. Two of the virus strains propagated in 2BS cells may prove useful as a source of antigen for serologic tests; one of them might be a candidate strain for HAV vaccine.

Studies on the effect of vanadate on endocytosis and shape changes in human red blood cells and ghosts

When amphipathic cationic drugs are added to intact human RBCs, the RBCs first undergo a stomatocytic shape change and then, if relatively large amounts of drug are added and if the metabolic state of the RBC is appropriate, endocytic vacuoles form. Vanadate has a structural similarity to the transition state of phosphate, which presumably accounts for its ability to inhibit phosphohydrolases, although other actions of vanadate have been described. Vanadate inhibited three forms of drug-induced endocytosis in intact RBCs despite the fact that the three drugs chosen (primaquine, chlorpromazine, and vinblastine) are known to have differing requirements for RBC ATP. Vanadate also inhibited the stomatocytic shape change produced by primaquine, chlorpromazine, and vinblastine, but not the stomatocytosis produced by low pH. Vanadate had no effect on RBC echinocytosis produced by lysophosphatidylcholine. In studying endocytosis in hypotonic, leaky, "white" ghosts, we discovered that vanadate inhibited only the endocytosis produced by Mg-ATP and not the endocytosis produced by manipulations that directly attack the cytoskeletal proteins. These findings suggest that ATP hydrolysis has a role in some forms of amphipathic cation-induced stomatocytosis and endocytosis in intact RBCs. In addition, studies in ghosts support the idea that Mg-ATP does indeed produce "energized" endocytosis dependent on utilization or hydrolysis of ATP.

Anorexia nervosa in a woman totally blind since the age of two

A 28 year-old woman, blind since the age of two, had become anorexic at 21. She had eating problems as a child, and weight preoccupation from her teens onwards. Psychiatric admission with other anorexic patients preceded the illness. Inability to see oneself does not protect against anorexia nervosa.

Endo- and exovesiculation and the structure of the human red cell membrane

Experiments were designed to study functional associations of proteins in human red cell membranes as the membranes are induced to undergo the critical membrane events of invagination or evagination followed by constriction and fusion. Three examples were chosen for study: the inside-out vesicle (IOV) produced in white ghosts by hypotonic removal of cytoskeletal proteins; the endocytic vacuole produced in white ghosts by incubation with Mg-adenosine triphosphate; and the exocytic vesicle produced by metabolic depletion of intact red blood cells. The resulting particles were harvested, and analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis for membrane protein content and by enzymic analysis to detect the presence or absence of the exofacial enzyme acetylcholinesterase (ACE), the cytosol facing enzyme glyceraldehyde phosphate dehydrogenase (GAPD), and the integral protein adenosine triphosphatases (ATPases). Each of the vesicles is variably depleted of spectrin and actin, and each retains the exofacial enzyme ACE as well as Mg-ATPase. These findings suggest that there must be local partial depletion of cytoskeletal proteins before invagination or evagination occurs and that in each case part of the exoface of the membrane containing ACE is carried along into the resulting vesicle. The two forms of endocytosis differ with regard to their ATPase content with the energized endocytic vacuole retaining Ca-Mg-ATPase and actin-activated ATPase. The large amount of hemoglobin present in the exocytic vesicle is best explained by trapping of free cytosol and probably reflects a direct interaction of cytosolic components containing hemoglobin with the phospholipid bilayer.

Infantile hemangioendothelioma of the liver: ultrastructural study of a type II case

A case of infantile hemangioendothelioma of the liver presenting with congestive heart failure and massive hepatomegaly in a two-mth old baby is described. Serum alpha-fetoprotein was elevated in this patient and clinically the lesion might not be distinguishable from other, commoner hepatic tumours in children. Histologically the tumour showed a type II pattern as defined by Dehner. The significance of classifying this tumour into two histologic types is discussed. Only 3 cases reported in the English literature were studied by electron microscopy; two of them were type I while the other was a type II lesion. In our case the endothelial cells appeared ultrastructurally less differentiated and architecturally more disorganized than in type I lesions. Like the previous case, the basal lamina showed marked thickening and reduplication. The significance of these findings is discussed.

Angiosarcoma of the thyroid. An immunohistochemical and ultrastructural study of a case in a Chinese patient

A case of angiosarcoma (malignant hemangioendothelioma) developing in a chronic goitrous thyroid gland of an elderly Chinese woman is described. Histologically it showed the same classical appearance of angiosarcoma occurring in the skin and soft tissue. The endothelial origin of this tumor was confirmed by demonstrating Factor VIII-related antigen in the neoplastic cells with the immunoperoxidase technique and Weibel-Palade bodies by electron microscopic study. Because of its extreme rarity outside the European Alpine regions, many authorities are reluctant to accept it as a distinct entity and merely consider it as a variant of an undifferentiated carcinoma. Our report not only provides additional evidence that angiosarcoma of the thyroid gland is a specific condition of endothelial origin but also documents the first case among Chinese.

Endogenous microbial dissemination following severe burns in rats

This study suggests that damage to the intestinal lining, an important mechanical barrier against bacterial invasion, is the main factor leading to the dissemination of endogenous microbes. Reduced phagocytic activity of Kupffer cells and compromised opsonic function also appear to contribute to the process.

Myxoma of the breast: report of a case and ultrastructural study

A case of myxoma of the breast is presented. The differential diagnosis with respect to other myxoid tumours of the breast is discussed. Ultrastructurally the tumour cells show features of a primitive mesenchymal cell with possible pericytic or modified myoepithelial cell differentiation. The histogenesis is discussed.

T suppressor lymphocytes reverse ongoing acute allograft rejection

(LEW X BN)F1 cardiac allografts are rejected within 8 days in untreated LEW recipients. At the critical time point of 5 days after transplantation, the obviously rejecting grafts are enlarged and maximally infiltrated by host cells as shown by 111In-labeled lymphocyte tracer studies. However, when such hearts were retransplanted back to naive (LEW X BN)F1 secondary hosts, they survive indefinitely, showing that even late rejection is reversible in the absence of sustained host immunological drive. Attempts were then made to abrogate this advanced immune responsiveness using Cyclosporine (CsA). CsA therapy (15 mg/kg/day for 7 days) starting from day 5 produced indefinite graft survival, similar as if initiated at the time of operation. Addition of exogenous IL-2, which drives the proliferation of Tc, could not reverse this effect. Serial changes in phenotype of lymphocyte subpopulations infiltrating both acutely rejecting and indefinitely functioning cardiac allografts in unmodified and CsA treated hosts, respectively, were then studied. Ratio of Th:Tc/s cells in acutely rejecting grafts was 1.6 by day 3; it inverted abruptly to 0.7 by day 5-6, suggesting predominance of Tc/s during the later stages of allograft rejection. Similarly, treatment with CsA produced a transient depression of Th, with recovery of original Th:Tc/s ratio during the next 2-3 weeks. Adoptive transfer experiments were then performed to investigate the functional significance of these findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Sclerosing stromal tumor of the ovary: case report and review of the literature

A case of sclerosing stromal tumor of the ovary in a Chinese girl of 17 years is reported. She presented with metrorrhagia and an abdominal mass in the right lower quadrant. At operation, a large unilocular cyst was found in the right ovary. Light microscopic and ultrastructural study established the diagnosis of sclerosing stromal tumor of the ovary. To date, 63 cases have been recorded in the literature, 33 of which have been described in detail.

A scanning electron microscope study of isolated glomeruli in glomerulonephritis

Glomeruli from 48 cases of glomerulonephritis (Gn) were isolated and studied by means of the scanning electron microscope (SEM). Overall glomerular loss due to processing was 2.4%. SEM of these isolated glomeruli showed good preservation of glomerular structure. Changes of the podocyte cell body and its foot processes were noted and correlated with light microscopic morphology. Individual podocyte necrosis, variable foot process fusion and cell body swelling were seen in IgA nephropathy. Podocyte degeneration with separation from the glomerular basement membrane was evident in idiopathic minimal change Gn while idiopathic membranous Gn was characterized by globular swelling of the podocyte cell bodies. In focal sclerosing Gn, large spherical bodies arising from swollen podocyte cell bodies were frequently encountered. Innumerable microvilli and small spherical bodies characterized membranoproliferative Gn. Variable podocyte cell body swelling, microvilli and small spherical bodies were seen in cases of lupus nephritis. Taken alone, none of the SEM changes were diagnostic. However, when the type of the change, the severity and the combination of the changes were considered as a whole, they were indicative of what light microscopy might reveal and helpful in differentiating between idiopathic minimal change Gn and focal sclerosing Gn.

Is sclerosing hemangioma of lung an alveolar mixed tumour?

A case of a peripheral lung tumour histologically categorized as a sclerosing hemangioma of the lung is presented. Ultrastructurally, the tumour is composed of a mixture of epithelial and mesenchymal elements in varying stages of differentiation. Type II pneumocytes are identified as one epithelial component, while primitive mesenchymal cells with a tendency to develop into pericytes are the predominant mesenchymal component. The tumour appears to differentiate along the line of the pulmonary alveolar septa, and should be designated as a 'pulmonary alveolar mixed tumour'.

Preparation of Epon-embedded renal tissue for scanning electron microscopy

A method for the preparation of Epon-embedded renal tissue for scanning electron microscopy (SEM) is described. This involves careful removal of Epon by potassium hydroxide in absolute methanol to expose the embedded kidney tissue. The method is simple and gives good surface morphology of the sectioned and trimmed surfaces of the tissue block. Both sectioned and intact glomeruli are well shown. The method also allows SEM observation of tubules and blood vessels.

Red blood cell membrane abnormalities during storage: correlation with in vivo survival

Experiments with citrate-phosphate-dextrose supplemented with adenine, 0.5 mM final concentration (CPD-A2), provided an opportunity for study of red blood cells (RBC) membrane storage lesions which could limit extension of storage. Impairment in drug-induced endocytosis in intact RBC occurred with storage, but the changes produced did not quantitatively predict or reflect the 24-hour in vivo 51Cr-labelled RBC survival. Abnormalities in RBC membrane protein did appear after storage, but these alterations neither paralleled nor predicted the in vivo 24-hour 51Cr-labelled RBC survival. The RBC membrance protein changes were not reminiscent of those produced by either acute adenosine triphosphate depletion, oxidative attack, or calcium accumulation. Therefore, while storage produces significant alterations in RBC membrane protein and function, the changes detected were not those that determined in vivo RBC survival.