[Evaluation of non-surgical therapy for the malignant lymphomas located mainly in the stomach and duodenum]

We evaluated the effects of the conservative treatment to 29 patients with non-Hodgkin lymphomas located mainly in stomach and duodenum. We could induce complete remission in all the cases of stage I, II, and III including MALT lymphomas by the combination therapy of Helicobacter pylori (H. pylori) eradication, chemotherapy, and radiation, and the complete remission persisted in all except for the three cases who died of other causes. Even in stage IV lymphomas mainly located in stomach and duodenum, we could induce complete remission in 50% of them. Considering the quality of life of patients with lymphomas located mainly in stomach and duodenum, the conservative treatment may be of benefit more than the surgical approach.

Dissolution rate of hen egg-white lysozyme crystal under microgravity

Protein crystallization under micro gravity has been already tried many times in the United States and other countries, and it is reported that about 20% of proteins were better crystallized under microgravity than on earth. This verified that microgravity is sometimes effective in protein crystallization. However, if these procedures continued to be carried out without clarifying which processes are effective, improved development of protein crystallization cannot be expected. The most effective way to study the process is to carry out protein crystallization experiments, each elementary stage of which is clearly observed. To this end, the dissolution rate of a single crystal of hen egg-white lysozyme has been measured both under microgravity and on earth in order to study the mechanism of protein crystallization. In May 1997, we had an opportunity to have an experiment on protein crystallization with use of STS-84 space shuttle missions (the time duration of which was 210 hours). The apparatus for protein crystallization by vapor diffusion techniques was available and we have tried to use it for measurement of crystal dissolution rate under microgravity. The barrels of two syringes (20 ml x 2) were filled with unsaturated protein solutions (hen egg-white lysozyme (HEWL): 0.0wt%, 0.1wt%, 0.2wt%, 0.3wt%; NaCl 3wt% aqueous solution) and a crystal (HEWL: tetragonal form; 1 mm +/- 0.2 mm in diameter) was put on the bottom of the one syringe. Dissolution of the crystal was started by extruding the unsaturated solutions onto the syringe tip with the crystal. The crystal dissoluted in 40 ml droplets that are extruded from syringes. The temperature was kept at 20 degrees C. Just before the Space Shuttle begins returning to the earth, the protein solution was withdrawn back into the syringes by the astronaut, and the melting experiment was finished. In the one syringe the incompletely melted crystal was withdrawn as well. The solution concentration in the other syringe was measured. In the flight experiment, only the initial and final solution concentrations can be measured. In the control experiment on earth the solution concentrations in the course of dissolution were also measured. 20 undersaturated solutions (40 ml in volume) were prepared and a crystal (1 mm +/- 0.2 mm in diameter) was put in each solution. The solution concentration was measured at constant time intervals. When the crystal starts to dissolute [correction of dissolue], molecules in the crystal surface leave the crystal, the concentration around the crystal becomes high and there occurs a radial concentration gradient centered on the nucleus. Molecules diffuse along the gradient and go farther from the crystal. On earth, the concentration gradient might be disturbed by convection and the high concentration around the crystal might be disturbed more quickly than under microgravity. We might therefore expect that dissolution rate on the ground should be larger than under micro-gravity. However, our experimental results show that the expectation was not correct. What might the reason be? One possible reason is that there might be Marangoni convection effects in the apparatus for protein crystallization by vapor diffusion techniques used for the melting experiment. This effect has also been observed by Chayen et al.

Long-term survival after surgical resection for pancreatic cancer

BACKGROUND/AIMS

Pancreatic cancer remains one of the most formidable tumors defying early detection and effective treatment. Long-term survivors, however, do exist after resection. We investigated the clinicopathologic features of patients with pancreatic cancer who survived more than 5 years to draw out some suggestions concerning the indication of surgical treatment.

METHODOLOGY

We studied the clinicopathologic features of 13 patients with pancreatic cancer who survived more than 5 years after resection. We reviewed their clinical records to investigate preoperative symptoms, serum tumor markers, operative findings, postoperative adjuvant therapy, and modes of recurrence and survival periods. Information on the location, size, histology and spread of the primary tumors were mainly obtained from pathology reports.

RESULTS

Histologic types of the long survivors included ductal adenocarcinoma of common type in 4 patients, mucinous noncystic adenocarcinoma in 2, intraductal papillary-mucinous carcinoma (invasive) in 4, undifferentiated carcinoma in 1, endocrine tumor (islet cell carcinoma) in 1 and acinar cell carcinoma in 1. All 4 cases of ductal adenocarcinoma of the common type showed a moderate invasion either to the retroperitoneum, the portal vein or the duodenum. Two patients with mucinous noncystic carcinoma attained a long survival despite extensive invasion of the pancreatic stroma, although one died of peritoneal carcinomatosis. Two of 4 patients with intraductal papillary-mucinous cancer (invasive) died of peritoneal dissemination 6 and 11 years after resection, respectively. Three patients with cancer of other special histologic types, i.e., undifferentiated, well-differentiated endocrine carcinoma and acinar cell carcinoma, showed invasion of the portal vein and splenic artery, involvement of the retroperitoneum and a metastatic tumor in the liver, respectively.

CONCLUSIONS

Whereas special histologic types including ductal variants tended to predispose to long-term survival, ductal adenocarcinoma of the common type had some chance of long survival even with invasion of the surrounding tissues.

[Latex allergy in patients with severe motor and intellectual disabilities syndrome]

Our experience of an anaphylactic reaction to latex in a severely disabled patient led us to investigate latex allergy in 58 cases with severe motor and intellectual disabilities syndrome. Latex specific IgE, total serum IgE, and eosinophil counts in peripheral blood were evaluated, as well as past history of treatment with medical latex materials, operation and allergic disorders. Only one case who had been operated three times, had anaphylactic reaction and mild atopic dermatitis. Fifteen cases (25.9%) had latex specific IgE of class 2 or more. In this latex positive group, past history of allergic disorders, such as bronchilal asthma, atopic dermatitis and drug eruptions, were the most prominent factor. Those without such a history were characterized by frequent use of medical latex materials and multiple operations. In conclusion, the danger of an anaphylactic reaction to latex should be recognized, particularly in the medical care for disabled patients.

[Evaluation of absorbed dose-distribution in the X-ray or gamma-irradiator for blood products]

Irradiation of blood products abrogates the proliferation of lymphocytes present in cellular component, which is currently the only accepted methodology to prevent transfusion-associated graft versus host disease (TA-GVHD). A range of irradiation dose levels between 15 Gy and 50 Gy is being used, but the majority of facilities are employing 15 Gy. It should, however, be recognized that the delivered dose in the instrument canister might differ from the actual dose absorbed by the blood bag. This study have evaluated the actual dose distribution under practical conditions where a container was loaded with blood products or water bags, or filled with distilled water. This approach provides data that the maximum attenuation occurred when the container was completely filled with a blood-compatible material. Thus, an error of approximately 20 percent should be considered in the dose measured in the in-air condition. A dose calibration in an in-air condition may lead to substantial underexposure of the blood products. A dose distribution study using adequately prearranged exposure period verified that the absorbed dose of 15 Gy was attained at any point in the container for both linear accelerator and gamma-irradiator. The maximal difference in the absorbed dose between measured points was 1.5- and 1.6-fold for linear accelerator and gamma-irradiator, respectively. In conclusion, using blood-compatible materials, a careful dose calibration study should be employed in which the absorbed dose of 15 Gy is obtained at the point where the lowest dose could be expected.

Esophageal inflammatory pseudotumor mimicking malignancy

A 54-year-old man with a complaint of dysphagia was found to have a prominent stricture in the proximal esophagus. A biopsy of the stenotic area indicated sarcoma, leading to subtotal esophagectomy. The surgically removed esophagus demonstrated a well-defined intramural mass, consisting of a mixture of fibroblastic cells with bland cytological appearances and inflammatory cells. Reflux esophagitis which was present distal to the stricture seemed to play a role in the development of this inflammatory pseudotumor.

Histologic and immunohistologic findings and prognosis of 40 cases of gastric large B-cell lymphoma

It has been considered that gastric large B cell lymphoma mainly consists of mucosa-associated lymphoid tissue lymphoma (MALToma) with large cell transformation. However, debate continues about the cell lineage. We analyzed 61 operated cases of gastric B cell lymphoma, mainly focusing on 40 cases of diffuse large cell lymphoma (DLCL). Immunohistologically, two cases were classified as CD10-positive follicular lymphoma, 19 cases were low-grade MALToma, 11 CD10-negative DLCL with a component of low-grade MALToma (high-grade MALToma), 12 CD10-positive DLCL, and 17 CD10-negative DLCL without MALToma (pure DLCL). Lymphoepithelial lesion (LEL) was found in all -cases of high-grade MALToma, and in eight of these its invasion was confined to the mucosa and submucosa. Expression of Bcl-6 was detected in two cases of high-grade MALToma. Only two cases of CD10-positive DLCL had large cell LEL, and seven cases showed tumor invasion beyond the submucosa. All 12 cases were positive for Bcl-6, and a delicate meshwork of CD35 (Ber-MAC-DRC)-positive follicular dendritic cells was detected in eight cases. Pure DLCL of all 17 cases reached the proper muscle layer or more, and expression of Bcl-6 was detected in 10 cases. For patients with pure DLCL, overall survival was significantly (p <0.05) worse than those of high-grade MALToma and CD10-positive DLCL by Kaplan-Meier and log-rank methods. Clinical staging and Bcl-6 expression were also good prognostic factors in patients with DLCL. Three groups of gastric DLCL each had unique histologic findings, immunohistologic characteristics, and prognosis.

Determination of (+)- and (-)-bromoisovalerylurea in sera of overdosed subjects

Bromoisovalerylurea (bromisovalum) is a sedative-hypnotic given orally as a racemic mixture of optical isomers (i.e., (+)- and (-)-enantiomer) and frequently taken in overdose in order to commit suicide. Sera from 16 overdosed subjects were analyzed for each enantiomer by high-performance liquid chromatography on chiral stationary phases. The (+)-enantiomer concentration was lower than the (-)-enantiomer concentration in all specimens, that is, the ratio of the (+)-enantiomer to the total concentration ranged from about 50% to 0%. The ratio of the (+)-enantiomer was continuously decreasing in each subject. The data indicate that the drug in gastrointestinal tract was absorbed into blood nonstereoselectively and that the drug in blood was eliminated stereoselectively. The enantioselective determination of this drug will give useful information on absorption and elimination.

Regulation of Na(+)-K(+)-ATPase by cAMP-dependent protein kinase anchored on membrane via its anchoring protein

Na(+)-K(+)- ATPase alpha-subunits in basolateral membrane vesicles (BLMVs) purified from rat parotid glands were (32)P-labeled within 5 s by incubation with [gamma-(32)P]ATP at 37 degrees C in the presence of cAMP, but no labeling occurred without cAMP. Phosphorylation of Na(+)-K(+)-ATPase was associated with a decrease in its activity. This alpha-subunit phosphorylation disappeared when BLMVs were briefly incubated with cAMP and subsequent washing before the incubation with [gamma-(32)P]ATP, indicating that catalytic subunit of protein kinase A (PKA) associated to BLMVs via binding with its RII regulatory subunit anchored on the membrane. In the absence of cAMP, a PKA catalytic subunit readily reassociated with the membrane-bound RII subunit. HT-31 peptide inhibited the Na(+)-K(+)-ATPase phosphorylation by membrane-bound endogenous PKA, indicating an involvement of A-kinase anchoring protein (AKAP). AKAP-150 protein in BLMVs was shown by immunoblotting and an RII overlay assay and was coimmunoprecipitated by anti-RII antibody. These results show that Na(+)-K(+)-ATPase of rat parotid gland acinar cells is regulated in vivo by membrane-anchored PKA via AKAP rather than by free cytosolic PKA.

Nuclear localization of immunoreactive beta-catenin is specific to familial adenomatous polyposis in papillary thyroid carcinoma

Thyroid carcinoma is the first symptom in some patients with familial adenomatous polyposis (FAP). We evaluated the cellular localization of beta-catenin in thyroid carcinomas associated (n = 4) or not associated (n = 173) with FAP, since loss of functional protein of the adenomatous polyposis coli (APC) gene leads to nuclear accumulation of beta-catenin in adenomas and carcinomas of the FAP colon. Immunoreactive beta-catenin was demonstrated at the cell membrane of glandular cells of the non-neoplastic thyroid and non-FAP carcinomas. On the other hand, cytoplasmic and nuclear accumulation of beta-catenin is specific to FAP-associated papillary carcinomas. The abnormality in the APC / beta-catenin pathway is thus also important in FAP-associated thyroid carcinoma, and beta-catenin immunohistochemistry is a feasible screening method to identify occult FAP in young patients with thyroid tumors.

Amino acids dissolved in stream water as possible home stream odorants for masu salmon

It is well established that salmon return to their home stream by sensing the odors of the stream water. In this study we have attempted to identify the home stream odorants used by masu salmon in Lake Toya. The salmon in Lake Toya return to the home stream which flows into the lake after lake life for 2-3 years. Besides water from the home stream, waters from two other streams which flow into Lake Toya were also used in the experiments. We analyzed the compositions of amino acids, inorganic cations and bile acids in waters from the three streams. Application of mixtures of inorganic cations or bile acids, reconstituted based on the compositions of the stream waters, to the olfactory epithelium induced only very small responses. On the other hand, application of mixtures of amino acids induced large responses. The response to artificial stream water reconstituted based on the compositions of amino acids and salts closely resembles that to the corresponding stream water. Cross-adaptation experiments with three combinations of the mixtures were carried out. The response pattern for each combination closely resembled that to the corresponding combination of stream waters. Based on the results obtained, we concluded that amino acids dissolved in the home stream water are possible home stream odorants.

Measurement of blood clearance time by Limulus G test of Candida-water soluble polysaccharide fraction, CAWS, in mice

The Limulus G test, responsive to beta-1,3-D-glucan, is a well-established method for the detection of invasive fungal infection. We have recently found that Candida albicans released a water-soluble polysaccharide fraction (CAWS) into synthetic medium (Uchiyama et al., FEMS Immunol. Med. Microbiol. 24 (1999) 411-420). CAWS was composed of a mannoprotein-beta-glucan complex and activated Limulus factor G, and thus would be similar to the Limulus active substance in patient's blood. In a preliminary investigation, we have found that CAWS is lethal when administered intravenously in a murine system. In this study, we examined the toxicity and then the fate of CAWS in mice. The lethal toxicity was strain-dependent and strain DBA/2 was the most resistant. The toxicity was, at least in part, reduced by salbutamol sulfate and prednisolone treatment in the sensitive strains. On intravenous administration, the half clearance time (t1/2) was approximately 40 min in mice (DBA/2). On intraperitoneal administration, CAWS appeared in the blood with a peak concentration at 1 h. In order to establish a treatment plan, it is important to demonstrate the onset and the termination of deep-seated mycosis. The Limulus G test is suitable for the above purpose; however, it is necessary to fully understand the fate of beta-1,3-D-glucan in patients' blood.

[A proposal of essentials for forensic pathological diagnosis of sudden infant death syndrome (SIDS)]

There are many sudden unexpected infant death cases which are easily diagnosed as sudden infant death syndrome (SIDS) both with or without autopsy in Japan. A SIDS diagnosis may provide a cover for accidental or criminal death. SIDS should not be a convenient diagnostic box that shelters the cases of unexpected infant death which lack the necessary antemortem information to make the correct diagnosis. The authors consider that SIDS should be diagnosed according to the direction of the international definition of SIDS, and propose the following essentials for a forensic pathological diagnosis. 1) A thorough autopsy should be performed based on precise autopsy protocol, including not only histological observation, but also, if necessary, toxicological, bacteriological, viral and/or biochemical examinations. 2) The forensic pathologist should be provided with pertinent information regarding antemortem health status, past clinical history, social circumstances, death scene investigation, etc. In order to collect more precise information, the authors recommend using a questionnaire such as the example in this report to record information from the deceased's guardians. 3) Suspicion of accidental death or infanticide should be completely ruled out. SIDS should be diagnosed only after these three essentials have been satisfied. When there is even a slight suspicion of accidental death or infanticide, or when the forensic pathologist can not obtain pertinent information about the deceased, the causes and classification of the death should be diagnosed as unspecified or undetermined. That is, the causes and classification of the death are undetermined as to whether it is a natural or unnatural death. Furthermore, several warning flags indicating a possible SIDS diagnosis were proposed: a case found dead in a supine position, the existence of a foreign body in the respiratory tract or mild infectious findings. The authors also emphasize the physician's responsibility to report a case found dead or dying of unnatural or clinically unexplained causes to the police. This is the crucial first step in getting an accurate diagnosis of SIDS.

[A case of Lemmel's syndrome with serious jaundice exacerbated by eating]

An 86-year old woman rapidly developed serious jaundice (T-Bil 18.3 mg/dl 12.3 mg/dl). Her jaundice was exacerbated by eating, and improved by fasting. Abdominal CT showed a giant diverticulum in the second part of the duodenum and dilation of the proximal common bile duct. Endoscopic findings confirmed juxtapapillary duodenal diverticulum in contact with the distal common bile duct. MRCP revealed extrinsic compression of the distal common bile duct by the diverticulum. Lemmel's syndrome was diagnosed. Jaundice did not recur after surgery. We speculated that in this case the diverticulum filled by duodenal contents easily compressed the distal common bile duct after eating.

Aspiration and imprint cytopathology of thyroid carcinoma associated with familial adenomatous polyposis

Thyroid carcinomas occur in association with familial adenomatous polyposis (FAP), and some are the first symptom of FAP. Although several histological features have been reported, the cytopathology of FAP-associated thyroid carcinoma has not yet been described. We report on two cases of FAP-associated thyroid carcinomas diagnosed by fine-needle aspiration biopsy and one case imprinted after resection. All 3 patients belonged to the same family, and thyroid carcinoma was the first symptom of the proband. Cytological features include fascicular or whorl formation of spindle cells with papillary, follicular, and/or solid architectures, in addition to the typical features of papillary carcinoma. The cytological features of FAP-associated thyroid carcinomas are characteristic and may suggest FAP.

Biliopancreatic fistula associated with intraductal papillary-mucinous pancreatic cancer: institutional experience and review of the literature

Intraductal papillary-mucinous tumour is clinicopathologically characterized by papillary growth and mucin production within the pancreatic duct system. The category includes a wide range of dysplasia, ranging from adenoma to carcinoma, the latter designated as intraductal papillary-mucinous cancer. In general, the tumor renders a favorable prognosis after complete resection. However, intraductal papillary-mucinous tumor with overt invasion outside the gland has been reported to have a poor prognosis, as is the case with the usual type of duct cell cancer of the pancreas. We experienced two cases of intraductal papillary-mucinous cancer with obstructive jaundice due to impaction of thick mucus protruding from the pancreas via a "spontaneous" biliopancreatic fistula. Preoperative examinations of both patients showed a large intraductal papillary-mucinous tumor in the head of the pancreas with fistula formation between the intrapancreatic portion of the common bile duct and the main pancreatic duct. Histopathological investigation of the two resected specimens suggested that the fistula may not have developed from invasion by papillary or tubular adenocarcinoma, but from compression and destruction of the intercalating tissues by abundant mucinous secretion. The first patient died of peritoneal carcinomatosis with clinicopathologic features of pseudomyxoma peritonei 6 years after surgery. The second patient is alive and has been well for 2 years postoperatively. Review of the world literature showed that half of the patients with intraductal papillary-mucinous cancer plus biliopancreatic fistula had no stromal invasion around the fistula, indicating that the fistula might have been caused by mechanical pressure. However, the other half of the cases did have stromal invasion around the fistula. Two-thirds of these cases, including our own patients, had foci of mucinous carcinoma in the stroma around the fistulization, implying that mucinous lakes in the stroma may have served as part of the "waterway" from the pancreatic duct to the bile duct, assisted by increased pressure by mucus production. Since intraductal papillary-mucinous cancer with biliopancreatic fistula has a comparatively favorable prognosis, surgical resection should be considered.

Pleomorphic carcinoma of the pancreas with massive lymphocytic stromal infiltration and long-term survival after resection

BACKGROUND

Pleomorphic carcinoma of the pancreas is a rare tumor with an extremely poor prognosis. The mean survival time is reported to be approx 3 mo.

CLINICAL AND HISTOLOGICAL FINDINGS

A 56-yr-old Japanese man presenting with general fatigue, loss of weight, and high fever was found to have a large hypervascular mass in the body of the pancreas with regional lymph node metastases. Laboratory investigation revealed leukocytosis, elevated erythrocyte sedimentation rate (ESR), and high serum C-reactive protein (CRP). In addition to distal pancreatectomy, splenectomy and lymph node dissection were performed. Histology showed the presence of pleomorphic large cells with bizarre mono- or multinuclei, growing in sarcomatoid pattern without mutual cohesiveness. Another noticeable finding was massive lymphocytic infiltration of the stroma of the neoplasm. Immunohistochemically, the infiltrating lymphocytes consisted of cytotoxic type of T cells. In addition, in situ hybridization for Epstein-Barr virus-encoded RNA (EBAR-1) was not seen in the tumor cells or in lymphocytes. After surgery the patient did not undergo chemotherapy or radiotherapy. He has been well without recurrence for 8 yr.

CONCLUSION

We report a case of pleomorphic carcinoma, possibly lymphoepithelioma-like carcinoma, of the pancreas with massive lymphocytic stromal infiltration and long-term survival after resection. Cytokine responses and cellular immunoreactivity may have contributed to a long-term survival, which is unusual in the common type of pleomorphic carcinoma of the pancreas.

Intraspecific variation in Cannabis sativa L. based on intergenic spacer region of chloroplast DNA

We analyzed the nucleotide sequences of the non-coding region of chloroplast DNA: the intergenic spacer between trnL (UAA) 3'exon and trnF (GAA). Two kinds of sequence, "type-1" and "type-2," were detected in 33 populations of Cannabis sativa. The length of the "type-1" fragment was 354 bp. In contrast, the "type-2" fragment from 3 populations was 353 bp long, with only one base deletion compared to "type-1." The fragment length from Humulus lupulus was 353 bp with a 1-bp deletion, and ten 1-bp substitutions compared to the sequences from C. sativa "type-1." Furthermore, we could clearly identify differences between C. sativa and H. lupulus using single-strand conformation polymorphism of PCR products (PCR-SSCP) analysis.