Rheumatoid arthritis and B cell lymphoma with pathological changes of reactive histiocytosis

A 67 year old woman with rheumatoid arthritis was admitted to hospital in acute renal failure. Her clinical features included increasing dyspnoea and oedema, and a computed tomogram of the abdomen showed a large mass in the retroperitoneum. Twenty six days later, she died, and a post mortem examination was carried out. The histological changes of the mass indicated B cell lymphoma of diffuse large cell type, with a reactive proliferation of erythrophagocytosing histiocytes. Immunocytochemical studies showed that the histiocytes were positive for CD-68 and lysozyme, but negative for S-100 protein. Such neoplastic B cell proliferation accompanied by activation of benign looking histiocytes with erythrophagocytosis is very rare.

Measurement of nonrandom event-by-event fluctuations of average transverse momentum in square root of (sNN)=200 GeV Au+Au and p+p collisions

Event-by-event fluctuations of the average transverse momentum of produced particles near midrapidity have been measured by the PHENIX Collaboration in square root of (sNN)=200 GeV Au+Au, and p+p collisions at the Relativistic Heavy Ion Collider. The fluctuations are observed to be in excess of the expectation for statistically independent particle emission for all centralities. The excess fluctuations exhibit a dependence on both the centrality of the collision and on the pT range over which the average is calculated. Both the centrality and pT dependence can be well reproduced by a simulation of random particle production with the addition of contributions from hard-scattering processes.

Eosinophil adhesion to cultured airway epithelial cells from guinea pig lungs

We examined the effects of histamine, tumor necrosis factor-alpha (TNF alpha), interferon-gamma (IFN gamma), indomethacin and dexamethasone on the adherence of eosinophils to airway epithelial cells. Epithelial cells were isolated from guinea pig trachea through enzymatic digestion, and cultured until they showed confluence. Eosinophils were taken by peritoneal lavage from guinea pigs sensitized with horse serum and purified. The adhesion of eosinophils to cultured epithelial cells was examined using 51Cr. The percentage adhesion was obtained by dividing counts per minute of lysed eosinophils adhered to epithelial cells by suspended eosinophils. Histamine significantly increased the adhesion of eosinophils to epithelial cells, while TNF alpha or IFN gamma did not significantly alter the adhesion. Indomethacin significantly inhibited the adhesion of eosinophils to epithelial cells in both nontreated and histamine-induced conditions. Dexamethasone also reduced adhesion, although it did not reach statistical significance. These findings indicate that histamine induced eosinophil adherence to airway epithelial cells, suggesting a role of endogenous prostaglandins in adherence.

A hexapeptide angiotensin antagonist, Des-(Asp1, Arg2), Ile8)-angiotensin II

In the smallest biologically active fragment of angiotensin or a 3-8 hexapeptide the C-terminal was substituted by isoleucine residue. It proved to be the smallest potent antagonist of angiotensin II so far reported.

In vitro evaluation of cross-circulation system using semipermeable membrane combined with whole liver perfusion

INTRODUCTION

Many types of isolated hepatocytes-based bioartificial liver have been developed. However, to maintain hepatocyte-specific functions for a long period is still a significant challenge. The possibilities of rejection or viral transmission still remain as untackled obstacles. We developed a cross-circulation system, using a semipermeable membrane combined with whole liver perfusion. Detoxifying functions of the extracorporeal porcine liver and molecular movements across the membrane were evaluated in vitro.

METHODS

The hollow-fiber module has a molecular cutoff of 100 kD. A spiked solution containing 500 mL low molecular dextran solution spiked with 12 mg ammonium chloride, 500 mg D-galactose, and 300 mg lidocaine, which mimicked a patient, was recirculated through the inner fiber space. The extracorporeal liver perfusion circuit consisted of an extra-fiber spaces. A reservoir containing 1000 mL healthy pig plasma, a membrane oxygenator, and a porcine whole liver. Both circuits circulated in the opposite direction for 6 hours.

RESULT

In 6 hours, 47.3% +/- 10.2% of ammonia, 89.5% +/- 1.7% of D-galactose, and 95.5% +/- 1.0% of lidocaine were eliminated from the circuits; 66.5 +/- 11.1 mg of urea were produced at the same time. Oxygen consumption was maintained between 0.248 and 0.259 mL/100 g liver/min for 6 hours. Movement of IgM was completely blocked by the 100-kD membrane, whereas albumin was freely transferred from the reservoir to the intrafiber space.

CONCLUSION

The perfusion experiments showed the possibility of using a whole liver with oxygenated plasma perfusion in a bioartificial liver system in vitro.

Living donor liver transplantation for a child with recurrent pediatric adult-type hepatocellular carcinoma

INTRODUCTION

Pediatric hepatocellular carcinoma (HCC) is an uncommon disease with a poor prognosis. There are few reports about liver transplantation for pediatric adult-type HCC. We experienced a case of living donor liver transplantation (LDLT) for a child with recurrent pediatric adult-type HCC.

CASE REPORT

A 12-year-old boy was admitted to the Department of Pediatrics in our institution due to HCC in May 2005. He underwent hepatectomy after 3 courses of chemotherapy in July 2005. After the operation, he had 2 more courses of the same chemotherapy. His posttheraputic course was uneventful for 1 year. However, his alpha-fetoprotein level increased and a computed tomography (CT) scan showed recurrent tumor in his remnant liver in October 2006. He underwent another chemotherapy session immediately. However, CT revealed multiple liver tumors after chemotherapy in December 2006. His mother requested to be an LDLT donor, which was performed on January 23, 2007. The donor operation was a right hepatic lobectomy. The postoperative course of the donor was unremarkable and she has now returned to work. The recipient's posttransplantation course was uneventful and he was discharged at postoperative day 53 and is currently doing well.

CONCLUSION

Liver transplantation in conjunction with chemotherapy may have an increasing role in the management of pediatric HCC.

[Changes in the level of thrombomodulin with aging]

Thrombomodulin (TM) is a thrombin receptor on endothelial cells. When endothelial cells are damaged TM is degraded and released into the blood. We examined whether levels of TM in plasma reflect endothelial damage related to aging. We measured the TM level in samples of plasma from 93 healthy men aged from 22 to 81 years. None had hypertension, obesity, diabetes mellitus, or cardiovascular disease. The relationship between the level of TM (Y) and age (X) could be approximated by Y = 0.176X + 10.379, the correlation was significant (r = 0.647, p < 0.01). Basal levels of TM in subjects from 20 to 60 years old showed a gradual increase, that was not statistically significant. Basal concentrations of TM were significantly higher in the older subjects than in the younger subjects. The high levels of TM in the older subjects might reflect endothelial damage. In conclusion, a high TM level in plasma may be a sign of endothelial damage related to aging.

Effects of long term enteral hyperalimentation on pancreatic secretion in dogs

Acute and chronic experiments in adult mongrel dogs were performed to investigate the influences of a low residue diet (Group I) and an elemental diet (Group II) on pancreatic function. 1) In the acute experiment, intraduodenal administration of the low residue diet produced a significant increase in amylase output in pancreatic juice, while the elemental diet die not. 2) Intragastric administration of the low residue diet or elemental diet to conscious dogs showed little difference between the two groups regarding secretin and gastrin release, at the same pH. 3) Long term enteral hyperalimentation showed that it is the low residue diets which enhance pancreatic secretions. 4) In both groups, carbohydrate metabolism, liver function and electrolyte balance were satisfactorily maintained during long term enteral hyperalimentation and morphologic changes of the liver, pancreas and small intestine were not evident. 5) From the viewpoint of nutritional management, low residue diets should be prescribed in some cases of alimentary surgery.

[Lower level of endothelin-1 in migraine with aura]

Endothelin-1 (ET-1) exerts powerful vasoconstrictive and blood pressure elevating properties through endothelial cells. However, no systematic examination of ET-1 in migraine has ever been attempted. The present investigation was focused on evaluating the level of ET-1 in patients with migraine with aura. Studies on ET-1 were made in 17 patients with migraine with aura (age, 23.4 +/- 9.1 years old, mean +/- SD) according to the Classification of Headache of the Ad Hoc Committee. All patients had been free of migraine attacks for at least 7 days prior to the examination. Twenty-eight age-matched healthy volunteers (age, 23.0 +/- 12.3 years old) were similarly used as a control group. None of them revealed evidence of any other disease, such as hypertension, obesity, or heart disease. Informed consent was obtained from each subject. We measured the immunoreactive ET-1 in plasma by radioimmunoassay. The plasma level of ET-1 in migraine was 2.53 +/- 1.06 pg/ml. On the other hand, the level of ET-1 in the controls was 4.24 +/- 0.80 pg/ml. The ET-1 level in migraine was significantly lower than that in the controls (p < 0.002). We also measured the level of ET-1 in the cerebrospinal fluid (CSF). There was no significant difference between migraine (23.2 +/- 3.10 pg/ml) and the control group (20.85 +/- 3.20 pg/ml). In conclusion, the lower plasma level of ET-1 observed in the patients with migraine is consistent with the pathogenesis of migraine, further supporting the hypothesis that a lower ET-1 may be closely related to marked vasodilatation following constriction partly due to a deficiency of ET-1 for maintaining vasoconstriction.

[Multiple cerebral infarction after treatment with cisplatin]

A 46-year-old woman with a tumor the uterine cervix who experienced cerebrovascular accident as a complication of cisplatin-based chemotherapy is presented. Five days after the eleventh cycle of cisplatin 75 mg, intravenously, she had an acute onset of mild memory disturbance and right-sided weakness. On neurological examination, pyramidal sign was discovered on the right side. MRI of the brain showed multiple infarction on the left basal ganglia. There was no evidence of coagulopathy, vascular, or endocardial disease that may have led to a cerebrovascular accident. Similar characteristics in patients previously reported suggest that thrombosis secondary to vascular endothelial injury induced by cisplatin therapy may be responsible for cerebrovascular complications.

[A case report of chronic sternal osteomyelitis after thoracic aortic aneurysmectomy]

A 76-year-old man, who was complicated with chronic sternal osteomyelitis after thoracic aortic aneurysmectomy was reported. He was treated with local wound care and antibiotics for about 3 months, but cutaneous fistula with persistent discharge required sternal bone debridement and omental pedicle grafting. After this treatment the patient was uneventful. 67Ga scintigram and 67Ga-SPECT may be more useful in the diagnosis of this serious complication.

Deep hypothermic intermittent circulatory arrest--an adjunct technique for operations on aneurysms involving the aortic arch

Aneurysms involving the aortic arch were repaired in 12 patients using a technique known as deep hypothermic intermittent circulatory arrest (DHICA). This technique consists of repeated cycles of 20 min of circulatory arrest and 10 min of cerebral and systemic reperfusion. Aneurysms were of the following types: 2 true atherosclerotic aneurysm, 8 aortic dissections, and 2 traumatic aneurysm. There were 2 operative deaths caused by coagulopathy as a result of hepatic failure and difficulty with left ventricular venting. The frequency of circulatory arrest ranged from 2 to 5 cycles, and total circulatory arrest ranged from 20 to 71 min (mean 43.6 min). The lowest tympanic temperature ranged from 17.7 to 19.2 degrees C. No permanent cerebral complications occurred in 10 patients. We believe that this adjunct technique offers excellent results in the surgical treatment of aneurysms involving the aortic arch.

[A case of codon 232 mutation-induced Creutzfeldt-Jakob disease visualized by the MRI-FLAIR images with atypical clinical symptoms]

A 50-year-old man was admitted to our hospital because of disorientation and nocturnal restlessness. The patient presented chronically progressive dementia. No myoclonus or periodic synchronous discharge (PSD) was found over time, with abnormal evidence in MRI-FLAIR (fluid-attenuated inversion recovery) images alone. Brain biopsy and prion protein gene analysis led to the final diagnosis of Creutzfeldt-Jakob disease (CJD) induced by the point mutation at codon 232 (Met to Arg). To date the cases of M232R mutation-induced CJD have been reported to present clinical symptoms and pathological evidences similar to sporadic CJD cases, and differential diagnosis between the types has been believed to be difficult. Our case suggests that some types of CJD induced by point mutation at codon 232 cannot be easily inferred from clinical findings.

Placental site trophoblastic tumor: p53 gene analysis

BACKGROUND

Placental site trophoblastic tumor (PSTT) is the rarest type of trophoblastic neoplasm. Because of its rarity, the clinical behavior and pathogenesis of PSTT are still unclear.

CASE

A 20-year-old woman presented with secondary amenorrhea and irregular vaginal bleeding. Examination of the patient revealed elevated serum hCG and a uterine mass. The specimen obtained by curettage was diagnosed as possible PSTT. The patient was treated with two cycles of EMA/CO, but her uterine mass increased in size. Subsequently, she underwent total abdominal hysterectomy. Microscopic observation revealed a PSTT. To estimate the status of expression of p53 protein and to determine whether p53 gene mutation was present in this PSTT, we carried out immunohistochemical staining for p53 and PCR-SSCP analysis. Immunohistochemical staining for p53 revealed intense nuclear labeling, but no p53 gene mutation was detected in exons 5-8.

CONCLUSION

Analysis of the p53 gene may aid understanding of the pathogenesis of PSTT.

Saturation of azimuthal anisotropy in Au + Au collisions at (square root)s(NN) = 62-200 GeV

New measurements are presented for charged hadron azimuthal correlations at midrapidity in Au+Au collisions at (square root)s(NN) = 62.4 and 200 GeV. They are compared to earlier measurements obtained at (square root)s(NN) = 130 GeV and in Pb + Pb collisions at (square root)s(NN) = 17.2 GeV. Sizeable anisotropies are observed with centrality and transverse momentum (pT) dependence characteristic of elliptic flow (upsilon2). For a broad range of centralities, the observed magnitudes and trends of the differential anisotropy, upsilon2(pT), change very little over the collision energy range (square root)s(NN) = 62-200 GeV, indicating saturation of the excitation function for upsilon2 at these energies. Such a saturation may be indicative of the dominance of a very soft equation of state for (square root)s(NN) approximately 60-200 GeV.

Attenuation of canine warm ischemic small bowel injury by novel combination of nitric oxide donor, FK409, and cytokine suppressive anti-inflammatory agent FR167653

Organ ischemia-reperfusion injury is caused by two consecutive steps, microcirculatory disturbance and neutrophil-endothelial cell interactions, which are caused by inflammatory cytokines. We examined the hypothesis that combination therapy with a donor (FK409) of nitric oxide, one of the potent mediators with diverse roles as a vosodilator and a platelet inhibitor, together with the cytokine suppressor agent (FR167653) attenuates warm ischemic injury in canine small bowel. Small bowel ischemia was initiated by clamping the superior mesenteric artery and vein. Animals were divided into two groups: a control group (n = 5) subjected to 2-hour small bowel ischemia only, and a combination therapy group (FK/FR group, n = 5) that received FK409 (300 mcg/kg/h) plus FR167653 (1 mg/kg/h) intravenously before and after the ischemic event. We evaluated animal survival, small bowel tissue blood flow, and enzyme release from the small bowel. All controls died from severe acidosis within 2 days and all the FK/FR animals survived 7 days (P < .05). The FK/FR group recovered more than 70% of blood flow immediately after the revascularization, while the flow was less than 40% among the controls. Serum creatine phosphokinase values in the control group after reperfusion were significantly higher than those in the FK/FR group. In conclusion improvement of the microcirculation by FK409 and inhibition of cytokine release by FR167653 together attenuated warm ischemic small bowel injury.