Thymolipoma: clinical and pathological features--report of three cases and review of literature

We report three recently resected cases of thymolipoma. Two cases (case 2 and 3) were female and the other (case 1) was male. The age of these three were 41 years, 63 years, and 29 years, respectively. While two cases (case 1 and 2) were asymptomatic, the other (case 3) had associated myasthenia gravis. Preoperative examination in each case was performed using chest CT scan or chest MRI, or both. Only one case (case 1) was diagnosed as thymolipoma preoperatively, and this was by a chest MRI showing the mass in continuity with the thymus. The diagnosis of each lesion was confirmed histologically by their composition of lobules of mature adipose tissue with minute islands of thymic tissue consisting of epithelial cells, lymphocytes, and Hassall's bodies.

Multilocular thymic cysts associated with thymoma. A case report

The association of multilocular thymic cysts (MTC) with thymoma is exceedingly rare, and the pathogenesis of this combination is controversial. We describe the case of a 42-year-old man with an anterior mediastinal mass found to contain MTC and thymoma. A multilocular cystic mass, measuring 13 x 6.5 x 2 cm, was found in the right lobe of the thymus, and contained a 4.7 x 2 cm thymoma in its center. Microscopic thymomas, lipomatously involuted remaining thymic tissue, and lymphoid follicles with germinal centers were found in the walls of MTC as well as in the left thymic lobe. Non-specific chronic inflammation was also present in the walls. In addition, microcysts, which were only found at the periphery of the thymoma and covered with epithelium, might have been formed secondarily by dilatation of the perivascular spaces and of Hassall's corpuscles. These findings suggest that a chronic inflammatory process was responsible for the early formation and enlargement of this patient's MTC, and that while the cavities of the MTC expanded to various degrees, the thymoma, which originated from one of the microscopic thymomas in the walls of MTC, increased in size, and grew to involve the remaining thymic tissue.

Alterations in left ventricular wall stress and coronary circulation in patients with isolated systolic hypertension

OBJECTIVES

To study the alterations in cardiac function and coronary circulation in patients with isolated systolic hypertension (ISH).

PATIENTS

Ten patients with a history of ISH were studied and findings were compared with those of seven normotensive subjects. All of the patients had angiographically normal coronary arteries. They underwent cardiac catheterization, and haemodynamic variables and coronary flow velocity were measured. All of the patients also underwent treadmill exercise testing.

MAIN OUTCOME MEASURES

Left ventricular mass was evaluated by echocardiography. The coronary flow velocity data were obtained by using the intracoronary Doppler catheter technique. ST-segment depression was observed on the exercise electrocardiogram.

RESULTS

Systemic vascular resistance did not differ, whereas total arterial compliance was decreased in the ISH patients versus the controls (P < 0.001). The left ventricular mass of the ISH patients was increased slightly, but their left ventricular systolic wall stress was greater than that of the controls (P < 0.01). The coronary flow reserve ratio and the ratio of diastolic to total coronary flow were decreased in the ISH patients versus the controls (P < 0.01). ST-segment depression on the exercise electrocardiogram was frequently observed in the hypertensive patients (80 versus 0% in control subjects, P < 0.01).

CONCLUSIONS

Patients with ISH were characterized haemodynamically by a decrease in arterial compliance. They showed an increase in left ventricular systolic wall stress and also showed decreases in coronary flow reserve ratio and in the relative diastolic coronary flow. Such alterations observed in patients with ISH are detrimental to the heart and may contribute to a reduced exercise capacity and the induction of subendocardial ischaemia during exercise.

Expandable metallic stents for tracheobronchial stenoses in esophageal cancer

BACKGROUND

Tracheobronchial stenosis in patients with esophageal cancer can be life threatening. Few reports have discussed use of expandable metallic stents for central airway stenoses in patients with esophageal cancer.

METHODS

Twelve patients with esophageal cancer underwent placement of expandable metallic stents for respiratory distress caused by tracheobronchial stricture. Single or double metallic stents were placed in the stenotic airways under fluoroscopic guidance. Improvement in respiratory symptoms and clinical outcome were assessed.

RESULTS

Most stenoses were located in the trachea or the left main bronchus. From one to four expandable metallic stents were placed in each stricture site, with immediate relief of respiratory symptoms in 8 patients. One patient with tracheomalacia in alive 3 years after stent placement and another is alive 6 months after stent insertion. The other 10 patients lived from 10 to 70 days (mean; survival, 35 days) after stent placement. Death was due to progression of disease.

CONCLUSIONS

Although metallic stents are useful for relieving respiratory distress in patients with advanced esophageal cancer, additional therapies should be considered.

The evaluation of masticatory function with low adhesive colour-developing chewing gum

Many objective methods have been described to evaluate masticatory function. Recently, a new chewing gum system has been reported that utilizes a phloxine-sodium bicarbonate reaction and measures a chromatic coordinate as a functional indicator. A low-adhesive colour-developing chewing gum has been developed by selecting an appropriate gum base. This study examined the applicability of the system and reproducibility of results in subjects with different dental states. Tests were performed on 15 natural dentate subjects and 15 complete denture wearers after determination of germane test conditions through a pilot study. The colour was measured by a*, one of the coordinates in the L*a*b* colour system. All subjects could perform the test. The coefficient of variation ranged from 1.87% to 7.90%, averaging 5.15% in the natural dentate subjects and from 1.5% to 17.9%, averaging 9.75% in the complete denture wearers. The 95% confidence interval of a* was 28.76 +/- 1.76 in the natural dentate subjects and 10.05 +/- 2.58 in the complete denture wearers. The results indicated that this material can be useful for both complete denture wearers and subjects with a natural dentition with adequate reproducibility.

Changes of vasoactive peptides and effects of inhaled nitric oxide after pneumonectomy

To clarify the role of vasoactive peptides in the physiologic response to pneumonectomy, we investigated the changes of atrial (A-type) natriuretic peptide (ANP). C-type natriuretic peptide (CNP), and endothelin-1 (ET-1) levels in the lung and blood after pneumonectomy and the effects of inhaled nitric oxide (NO; 5 ppm) after pneumonectomy in beagle dogs. The concentrations of these peptides in the lung and blood were measured by radioimmunoassay. The dogs in group A (n = 10) were observed without NO inhaling after right pneumonectomy, and the dogs in group B (n = 5) were observed with NO inhaling from 120 to 180 min after right pneumonectomy. After the thoracotomy, right lung tissue was resected for the pre-operative histological control. Tissue from the left lung was obtained at 120 min (5 dogs in group A), at 180 min (5 dogs in group A), and after 60 min of NO inhalation (group B) for the post-operative histological material. Peripheral blood was collected from the femoral artery. The pulmonary arterial pressure (PAP) was significantly increased after pneumonectomy, but rapidly decreased to the same level as the pre-operative stage after NO inhalation. Increases of plasma ANP, lung ANP and lung CNP levels occurred after pneumonectomy, while the ET-1 level was unchanged. Inhaled NO rapidly reduced the plasma ANP, lung ANP and lung CNP. These results indicate that both ANP and CNP act to maintain normotensive homeostatic balance in the pulmonary circulation.

Two-dimensional intravenous coronary arteriography using above-K-edge monochromatic synchrotron X-ray

RATIONALE AND OBJECTIVES

For intravenous (i.v.) coronary arteriography, a real-time two-dimensional (2D) imaging system is being developed using above-K-edge monochromatic X-rays alone. The potential diagnostic value of this system was examined in the current study.

METHODS

The angiographic system consisted of an asymmetric silicon (311) monocrystal, an image intensifier, and a charged-coupled device camera. It was constructed at the beam line of the Tristan Accumulation Ring. Monochromatic X-rays of 33.32 keV were used, and each image was recorded over 2 msec.

RESULTS

Ventricular wall motion and the anatomy of the coronary arteries could be seen in dogs by sequential images obtained without subtraction. The left anterior descending coronary artery, left circumflex coronary artery, and right coronary artery and the branches of these vessels were observed. The parts of the coronary arteries overlapping the aorta and left ventricle were revealed somewhat during washout of the contrast material.

CONCLUSION

For a 2D imaging system, monochromatic i.v. coronary angiography using an energy above the iodine K-edge might be able to image the coronary arteries without subtraction. However, the image quality needs to be improved by increasing the X-ray flux, decreasing background radiation scatter from the object, and decreasing contamination with 99-keV X-rays.

[Multiparametric cytometric analysis of hepatocellular carcinoma and its allied lesions combining DNA ploidy analysis with morphometry using DAPI/HP double staining]

Hepatocellular carcinomas (HCC) of various differentiation, Edmondson (Edm) grade I-IV, often based upon viral infectious hepatitis transformed through regeneration, nodular and/or dysplastic adenomatous hyperplasia. Aspiration cytology, even needle biopsy for such lesions, is very difficult to interpret. We have been studying multiparametric cytologic analysis using DAPI/Hematoporphyrin (HP) staining for the cece samples provided from exactly trimmed 50-microns thick paraffin sections, employing a new software program which we developed, combining DNA ploidy and cell protein content analysis with morphometry. DAPI indicates DNA content and nuclear size and HP indicates cell protein content and cell size. From 21 cases of HCC, 43 nodules or masses including multiple lesions and nodule in nodule were analyzed. Surrounding non-neoplastic hepatic tissues were examined as the control specimens. On DNA histogram, cases with the peak over 2.4 c are identified as aneuploid (Aneupl). Cases of Edm I, or II, 6 of 8 samples showed Aneupl., all of 11 cases of Edm II, 11 cases of Edm III, and one of Edm IV showed Aneupl. Multinodular foci in the same cases and also nodule in nodule often showed different modes of Aneupl. This suggested heterogenetic carcinogeneity. Noncarcinomatous foci often showed Aneupl. modes, which may indicate malignant transformation or malignant potential.

Localization of three fragments of connectin in chicken breast muscle sarcomeres

Connectin (titin) links the Z line to the myosin filament in sarcomeres of vertebrate skeletal muscle. An 800 kDa fragment of alpha-connectin runs from the Z line up to the N2 line region in the I band, and the following beta-connectin portion runs up to the edge of the M line on the myosin filament in chicken breast muscle sarcomeres. Immunoelectron microscopy showed that a 400 kDa fragment following the 800 kDa fragment reaches the edge of the myosin filament and, thereafter a 1,700 kDa fragment runs to the M line on the myosin filament in chicken breast muscle sarcomeres. When stretched, the epitopes to anti-400 kDa fragment antibodies outside the myosin filament moved toward the inside of the I band.

[Evaluation of the peripheral skin sympathetic function by cooling thermography in women with climacteric complaints]

To evaluate the peripheral skin sympathetic function, cooling thermography was performed on women with climacteric complaints (CG) and without them (NG). Both hands were immersed into 4 degree C water for 1 minute ant the nail temperature of the right second finger was measured before and after the stress every 1 minute for 7 minutes. And the recovery rate was calculated. By dividing the CG groups by the 5 minute recovery rate minus the 2SD of the NG groups, there was seen to be a significant difference between the recovery patterns. One is a good recovery group (GR, N = 26) and the other is a poor recovery group (PR, N = 28). The significant difference between GR and PR groups was only recognized in the pre-cooling nail temperature. No significant difference was seen in age, Body Mass Index, Kupperman Index, symptoms, serum estradiol or serum testosterone levels. These results indicate that in about half of women with climacteric symptoms, peripheral skin sympathetic nerve function is continuously hypertensioned and the response to cooling stress is decreased. Although the reason for these results is not clear, sympathetic nerve dysfunction is supposed to be the main cause. This test is useful for evaluating peripheral skin sympathetic function.

Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction

OBJECTIVES

This study investigated the long-term effects of decreased aortic distensibility on the heart in relation to coronary perfusion.

BACKGROUND

Aortic distensibility is decreased in patients with atherosclerosis and hypertension and in the elderly. However, the effect of a long-term decrease in aortic distensibility on coronary perfusion has not been fully investigated.

METHODS

Twelve anesthetized dogs underwent thoracotomy and were allocated to two groups: Group I included six control dogs with a normal aorta; Group II included six dogs with decreased aortic distensibility produced by banding the descending aorta. After 4 to 6 weeks, the dogs had a second operation to measure coronary artery flow and transmural flow distribution. Because the effect of decreased aortic distensibility on coronary perfusion may be affected by ventricular contractility, measurements were performed at baseline and during increased ventricular contraction induced by isoproterenol infusion.

RESULTS

At baseline, arterial compliance was reduced by 35% in Group II, but there was no change in total mean arterial resistance. Hemodynamic variables, regional wall motion and coronary flow were also similar in both groups. However, during isoproterenol infusion, coronary flow increased more in Group II than in Group I (p < 0.01), and the coronary flow reserve ratio (maximal peak hyperemic flow divided by rest flow) decreased more in Group II than in Group I (mean [+/- SD] 1.9 +/- 0.4 vs. 2.4 +/- 0.3, p < 0.05). Moreover, although the transmural flow distribution was similar in the two groups at baseline, during isoproterenol infusion the endocardial flow increased less in Group II than in Group I (p < 0.05), and the endocardial/epicardial flow ratio was significantly decreased in Group II compared with Group I (mean [+/- SD] 0.70 +/- 0.18 vs. 0.99 +/- 0.22, p < 0.05). The subendocardial electrocardiogram showed ST segment elevation during isoproterenol infusion in Group II (p < 0.05) but not in Group I.

CONCLUSIONS

These results demonstrate that during increased ventricular contraction, chronically decreased aortic distensibility contributes to a further decrease in the coronary flow reserve ratio, impairs endocardial blood flow and may induce subendocardial ischemia even in the absence of coronary artery stenosis.

Ventricular wall stress revisited. A keystone of cardiology

Wall stress has been used as one of the parameters of myocardial mechanics. The present review focuses on recently developed data on ventricular wall stress, especially in relation to other newly developed areas in cardiology. In hypertensive hearts, there is a broad continuous spectrum in the structural and functional changes: those with low wall stress (inappropriate hypertrophy), those with normal wall stress (appropriate hypertrophy) and those with high wall stress (inadequate hypertrophy). Among them, the responses to neurohumoral stimuli are various, and their clinical features and courses also varied. These differences in wall stress among the different categories of hypertensive hearts may be caused by the variable influences of non-mechanical factors, such as molecular, metabolic and neurohumoral ones. Wall stress is an essential determinant of myocardial oxygen consumption, and is also an important determinant of the myocardial contractile state and diastolic function. In contrast to excitation-contraction coupling, contraction-excitation feedback has been studied, suggesting the importance of wall stress regulating electrical phenomena. The interrelationship between mechanical factors (including wall stress) and non-mechanical factors (including molecular, metabolic, neurohumoral and genetic ones) has been investigated intensively. In conclusion, wall stress (or force on the myocardial cell) may be a keystone in cardiology, relating to each of the cardiac phenomena. If wall stress deviates from the normal range, even with compensatory mechanisms, severe cardiac events occur. The compensatory mechanisms for wall stress may act as a risk factor on the heart, especially when the wall stress remains outside the normal range.

Post-infantile giant cell hepatitis in an elderly female patient with systemic lupus erythematosus

A 69-year-old Japanese female was admitted because of general fatigue. Laboratory data showed elevation of serum total bilirubin, transaminase, gamma-glutamyl transpeptidase, and creatinine levels. An immunological study revealed hypergammaglobulinemia, low titer of complement, and high titers of antinuclear antibody, anti-DNA antibody, and circulating immune complexes. Antibodies to parainfluenza virus 3 were positive. Histology of the liver disclosed numerous giant cell hepatocyte transformations with the lobular architecture being slightly distorted by portal inflammation and fibrosis. These findings led us to make a diagnosis of giant cell hepatitis associated with systemic lupus erythematosus. Prednisolone was effective in improving the anemia and the serum immunoglobulin, immune complex, and antinuclear antibody levels. The addition of cyclosporine to the initial corticosteroid therapy was also beneficial in decreasing the transaminase level and in improving liver histology. The patient died of acute pneumonitis and renal failure on the 166th day after admission. Parainfluenza virus 3 and autoimmune mechanisms were thus considered to be the causes of the giant cell hepatitis.

Experimental rat pancreas transplant: surgical technique and immunological considerations

Vascularized whole pancreas transplantation in the rat was performed on the abdomen using a cuff technique for vascular anastomoses. Two different exocrine drainage procedures, either intestinal or ureter drainage, were used. In the isograft transplant models, hyperglycemia was ameliorated immediately after transplantation and all of the grafts functioned during the observation period. In the allograft transplant models without immunosuppression, graft rejection, as defined by recurrence of hyperglycemia (blood glucose > 200 mg/dl) occurred 6-9 days post-transplant. Allograft rejection could be delayed approximately 1 month after transplant with short-term use of FK506. These different models, using either intestinal or ureter exocrine drainage, are similar to dominant clinical pancreas transplantation with enteric exocrine drainage or urinary tract drainage, respectively. It is thus concluded that whole pancreas transplant with either intestinal or ureter exocrine drainage is an ideal model for physiological and immunological experimental studies in pancreas transplantation.

Ankyloblepharon, ectodermal dysplasia, cleft lip and palate (AEC) syndrome: surgical corrections with an 18-year follow-up including maxillary osteotomy

A rare case of AEC syndrome is presented. Surgical corrections and an 18-year follow-up, including maxillary advancement osteotomy, are described.