Primary embryonal carcinoma of the retroperitoneum

A 32-year-old man with primary embryonal carcinoma of the retroperitoneum, a very rare condition, is reported. The disease took an acute course with rapid enlargement of cervical and inguinal lymph nodes, and high serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) values were observed. His testes were, however, intact. Remarkable tumor regression was achieved by systemic combination chemotherapy with cisplatin, vinblastine, and bleomycin (PVB therapy). This chemotherapy is beneficial even in advanced cases. In the two years since therapy, no recurrence has been observed.

[Fluorocytometric DNA analysis of borderline lesions in the large intestine]

A total of 9 surgically resected non-cancerous benign lesions (5 regenerative epithelium, 4 hyperplastic or metaplastic epithelium), 4 normal epithelium, 30 carcinomas and 12 adenomas containing 7 moderate dysplastic epithelium and 5 severe dysplastic epithelium in the large intestine, were used. Then 40 microns thick paraffin sections were made from each specimen, dewaxed, and the target portion was excised under microscopic visualization. Free cells isolated by 0.5% pepsin solution were smeared and followed by DNA staining by DAPI, and fluorocytometric DNA measurement was performed using a fluorocytometer (BH 2.QRFL, Olympus). All specimens of non-cancerous benign epithelium and normal epithelium showed diploidy. The average mean DNA value was 2.03 +/- 0.04 c (1.95-2.10), the percentage of cells above 4.1 c (4.1 c > or = %) averaged 0.26 +/- 0.42% (0-1.25) and the coefficient of variation (CV) averaged 14.30 +/- 3.18% (10.19-19.58). Seven of 30 carcinomas showed diploidy. Among these diploid carcinomas, the mean DNA value averaged 2.30 +/- 1.98 c (2.01-2.71) (p < 0.05), 4.1 c > or = % averaged 4.17 +/- 2.91% (2.0-10.5) (p < 0.05) and CV averaged 32.2 +/- 5.8% (24.43-38.90) (p < 0.01). Based on these results, aneuploid cases were judged to be malignant. In the case of diploidy, if the percentage of cells above 4.1 c was more than 2.0% and CV was more than 24.43%; when the former was less than 1.25% and the latter was less than 19.58%; and when one or both of the two was out of the range described in the above two categories, they were judged to be malignant, benign or borderline, respectively. From these criteria, 7 adenomas showing moderate dysplasia were analyzed as benign in 2, borderline in 4 and malignant in 1, while 5 adenomas evidencing severe dysplasia were analyzed as malignant in 4 and borderline in 1. In conclusion, fluorocytometric evaluation of the malignant or benign tumor of borderline lesions in the large intestine was found to be possible.

Demonstration of inguinal hernia by means of peritoneal 99mTc-MAA scintigraphy with a load produced by standing in a patient treated by continuous ambulatory peritoneal dialysis

A 45-year-old man receiving continuous ambulatory peritoneal dialysis developed scrotal swelling and edema which was aggravated in the standing position. Physical examination failed to find inguinal hernia and although ultrasonography revealed the patent had processus vaginalias, it failed to prove its continuity to the peritesticular space of the tunica vaginalis. Peritoneal scintigraphy with intraperitoneal instillation of 99mTc-Macroaggregated albumin followed by standing clearly demonstrated the connection. The use of the standing load makes possible faster visualization of a positive finding and more accurate diagnosis than examination in the supine position.

Intra-tumor DNA ploidy distribution pattern and its relation to histologic type in gastric carcinoma

The pattern of intra-tumor DNA ploidy distribution was analyzed in stepwise sections in 64 cases of surgically resected gastric carcinoma. Five varying patterns were identified: Type A comprised only diploidy in all stepwise sections, Type B comprised only aneuploidy with the same DNA Index(DI), Type C comprised diploidy in the great majority of sections with aneuploidy in some parts, Type D comprised aneuploidy in the great majority of sections with diploidy in some parts and Type E comprised only aneuploidy, but with varying DI. These 5 patterns could be grouped into 2 categories; predominantly diploid (Types A and C) and predominantly aneuploid (Types B, D and E). The former category included 34 cases (12 differentiated carcinomas) while the latter included 30 cases (22 differentiated carcinomas). Thus, a statistically significant correlation was detected between the histologic type and the intra-tumor DNA ploidy distribution pattern; in the majority of cases, differentiated carcinoma exhibited predominantly aneuploidy, while undifferentiated carcinoma exhibited predominantly diploidy (p less than 0.01). This tendency was the same for all depths of invasion, except for submucosal carcinomas which exhibited predominantly diploidy.

[CT-guided percutaneous lung biopsy using a cutting needle and an automated biopsy gun. Comparison with lung biopsy using a manual aspiration needle]

Twenty-five percutaneous lung biopsies using a 20-gauge cutting needle and automated biopsy gun (ABG) were performed under CT guidance in 25 patients with thoracic lesions. This procedure was compared with that using a 21-gauge manual aspiration needle in 36 patients (40 examinations, 37 lesions) in terms of success rate, rate of correct diagnosis, mean examination time and rate of complications. Specimens obtained from lung biopsy were graded by a histopathologist according to quality and quantity from 0 to 4 (pathological score). There were no statistically significant differences between the two procedures in terms of success rate, rate of correct diagnosis and rate of complications; only the time required was significantly different. However, sufficient biopsy material and a mean pathological score of G-II 2.8 (that of G-I was 1.9, p less than 0.05) could be obtained by the biopsy procedure using the cutting needle. The above results indicated that aspiration needle biopsy was adequate for lung biopsy, but that a cutting needle and ABG should be used when a good biopsy specimen is needed for tissue diagnosis.

Local control of prostate cancer by intraarterial infusion chemotherapy facilitated by the use of angiotensin II

Intraarterial infusion chemotherapy with angiotensin II was carried out in 8 prostate cancer patients whose ages ranged from 61 to 77 years. They had stage C or D tumor progression and complained of difficult urination, bone pain or lymphedema caused by intrapelvic tumor infiltration. Endocrine therapy had been done before the infusion therapy but the clinical status showed little change with a persistence of local symptoms. Cis-platinum and doxorubicin were infused with an indwelling catheter into both internal iliac arteries. After the completion of 1-5 courses, 6 of 8 patients responded remarkably in local symptoms. It is thought that intraarterial infusion chemotherapy can be used safely and effectively in elderly patients.

[Giant seminoma of the left testis: a case report]

A 66-year-old man visited our hospital with a history of a slowly growing left scrotal contents for the past 5 years. Serum beta-human chorionic gonadotropin and lactate dehydrogenase was greatly elevated. The resected mass was 26 cm x 16 cm x 13 cm in size, 2,258 g in weight. It arose from left testis and grew to the left inguinal region. Histologically it was pure seminoma.

Bi-directional transmission of molecular information by photon or electron beams passing in the close vicinity of specific molecules, and its clinical and basic research applications: 1) Diagnosis of humans or animal patients without any direct contact; 2) Light microscopic and electron microscopic localization of neuro-transmitters, heavy metals, Oncogen C-fos (AB2), etc. of intracellular fine structures of normal and abnormal single cells using light or electro-microscopic indirect Bi-Digital O-Ring Test

In 1985, Omura, Y. discovered that, when specific molecules were placed anywhere in the close vicinity of the path of a light beam (laser), their molecular information, as well as information on electrical & magnetic fields, is transmitted bi-directionally along the path of this light beam. Namely, this information is transmitted in the direction the light beam is projected and towards the direction from which the light beam is coming. This finding was applied to the following clinical and basic research: 1) In the past, using indirect Bi-Digital O-Ring Test, human or animal patients were diagnosed through an intermediate third person holding a good electrical conducting probe, the tip of which was touching the part of the patient to be examined. However, in order to diagnose the patient in isolation from a distance, or a dangerous or unmanagable unanesthesized animal, such as a lion or tiger, the author succeeded in making a diagnosis by replacing the metal conducting probe with a soft laser beam which is held by the one hand of the third person whose index finger is placed in close vicinity of the laser beam generated by a battery-powered penlight-type solid state laser generator. Thus, diagnosis within visible distance, without direct patient contact, became a reality. 2) Using a projection light microscope, by giving indirect Bi-Digital O-Ring Test while contacting with a fine electro-conductive probe on the magnified fine structure of normal and abnormal cells, various normal and abnormal intracellular substances were localized through a third person holding a pure reference control substance with the same hand that is holding the probe as an intermediary for the indirect Bi-Digital O-Ring Test. Instead of the photon beam in a light microscope, the author found that, using an electron beam passing through the close vicinity of specific molecules of specimens in an electron microscope, the molecular information is transmitted to the magnified fluorescent screen, and an indirect Bi-Digital O-Ring Test could be performed through a projected penlight-type solid state soft laser beam on the magnified intracellular structure through an observation glass window. Using the magnified fine structure of the cells, by either a light projection microscopic field or electron microscope, in various cancer cells of both humans and animals, Oncogen C-fos (AB2) and mercury were found inside of the nucleus. Integrin alpha 5 beta 1 was found on cell membranes and nuclear cell membranes of cancer cells. Acetylcholine was not found anywhere within cancer cells.(ABSTRACT TRUNCATED AT 400 WORDS)

[Demonstration of the architecture of the tracheobronchial wall by MR imaging: an experimental study]

To study the potential of MRI to demonstrate the architecture of the tracheobronchial wall, resected tracheobronchi of rabbits were examined with MRI. As a result, epithelium and cartilage were demonstrated as relatively low intensity bands on T1- and T2-weighted images (T1WI and T2WI). The subepithelium was of intermediate-high intensity on T1WI and of markedly high intensity on T2WI and Gd-DTPA enhanced T1WI. Peritracheobronchial fat was of markedly high intensity on T1WI and of relatively low intensity on T2WI. In conclusion, MRI was found to have the potential to demonstrate the architecture of the tracheobronchial wall as 4 layers on each sequence.

[The appearance of "lambda" and "panda" sign on Ga-67 scintigraphy in sarcoidosis]

The lesions of sarcoidosis generally show relatively high Ga-67 uptake and the usefulness of scintigraphy using this agent in the evaluation of lesion activity is well known. In this report, we assessed characteristic uptake of Ga-67 in intrathoracic lymphnodes, the shape of which resembled the Greek letter Lambda (Lambda sign) and a symmetrical accumulation in bilateral lacrimal and salivary glands which resembled a Panda face (Panda sign) in patients with sarcoidosis. Our review of Ga-67 scans obtained from 15 patients with sarcoidosis and 1,779 patients with other disorders during the past 3 years revealed that the simultaneous presence of both Lambda and Panda signs was specific to patients with sarcoidosis and was not found in patients with various other disorders, although one of these signs might be observed in patients without sarcoidosis. When Lambda-like sign was observed, chest radiogram or CT was necessary for the differential diagnosis of sarcoidosis. Panda sign was observed frequently among patients who had previously received irradiation of the neck. Our results confirmed that sarcoidosis must be suspected when both Lambda and Panda signs were observed.

Growth patterns and prognosis of submucosal carcinoma of the esophagus. A pathologic study

Sixteen cases of esophageal carcinoma invading the submucosa were analyzed in terms of growth patterns. Seven were classified into the massively penetrating (down growth) type, four into the superficially spreading (spreading growth) type, and five into the unclassified type. In the down growth type, the ratio of the submucosal area to the total (mucosa and submucosa) area was more than 0.2 (one fifth), and in the others that ratio was less than 0.2. The down growth type is characterized by a tendency toward elevated lesions, a high incidence of vessel invasions and lymph node metastasis, and a poor prognosis after surgery. Lymphatic and/or vascular invasions were recognized in six of seven cases, and the 5-year survival rate was 0%. In contrast, the spreading growth and unclassified types was characterized by superficial lesions, a low incidence of vessel invasions and lymph node metastasis, and a favorable prognosis. In only one with the spreading growth type was there lymphatic invasion. Three of the four with the spreading growth type survived over 5 years, and the other one with the spreading growth type and all of five with the unclassified type are alive without recurrences 15 to 52 months after surgery. Thus, growth patterns reflect well the prognosis of the submucosal carcinoma of the esophagus.

Orbital rhabdomyosarcoma. Immunohistochemical studies of seven cases

An immunohistochemical analysis using a series of mono- and polyclonal antibodies against myoglobin, desmin, vimentin, actin, NSE, S-100 protein and keratin was done on alveolar rhabdomyosarcoma (3 cases), embryonal (3) and pleomorphic rhabdomyosarcoma of the orbit (1). All tumors were stained by monoclonal antibodies to desmin and vimentin, whereas 6 of the 7 cases were stained by myoglobin. The results indicate that desmin and vimentin are highly sensitive immunohistochemical markers for the diagnosis of rhabdomyosarcoma, especially in poorly differentiated ones.

[Pulmonary artery banding for double inlet left ventricle]

Thirteen patients with double-inlet left ventricle who had undergone pulmonary artery banding (PAB) were reviewed. At the time of PAB, the age ranged from 2 months to 3 years. Pulmonary-systemic arterial pressure ratio and pulmonary arterial mean pressure were reduced from 0.95 +/- 0.12 to 0.4 +/- 0.18, and from 57.3 +/- 11.6 mmHg to 29.9 +/- 12.7 mmHg after PAB. Pulmonary resistance showed no statistically significant change after PAB. (from 7.6 +/- 5.2 unit to 4.8 +/- 3.9 unit) Ventricular end-diastolic volume decreased from 379.9% +/- 140.0% to 275.7% +/- 118.0% after PAB. The smallest one was 170% who successfully underwent septation procedure. Ejection fraction significantly decreased from 64.5 +/- 6.1% to 56.3 +/- 7.9%. (p less than 0.005) Ventricular end-diastolic pressure showed no significant change after PAB. (from 9.2 +/- 2.8 mmHg to 9.9 +/- 2.0 mmHg) After PAB subaortic stenosis occurred in three cases and pressure gradient were 10, 20, and 85 mmHg, respectively. Seven cases, including three cases with subaortic stenosis, underwent septation procedure and all survived. Before septation, ventricular end-diastolic volume calculated as % of normal left ventricular volume ranged from 173% to 570% and pulmonary resistance ranged from 1.6 unit to 11 unit. These data suggested that the patients with double-inlet left ventricle had efficient ventricular volume and cardiac function for septation even after PAB.

Interaction of S-activated enkephalin analogs with opiate receptors

Enkephalin analogs containing a thiol activated by a thiomethyl (SCH3)*** or 3-nitro-2-pyridinesulfenyl (Npys) group were synthesized. Incubation of such S-activated enkephalin analogs as [D-Ala2, Leu(CH2S)SCH(3)5]enkephalin or [D-Ala2,Leu(CH2S)Npys5]enkephalin with guinea pig ileum (GPI) resulted in the continuous stimulation of the mu opiate receptors. This sustained GPI-activity was completely reversed with the antagonist naloxone, while subsequent washings elicited again the full enkephalin activity. When GPI showing full enkephalin activity was incubated with 1 mM dithiothreitol, about 70% of the activity was eliminated. Examination of enkephalin analogs containing Cys(Npys) at position 1, 5, or 6 suggested that no other thiols occur near the enkephalin binding site of the mu receptor. From these results, it is considered that only one thiol group exists near the binding site of the mu receptor in GPI. Similar results were also obtained for the mu receptors in mouse vas deferens.

The role of monokines in granuloma formation in mice: the ability of interleukin 1 and tumor necrosis factor-alpha to induce lung granulomas

Granulomatous inflammation is associated with many significant human diseases, including tuberculosis, leprosy, sarcoidosis, parasite infection, and berylliosis. Very little is known about the basic mechanism of this type of inflammation. In the present study, we showed that pulmonary granulomas were induced in mice by the intratracheal injection of agarose beads coupled to recombinant interleukin 1 (IL-1) or tumor necrosis factor-alpha (TNF-alpha). Histologically, the bulk of granulomas was composed of macrophages and their derivatives. In contrast, the inflammatory reactions induced by beads coupled to either recombinant IL-2 or murine interferon-gamma were considerably smaller than those induced by beads coupled to monokines. These results suggest that macrophages and monokines such as IL-1 and TNF-alpha, but not T cell-derived lymphokines, play an essential role in granuloma formation.

Granuloma formation by artificial microparticles in vitro. Macrophages and monokines play a critical role in granuloma formation

To investigate the basic mechanisms of granuloma formation, in vitro granulomas were induced by culturing murine spleen cells in the presence of artificial microparticles. Large granulomas developed around dextran beads. The lesions were inducible by spleen cells from either normal mice or athymic nude mice. Minimal inflammation was produced around latex beads. The histologic features and time kinetics of granulomas in vitro. Culture supernatants of dextran induced granulomas contained high levels of interleukin-1 (IL-1) activity but not interleukin-2 (IL-2) or interleukin-4 (IL-4) activity. IL-1 activity was correlated with granuloma size. Additionally, granulomas were produced by culturing spleen cells in the presence of agarose beads coupled to recombinant IL-1 or recombinant tumor necrosis factor-alpha (TNF-alpha). Granulomatous lesions also were induced by macrophage-enriched populations in the presence of monokine-coupled beads. Adherent macrophages, but not nonadherent cells, were required for induction of granulomas in vitro. In contrast, very small lesions were seen when spleen cells or adherent cells were cultured in the presence of beads coupled to recombinant IL-2 or recombinant interferon-gamma (IFN-gamma). These results suggest that macrophages and monokines such as IL-1 and TNF-alpha play an essential role in granuloma formation in vitro.

[The results of surgical treatment of total anomalous pulmonary venous return in neonates]

By the time, the results of surgical treatment for total anomalous pulmonary venous return have been unsatisfactory. From 1981, we changed a surgical procedure fro Gersony-Malm procedure to the posterior approach method, and a surgical technique from the deep hypothermia and the circulatory arrest to the moderate hypothermia and the pump perfusion. Consequently, the results of surgical treatment was improved. From 1981 to 1987, 18 neonates with total anomalous pulmonary venous return underwent corrective operations in our institute. This diagnosis was decided by echocardiography without cardiac catheterization, because the preoperative status of these neonates were poor. Under the cardiopulmonary bypass, we performed the posterior approach method for type I and III, the cut-back method and Van Praagh procedure for II and IV without aortic clamping. According to the posterior approach method, the atrial septal defect was closed through the left atrial incision and the left atrium was anastomosed to the common pulmonary trunk during ventricular fibrillation. The incision was limited within the common pulmonary trunk or the vertical vein and was not extended into the pulmonary veins. According to cut-back method and Van Praagh procedure, the coronary sinus was closed internally so as to avoid the postoperative conduction disturbance. There were four hospital deaths (22.2%). The causes of deaths were pulmonary hypertension in two, low cardiac output in one, and intracranial bleeding in one. From the results of our institution, we concluded that the primary factors determining the outcome were the condition of the patients prior to repair and the severity of pulmonary hypertension.

[Pulmonary valve replacement using the right ventricle-pulmonary artery bypass without cardiopulmonary bypass]

We underwent pulmonary valve replacement using the right ventricule pulmonary artery bypass without cardiopulmonary bypass. This right heart bypass was consisted of the vascular graft and the polystyrene tube. The vascular graft was anastomosed to the main pulmonary artery and the polystyrene tube was inserted into the free wall of the right ventricle. These were connected with a cannulating magnetic flow probe. After the bypass was established, the pulmonary artery was clamped and divided. The pulmonary valves were excised and the pulmonary valve replacement was undergone with a pulmonary valve homograft. Hemodynamics during the pulmonary valve replacement was stable and the postoperative course was uneventful. One month later, the cardiac catheterization and cineangiography showed that the implanted homograft was effective sufficiently. We concluded that this right heart bypass was useful for the pulmonary valve replacement.

Assessment of pancreatic islet-cell population in the hyperglycemic athymic nude mouse: immunohistochemical, ultrastructural, and hormonal studies

Previous studies in diabetic animal models have demonstrated altered pancreatic islet-cell populations. To further characterize the diabetic syndrome in our athymic nude mouse colony, we studied the population of endocrine cells in pancreatic islets of 4-week-old normoglycemic and 8-week-old hyperglycemic athymic nude (nu/nu) mice using immunohistochemistry, morphometry, and electron microscopy. In normoglycemic 4-week athymic nu/nu mice, the proportions of B (insulin-secreting) cells and A (glucagon-secreting) cells were similar to those in control Balb/c mice; however, the D (somatostatin-secreting) cells were significantly decreased in nu/nu mice. The populations of B and A cells appeared to be normal in hyperglycemic 8-week-old nu/nu mice while there was a significant increase in the proportion of D cells when compared with the proportion in Balb/c mice. Electron microscopic studies indicated that the appearance of B and A cells was similar in the 8-week-old hyperglycemic nu/nu and in controls; however, the D cells appeared to be enlarged and were finely packed with electron-dense secretory granules. Radioimmunoassays of the pancreatic content (micrograms/g fresh pancreas) of insulin, glucagon, and somatostatin in pancreata in 8-week-old normal Balb/c and hyperglycemic athymic nude mice were similar; however, the somatostatin content was significantly increased in the 8-week-old hyperglycemic nu/nu mice compared with age and sex-matched controls. These results demonstrate an altered D cell population and an increase in somatostatin levels in the pancreatic islets of the hyperglycemic athymic nude mouse animal model.(ABSTRACT TRUNCATED AT 250 WORDS)

Induction of bronchial hyperresponsiveness by Bordetella bronchiseptica infection in dogs

Six beagles were examined for time-related changes of bronchial responsiveness to methacholine, plasma histamine and thromboxane B2, and biopsy of bronchial tissues after intratracheal injection of Bordetella bronchiseptica. A progressive increase in bronchial responsiveness was induced after injection. The mediators, however, did not elevate and tissue neutrophil counts did not correlate with increased airway hyperresponsiveness. Intratracheal injection of heat-killed Bordetella bronchiseptica produced no alteration in these parameters. Thus, it is speculated that airway epithelial damage and effects on ciliostatic function induced by the organism are primarily involved in the pathogenesis.

[Clinical evaluation of the prehospital phase of acute myocardial infarction in the elderly]

In order to clarify the clinical characteristics of the prehospital phase of acute myocardial infarction (AMI) in the elderly, we studied 92 elderly (65 years old or more) and 41 younger patients with first AMI. Fifty eight elderly (63.1%) and 30 younger (72.7%) patients had typical symptoms such as chest pain at onset. There were 5 elderly cases who had no symptom, although all of the younger had some symptoms at onset. More than 70% of the younger cases developed their symptoms either between 6 am and noon or between 6 pm and midnight, whereas the elderly showed no such tendency. Intervals between the onset of symptoms and hospital admission (admission time) averaged 6.8 hours (hr) in the younger and 7.7 hr in the elderly. Approximately one half of the elderly and a quarter of the younger showed admission time more than 6 hr, respectively. Elderly cases with atypical symptoms tended to have a longer admission time than younger cases (7.2 vs 3.1 hr), although there was no significant difference between the elderly and the younger with typical symptoms (8.0 vs 7.9 hr). Younger patients with heart failure had significantly shorter admission time than those without heart failure (3.6 vs 8.6 hr). However, the elderly with heart failure showed a prolonged admission time (6.1 hr). Although there was no difference on admission time between survivors and non-survivors within 28 days after admission in the elderly (7.5 vs 8.4 hr), the elderly non-survivors with atypical symptoms had the longest admission time (13.0 hr).(ABSTRACT TRUNCATED AT 250 WORDS)

[Successful repair of a coarctation complex with an anomalous right subclavian artery in an infant]

A 46-day-old infant weighing 2250 g with the coarctation of the aorta, ventricular septal defect, PDA, the anomalous right subclavian artery, and the persistent left superior vena cava initially underwent by the reversed subclavian flap aortoplasty with the anomalous right subclavian artery and pulmonary arterial banding. The reversed subclavian flap aortoplasty was useful for the coarctation complex with the anomalous right subclavian artery. Two months later he gained weight to 2500 g, and then VSD closure and debanding of PAB was performed successfully. This two-staged operation was recommended for the poor risk coarctation complex with the anomalous subclavian artery.

Superoinferior ventricular heart with situs inversus, levo-loop and dextro-malposition (I,L,D), and double-outlet right ventricle: a case report

A case of a 20-year-old man with superoinferior ventricular heart complicating situs inversus, levo-loop and dextro-malposition (I,L,D), and double-outlet right ventricle is described. The associated anomalies were hypoplastic right ventricle, ventricular septal defect, atrial septal defect secundum, infundibular and valvular pulmonary stenosis, and mitral regurgitation. Intraventricular conduit repair was successfully performed.

Osteoporosis in juvenile-onset diabetes mellitus: morphometric and comparative studies

Ribs and vertebrae of 8 children and young adults aged from 17 months to 24 years with juvenile-onset diabetes mellitus, 4 with diabetes secondary to cystic fibrosis and 2 with diabetes secondary to thalassemia major, were analyzed for osteoporosis by a point-count morphometric method. The mean ratio of bone spicule to marrow space in cancellous bone of ribs of patients with juvenile-onset diabetes mellitus or with diabetes mellitus secondary to cystic fibrosis or thalassemia was 55% that of 10 control patients. The lengths of the zones of proliferating and mature cartilage cells in costal epiphyses of patients with juvenile-onset diabetes mellitus were also below normal. The ratio of bone spicule to marrow space of vertebrae of the diabetic patients was not significantly different from control values. The data confirm clinical reports that osteoporosis is a regular feature of juvenile-onset diabetes mellitus and suggest that the degree of bone matrix and mineral deficiency in such patients is greater than is usually considered.

Pancreatic islets in older patients with cystic fibrosis with and without diabetes mellitus: morphometric and immunocytologic studies

Forty patients with cystic fibrosis (CF), including 34 who died above age 10 years without having developed clinical diabetes mellitus and 6 who died with both cystic fibrosis and diabetes mellitus, were studied. The mean age of the female patients with CF but not diabetes was 15.8 +/- 5.6 years; of males without diabetes, 17.2 +/- 6.4 years; of female patients with CF and diabetes mellitus, 20.2 +/- 6.9 years; and of males with CF and diabetes, 21.3 +/- 6.6 years. The mean number of pancreatic islets in microscopic sections for patients with cystic fibrosis but not diabetes was 4.18 +/- 2.76/mm2, and the value for patients with both cystic fibrosis and diabetes mellitus was 2.61 +/- 2.07/mm2. The lowest density of pancreatic islets (1.69 +/- 0.48/mm2) for cystic fibrosis was found in patients with the latest-stage pathologic lesion. Nesidioblastosis (presence of ductuloinsular complexes) was identified in 14 of 38 cystic fibrosis patients, both with and without diabetes mellitus. The pancreatic islets of both diabetic and nondiabetic patients with CF showed hypertrophy; the mean volume of the three largest pancreatic islets for CF only was 0.0117 +/- 0.00657 mm3 and that for cystic fibrosis and diabetes was 0.00795 +/- 0.00599 mm3, both values being larger than normal. Ratios of the amounts of islet endocrine cells, A cells, B cells, and D cells, were determined by peroxidase--anti-peroxidase labeled antibody staining. The B cells composed 43.0% of endocrine cell mass in cystic fibrosis alone and 30.1% in cystic fibrosis with diabetes mellitus, which were lower than normal proportions. The D cell values, 11.9% in cystic fibrosis and 15.1% in cystic fibrosis with diabetes mellitus, on the other hand, were greater than normal ratios.

Pathologic studies of the osteoporosis of Von Gierke's disease (glycogenosis 1a)

Pathologic and point count-morphometric studies of ribs, vertebrae, and iliac crests of 7 patients with Von Gierke's glycogenesis type Ia aged 5 months to 30 years were performed. The bone lesion is a pure osteoporosis (reduction in mass of bone matrix) with no evidences of significant physeal cartilage abnormality or of osteitis fibrosa or osteomalacia (reduced mineralization of bone matrix). The osteoporosis was already marked in the youngest patient studied (5 months). The discrepancy between normal and glycogen storage disease (GSD) bones increased progressively with age for ribs and was less severe for vertebrae. Available biochemical data give no indication of primary disturbance of calcium or phosphate metabolism, of parathyroid activity, or of vitamin D metabolism. Clinical data suggest that the osteoporosis of Von Gierke's disease is due to hypoglycemia or a metabolic sequela thereof, such as insulinopenia, but pathologic study of patients treated by newer techniques of maintaining euglycemia in GSD is needed.

Growth patterns and prognosis in early gastric carcinoma. Superficially spreading and penetrating growth types

One hundred and sixty-seven cases of early gastric cancer were analyzed in terms of growth patterns and were then classified into the Small mucosal type, the superficially spreading (Super) type and the penetrating growth (Pen) type, the latter further subdivided into the Pen A type growing expansively and the Pen B type deepening infiltratively. The Small mucosal, Super, and Pen B types are characterized by a tendency toward dominant depressed lesions, a low incidence of vessel invasion and lymph node metastasis, and a good prognosis after surgery (about 90% of the patients survived for ten years). In contrast, the Pen A type is characterized by dominant elevated lesions usually comprised of well differentiated carcinoma, a relatively high incidence of vessel invasion and lymph node metastasis and a poor prognosis after surgery (64.8% five-year survival), due to early recurrence in the form of liver metastasis. Some attention is given to the related surgical approaches.