Epithelioid hemangioendothelioma presenting as a chest wall tumor

We report a case of epithelioid hemangioendothelioma presenting as a chest wall tumor. The patient had invasive bladder carcinoma and a soft-density mass protruding into the left thoracic cavity from the lateral chest wall on a computed tomographic scan. Percutaneous needle biopsy was performed to obtain a definite diagnosis of the chest wall tumor. Because of an intrathoracic hemorrhage after the procedure, the patient underwent an emergency thoracotomy and excision of the mass with adjacent structures. Pathologic examination demonstrated the mass to be a subpleural epithelioid hemangioendothelioma. This rare tumor has never been reported previously as arising from the chest wall.

Effects of flavonoids isolated from scutellariae radix on the production of tissue-type plasminogen activator and plasminogen activator inhibitor-1 induced by thrombin and thrombin receptor agonist peptide in cultured human umbilical vein endothelial cells

The effects of different flavonoids isolated from the roots of Scutellaria baicalensis Georgi on the production of tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) induced by thrombin and thrombin receptor agonist peptide, Ser-Phe-Leu-Leu-Arg-Asn-Pro-Asn-Asp-Lys-Tyr-Glu-Pro-Phe, have been examined in cultured human umbilical vein endothelial cells (HUVECs). Thrombin and thrombin receptor agonist peptide induced production of both t-PA and PAI-1 and the elevation of intracellular free calcium concentration ([Ca2+]i). Baicalein isolated from Scutellariae Radix dose-dependently inhibited PAI-1 production induced by thrombin and thrombin receptor agonist peptide; its concentrations for 50% inhibition (IC50) were 6.8 and 3.5 microM, respectively. Other flavonoids had no effect. In contrast, flavonoids isolated from Scutellariae Radix had no effect on production of t-PA induced by thrombin and thrombin receptor agonist peptide. Baicalein inhibited the elevation of [Ca2+]i induced by thrombin and thrombin receptor agonist peptide and, at a concentration of 1000 microM, slightly increased t-PA production. These findings suggest that the mechanism by which baicalein inhibits PAI-1 production induced by thrombin and thrombin receptor agonist peptide might be by reduction of [Ca2+]i elevation. The results suggest that baicalein in Scutellariae Radix might be active as a drug in the treatment of arteriosclerosis and thrombosis.

Prevention of endotoxemia-induced acute respiratory distress syndrome-like lung injury in rabbits by a monoclonal antibody to IL-8

We have herein established an endotoxemia-induced acute respiratory distress syndrome (ARDS)-like lung injury administered a sublethal dose of lipopolysaccharide (LPS) intravenously 36 hours after the intratracheal instillation of heat-killed Streptococcus pyogenes (OK-432). At 36 hours after OK-432 priming, a mild infiltration into the lungs, consisting of a small number of neutrophils and macrophages, was observed without destruction of pulmonary architecture. A subsequent challenge with a sublethal dose of LPS induced pathologic changes characteristic of ARDS--such as extensive edema in alveolar lumina, marked infiltration composed of a large number of neutrophils and a few macrophages, fibrin deposit in alveolar space, and destruction of pulmonary architecture--resulting in severe hypoxemia. Concomitantly, LPS challenge after priming with OK-432 induced a marked elevation of IL-8 levels in serum and bronchoalveolar lavage fluid with local IL-8 production in lungs, as revealed by immunohistochemical analysis. An anti-IL-8 antibody treatment almost completely prevented pulmonary edema, destruction of pulmonary architecture, and impairment in gas exchange as well as neutrophil infiltration in lungs; there was also a significant reduction in the rate of acute lethality. These results provide evidence that IL-8 has a pivotal role in the induction of ARDS associated with endotoxemia, probably by recruiting and activating neutrophils locally.

Surgical outcome of microscopic vasectomy reversal: an analysis of 30 cases

The results of 30 consecutive microscopic vasovasostomy procedures performed at a single institution over a five-year period between 1991 and 1995 were reviewed. When the surgical outcomes of patients who were operated on less than five years after their vasectomy were compared with the outcomes of those patients who received a vasovasostomy more than five years after their vasectomy, decreases in technical success rates were observed as measured by appearance of sperm in ejaculate (56% vs. 36%), biologic recovery as measured by mean sperm counts (56 million vs. 35 million) and mean progressive sperm motility (44% vs. 21%), along with a decrease in clinical success, as measured by overall pregnancy rates (50% vs. 7%, p < 0.05). Therefore, a microscopic vasovasostomy within 5 years of a vasectomy is a favorable procedure for vasectomy reversal.

Tumor lysis syndrome in invasive thymoma with peripheral blood T-cell lymphocytosis

Tumor lysis syndrome has rarely been observed in solid tumors. We report a case of a patient with advanced invasive thymoma associated with peripheral blood T-cell lymphocytosis in whom tumor lysis syndrome developed after chemotherapy. The potential for tumor lysis syndrome should be anticipated when treating extensive thymoma.

Effect of ischemia and partial outflow obstruction on rat bladder function

We investigated the effects of ischemia induced by ligation of the bilateral internal iliac arteries following partial outlet obstruction on changes in detrusor function in rat. Rats were divided into three groups: sham-operated control rats, rats with partial outlet obstruction, and rats with obstruction+ischemia. Bladder function was studied by the in vitro organ bath technique 7 days after surgery. The weight of the bladder was significantly increased in both the obstruction and obstruction+ischemia groups. The obstruction+ischemia group exhibited a greater increase in weight. The passive length-tension relationship of detrusor muscle strips showed that tissue elasticity was decreased and the active length-tension relationship demonstrated that the peak response was observed at a shorter tissue length in the obstruction+ischemia group compared with the other two groups. There was no difference in the passive and active length-tension relationships between the control group and the obstruction group. The contractile response to various kinds of stimulation (field stimulation, bethanechol, ATP, and KCl) increased in the obstruction group and decreased in the obstruction+ischemia group. These findings suggest that partial outflow obstruction alone increased bladder contractility in response to stimuli. However, ischemia reduced the contractility and elasticity of the bladder wall.

Association of eosinophil granule major basic protein with atopic cataract

PURPOSE

To investigate the mechanism of atopic cataract development, we examined a tissue-destroying major basic protein, derived from eosinophils, in the anterior capsule of cataractous lenses and the aqueous fluid of atopic dermatitis patients.

METHODS

Major basic protein deposition in anterior capsule tissues was evaluated immunohistochemically using anti-major basic protein monoclonal antibody in three consecutive eyes from three atopic cataract patients and three consecutive eyes from three senile cataract patients. Also, major basic protein concentration in aqueous fluid obtained during cataract surgery was measured by radioimmunoassay in 12 consecutive eyes from 11 atopic cataract patients and 15 consecutive eyes from 15 senile cataract patients.

RESULTS

Immunohistochemical investigation demonstrated lens epithelial major basic protein deposition in all three atopic cataracts but not in any of the senile cataracts. Major basic protein was detected in the aqueous fluid by radioimmunoassay in four of the 12 atopic cataract eyes and ranged in concentration from 11 to 70 ng/ml. No major basic protein was detected in the aqueous fluid of the 15 senile cataract eyes.

CONCLUSION

Major basic protein in anterior capsule tissues and in the aqueous fluid of eyes with atopic cataract may be associated with the pathogenesis of atopic cataract.

Damage to the primary dentition resulting from thumb and finger (digit) sucking

It is estimated that approximately 50 percent of infants at one year of age suck a thumb or finger. The number decreases rapidly by ages four to five years. The average age for spontaneous cessation of the habit is 3.8 years of age. Anterior open bite is the most frequent malocclusion reported with digit sucking. In this study the authors investigated the influence of thumb and finger-sucking in the anterior and posterior sections of the primary dentition in three age-groups: three, four, and five years. The study population included 930 subjects. Data for the non-oral-habit group were compared with the data for the thumb and/ or finger-sucking group. At all ages the frequencies of open-bite and maxillary protrusion for the thumb and finger-sucking group were higher than the non-oral-habit group. The frequencies did not appear age-related. There appeared to be an increased tendency to a permanent malocclusion in children who continued after four years of age.

[Diagnosis of pleural dissemination lung cancer by thin-section CT--a prospective study]

In this prospective study, thin-section CT was used to diagnose pleural dissemination in patients with pulmonary adenocarcinomas in which the primary lesion was found to be adjacent to the pleural surface by conventional CT. The subjects were 32 patients (25) who had undergone resection and 7 who had not with pulmonary adenocarcinoma without pleural effusion from among the 136 patients with pulmonary adenocarcinoma examined at our institution over 3 years. Thin-section CT images of three regions were obtained, and these included the pleural surface adjacent to the lesion, the minor fissure, and the diaphragmatic dome. Histopathological examination revealed pleural dissemination in 12 patients (5 who had undergone resection and who had not), in 2 of whom a diagnosis could not be made preoperatively. Pleural dissemination was diagnosed by CT in 12 patients; there were 2 false positives. In 6 patients who did not undergo resection, cancerous cells were found in fluid obtained by percutaneous pleural lavage, and mediastinal lymph node metastases or distant metastases were also detected. The diagnostic rate of CT was as follows interlobar space. 100% (7/7); mediastinum, 75% (3/4); diaphragm, 71% (5/7); and chest wall, 57% (4/7). In the patients who underwent resection, sensitivity was 100% for the interlobar space, but it was 0% to 33% for other pleural surfaces.

Effects of ethanol on in vivo cystometry and in vitro whole bladder contractility in the rat

PURPOSE

It is known that acute ethanol intoxication can produce urinary retention in patients with benign prostatic hyperplasia. We evaluated the effects of ethanol on rat bladder function in vivo and in vitro.

MATERIALS AND METHODS

Infusion cystometry was performed under urethane anesthesia with or without intravenous injection of ethanol. Voided volume, maximum voiding pressure, residual urine, bladder capacity, the pressure at which micturition was induced and voiding efficacy were compared. Subsequently, the in vitro whole bladder pressure generated by field stimulation, bethanechol, adenosine triphosphate and KCl in the presence of ethanol 0 to 5.0% was investigated.

RESULTS

Intravenous administration of ethanol changed the in vivo cystometrogram. Bladder capacity and residual urine volume were significantly increased, and voiding pressure was decreased. Contractility of the isolated whole bladder to various kinds of stimulation in vitro was suppressed by ethanol in a dose-dependent manner. Washing the bladder and incubating it in normal Krebs' solution following exposure to 5% ethanol restored detrusor contractility.

CONCLUSION

Ethanol significantly impairs detrusor contractility in the rat in vivo and in vitro.

[An elderly patient with gastric cancer surviving long after chemotherapy using UFT alone]

A 77-year-old patient with low activity of daily life (ADL) having advanced gastric cancer was treated by low dose UFT alone (300 mg/day) for more than 11 years. He survived, and neither remarkable progression nor metastasis of the gastric cancer has been observed in more than an 11-year hospital-free survival period. He has maintained his low ADL, and no side effects of the chemotherapy were observed. This case is probably rare, but suggestive in the choice of treatment for elderly patients.

High frequencies of human T-lymphotropic virus type I (HTLV-I) infection and presence of HTLV-II proviral DNA in blood donors with anti-thyroid antibodies

To investigate the relationship between human T-lymphotropic virus (HTLV) types I and II and the pathogenesis of autoimmune thyroid diseases, we examined serum anti-thyroid antibodies in 1019 blood donors with or without serum anti-HTLV-I antibody as well as proviral DNA for HTLV-II in leukocyte DNA by the polymerase chain reaction in 395 blood donors with or without anti-thyroid antibodies. The frequency of donors with anti-HTLV-I antibody who also showed anti-thyroid antibodies (7.9%) tended to be higher than that (6.3%) among donors who did not have the anti-HTLV-I antibody. The frequency of anti-thyroid antibodies in 125 young male donors aged 16-39 years with anti-HTLV-I antibody (4.8%) was significantly higher (P < 0.05) than that (0.6%) in 164 control donors without the antibody. In blood donors with anti-thyroid antibody, 25.0% of those with anti-HTLV-I antibody and 14.3% of those without the antibody had HTLV-II proviral DNA. In contrast, in donors without anti-thyroid antibody HTLV-II proviral DNA was detected in 2.3% of those with anti-HTLV-I antibody and in 0.6% of those without the antibody. Thus the detection rates in donors with anti-thyroid antibody were significantly higher (P < 0.001) than those in donors without the antibody, regardless of HTLV-I infection. These results suggest that HTLV-I infection and the presence of HTLV-II proviral DNA may be independently related to the pathogenesis of autoimmune thyroid diseases.

[A case of chronic scrotal hematocele]

We report a case of chronic scrotal hematocele. A 94-year-old man complained of urine retention and a painless mass in the right scrotum. He had no history of trauma at the perinium. Tumor markers such as human chorionic gonadotropin, alpha fetoprotein and carcinoembryonic antigen were within normal limits. A transillumination test was negative. A right high orchiectomy was carried out after admission with the diagnosis of suspicion testicular cancer. The extracted mass measured 85 x 60 x 75 mm and contained old brownish black blood. The right testis was located separately from the mass and had a normal appearance. Microscopic examination revealed depositions of cholesterin crystals characteristic of chronic hematocele.

Effect of age and dietary protein level on tissue mineral levels in female rats

Mineral (phosphorus, sulfur, potassium, calcium, magnesium, iron, zinc, copper, and manganese) concentrations were measured in plasma, and several tissues from female Wistar rats (young: 3-wk-old; mature: 6-mo-old) were fed on a dietary regimen designed to study the combined or singular effects of age and dietary protein on mineral status. Three diets, respectively, contained 5, 15, and 20% of bovine milk casein. Nephrocalcinosis chemically diagnosed by increased calcium and phosphorus in kidney was prevented in rats fed a 5% protein diet. Renal calcium and phosphorus were more accumulated in young rats than mature rats. A 5% protein diet decreased hemoglobin and blood iron. The hepatic and splenic iron was increased by a 5% protein diet in mature rats but was not altered in young rats. Mature rats had higher iron in brain, lung, heart, liver, spleen, kidney, muscle, and tibia than young rats. A 5% protein diet decreased zinc in plasma and liver. Zinc in tibia was increased with dietary protein level in young rats but was not changed in mature rats A 5% protein diet decreased copper concentration in plasma of young rats but not in mature rats. Mature rats had higher copper in plasma, blood, brain, lung, heart, liver, spleen, and kidney than young rats. With age, manganese concentration was increased in brain but decreased in lung, heart, liver, kidney, and muscle. These results suggest that the response to dietary protein regarding mineral status varies with age.

Morgagni hernia diagnosed by MRI

We herein present a patient with Morgagni hernia which was diagnosed by magnetic resonance imaging (MRI). The patient had a progressively enlarging mass in the right cardiophrenic angle on chest roentgenogram. On computed tomography (CT) scans, the mass was revealed to have fat density and therefore was suspected to be either a lipoma or liposarcoma. MRI clearly demonstrated that the mass shadow was composed of omental fat herniating into the right thorax through the diaphragmatic hiatus. MRI is thus considered to be a useful noninvasive modality for the evaluation of lower anterior mediastinal masses demonstrating fat density on CT.

Functional restoration of rat bladder after subtotal cystectomy: in vivo cystometry and in vitro study of whole bladder

Functional restoration of the rat urinary bladder following subtotal cystectomy was studied via in vivo infusion cystometry and an in vitro whole bladder model. After the bladder had been separated from the prostate, subtotal cystectomy was achieved by ligating the bladder completely at a level just above the insertion of the ureters into the bladder. Bladder function was investigated immediately and 7, 14, and 28 days after surgery. Bladder weight was reduced to 17% that in sham-operated controls immediately after surgery, but recovered to 76% of that in controls 28 days after the operation. In vivo capacity also increased after surgery from 13% that of controls to 59% 28 days later. However, voiding pressure remained low (34% of control) 28 days later. An in vitro whole bladder study showed that the response to field stimulation decreased significantly on day 7, but had recovered considerably by day 28. The maximal response to bethanechol decreased significantly 7 days after surgery, but recovered thereafter. The response to phenylephrine increased significantly immediately after surgery, but gradually returned to the control level. An in vitro volume-pressure study showed that passive compliance of the cystectomized bladder decreased after surgery, but improved with time. The peak of the active pressure increase to field stimulation occurred at a low infusion volume immediately after surgery, but bladder capacity increased gradually until 28 days later, when the maximal active pressure was obtained. Our results suggest that restoration of the bladder following subtotal cystectomy may not derive simply from an expansion of the bladder wall. Functional alteration involving the bladder base was also observed.

Evidence of HTLV-I in thyroid tissue in an HTLV-I carrier with Hashimoto's thyroiditis

Human T-lymphotropic virus type l (HTLV-I) protein and messenger RNA (mRNA) for HTLV-I were examined in thyroid tissues from two patients with Hashimoto's thyroiditis and serum anti-thyroid antibody. The virus envelope protein and signals for the mRNA were detected in many of the follicular epithelial cells of the thyroid tissue from one of the patients, respectively, by immunohistochemistry and in situ hybridization. PCR-Southern blotting revealed the presence of HTLV-I DNA in the thyroid tissue, in which the viral protein and mRNA were detected, although no virus particles were found in the epithelial cells by electron microscopy. HTLV-I virus was not present in the thyroid tissue from the second patient. The present findings suggest that infection of thyroid tissue with HTLV-I is associated with the pathogenesis of Hashimoto's thyroiditis in some patients.

Facial injury by mercury from a broken thermometer

The case of a 2-year-old girl with a facial soft-tissue injury from an accident with a mercury thermometer is presented. All tissues containing droplets of metallic mercury should be removed immediately and careful examination for signs of mercury poisoning should be conducted over the long term.

Tissue manganese levels and liver pyruvate carboxylase activity in magnesium-deficient rats

To investigate the manganese status in magnesium deficiency, 40 male Wistar rats, 3 wk old, were divided into two groups and fed a magnesium deficient diet or a normal synthetic diet for 2 wk. Dietary magnesium depletion decreased magnesium levels in brain, spinal cord, lung, spleen, kidney, testis, bone, blood, and plasma, while it elevated the magnesium level in liver. In magnesium-depleted rats, calcium concentration was increased in lung, liver, spleen, kidney, and testis, while it was decreased in tibia. In magnesium-depleted rats, manganese concentration was decreased in plasma and all tissues except adrenal glands and blood. Dietary magnesium depletion diminished pyruvate carboxylase (EC 6.4.1.1) activity in the crude mitochondrial fraction of liver. Positive correlation was found between the liver manganese concentration and the pyruvate carboxylase activity. In the magnesium-depleted rats, glucose was decreased while plasma lipids (triglycerides, phospholipids, and total cholesterol) were increased. These results suggest that dietary magnesium deficiency changes manganese metabolism in rats.

Isolated incisional recurrence after curative resection for primary lung cancer

We present a long-term survivor with isolated recurrent tumor in the incisional scar that developed 9 months after a curative resection for primary lung adenocarcinoma. She underwent an excision of the tumor followed by systemic chemotherapy, and is currently alive with no evidence of disease 69 months after the recurrence. Isolated incisional recurrence after complete resection of lung cancer is a rare phenomenon and may be curable using multimodal treatment.

Takayasu's arteritis associated with antiphospholipid antibodies. Report of two cases

The authors describe 2 patients with Takayasu's arteritis in whom lupus anticoagulant was positive and the titer of anticardiolipin antibody was elevated. One patient developed diffusely stenotic and occlusive changes in the multiple larger arteries. Histology of the small-sized arteries in another patient showed occlusive vasculitis without thrombosis, in addition to the findings in large-sized arteries compatible with Takayasu's disease. These findings are uncommon in Takayasu's arteritis. These findings suggest that antiphospholipid antibodies may have contributed to the pathogenesis of the extensive vasculopathy and may have triggered vasculitis in these patients.

Effects of in vivo Ischemia on the infusion cystometry and in vitro whole bladder contractility of the rat

Ischemia induced by atherosclerosis is a common cause of organ failure in the elderly. We investigated the effects of in vivo ischemia created by ligation of the internal iliac arteries on the parameters of in vivo infusion cystometry under urethane anesthesia and on in vitro whole bladder contractility of the rat. Bladder weight significantly increased after ischemia for 14 days. Infusion cystometry demonstrated that in the ischemic bladders the capacity increased, the voiding pressure decreased, and the volume of residual urine increased, which resulted in deteriorated voiding efficacy. The in vitro whole bladder contractility to field stimulation, bethanechol, ATP, and KCl was reduced by ischemia. The passive pressure increased as the bladder volume enlarged and the bladder compliance once decreased by ischemia on the 7th day, but increased on the 14th day. In an active volume-pressure relationship study the peak response was decreased by ischemia. The volume at which response reached a peak value shifted to a larger volume 14 days after surgery. In conclusion, ischemia impaired in vivo rat detrusor power to empty. Since detrusor contractility in vitro decreased in response to various kinds of stimulation, this deteriorated bladder function was supposed to be caused by muscle degeneration.

Brain metastasis in resected lung cancer: value of intensive follow-up with computed tomography

BACKGROUND

Brain metastases are a common mode of recurrence in resected lung cancer and are usually associated with an ominous outcome.

METHODS

To assess the usefulness of follow-up using computed tomography of the brain for early detection and effective treatment of brain metastases, we prospectively studied 128 patients with completely resected non-small cell lung cancer. Follow-up computed tomographic scans were obtained every 2 to 6 months over 24 postoperative months in 69 patients and every 2 months for 6 postoperative months in 59.

RESULTS

Brain metastases were discovered in 11 patients (8.6%), and 7 patients were neurologically asymptomatic when the metastases were diagnosed. Single metastasis was found in 5 patients and multiple metastases in 6. The maximal size of all but one lesion was less than 25 mm. The median survival time and 5-year survival rate in all 11 patients with brain metastases were 10 months and 24%, respectively. Furthermore, those in 7 asymptomatic patients were 25 months and 38%, respectively.

CONCLUSIONS

We consider intensive follow-up with computed tomography to be worthwhile for early detection and effective treatment of brain metastases in patients with completely resected lung cancer.

Effects of Ischemia on the function of the isolated rat detrusor muscle

Ischemia of vital organs causes various degrees of impairment. We studied the in vitro effects of ischemia on the function of the rat bladder. Ischemia was induced by ligation of the bilateral (bilateral ischemia) or right (unilateral ischemia) internal iliac arteries. Bladder weight increased significantly following 1 week of bilateral and unilateral ischemia. Passive tension was significantly higher in ischemic bladders than in control bladders at an increase in length between 6 and 12 mm. In both control and ischemic bladders, active tension was highest at a 16-mm increase in length. Bladders subjected to unilateral or bilateral ischemia for 1 or 2 weeks demonstrated impaired contractile responses to field stimulation, bethanechol, ATP and KCl. There were no differences in contractile strength between muscle specimens obtained from the ipsilateral or contralateral sides of unilateral ischemic bladders. Our findings showed that unilateral and bilateral ischemia inhibited the in vitro contractile strength of the detrusor muscle in response to intramural and pharmacologic stimulation.

[Double-primary cancer of the lung and trachea]

A 70-year-old woman with no history of smoking was admitted to the hospital because of a persistent cough and pneumonia in the right lower lobe. Examination with a fiberoptic bronchoscope revealed an intratracheal polypoid tumor and a polypoid tumor almost completely obstructing the right bronchus B(8). Biopsies were done, and histological diagnosis of both tumors was squamous cell carcinoma. A sleeve resection of the trachea with end-to-end anastomosis and right lower lobectomy were done. Examination of specimens resected from both tumors revealed moderately differentiated squamous cell carcinoma. Synchronous double-primary cancer (both squamous cell carcinoma) of the lung and trachea in a non-smoker is very rare.

Iron accumulation in tissues of magnesium-deficient rats with dietary iron overload

The mineral imbalances in magnesium-deficient rats with dietary iron overload were studied. Forty-four male Wistar rats were divided into six groups and fed six diets, two by three, fully crossed: magnesium adequate or deficient, and iron deficient, adequate, or excess. The concentrations of iron, magnesium, calcium, and phosphorus in tissues of the rats were measured. The results were as follows: (1) The excess iron intake reinforced the iron accumulation in liver and spleen of magnesium deficient rats; (2) The saturation of iron binding capacity was enormously elevated in the magnesium deficient rats fed excess iron; and (3) Dietary iron deprivation diminished the degree of calcium deposition in kidney of magnesium deficient rats. These results suggest that magnesium-deprived rats have abnormal iron metabolism losing homeostatic regulation of plasma iron, and magnesium deficient rats with dietary iron overload may be used as an experimental hemochromatosis model.

Effect of low dietary rubidium on plasma biochemical parameters and mineral levels in rats

The effects of low dietary rubidium on plasma biochemical parameters and mineral levels in tissues in rats were studied. Eighteen male Wistar rats, weighing about 40 g, were divided into two groups and fed the diets with or without supplemental rubidium (0.54 vs 8.12 mg/kg diet) for 11 wk. Compared to the rats fed the diet with supplemental rubidium, the animals fed the diet without rubidium supplementation had higher urea nitrogen in plasma; lower rubidium concentration in tissues; lower sodium in muscle; higher potassium in plasma, kidney and tibia, and lower potassium in testis; lower phosphorus in heart and spleen; lower calcium in spleen; higher magnesium in muscle and tibia; higher iron in muscle; lower zinc in plasma and testis; and lower copper in heart, liver, and spleen, and higher copper in kidney. These results suggest that rubidium concentration in tissues reflects rubidium intake, and that rubidium depletion affects mineral (sodium, potassium, phosphorus, calcium, magnesium, iron, zinc, and copper) status.

Highly sensitive and simple liquid chromatographic determination in plasma of B6 vitamers, especially pyridoxal 5'-phosphate

A simple and sensitive high-performance liquid chromatographic method for measuring the major vitamers of vitamin B6, i.e. pyridoxal and pyridoxal 5'-phosphate (PLP), and 4-pyridoxic acid (4-PA) in plasma was developed. The vitamers and 4-PA from plasma were extracted with 0.8 mol/l perchloric acid. The separation by HPLC is accomplished using an ODS reversed-phase column and a mobile phase of 0.1 mol/l potassium dihydrogen phosphate containing 0.1 mol/l sodium perchlorate, 0.5 g/l sodium bisulfite adjusted to pH 3, at a flow-rate of 1.0 ml/min. The vitamers and 4-PA were eluted within 13 min and their concentration is determined with a fluorometric detector (excitation, 300 nm; emission, 400 nm). In this method, PLP in plasma can be determined with high sensitivity using derivatization with sodium bisulfite in the mobile phase.

Pleuropneumonectomy and postoperative adjuvant chemotherapy for carcinomatous pleuritis in primary lung cancer: a case report of long-term survival

We present a 5-year survivor with lung adenocarcinoma accompanied by carcinomatous pleuritis who underwent pleuropneumonectomy followed by systemic chemotherapy. The pleural disease was not detectable on the chest roentgenograms or computed tomographic scans. The combination of the surgical procedure and postoperative adjuvant chemotherapy may be a potentially curative treatment in selected patients with carcinomatous pleuritis of lung cancer.

Neurological disorder and excessive accumulation of calcium in brain of clinically vitamin A-deficient rats

Three groups of rats were fed two types of synthetic diets for 52 d. The -A group was allowed free access to a vitamin A-deficient diet and showed classical signs of vitamin A deficiency. The brain was the only organ in our experiment where no significant weight difference was present among the three groups. In the brain, calcium concentration was significantly higher in the -A group when compared with the PF (Pair-fed; allowed restricted amount of control diet) and +A groups (allowed free access to control diet). In the tibia, calcium and magnesium concentrations were significantly lower in the -A group when compared with other two groups. Excessive accumulation of calcium in brain and apparently similar unbalance in bone mineral concentration were observed in central nervous system (CNS) degenerative diseases. Our results suggest that abnormal metabolism of calcium and magnesium in some tissues and excessive accumulation of calcium in brain may be responsible for the development of neurological disorders in vitamin A-deficient rats.

A case of sex reversal syndrome with sex-determining region (XX male)

We examined a 32-year-old man with a 4-year history of infertility. The man's sex life, male hair pattern, and penis were normal, and he had no history of erection problems. Left and right testicular volumes were 2 ml and 3 ml, respectively. Semen analysis showed no sperm. The endocrine panel revealed increased serum luteinizing hormone and follicle-stimulating hormone levels, and a normal serum testosterone level. A testicular biopsy demonstrated that both Leydig cell and Sertoli cell hyperplasia were present, and that no germ cells were found in the tubules. A chromosome analysis done on the peripheral blood lymphocytes revealed a karyotype of 46, XX. We identified the sex-determining region, Y, by polymerase chain reaction using Y-specific probes in this patient. The diagnosis was XX male.

Increased serum IgE level and interleukin-4 release from cultured lymphocytes from a patient with adult onset Still's disease

OBJECTIVE

To evaluate the relationship between high serum levels of IgE and the release of interleukin-4 (IL-4) from cultured lymphocytes of a patient with adult onset Still's disease.

METHODS

IL-4 concentrations in plasma and culture from inactivated peripheral blood mononuclear cells were assessed by enzyme immunoassay during febrile episodes and remission.

RESULTS

A high level of IL-4 was detected by enzyme immunoassay in the peripheral blood mononuclear cells cultured from the patient. These seemed to correspond with a febrile episode and a high serum IgE concentration.

CONCLUSION

Increased serum IgE concentrations during a febrile episode are rare in patients with adult onset Still's disease, but the relationship between the high levels of serum IgE and IL-4 in cultured lymphocytes may provide clues to pathogenesis of the condition.

Endovascular papillary angioendothelioma-like tumour associated with lymphoedema

A case of endovascular papillary angioendothelioma-like tumour associated with lymphoedema is described. Microscopically, the tumour was composed of anastomosing vascular channels, some of which contained papillary projections, producing tuft-like or glomeruloid appearances. The dermis also showed moderate lymphoedema and lymphocytic infiltrate. The tumour resembled endovascular papillary angioendothelioma but also had several features that differed from typical examples: occurrence in an old patient and less prominent endothelial hobnail features and lymphocytic infiltrate. Three types of proliferating cells were observed: 1 mature flattened endothelial cells, which were strongly positive for endothelial markers (factor VIII-related antigen, CD31, CD34) and bound ulex europaeus agglutinin 1;2 immature endothelial cells with round nuclei and vacuolated or pale cytoplasm, which were strongly positive for CD31 and muscle-specific actin (HHF35) and focally positive for other endothelial markers; and 3 stromal spindle cells in papillary or glomeruloid areas, which were positive for vimentin, HHF35, and alpha-smooth muscle actin but negative for desmin. The tumour was diploid by flow cytometry. The patient was well without disease twelve months after the excision. We postulate that this tumour was caused by circulatory disturbance, namely lymphoedema associated with syringomyelia and a Charcot's joint.

[Thymic Hodgkin's disease with cystic variants: a case report]

We report an unusual case of thymic Hodgkin's disease with cystic variants. The patient complained of nodules in his neck. Chest radiographs showed a mass with cystic lesions in the anterior mediastinum. Although Hodgkin's disease was suspected from pathologic examination of biopsy specimens of the neck nodules, the mediastinal and neck masses could not be precisely diagnosed until a median sternotomy was done. The surgically excised mediastinal masses revealed thymic Hodgkin's disease with cystic lesions. The patient has done well after chemotherapy and radiotherapy. Thymic Hodgkin's disease with cystic variants is very rare and only seventeen cases of this disease have been reported.

[Clinical evaluation of the small solitary pulmonary nodule]

The diagnostic process for small solitary pulmonary nodules was retrospectively analyzed. Three hundred and forty-three patients, each with a solitary pulmonary lesion of less than 3 cm on chest radiography, were evaluated. The patients were seen at our hospital between September 1986 and December 1993. They consisted of 138 with malignant diseases (114 with lung cancer and 24 with metastatic tumors), and 205 with benign diseases. There were 146 patients (71%) with benign lesions of less than 2 cm. The diagnosis in 118 patients (86%) with malignant disease was made by lung biopsy. Of these 118 patients, 19 underwent biopsy of the lung through a thoracoscope or open lung biopsy via a thoracotomy. Benign diseases were diagnosed in 167 patients (81%) by various laboratory tests and imaging techniques, including chest radiography. Thinsection CT was done in 132 patients. In 72 of these 132 patients (16 with lung cancer, 23 with metastatic tumors, and 33 with benign tumors), a judgement regarding whether the lesion was malignant or not could not be made. Therefore, open lung biopsy was done in 5 patients. Twenty-four patients were only observed, 43 underwent biopsy, and 35 underwent surgery. A decision tree needs to be established to select therapeutic options for management of patients whose diagnoses remain indeterminate even after thin-section CT. Formulation of a decision tree based not only on clinical findings but also on the results of diagnostic imaging is necessary to improve clinical decision making regarding small solitary pulmonary nodules.

Mitochondrial encephalomyopathy with autosomal dominant inheritance: a clinical and genetic entity of mitochondrial diseases

We report a Japanese family with chronic progressive external ophthalmoplegia (CPEO) with autosomal dominant inheritance, and review 54 reported CPEO patients in seven families (including the present family) with autosomal dominant inheritance and mtDNA deletions in the skeletal muscle. Mean age at onset in the CPEO was 26 years, which is older than that in published solitary cases. In addition to blepharoptosis and external opthalmoplegia, proximal muscle atrophy and weakness were found in 62%, hearing loss in 25%, and ataxia in 17% of the patients. Retinal degeneration was not found, and cardiac involvement was very rare. mtDNA deletions in the muscle were multiple and large scale, and all such deletions were located in the non-D-loop region. Autosomal dominant CPEO has unique clinical features which differ from those of solitary CPEO, and is associated with multiple large-scale mtDNA deletions. Thus, autosomal dominant CPEO can be considered a clinical and genetic entity of mitochondrial diseases.

Iron, zinc, and copper levels in different tissues of clinically vitamin A-deficient rats

To clarify the effect of vitamin A deficiency on iron, zinc, and copper status in different tissues, three groups of rats were fed two types of synthetic diets for 52 d. Group one, which was fed a vitamin A-deficient diet, showed severe signs of vitamin A deficiency. Groups two (fed restricted amount, pair-fed with group one), and three (fed diet ad libitum) were fed a control diet. After said period of feeding, iron, zinc, and copper were measured in different tissues. Significant changes observed when the groups were compared are summarized below: 1. Iron and copper in testes were increased significantly, whereas zinc was strikingly decreased in group one when compared with the other groups; 2. Copper (in lung and kidney) and iron (in the spleen) were increased significantly in group one compared with the other groups; 3. In the liver, iron, zinc, and copper were significantly different between group one and group two; 4. In muscle, iron was significantly higher in group one than group two; 5. In tibia and blood, iron levels (but not zinc and copper) in groups one and two were significantly higher than group three. These results suggest that vitamin A deficiency affects iron, zinc, and copper status in rats.

Presence of human T-lymphotropic virus type II-related genes in DNA of peripheral leukocytes from patients with autoimmune thyroid diseases

No etiologic role of human T-lymphotropic virus type II (HTLV-II) in any disease is yet known. The present study showed a high incidence of HTLV-II proviral DNA fragments in DNA of peripheral blood leukocytes from patients with autoimmune thyroid diseases. Using primers for the pol and tax regions of HTLV-II proviral DNA, amplified DNA fragments were demonstrated in 51.5% of the patients with Hashimoto's thyroiditis and in 11.8% of those with Graves' disease examined, but in only 1.9% of the disease controls and 1.0% of healthy individuals. These amplified DNA fragments hybridized with each of the inner probes. The nucleotide sequences of the DNA fragments of the pol and tax regions showed high homology with those of the prototype of HTLV-II. No antibodies for HTLV-II could, however, be detected in the patients examined. Because of the absence of its antibody, HTLV-II infection was not confirmed in these patients, but the presence of HTLV-II proviral DNA or its related DNA at high frequency suggests a relationship of HTLV-II with the development of autoimmune thyroid diseases.

Water content in experimental dentine primers to minimize the contraction gap width of a light-cured resin composite

OBJECTIVES

The effect of water content in experimental dentine primers consisting of an aqueous solution of either glyceryl methacrylate (GM) or hydroxyethyl methacrylate (HEMA), and in experimental self-etching dentine primers composed of methacryloxyethyl hydrogen phenyl phosphate (Phenyl-P), was evaluated by measuring the wall-to-wall polymerization contraction gap width of a commercial light-activated resin composite filled in a cylindrical dentine cavity prepared in an extracted human molar.

METHODS

A commercial light-cured dentine bonding agent was applied to the cavity after cleaning with EDTA and priming with either GM or HEMA, or after self-etching priming by Phenyl-P diluted in either GM or HEMA solution.

RESULTS

In the GM and HEMA solutions, the gap width was minimized when the water content was 65 wt% even though gap formation could not be prevented by HEMA solution. With the self-etching dentine primers, gaps could not be observed under the light microscope with 16 wt% Phenyl-P diluted in 35 wt% GM or HEMA or with 20 wt% Phenyl-P diluted in 20 wt% GM or HEMA.

CONCLUSION

The water content in both the experimental dentine primers and the self-etching dentine primers which yielded the minimum contraction gap width for the resin composite in the dentine cavity was approximately 60 wt%.

Serum inhibin levels in normal men and men with idiopathic infertility

In vitro studies have shown that the Sertoli cell is the primary source of inhibin in the male. To assess the regulation of inhibin production we measured serum inhibin, FSH, LH and testosterone in 21 normal men and 104 men with various testicular disorders resulting in infertility. The infertile men were subdivided into groups on the basis of their mean sperm count, FSH and LH levels. The mean serum concentrations of inhibin in the normal men were 602 +/- 29 U/L and were significantly decreased in those groups with severe oligozoospermia (p < 0.01) or azoospermia (p < 0.01; p < 0.001). The FSH concentrations correlated inversely with serum inhibin concentrations (p < 0.001) in azoospermic men. Azoospermic men with high FSH had significantly lower inhibin and testosterone levels when compared with normal men (p < 0.01; p < 0.001). Serum FSH concentrations were significantly increased in azoospermic men (p < 0.001). Our present results of serum concentrations of inhibin correlating inversely with those of FSH levels suggest that measurement of inhibin may be a useful circulating marker of Sertoli cell function.

The effect of varicocelectomy on testicular volume in infertile patients with varicoceles

The presence of a varicocele has been associated with decrease in testicular volume both in adult and pediatric patients. However, a study on the effect of varicocelectomy on testicular volume in the adult varicocele patient has never been reported. We determined the testicular volume before and after varicocelectomy in 52 patients with varicocele. A significant increase in testicular volume with the right side showing a greater increase was observed (p < 0.05). No greater increase in testicular volume was noted among the patients who achieved a pregnancy with their spouses. In addition, the age of the patient did not correlate with the observed change in testicular volume. These results suggest that varicocele is clearly related to decreased testicular volume and that varicocelectomy can increase bilateral testis volume resulting in improved testicular function.

Graves' disease in HTLV-I carriers

Three carriers of human T-lymphotropic virus type I (HTLV-I) with Graves' disease are reported. All three cases were complicated with uveitis, and one also showed chronic arthropathy. Anti-HLTV-I antibody was found in the serum by the particle agglutination method and western blotting, and HTLV-I proviral DNA was detected in peripheral lymphocytes by the polymerase chain reaction and Southern blotting. HTLV-I is a causal agent of adult T-cell leukemia and HTLV-I associated myelopathy/tropical spastic paraparesis, and is believed to be related to the pathogenesis of diseases such as chronic arthropathy, uveitis, chronic bronchoalveolitis, and Sjögren's syndrome. On the other hand, retrovirus infection is considered to cause autoimmune diseases. Thus, the pathogenesis of Graves' disease in the present patients might be associated with HTLV-I infection.

Cholesterol emboli following percutaneous transluminal coronary angioplasty as speculated by toe skin biopsy

A 55-year-old man required hemodialysis for acute renal failure 3 days after repeat percutaneous transluminal coronary angioplasty (PTCA). Bilateral acrocyanosis and necrotic lesions of the toes occurred 10 days after PTCA. Skin biopsy samples revealed needle-shaped cholesterol crystals of the intraluminal clefts in his small arteries. He was diagnosed with cholesterol emboli presenting as blue toe syndrome. The conditions improved with anticoagulation and vasodilation, but improvement in renal function was temporary. He later required maintenance hemodialysis. Cholesterol emboli following PTCA are life threatening because they are difficult to diagnose and can cause severe complications.

Successful in vitro fertilization and pregnancy by the micromanipulation with sperm from efferent duct retrieved by micropuncture technique in a patient with congenital absence of the vas deferens

A case of successful in vitro microfertilization and pregnancy of 30-year-old woman with sperm from efferent duct retrieved by a micropuncture technique combined with perivascular nerve stimulation from a patient with congenital absence of the vas deferens is reported. Treatment of couples involving men with surgically unreconstructible vasal obstruction is now possible. Our experience indicates that sperm from the efferent duct retrieved by this new technique, when combined with assisted reproductive technologies, permit fertilization and subsequent pregnancy for the men with surgically irreparable vasal obstruction.