WS9326A, a novel tachykinin antagonist isolated from Streptomyces violaceusniger no. 9326. I. Taxonomy, fermentation, isolation, physico-chemical properties and biological activities

Data from several studies suggest that tachykinins may play an important role in the pathophysiology of airway diseases, especially asthma. Our aim is to discover tachykinin antagonists which exhibit therapeutically useful anti-asthmatic activity. In our search for activities inhibiting the binding of [3H]substance P to guinea-pig lung membrane preparations, we have found that the fermentation product, WS9326A, isolated from Streptomyces violaceusniger, is a potent tachykinin receptor antagonist.

[Experimental studies on metastases from an irradiated tumor]

This study was carried out to determine the effect of irradiation of a tumor on the development of lung metastases. SANH, a spontaneous sarcoma, was isotransplanted in the right thighs of C3H mice which were either locally preirradiated (30 Gy: TBR) or non-irradiated. When the tumors had grown to 7 mm in diameter, they received 20-30 Gy of electron beams (RTx). The tumor-bearing legs were amputated at various tumor sizes, and the incidence of metastasis and number of lung nodules were compared in each treatment group. The incidences of metastases from 7 mm tumors in mice with regrowing tumors after RTx (30 Gy) and non-irradiated mice were 28% and 4%, respectively. When tumors grown in preirradiated legs were removed at 7 mm in diameter, the incidence of metastases (58%) was also enhanced by preirradiation of the tumor bed. Seven millimeter tumors that were growing in TBR legs and received RTx (20 Gy) developed a higher incidence (82%) and greater numbers of metastases than either the RTx or TBR groups. To determine the relationship between the interval of tumor bearing and development of metastases, tumors were removed at various intervals after tumor transplantation in 4 groups, namely, non-irradiated, TBR, RTx and TBR with 20 GyRTx. Lung metastases came later but increased steeply in mice given either TBR or RTx, compared with non-irradiated mice. Tumors growing in TBR and receiving RTx (20 Gy) developed many more metastases than any other group.(ABSTRACT TRUNCATED AT 250 WORDS)

Identification of 7 alpha-hydroxy-3-oxo-4-cholestenoic acid in chronic subdural hematoma

We detected a novel kind of bile acid in the content of chronic subdural hematoma. This substance was specifically found in chronic subdural hematoma, and not in subdural hygroma, which is pathologically similar except for the lack of capsular membrane. The compound was identified as 7 alpha-hydroxy-3-oxo-4-cholestenoic acid by high performance liquid chromatography, gas chromatography-mass spectrometry, and nuclear magnetic resonance spectrometry. The structure was confirmed by the comparison with the chemically synthesized compound. The average contents in chronic subdural hematoma were 658.09 +/- 137.53 ng/ml, while those in normal human plasma were 126.27 +/- 17.73 ng/ml. It was not detected in normal cerebrospinal fluid. The higher level in chronic subdural hematoma than human plasma strongly suggests the local, extrahepatic production of this type of C27 bile acids.

Simultaneous measurements of adenosine deaminase activity and tuberculostearic acid in pleural effusions for the diagnosis of tuberculous pleuritis

Adenosine deaminase (ADA) activity and tuberculostearic acid (TSA) levels in pleural effusions were measured in 18 patients with active tuberculous pleuritis, 16 patients suspected of having tuberculous pleuritis, 14 patients with carcinomatous pleuritis, and 19 patients suffering from pleuritis of non-malignant and non-tuberculous etiology. In the patients with active tuberculous pleuritis, ADA was elevated in 56% and TSA was positive in 78%. In 83% of these patients, either ADA was elevated or TSA was positive. ADA was elevated together with a positive TSA in 50%. In contrast, TSA was positive in only 6% and ADA was elevated in 24% of the patients with non-tuberculous pleuritis, and none of these patients showed the combination of an elevation of ADA and a positive TSA. These results suggest that simultaneous measurements of both ADA and TSA in pleural effusions are useful for the diagnosis of tuberculous pleuritis.

WF11605, an antagonist of leukotriene B4 produced by a fungus. II. Structure determination

The structure of WF11605, a novel tetracyclic triterpene glucoside, was determined to be 1. The plane structure of deacetyl-WF11605 aglycone was elucidated as 2 through the concerted application of a series of 2D NMR techniques. The relative configurations were established by X-ray crystallographic analysis of bis(p-bromobenzoyl) derivative 3 and absolute stereochemistry by CD exciton chirality method.

[Evaluation of plasma SC5b-9 (SMAC) in patients with ARDS]

The adult respiratory distress syndrome (ARDS) occurs in patients with various underlying illnesses. It has been suggested that complement activation may play a crucial role in the pathophysiology of ARDS by direct actions of complement fragments and/or by release of mediators including endotoxin, superoxide anion, and arachidonate metabolites. Therefore, complement evaluation was performed in patients with ARDS, with emphasis on SC5b-9 (Membrane Attack Complex). Complement split products, C4d, Bb, and SC5b-9, respectively from the classical, alternative, and terminal complement pathway were measured by enzyme immunoassay (EIA) using respective monoclonal antibodies. Plasma S-protein (vitronectin) concentration was also evaluated by EIA. We could not detect SMAC in normal controls or in a C5-deficient patient with abdominal infection. In contrast, most patients with ARDS and patients at risk showed elevated SMAC, and an increase in the values in association with exacerbation of the disease. However, two patients with ARDS exhibited lower values of SMAC in spite of deterioration and subsequent death. It was suggested that in these two ARDS patients, liver dysfunction may have contributed to the reduced SMAC formation. The finding that S-protein concentration (a MAC inhibitor) in the plasma of these two patients was reduced supports this speculation. It is suggested that simultaneous evaluation of SMAC and S-protein in plasma is helpful in determining the prognosis of critically ill patients.

Adverse effect of chronic tonsillitis on clinical course of sarcoidosis in relation to HLA distribution

We examined the effect of chronic inflammatory foci in the upper respiratory tract and/or HLA class 2 antigens on the clinical course of sarcoidosis. Sarcoidosis resolved spontaneously in 6 of 27 (22 percent) patients with CTL and in 19 of 29 (66 percent) without CTL (p less than 0.01). The clinical course became favorable after TLT in 7 of 14 cases with CTL. Patients with HLA-DR9 and DRw8 showed the highest ratio of patients who had protracted clinical course; those with HLA-DR2, DR5 and DR6 showed the lowest; and those with HLA-DR4, DRw52 and Drw53 were between these levels. A high responsiveness to SCW antigens was seen more frequently in sarcoidosis patients with protracted clinical course. The high responsiveness to SCW antigens was related to HLA-DR4, DRw8, DR9 and DRw53 in sarcoidosis patients. HLA antigens, especially HLA-DR, modulate the immune response to inhaled antigenic agents. Immune response seemed to affect the clinical course of sarcoidosis.

A case of pulmonary tuberculosis with bilateral hilar lymphadenopathy diagnosed by sputum culture subsequent to open thoracic biopsy

We report a case of pulmonary tuberculosis with bilateral hilar lymphadenopathy. Open thoracic lymph nodes and lung biopsy revealed findings consistent with sarcoidosis. Culture and special staining of the biopsied specimen for mycobacteria were negative. Culture of the postoperative sputum grew Mycobacterium tuberculosis and antituberculous therapy resulted in a decrease in sizes of the lymphadenopathy. A review of the literature, with emphasis on the differential diagnosis between tuberculosis and sarcoidosis, is discussed.

Time-dependent alterations of leukotriene production and catabolism in rat peritoneal macrophages following intraperitoneal injection of thioglycollate broth

Alterations of leukotriene (LT) productivity in peritoneal macrophages (PM) from untreated rats (control) as well as from rats treated i.p. with thioglycollate broth (TG) were investigated on days 3, 7 and 14 after TG administration. The resident PM from the untreated rats produced mainly LTB4 and 5-HETE with small amounts of 12-HETE and LTD4 with only a trace of LTC4 when stimulated with the calcium ionophore A23187. The PM elicited from rats on days 3 and 7 produced more LTC4 than did the resident PM but fewer other lipoxygenase metabolites. On day 14, however, the elicited PM resembled the resident PM in terms of lipoxygenase metabolite production. Similar results were achieved in the presence of arachidonic acid and A23187. A decrease in lipoxygenase metabolism in the elicited PM was also suggested by using opsonized zymosan. Catabolism studies indicated a reduction in r-glutamyl transpeptidase activity in the elicited PM and suggested a reduction in catabolism for LTB4 in the former cells. The authors conclude that the TG-elicited PM generate fewer lipoxygenase metabolites than the resident PM following stimulation, but show a preferential conversion of LTA4 to sulfidopeptide LTs rather than to LTB4. The elicited PM also show a reduced catabolism for LTC4 and LTB4.

Effects of a 5-lipoxygenase inhibitor, AA861, on lipoxygenase metabolism and superoxide anion generation by human polymorphonuclear leukocytes--potentiation of superoxide anion generation by LTB4

We studied the influence of a selective 5-lipoxygenase inhibitor, AA861, on the generation of the superoxide anion (O2-) and the lipoxygenase metabolites by human polymorphonuclear leukocytes (PMN). PMN produce O2- in a dose-dependent manner following stimulation with arachidonic acid (AA), leukotriene B4 (LTB4), or C5a. When PMN were stimulated with one of those three agents in the presence of high doses of AA861 (1-10 micrograms/ml), a significant reduction of O2- release was observed. In contrast, the generation of O2- by PMN stimulated by LTB4 was potentiated at lower concentrations of AA861 (0.025-0.25 micrograms/ml). However, stimulation with AA or C5a did not influence O2- generation in the presence of AA861 at the same concentration range. Furthermore, treating the PMN with the cyclooxygenase inhibitor, acetylsalicylic acid, did not potentiate the generation of O2- by stimulation with LTB4 over a wide range of concentrations. Quantification of lipoxygenase metabolites by reverse-phase high-performance liquid chromatography revealed that a high concentration of AA861 (0.5-5 micrograms/ml) completely inhibited the production of LTB4 and its omega-oxidative metabolites by PMN following stimulation with 100 microM AA, but only partially inhibited that of 5-hydroxyeicosatetraenoic acid (5-HETE). AA861 at a concentration of 5 micrograms/ml significantly increased the production of 15-HETE by PMN following the same stimulation. AA861 did not influence catabolism of LTB4 added to the reaction mixture to its omega-oxidative products by PMN over a wide range of concentrations. These findings suggest that the inhibition of 5-lipoxygenase metabolism may stimulate 15-lipoxygenase in human PMN.(ABSTRACT TRUNCATED AT 250 WORDS)

Step section preparation of transbronchial lung biopsy. Significance in the diagnosis of diffuse lung disease

We retrospectively prepared step sections of nondiagnostic TBLB materials obtained from patients with diffuse or multiple lung disease and evaluated the diagnostic significance of the step section method. Among 112 patients with nondiagnostic TBLB findings, the preparation of step sections resulted in specific findings in seven cases. Step sections were especially useful for the detection of epithelioid granulomas and tumor tissue in patients with sarcoidosis and lymphangiosis carcinomatosa, respectively, but their contribution to the diagnosis of hypersensitivity pneumonitis, collagen-vascular disease, Mycoplasma pneumonia and pneumoconiosis was relatively small. In addition, step sections were useful for the detection of bronchiolitis obliterans affecting respiratory bronchioles. Overall, the examination of step sections was considered to be clinically useful in 30 cases (26.8 percent). Accordingly, the examination of step sections can be recommended before a further diagnostic procedure is chosen, if a TBLB performed in patients with diffuse or multifocal lung disease is nondiagnostic.

Adverse effect of chronic tonsillitis on clinical course of sarcoidosis

Sarcoidosis resolves spontaneously in many cases on a long-term basis. However, there are many cases whose resolution is delayed. We have experienced a frequent association of chronic tonsillitis (CTL), and dental caries in those patients of persistent course. We hypothesized that the presence of chronic or recurrent inflammatory foci in the upper airway may adversely affect the natural resolution of sarcoidosis. We analyzed the difference of regression of bilateral hilar lymphadenopathy on chest roentgenogram (CXR) in relation to changes in serum angiotensin converting enzyme (SACE) in sarcoidosis patients with and without CTL, and the effect of tonsillectomy (TLT) on the clinical course. In this study, we focused only on the tonsil for the sake of simplicity of analysis. Sarcoidosis resolved spontaneously in 10 of 28 (36%) patients with CTL and in 19 of 25 (76%) without CTL, and after TLT 9 cases became favorable in the course and the rate of unfavorable turned similar to those without CTL. The presence of CTL may be adversely related to the resolution of sarcoidosis.

[The CT diagnosis of emphysema and correlation with pathologic findings]

It is difficult to diagnose clinically silent or mild emphysema. The efficacy of CT scans for the diagnosis of emphysema has attracted attention and comparisons have been made between CT images and the pathological grade of emphysema in resected lungs. With a view to determine to what extent high resolution CT images are accurate concerning the diagnosis of mild emphysema, we conducted an extensive comparative study on CT scores of emphysema, based on high resolution CT, the pathology score derived from the cut surface of the lung identical in its plane with that of the CT and destructive index (DI) which is said to be instrumental in representing the degree of deterioration of alveolar walls in the same regions of the lungs. In this study, 42 patients who underwent thoracotomy and their lung specimens including a solitary nodule of considerable size have been employed. The CT scores and pathology scores depend on the picture grading system developed by Thurlbeck and coworkers for the basis of counting. The findings were such that with 1 mm collimation, the CT scores ranged between 12 and 57 with a mean +/- SD of 22.1 +/- 9.6 (n = 35) while with 5 mm collimation, the CT scores ranged between 7 and 46 with a mean +/- SD of 16.5 +/- 8.3 (n = 33). The pathology scores stood at 10 to 57 with a mean +/- SD of 23.2 +/- 9.8 (n = 42).(ABSTRACT TRUNCATED AT 250 WORDS)

Possible roles of the peripheral vagal nerve in histamine-induced bronchoconstriction in guinea-pigs

Although the importance of the vagal nerve in the pathogenesis of bronchial asthma has been reported, its precise contribution is still not fully understood. To shed more light on this area, we evaluated the possible contribution of vagal reflex in histamine-induced bronchoconstriction (HIB), and decided the site of action of histamine on the vagal nerve. For this purpose, we studied the effects of the bilateral cervical vagotomy, hexamethonium (2 mg.kg-1) or tetrodotoxin (0.5 mg.kg-1) on HIB (8 micrograms.kg-1, iv) in anaesthetized and mechanically-ventilated guinea-pigs. We also studied whether or not atropine (1 mg.kg-1) decreases HIB after vagotomy, including either the treatment of hexamethonium or tetrodotoxin. Airway responses were assessed by measurement of pulmonary resistance. The following results were obtained; 1) the response to histamine was significantly enhanced by the vagotomy, hexamethonium or tetrodotoxin; 2) propranolol increased HIB, and HIB was further enhanced by the vagotomy in the animals treated with propranolol; 3) atropine significantly suppressed HIB after the vagotomy, hexamethonium or tetrodotoxin. These results suggest that the postganglionic vagal nerve plays an excitatory role in HIB through the release of acetylcholine from the nerve terminals. It is also suggested that the vagal reflex mainly exhibits an inhibitory role in the HIB of guinea-pigs, presumably by the action of the nonadrenergic inhibitory nervous system.

Possible roles of the peripheral vagal nerve in histamine-induced bronchoconstriction in guinea-pigs

Although the importance of the vagal nerve in the pathogenesis of bronchial asthma has been reported, its precise contribution is still not fully understood. To shed more light on this area, we evaluated the possible contribution of vagal reflex in histamine-induced bronchoconstriction (HIB), and decided the site of action of histamine on the vagal nerve. For this purpose, we studied the effects of the bilateral cervical vagotomy, hexamethonium (2 mg.kg-1) or tetrodotoxin (0.5 mg.kg-1) on HIB (8 micrograms.kg-1, iv) in anaesthetized and mechanically-ventilated guinea-pigs. We also studied whether or not atropine (1 mg.kg-1) decreases HIB after vagotomy, including either the treatment of hexamethonium or tetrodotoxin. Airway responses were assessed by measurement of pulmonary resistance. The following results were obtained; 1) the response to histamine was significantly enhanced by the vagotomy, hexamethonium or tetrodotoxin; 2) propranolol increased HIB, and HIB was further enhanced by the vagotomy in the animals treated with propranolol; 3) atropine significantly suppressed HIB after the vagotomy, hexamethonium or tetrodotoxin. These results suggest that the postganglionic vagal nerve plays an excitatory role in HIB through the release of acetylcholine from the nerve terminals. It is also suggested that the vagal reflex mainly exhibits an inhibitory role in the HIB of guinea-pigs, presumably by the action of the nonadrenergic inhibitory nervous system.

[Carcinogenic effects of polychlorinated biphenyls (PCBs) and their derivatives, including carcinogenicity to the lung]

PCBs are compounds whose physical/chemical properties led to their wide spread commercial use. The persistence and stability of PCBs have resulted in a world wide distribution. PCDFs, ones of PCB derivatives, are primary causal agents of mass food poisoning, called Yusho in Japan and Yu-Cheng in Taiwan. Several epidemiologic studies on the carcinogenicity of PCBs in both occupational exposure and accidental intoxication suggest that PCBs might be a potent carcinogen in liver and lung. Many investigators reported that PCBs induced hepatocellular carcinoma in rat and mice. Although either mutagenic or genotoxic effects of PCBs are not definite, their tumor promoting effects have been repeatedly demonstrated in the liver. The effects of PCBs as tumor promoter in the lung have also been reported. PCB congeners that efficaciously promote carcinogenesis increase cytochrome P-450-dependent monooxygenases, which are abundant both in bronchiolar Clara cells and in hepatocytes. PCB congeners which are inducers of P-450 may be active as tumor promoter by inhibiting intercellular communication and/or by stimulating cell proliferation. Furan derivatives like PCDFs have high affinity to bronchiolar Clara cells and hepatocytes. PCDFs induce necrosis and epoxide formation to their target cells, which might result in carcinogenesis of liver and lung.

High dose rate intracavitary brachytherapy for recurrent cervical cancer of the vaginal stump following hysterectomy

Forty-eight patients with recurrent cervical cancer of the vaginal stump following hysterectomy for cervical cancer, were treated with high dose rate intracavitary brachytherapy with or without external irradiation. The intervals between primary surgery and vaginal recurrences varied widely from 3 months to 36 years. Patients were classified into two groups, either with or without palpable tumor of the vaginal stump. Tumor size was determined by bimanual rectovaginal examination at the time of recurrence. Survival rates were 8% for the group with palpable tumors and 80% for those without, respectively. The survival rate of patients who did not have palpable masses and were treated with brachytherapy alone was not improved by combination with external irradiation. The time interval from the primary hysterectomy to the recurrence did not influence survival. These results suggest that the only significant prognostic factor for recurrent cervical cancer after hysterectomy is tumor size. The relationship between recurrent cervical cancer of the vaginal stump and second primary vaginal cancer is also discussed.

Simultaneous assay of the activities of two key enzymes in cholesterol metabolism by gas chromatography-mass spectrometry

A very sensitive and specific method for the simultaneous assay of the activities of two key regulatory enzymes in cholesterol metabolism, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase (EC 1.1.1.34), and cholesterol 7 alpha-hydroxylase (EC 1.14.13.7), is described. The assay is based on the measurement of [2H3]mevalonolactone and 7 alpha-hydroxycholesterol produced by the incubation of [2H3]HMG-CoA and endogenous cholesterol with hamster liver microsomes using isotope dilution mass spectrometry. The incubation mixture was purified by means of solid extraction cartridges, and the extract was treated with benzylamine followed by dimethylethylsilyl imidazole. The resulting ether derivatives of the mevalonylbenzylamide and 7 alpha-hydroxycholesterol were quantified by gas chromatography-mass spectrometry with selected-ion monitoring in a high resolution mode. The method made it possible to assay simultaneously the activities of HMG-CoA reductase and cholesterol 7 alpha-hydroxylase in hamster liver microsomes with high sensitivity and accuracy.

Effect of cyclooxygenase inhibitor on excessive sputum

Indomethacin suppository and aspirin inhalation reduced the amounts of sputum in the patients with bronchiectasis and chronic bronchitis. A 67-year-old woman with bronchiectasis received indomethacin suppository to relieve the lumbar pain. After the start of indomethacin, a reduction in the amount of sputum was observed and the volume of sputum returned to pretreatment levels after the cessation of indomethacin. Levels of cyclooxygenase products in the sputum during indomethacin was also much lower than their levels after discontinuance of indomethacin. A 64-year-old man with chronic bronchitis was also administered inhaled aspirin to control the sputum volume. Both indomethacin suppository and aspirin inhalation reduced the amounts of sputum. In addition to these cases, a 31-year-old woman with bronchial asthma was tried to control the sputum production with indomethacin, but it had no effect on the sputum volume. It is suggested that these drugs may be useful in the treatment of excessive sputum in bronchiectasis and chronic bronchitis.

Clinicopathological study of migratory lung infiltrates

Clinical features and the histological appearances of transbronchial lung biopsy specimens were investigated in 11 patients with migratory infiltrates on the chest radiograph. Serum circulating immune complexes were increased at the time that infiltrates were present in all patients and the levels returned to normal as patients recovered clinically and radiologically. The Mantoux test response was negative in most patients. Fifty serial sections were obtained from each paraffin embedded biopsy specimen block and every 10th section was stained (step sectioning) with haematoxylin and eosin. Six patients (group 1) did not have eosinophilic infiltration; four of these had granulation tissue plugs within respiratory bronchioles when the tissue was examined by step sectioning. All had organising pneumonia and interstitial inflammation in the setting of a clinical picture consistent with bronchiolitis obliterans organising pneumonia. In two cases IgG had been deposited in intraalveolar macrophages. Biopsy specimens in five patients (group 2) showed eosinophilic infiltration; four patients had chronic eosinophilic pneumonia and one the Churg-Strauss syndrome. Step sectioning of transbronchial biopsy specimens in patients with migratory pulmonary infiltrates is useful and may support the diagnosis of bronchiolitis obliterans organising pneumonia.

Structure and synthesis of an immunoactive lipopeptide, WS1279, of microbial origin

The structure of WS1279, isolated from Streptomyces sp. as an immunoactive lipopeptide, has been deduced on the basis of chemical and physical evidence as S-[2,3-bis(palmitoyloxy)propyl]-N alpha-palmitoyl-Cys-Asn-Ser-Gly-Gly-Ser- OH. This was confirmed by synthesis.

[Evaluation of pulmonary emphysema with high resolution computed tomography and the effect of smoking]

Cigarette smoking is thought to play an important part in the development of pulmonary emphysema. The authors previously reported on the correlation of high resolution computed tomography (CT) with the pathology grade of emphysema and the destructive index of lung specimens from 42 patients undergoing thoracotomy for a solitary pulmonary nodule. High resolution CT was effective to identify the presence and grade of mild emphysema. The mean per cent predicted FEV1 was 97 per cent. There were 28 smokers and 14 nonsmokers. In this report, the correlation of smoking history with pathology score and high resolution CT was analyzed. There was significant correlation among these indices. These results further support the relationship between smoking and pulmonary emphysema. High resolution CT scan may help in the understanding of the role of cigarette smoking in the development of early pulmonary emphysema.

[Hypoxemia of liver cirrhosis--an autopsy case study]

41 year-old male with liver cirrhosis accompanying severe hypoxemia was presented. Shortly after the diagnosis of liver cirrhosis, he suffered from exertional dyspnea and cyanosis. Though home oxygen therapy had been prescribed for 2 years, hypoxemia gradually progressed accompanied by persistent cough, mucous sputa and intermittent fever. The chest X-ray revealed bilateral interstitial shadow particularly localized in lower lung fields. The arteriovenous shunt ratio was shown to be 24% by oxygen method. Perfusion lung scan using 99mTc-labeled MAA revealed perfusion defects in bilateral lung fields and radionuclide uptake was strongly demonstrated in the kidneys. These clinical data suggested that severe hypoxemia was probably due to multiple arteriovenous shunt. With further progression of hypoxemia for 4 months, he died of hepatic failure and pulmonary infection. Autopsy showed Miyake's type B cirrhosis. Multiple pleural and subpleural arteriolar nevi were demonstrated grossly and microscopically. There were no arteriovenous malformations demonstrated after injection of barium-gelatin solution into the pulmonary artery. Histologically, irregularly dilated vessels were found in the lung parenchyma beneath the pleura and filled with blood and injection material. These clinical and pathological findings provided evidence that the mechanism of arterial desaturation was pulmonary arteriovenous shunting due to liver cirrhosis.

Subpleural mononuclear cell infiltration. Significance in the differential diagnosis of pleuritis showing nonspecific histologic findings

To determine if patients who had lymphocyte-rich pleural effusion and a pleural biopsy without any specific findings could be histopathologically differentiated between those with tuberculous and nontuberculous pleuritis, we histologically re-evaluated the pleural biopsies of all patients whose pleural effusion was predominant with lymphocytes and contained no malignant cells. A total of 40 patients with a nonspecific histologic findings of pleural biopsy specimen were categorized based on their ultimate diagnosis as having tuberculous (n = 15), carcinomatous (n = 10) or nontuberculous, benign pleuritis (n = 15). The pleural biopsy specimen of patients with nontuberculous, benign pleuritis frequently showed a band-like infiltration of mononuclear cells in the subpleural adipose tissue with minimal pleural inflammatory infiltrate (10 out of 15 patients), while the same finding was infrequent in those with tuberculous pleuritis (0 out of 15, p = 0.0001) and pleuritis associated with carcinoma (three out of 10, p = 0.082). Based on these results, the presence of band-like infiltration of mononuclear cells in the subpleural adipose tissue with minimal pleural inflammatory infiltrate in pleural biopsy specimens of patients with lymphocyte-rich pleural effusion suggests that the pleuritis is nontuberculous in its nature.

[Non-Hodgkin's lymphoma of the Waldeyer's ring: the treatment results of the past 22 years and the significance of CHOP]

From 1966 through 1988, 124 patients with non-Hodgkin's lymphoma of the Waldeyer's ring were treated. Seventy patients were male, and 54 were female. Age ranged from 5 to 81 years with a median value of 53 years. Pathological slides were reviewed and reclassified according to the Working Formulation. Diffuse large cell type was most common (53%). Since 1981, CHOP has been incorporated into the treatment including stage I and II patients. During these 22 years, new imaging modalities have developed, and an upstage rate by using those modalities has increased from 5% to 9%. In order to make the comparison meaningful, we used clinical stage determined at the day of the first visit. Fifty-one patients were clinical stage I, 64 were stage II, seven were stage III, and two were stage IV. B symptom was seen in 8 patients. Relapse developed in 45 patients (41%) out of 111 who achieved complete remission, and distant relapse was most frequent (89%). Salvage therapy was successful in only three patients of the 45 relapsed patients. Overall 5-year freedom from relapse (FFR) were 38% for the patients treated until 1980, and 69% for the patients treated thereafter (p less than 0.01). Addition of CHOP to radiotherapy has increased 5-year FFR of the stage II patients from 31% to 81% (p less than 0.01). In stage I, 5-year FFR was 71% in the patients treated with CHOP and radiotherapy, and it was 27% treated without CHOP. But the difference has no statistical significance, and we can not rule out the presence of selection bias.(ABSTRACT TRUNCATED AT 250 WORDS)