Specular microscopic observation of posterior corneal vesicles

Specular microscopic investigation was conducted on 5 cases with the diagnosis compatible with posterior corneal vesicles. Endothelial cells were considerably enlarged with a more or less indistinct margin. Deposits onto endothelial cells were occasionally seen. The results of specular microscopy suggest that posterior corneal vesicles be classified as a nonfamilial, unilateral variant of posterior polymorphous dystrophy of the cornea.

[Clinical analysis of 24 cases of caudate hemorrhage]

Twenty-four patients with caudate hemorrhage, in whom such definite organic lesions as arteriovenous malformations or ruptured cerebral aneurysms could not be proved, were analyzed. These cases comprise 2.0% of 1202 cases of hypertensive intracerebral hemorrhage diagnosed by computed tomography and experienced from 1976 through 1987. Thirteen patients were male and 11 were female. Their average age was 61 years. Headache (67%) and nausea and vomiting (50%), which were often the initial symptoms, were similar to those of subarachnoid hemorrhage. The main clinical symptoms were signs of meningeal irritation. Ten patients (42%) had transient disturbance of consciousness, and nine (38%) of these were somnolent; only one patient, who had a massive hematoma, was stuporous. When the hematoma extended to the internal capsule, the patient showed motor disturbance (38%). Two patients (8%) had Horner's sign, five (21%) exhibited diminished activity, and one (4%) suffered anosognosia. The volume of the intracerebral hematoma averaged 4.7 ml and was less than 5 ml in 17 patients (71%). In 20 patients (83%), the hematoma was confined to the head of the caudate nucleus. The hemorrhage tended to rupture into the anterior horn of the lateral ventricle, and in nearly all cases (96%), intraventricular hematoma was observed. Seventeen patients (71%) underwent cerebral angiography. There were no instances of dilation of the recurrent artery of Heubner. Twenty patients (83%) were treated conservatively. Continuous ventricular drainage was employed in four patients (17%), and ventriculoperitoneal shunting in three (13%). However, it was judged retrospectively that continuous ventricular drainage had been necessary in only two cases in which disturbance of consciousness was progressed due to acute hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)

Metastatic squamous cell carcinoma of the paranasal sinuses from a primary squamous cell carcinoma of the urinary bladder

Metastatic tumours of the paranasal sinuses from primary lesions of the urogenital tract are rare, with about 50 cases so far being reported in the literature. The most frequent primary lesions is a renal carcinoma. We have experienced a case of paranasal sinus malignancy. There were no symptoms of urinary tract carcinoma preceding those in the paranasal sinuses. This case was later revealed at autopsy to be a metastasis from a diverticulum of the urinary bladder.

Specific immune response of the adenoids to a respiratory antigen

The specific antibody response of the adenoids to a respiratory antigen was investigated, both in vitro and in vivo. The in vitro immunoglobulin (Ig) production of adenoidal and tonsillar lymphocytes in the same patient in 18 cases was measured by an enzyme-linked immunosorbent assay. Adenoidal lymphocytes produced more IgM than IgG or IgA under culture conditions without any mitogens, whereas IgG was the major Ig produced by tonsillar lymphocytes. The same results were obtained when cultured with pokeweed mitogen. Under culture conditions with Dermatophagoides farinae (mite) antigen, adenoidal lymphocytes produced only specific IgM class antibody, and at a level significantly greater than tonsillar lymphocytes. Through an in vivo study, we established experimental adenoidal tissue in the guinea pig by long-term exposure to an ovalbumin aerosol. Infiltration of cells producing the specific antibody against an ovalbumin was demonstrated in the epipharyngeal mucosa using immunofluorescent staining. Our results confirm that the adenoids play a role in specific immune responses to respiratory antigens.

Mesangiolytic glomerulonephritis associated with Takatsuki's syndrome: an analysis of five renal biopsy specimens

Renal biopsy specimens from five patients with Takatsuki's syndrome were studied. Proteinuria and hematuria were modestly positive in four cases and three cases, respectively. One case demonstrated early azotemia, while four cases revealed normal serum creatinine levels. All cases displayed glomerular enlargement and lobulation, mesangial cell proliferation, and double contour structure, simulating membranoproliferative glomerulonephritis. It is noteworthy that mesangial loosening was also detected in the renal biopsy specimens of this study. This change was present diffuse-globally in the well-developed cases and focal-globally or segmentally in the developing cases. In addition, various morphologic expressions were observed, ie, microaneurysms congested with RBCs, tentatively termed mesangial hyaline thrombi, nodule-like lesions, and tiny to small-sized mesangiolytic lesions. Since all these features could be explained by low-grade mesangiolysis, the renal alteration associated with this syndrome was termed mesangiolytic glomerulonephritis. Humoral factor(s) also toxic to the mesangium were implicated.

The pathophysiological role of kinin and chemical mediators on experimental allergic rhinitis

In order to clarify the pathophysiological role of the chemical mediators, the releases of kinins, histamine and leukotriene C4(LTC4) into the nasal cavity were measured following nasal allergic challenge in ovalbumin(OA)-sensitized guinea pigs, or following nasal stimulation with one of these chemical mediators in OA-non-sensitized animals. In sensitized animals, an increased vascular permeability of nasal mucosa was recognized immediately after antigenic stimulation and lasted for 60-90 minutes. Releases of kinins and LTC4 into the nasal lavage fluid augmented not only immediately after the antigenic challenge, but also during 60 to 90 minutes after the stimulation. Release of histamine into the nasal lavage fluid was observed only immediately after the antigenic stimulation. In non-sensitized guinea pigs, nasal stimulation with bradykinin accelerated nasal vascular permeability. Nasal stimulation with histamine or LTC4 resulted in increase of nasal vascular permeability and of kinins concentration in the nasal lavage fluid. These results suggest that kinins might be concerned with the immediate and later vascular permeability during the allergic response.

Respiratory fluctuations of the human pupil

We simultaneously recorded respiration and pupil size in six normal subjects with an age range of 23-40 years (mean = 30.1), to study the relationship between the respiratory rhythm and changes in pupil size. In all subjects, respiratory fluctuations of the pupil (inspiratory mydriasis and expiratory miosis) were observed during normal spontaneous respirations. The amplitude of these pupillary changes was closely proportional to the tidal volume.

[The roles of surgery and radiotherapy on the control of maxillary cancer]

We performed a clinical study on 128 patients with squamous cell carcinoma of maxillary sinus who were treated at Sapporo Medical College (SMC) and National Sapporo Hospital (NSH) from 1977 to 1985. All patients were treated with the combination of external irradiation, surgery and intra-arterial infusion of anti-cancer drugs. Each patient was grouped according to the variation of surgical treatment. Final local tumor control rate was the best in the group of patients undergoing radical operation or thorough tumor reduction surgery in each hospital (68% in group C in SMC and 62% in reduction surgical level 3 in NSH). No patients with a residual tumor after primary treatment were salvaged by any secondary treatment. Eleven out of 30 patients with a local tumor recurrence were salvaged by the second treatment. The salvage rate in the patients with a minor recurrence which might be resected by minor surgery was better than with a major recurrence which might be treated by a wide resection (80% and 28%, respectively). 3 patients with a local recurrence were treated by the combination of the surgery and brachytherapy, and encouraging results were obtained in these patients.

CT demonstration of portal vein aneurysm

We report a case of portal vein aneurysm showing characteristic enhancement on dynamic CT.

Squamous cell carcinoma of bladder diverticulum with initial symptoms produced by metastasis to maxillary sinus

A rare case of squamous cell carcinoma in the bladder diverticula of a 74-year-old man with initial clinical symptoms caused by metastasis to the maxillary sinus is reported. The histopathological examination at autopsy confirmed the metastatic squamous cell carcinoma in the maxillary sinus from the bladder diverticula. The vertebral vein plexus seems responsible for this type of metastasis.

Spontaneous nasal oscillations in dog. A mucosal expression of the respiration-related activities of cervical sympathetic nerve

We studied the respiratory oscillations of the nasal mucosa in dogs. Even after temporarily stopping the respirator, intranasal balloon pressure showed respiration-related oscillations (spontaneous nasal oscillations). These spontaneous oscillations were recorded in all 21 dogs. Spontaneous nasal oscillations were not abolished even after thoracotomy, vagotomy and vidian neurectomy. Only cervical sympathectomy could to a large extent abolish the spontaneous nasal oscillations. Furthermore, the spontaneous nasal oscillations were found to be synchronized with the respiration-related fluctuations of cervical sympathetic nerve activities. Rhythms of the spontaneous nasal oscillations were not dependent on the rates of artificial ventilation, but were closely related to the rates of spontaneous respiration before administering the muscle relaxant. On some occasions, we recognized remarkable differences in the height of waves of the spontaneous nasal oscillations between the sides of the body. On eight occasions in 5 dogs, reciprocal changes of the dominant side of bilateral spontaneous nasal oscillations were noted which might be an expression of the nasal cycle.

[A case of unruptured anterior temporal artery aneurysm showing pupil-sparing oculomotor palsy]

The authors report a case of unruptured anterior temporal artery aneurysm showing pupil-sparing oculomotor palsy. The patient was a 55-year-old male with the complaints of left blepharoptosis and diplopia. He had a history of tuberculous meningitis 9 years previously, and since then he suffered from paraparesis of lower extremities and bladder and bowel disturbance. Neurological examination on admission revealed left blepharoptosis and disturbance of medial and vertical movement of the left eye ball, but the pupils were isocoric with normal light reaction. Carotid angiography demonstrated that the left internal carotid artery was tortuous toward the medial side in the C2 portion, and the saccular aneurysm was present in the anterior temporal artery 3 mm distal from the middle cerebral artery. At operation it was revealed that the aneurysm which had a diameter of 17 mm located in the proximal portion of the anterior temporal artery, and compressed the dorsal aspect of the oculomotor nerve. A month after operation the left oculomotor palsy disappeared. There had been no report of the case of unruptured middle cerebral artery aneurysm causing oculomotor palsy. Pupil-sparing oculomotor palsy is characteristic of diabetic oculomotor palsy, and rare cases showing pupil-sparing oculomotor palsy are caused almost by aneurysms of the internal carotid-posterior communicating artery junction. Anatomical study revealed that the parasympathetic fibers which go to the pupil constrictor muscle were in the dorsomedial aspect of the oculomotor nerve in the subarachnoid portion.(ABSTRACT TRUNCATED AT 250 WORDS)

Respiration-related movements of the nose in dogs

We studied the respiration-related movements of the canine nose by examining the respiratory oscillations of intranasal balloon pressure and EMG activities of the dilator nares in dogs. Under spontaneous respiration, balloon pressure decreased and EMG activities increased during the early inspiratory phase. These respiratory movements of the nose differed and changed reciprocally in strength between the two sides of the body spontaneously, after painful stimulation or intranasal histamine administration. When the muscle relaxant was administered and the respiration was controlled by the ventilation pump, the intranasal balloon pressure increased during the inspiratory phase. This phenomenon had a completely inverted pattern compared with that during spontaneous respiration. Furthermore, even when the ventilation pump was stopped, respiration-like spontaneous oscillations of the intranasal balloon pressure were recognized. These were abolished by sectioning of the ipsilateral cervical sympathetic nerve trunk. From these findings, the respiration-related movements of the nose were thought to be controlled not only by the cardiac output and the vagal nerve reflexes but also by respiratory activities in the nervous systems controlling the nose, which might be originated from the medullary respiratory centres.

Control of the nasal mucosa by the tonic activities of the autonomic nervous system in dogs

We studied the effects of stimulation and acute denervation of the cervical sympathetic nerve and the vidian nerve on the nasal vascular tone, as measured by intranasal balloon pressure. Significant vasoconstriction was found during electrical stimulation of the cervical sympathetic nerve. When the cervical sympathetic nerve was sectioned, causing a transient vasoconstriction due to the stimulatory effect of the nerve injury, then significant vasodilation was found in 23 out of 30 experiments. Significant vasodilation during electrical stimulation of the vidian nerve and slight but significant vasoconstriction after sectioning of the vidian nerve were also found. In addition, we found spontaneous nerve discharges in the cervical sympathetic nerve trunks. These nerve discharges increased after stopping the respiratory pump. Differences in these sympathetic nerve discharges between the sides of the body were also recognized.

[Nontraumatic chronic subdural hematoma due to dural metastases of breast cancer. Case report]

A case of nontraumatic chronic subdural hematoma due to obstruction of dural vessels by tumor cells is presented and 25 reported cases are reviewed. A 39-year-old female was referred for headache, vomiting, disturbance of consciousness and right homonymous hemianopia with macular sparing. She had undergone mammectomy for medullary nodular carcinoma of the left breast five years before. She had been treated with combined hormonal therapy and chemotherapy for the cancer metastases to the liver in preceeding six months. Hematological examination revealed drug-induced thrombocytopenia, increase of FDP in blood (80 micrograms/ml), but no abnormality of prothrombin time and fibrinogen content. Therefore in the present case there was no evidence of disseminated intravascular coagulation (DIC) after Colman's criteria. However, it was suggested that this case had compensated DIC after Cooper's criteria. CT scan showed a biconvex-shaped low and partially iso-density area over the left fronto-temporal convexity, indicative of chronic subdural hematoma, and no abnormal findings in the occipital area. After removal of the hematoma she became alert without headache and vomiting. However, seven days later she complained of headache and vomiting again. Repeated CT scan showed a larger biconvex-shaped low density area over the left hemisphere extending to the parietal region at that time. Second operation was performed, but she expired four days later. Autopsy showed systemic metastases of the medullary nodular carcinoma in the scalp, temporal muscle and dura as well as lungs, adrenal glands, ovaries and bone marrow.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of traumatic anterior dislocation of C4 recovered from complete tetraplegia]

A case of traumatic anterior dislocation of C4 is presented. A 65-year-old man who was beastly drunken fell down backward and severely struck occipital region against the door and immediately developed tetraplegia. Neurological examination 12 hours after the trauma revealed complete flaccid tetraplegia, abdominal respiration, bladder-bowel disturbance, anesthesia below C5 and hyperpathia in C3 and C4 dermatomes. Plain films of the cervical spine disclosed anterior dislocation of C4 upon C5 approximately 6 mm and possible disc herniation of C4/5. On Amipaque cervical myelography via C1C2 lateral puncture, there was almost complete block of the dye at C4/5 level. With diagnosis of acute cervical spinal cord injury on C4/5 caused by pincer mechanism and herniated disc material, the patient was operated on 19 hours after the trauma by anterior discectomy of C4/5 and fusion under Crutchfield skull traction. Neurological recovery began with the right leg from the day after the operation and it's recovery pattern showed the syndrome of acute central cervical spinal cord injury reported by Schneider. The patient discharged on March '84 four months after the trauma walking by himself with tetraparesis especially weakness of the hands and hypesthesia of glove and stocking type. We emphasized importance of Amipaque cervical myelography via C1C2 lateral puncture and anterior approach on the treatment of acute cervical spinal cord injury to be done as soon as possible.

Spontaneous glomerular IgA deposition in ddY mice: an animal model of IgA nephritis

It was found that ddY mice derived from non-inbred dd-stock mice brought from Germany before 1920 and then raised in Japan developed spontaneously IgA dominant deposition in the glomerular mesangium. In this report we give a detailed natural history of the renal pathology of those mice. The animals were fed rodent laboratory chow and sacrificed in groups of 9 to 10 at 6, 10, 16, 24, 28, 40, and 59 weeks of age. The bladder urine was analyzed, serum immunoglobulins were measured, and the kidney specimens were evaluated with light, fluorescent, and electron microscopy. Proteinuria was (plus) to (2 plus) after 28 weeks and (2 plus) to (3 plus) at 59 weeks with negative hematuria. Mesangial cell proliferation began to appear at 16 weeks, then progressed to a definite proliferative glomerulonephritis. At 59 weeks an additional increase of the mesangial matrix occurred. By immunofluorescence, there were IgG of (2 plus), IgM (plus) to (2 plus), IgA (plus) and C3 (plus) in the glomeruli until 28 weeks. However, IgA started to be dominant at 40 weeks and the glomerular pattern was IgA (2 plus) to (3 plus), IgG (plus) to (2 plus), IgM (+/-) to (plus) and C3 (plus) to (2 plus) at 59 weeks. Polyclonal IgA and IgG2a among immunoglobulins steeply rose at 40 weeks, and at 59 weeks IgA increased by 850%, IgG2a by 280%, IgG1 by 170%, IgG2b by 90%, and IgM by 60%, as compared with their level at 6 weeks. There was no anti-nuclear antibody. Thus, ddY mice, at least after the age of 40 weeks, can be used as a new animal model for spontaneous IgA nephritis. The probable origin of IgA is also discussed.

Malignant melanoma in the maxillary sinus--a case successfully treated with radiotherapy

In this paper, we present a case where radiotherapy was very effective against malignant melanoma. We performed a total maxillectomy as the primary treatment, but the tumor recurred rapidly in the operated wound. Then, the patient was treated with 50 Gy in twenty-five treatments. After that, the tumor disappeared remarkably. On the other hand, this malignant melanoma was of the amelanotic type. We carried out a Fontana's stain and electronic microscopy to provide the criteria for the diagnosis of malignant melanoma. The pathological character of this malignant melanoma was investigated.

Nasal responsiveness to methacholine stimulation in allergic rhinitis patients

We examined the nasal responsiveness to topical methacholine application in allergic rhinitis and non-allergic chronic rhinitis patients, and in control subjects. Methacholine responsiveness was significantly higher in allergic rhinitis patients than in non-allergic patients and control subjects. In perennial rhinitis, methacholine responsiveness correlated with the severity of daily nasal symptoms and those provoked by specific allergen challenge tests. Among nasal symptoms, hyper-rhinorrhoea was found to be closely related to methacholine responsiveness. As a result of these findings, the possibility of cholinergic hyper-reactivity in allergic rhinitis patients is discussed.

[Application of radiofrequency hyperthermia for treating advanced urinary bladder cancer--a case report]

A patient with advanced urinary bladder cancer treated with a combination of radiation and hyperthermia, using short-wave radiofrequency (RF) and intravesical irrigation with warm water is reported. The tumor temperature was successfully maintained at 43 degrees to 44.6 degrees by external application of 13.56 MHZ RF when the bladder was irrigated with heated saline (intravesical temperature: 43 degrees) Hyperthermia was performed for 30 min immediately after each course of external bladder irradiation (Linac: 400 rad, twice a week; total 5 weeks exposure of 4000 rad). The tumor disappeared completely (CR) after the completion of the combination therapy.

Central origin of canine vidian nerve studied by the HRP method

Central origin of the vidian nerve in the dog was investigated using the retrograde tracing technique of horseradish peroxidase (HRP). After HRP was applied to the vidian nerve, labelled neurons were found in the medulla oblongata and the geniculate ganglion but could not be found in the trigeminal ganglion. Labelled neurons in the medulla oblongata were found not only in the dorsal part but also in the ventral part to the facial motor nucleus and were maximum in number at the level of the rostral third of the facial motor nucleus. These labelled neurons were generally medium-sized multipolar neurons with well-developed dendrites.

Ultrastructure and chloride cytochemistry of the hindgut epithelium in the larvae of the seawater mosquito, Aëdes togoi Theobald

The hindgut of Aëdes togoi larvae adapted to various external salinities was studied by light and electron microscopy. The larvae's pyloric chamber and the ileum of the hindgut are surrounded by a thick muscular layer and lined with a very thin unspecialized epithelium. There is no detectable difference in the ultrastructural organization of the epithelium between seawater-adapted and freshwater-adapted larvae. The rectum and the anal canal are greatly dilated and densely tracheated and have a very thick, highly specialized epithelium. The rectal epithelium is characterized by shorter apical and longer basal infoldings closely associated with mitochondria, and a particulate coating on the apical infoldings. The intercellular spaces and the basal channels are tightly closed in the rectal epithelium of freshwater-adapted larvae, whereas widely dilated in that of 100 to 200% seawater-adapted larvae. The rectum seems to reabsorb water from excretory fluid when larvae are in hyperosmotic media. The anal canal epithelium possesses well-developed apical infoldings, which are coated with small particles an intimately associated with mitochondria. The basal infoldings are short. No perceptible difference in the ultrastructural organization of the epithelium was observed between seawater-adapted and freshwater-adapted larvae. The lumina of the apical infoldings of the anal canal epithelium in seawater-adapted larvae, however, demonstrated a strongly positive reaction to the cytochemical assay for chloride ions, whereas the reaction was very weak in freshwater-adapted larvae. Unlike salt-water-mosquito larvae of the other species, in which the rectum is considered to be concerned with the formation of hyperosmotic urine, the anal canal in A. togoi larvae seems to play an important role in excretion of excess ions in the haemolymph when adapted to hyperosmotic media.

Histochemical demonstration of peripheral autonomic innervation in canine nasal mucosa by retrograde axonal transport of horseradish perioxidase

The peripheral autonomic nervous pathways of the nasal mucosa in dogs were investigated by the horseradish peroxidase (HRP) method. HRP was applied to the nasal mucosa, caudal nasal nerve, ethmoidal nerve, vidian nerve and pterygopalatine ganglion in 20 dogs, and retrogradely labelled neurons were observed in the superior cervical ganglion (SCG) and the pterygopalatine ganglion (PPG) by the blue reaction method. It was suggested that the vidian nerve, the maxillary branch of the trigeminal nerve, the caudal nasal nerve, the pterygopalatine nerve and the ethmoidal nerve contained the postganglionic sympathetic fibres which originated in SCG and terminated in the nasal mucosa. Moreover, other sympathetic pathways, such as those around the blood vessels, were also suggested to be a main route. It was suggested that the postganglionic parasympathetic fibers originating in PPG travelled along the caudal nasal nerve and the ethmoidal nerve.

Studies on the intracellular cAMP metabolism of tonsillar lymphocytes

cAMP metabolism, including the intracellular cAMP level and adenylcyclase activity, was studied in tonsillar and peripheral lymphocytes. The basal activity of adenylcyclase was significantly higher in tonsillar lymphocytes than in peripheral lymphocytes, although the basal level of intracellular cAMP did not differ. The responsiveness of the intracellular cAMP level and adenylcyclase activity stimulated by 10(-5) M isoproterenol, or 10(-5) M prostaglandin E1, which was thought to stimulate this enzyme through a specific receptor, was significantly lower in tonsillar lymphocytes than in peripheral lymphocytes. Moreover, the responsiveness of adenylcyclase activity to 10(-2) M NaF, which was thought to stimulate this enzyme directly, was also significantly lower in tonsillar lymphocytes. Tonsillar T lymphocytes represented a lower cAMP basal level than tonsillar B lymphocytes, but no difference was observed in the responsiveness of intracellular cAMP to the above agents. Tonsillar lymphocytes derived from patients with recurrent tonsillitis represented significantly lower cAMP responsiveness than those from patients of other chronic tonsillitis. Furthermore, in the tonsillar lymphocytes from patients with a recent attack of acute tonsillitis, a more depressed responsiveness of the intracellular cAMP level to the above agents was recognized. The cAMP basal level was not changed by these pathological alterations of tonsillitis.