Grossly punched-out lesions in the aorto-iliac region can be histologically classified as false, pseudo-false, or disguised aneurysm

Aneurysms are morphologically classified as true or false based on the nature of their walls. True aneurysms are composed of all or parts of layers of the vessel. False aneurysms are the result of rupture and their walls have only fibrous tissues. The orifice of false aneurysms is narrow relative to the aneurysmal diameter and thus they are grossly or angiographically referred to as punched-out lesions. Hence false aneurysms present with punched-out lesions, but in reverse, are all of punched-out lesions false aneurysms? We experienced some cases of punched-out lesions which histologically contained traces of elastin, and the purpose of this report was to histologically investigate grossly punched-out lesions. We examined 671 elderly autopsy cases, and a total of 21 grossly punched-out lesions in the aorto-iliac region were selected. They were histologically classified as false, "pseudo-false", or "disguised" aneurysm. False aneurysms were found in 3 patients (0.45%), and were histologically mycotic. A total of 5 "pseudo-false" aneurysms were found in 3 patients (0.45%). They histologically contained traces of elastin, and thus they were categorised in true aneurysms. A total of 13 "disguised" aneurysms were found in 6 patients (0.89%). They were true fusiform aneurysms with an eccentric thrombus, on which a fibrin-cap formed a narrow orifice. Partial sections are insufficient for diagnosis; cross-sections are necessary. To the best of our knowledge, there have been no reports of "pseudo-false" or "disguised" aneurysms in the aorto-iliac region.

Analysis of T-cell receptor beta of the T-cell clones reactive to the human PDC-E2 163-176 peptide in the context of HLA-DR53 in patients with primary biliary cirrhosis

T-cell-mediated autoimmune mechanisms are considered to be involved in the pathogenesis of primary biliary cirrhosis (PBC). In the previous study, we identified the immunodominant T-cell epitope on the E2 component of pyruvate dehydrogenase complex (PDC-E2) in patients with PBC who have HLA-DRB4*0101. In this report, we revealed that the frequency of the T cells reactive to the human PDC-E2 163-176 peptide is significantly increased in the peripheral blood of patients with PBC as compared with healthy subjects. We also confirmed that these T cells were all restricted with HLA-DRB4*01 (DR53) by using HLA-DR-transfected L cells. These results together with the evidence that the immunodominant B-cell epitope overlaps with the human T-cell epitope of the PDC-E2 antigen indicate that the T cells reactive to this epitope are closely associated with the pathogenesis of PBC at least in patients who have HLA-DR53. Therefore, we analyzed the T-cell receptor (TCR) Vbeta sequence of the five different T-cell clones and the three T-cell clones derived from three patients with PBC and healthy subjects, respectively, which are reactive to the human PDC-E2 163-176 peptide in the context of HLA-DR53. The Vbeta- and the Jbeta-gene usages were diverse among the T-cell clones (Vbeta11-Jbeta1.4, Vbeta8-Jbeta1.2, Vbeta12-Jbeta2.1, Vbeta10-Jbeta1.5, and Vbeta20-Jbeta2.1) in patients with PBC. By contrast, in the third complementarity determining region (CDR3), G was frequently found and GXG or GXS motif was identified in all T-cell clones. Moreover, RGXG motif was found in three clones generated from two patients. In healthy subjects, the Vbeta- and the Jbeta-gene usages were also diverse, and GXG and RGXG motif were found. These results indicate that the T cells may recognize the ligand (the human PDC-E2 163-176 peptide/HLA-DR53 complex) using the limited motif in the CDR3 region and that the design of CDR3-specific immunotherapy would be possible using these motifs.

Anplag, a selective 5-HT2 receptor antagonist, reduces stenosis induced by balloon injury in the hypercholesterolaemic rabbit

The purpose of this study was to examine the effect of anplag, a 5-HT2 receptor antagonist, on intimal hyperplasia (IH) after balloon injury. In 39 male New Zealand white rabbits, the left carotid artery was denuded of endothelium by an inflated balloon. The injury not only damaged the endothelium, but also caused damage to underlying smooth muscle cells. Twelve rabbits fed normal chow were divided into 2 groups: Group A; anplag was not administered, and Group B; anplag, 100 mg/kg, was given by gavage, including on the day of ballooning. The remaining 27 rabbits were fed chow containing 1% cholesterol and divided into 3 groups: Group C; anplag was not administered, Group D; anplag, 100 mg/kg, was given orally except on the day of ballooning, and Group E; anplag, 100 mg/kg, was given orally including on the day of ballooning. IH in Group B was 13.2% less than that in Group A and IH in Group D was 11.7% less than that in Group C. However, neither of these differences was significant. IH in Group E was significantly less (by 40.1%) than that in Group C. In conclusion, anplag significantly reduced IH after balloon injury in the hypercholesterolaemic rabbit by inhibiting proliferation of smooth muscle cells and cholesterol-uptake by macrophages when it was administered immediately before the procedure.

Results of arteriovenous fistula revision in the forearm

PURPOSE

We assessed the usefulness of revision for hemodialysis arteriovenous fistulae.

METHODS

From 1985 to 1994, 287 arteriovenous fistulae were created at our facility. "Primary" patency was defined as the duration of fistula patency without revision, and "secondary" patency was defined as the duration of fistula patency after successful revision in the forearm not requiring prosthesis.

RESULTS

The secondary patency rate was significantly better than the primary patency rate (89% versus 41% at 5 years, P < 0.01). The secondary patency rate in diabetic patients did not differ from that in nondiabetics, although there was a significant difference in the primary patency rate between these two patient groups (diabetics 30% versus nondiabetics; 45% at 5 years, P < 0.01).

CONCLUSIONS

Revision is a reliable procedure for salvaging a failed fistula, which yields an acceptable patency rate regardless of the patient's risk factors for arteriosclerosis.

A new method for the assessment of venous insufficiency in primary varicose veins using near-infrared spectroscopy

PURPOSE

Patients with chronic venous insufficiency (CVI) were evaluated from the aspect of ambulatory venous function using near-infrared spectroscopy (NIRS).

METHODS

Seventy-two primary varicose veins of 59 patients (varicose group) and 20 normal limbs of 13 volunteers (normal group) were studied. The affected limbs of the patients were divided into three groups according to the classification advocated by an International Consensus Committee in 1995: mild CVI with class 2 or 3 (50 limbs); moderate CVI with class 4 (11 limbs); and severe CVI with class 5 or 6 (11 limbs). All of the patients underwent a treadmill walking test, during which NIRS was applied. Oxygenated hemoglobin (OxyHb) and deoxygenated hemoglobin (DeoHb) were continuously measured by NIRS during exercise. The ambulatory venous retention index (AVRI) obtained from serial changes in DeoHb was assessed comparatively in the four groups (normal and mild to severe CVI). In addition, 19 limbs in 13 patients were evaluated with air plethysmography for comparison with the data obtained by NIRS.

RESULTS

Two distinct patterns of DeoHb change were observed. During exercise, the DeoHb level decreased in the normal group as a result of calf muscle contraction, whereas in the varicose group the DeoHb level rose because of an apparent venous reflux into the calf muscles. AVRI studies demonstrated a significant difference (p < 0.0001) among groups. Although there was no apparent relationship between AVRI and ejection fraction, AVRI showed a significant correlation with the venous filling index (r = 0.61) and a weak correlation with the residual volume fraction (r = 0.41).

CONCLUSION

NIRS is useful for accurately assessing ambulatory venous dysfunction in patients with primary varicose veins.

Role of the vav proto-oncogene product (Vav) in erythropoietin-mediated cell proliferation and phosphatidylinositol 3-kinase activity

The vav proto-oncogene product (Vav), which is specifically expressed in hematopoietic cells, contains multiple structural motifs commonly used by intracellular signaling molecules. Although a variety of stimuli including erythropoietin (Epo) have been shown to tyrosine phosphorylate Vav, little is known about the Vav signal transduction pathway. Here, we have investigated the role of Vav in the Epo signaling pathway by characterizing its interaction with other proteins, using the human Epo-responsive cell line, F-36P. Immunoprecipitation and immunoblot analyses have demonstrated that Vav was associated with the Epo receptor (EpoR) in an Epo-independent manner and was tyrosine-phosphorylated after Epo stimulation. Furthermore, two phosphotyrosine proteins (pp70 and pp100) co-immunoprecipitated with the regulatory subunit of phosphatidylinositol 3-kinase (PI3-kinase) (p85) were identified as EpoR and Vav, respectively. The interaction between Vav and p85 was shown to be mediated through the SH2 domains of p85 by an in vitro binding assay and confirmed by the presence of in vitro PI3-kinase activity associated with Vav. Treatment of the cells with antisense-vav and -p85 abrogated Epo-induced cell proliferation and PI3-kinase activity. Finally, we found that JAK2 was associated with Vav in vivo and that Vav could be tyrosine-phosphorylated by activated JAK2 in vitro. These results suggest the possible role of JAK2 for tyrosine phosphorylation of Vav and involvement of Vav and PI3-kinase in Epo-induced proliferative signals.

Platelet endothelial cell adhesion molecule-1 is a major SH-PTP2 binding protein in vascular endothelial cells

Platelet endothelial cell adhesion molecule-1 (PECAM-1, CD31) is rapidly tyrosine phosphorylated in mechanically stimulated vascular endothelial cells (ECs). A 65-kDa protein from ECs specifically bound to the c-Src phosphorylated PECAM-1 cytoplasmic domain and was identified as a protein tyrosine phosphatase SH-PTP2 (SHP2, Syp). PECAM-1 was coimmunoprecipitated by anti-SH-PTP2 from EC extracts as a major binding protein, and the level of association increased when PECAM-1 was tyrosine phosphorylated. This association was mediated by SH2 domains of SH-PTP2. A rapid translocation of SH-PTP2 into cell-cell adhesion sites, where PECAM-1 was localized, occurred in mechanically stimulated cells. Our results suggest that PECAM-1 is a component of a mechanosensing machinery acting upstream of SH-PTP2.

Sarcomatoid renal cell carcinoma with widespread metastases to liver and bones in a kidney transplant recipient

A case of sarcomatoid renal cell carcinoma with widespread metastases to liver and bones in a cadaver renal transplant recipient is reported in this article. The patient underwent a kidney transplant at the age of 43 and was treated with various immunosuppressive agents after surgery. Twelve months after the transplantation, multiple tumors were found in the liver, and the patient died 8 months later. Pathological examination at autopsy revealed renal cell carcinoma with a sarcomatoid component in the right native kidney and metastases to liver and bones. It is unusual for renal cell carcinoma to undergo sarcomatous transformation and to metastasize to the liver before reaching other organs. We speculate that immunosuppressants may have altered malignant cell proliferation, invasion, and the form of metastasis in this case.

Histological grading and staging of IgA nephropathy

More than 25 years have passed since immunoglobulin A (IgA) nephropathy was introduced as a disease entity independent of glomerulonephritis. It has been known that more than 30% of cases have gone into end-stage renal failure within 20 years, indicating the presence of a chronic active group in this disease. Histologically this disesase is composed of at least three types of tissue damage: (i) minimal inflammation including deposition of IgA-containing substances with minor matricial increase; (ii) acute lesions characterized by matricial damage of glomerular basement membrane (membranolysis) and/or mesangial matrix (mesangiolysis) with inflammatory cell accumulation and/or intrinsic cell proliferation; and (iii) chronic lesions mainly composed of postinflammatory sclerosis. The progression is actually accelerated by the frequency of acute lesions, resulting in increased glomerular sclerosis foci. In such a situation, the histologic grading and staging (G-S) system is proposed, with the aim of having a more precise understanding of the disease process. The histological grade (G) is estimated by the extent of acute glomerular and tubulointerstitial lesions, and the stage (S) is evaluated by the increase of extracellular matrices of the glomeruli and interstitial fibrosis. The evaluation of G and S is expressed semiquantitatively for more helpful clinical use.

[Renal pathology of VTEC related HUS]

Renal histopathology of verotoxin producing escherichia coli(VTEC) related hemolytic uremic syndrome (HUS) was described. Endothelial damage is expressed in renal small arteries and glomeruli as luminal narrowing due to endothelial swelling and subendothelial edema. Extracellular matrix shows reticularization and/or mesangiolysis in glomeruli. Although HUS and thrombotic thromocytopenic purpura (TTP) is recently considered as a single entity, the tissue expression is different. In the latter endothelial proliferation is profound resulting in arteriolar deteriolation such as glomeruloid structure.

Production of a T-cell clone which reacts with membrane proteins of Acholeplasma laidlawii

The role of cellular immunity in mycoplasma infection is not completely understood. In this study, we established mycoplasma-specific T-cell clones to evaluate cellular immunity in mycoplasma infection. We developed a T-cell clone (G-10) which was stimulated with Acholeplasma laidlawii. The T-cell clone G-10, CD4+ and T-cell receptor (TCR) alpha beta- recognized the 42- and 65-kilodalton (kDa) membrane proteins of A. laidlawii and responded to A. hippikon. Hence, the application of mycoplasma-specific T cells such as G-10 in animal models may allow the assessment of cellular immune response to mycoplasma infection.

[Clinical efficacy of imipenem/cilastatin sodium for respiratory infections in patients with lung cancer]

Imipenem/cilastatin sodium (IPM/CS) was administered to 102 patients with respiratory tract infections and lung cancer. Patients with other serious diseases were excluded and a total of 73 patients were enrolled. They were divided into 12 patients who underwent surgery (operated group) and 61 who did not (non-operated group); the latter group included 28 patients treated with anticancer agents or radiation therapy (treated group) and 33 untreated patients (untreated group). IPM/CS was effective in 75% of the patients, both with and without surgery. The drug was effective in 81% of the treated group, although many of the patients had Stage III or more advanced cancer, as well as bronchial occlusion. IPM/CS was also effective in 69% of the untreated group, although many of the patients have serious infections and a PS (Performance Status) of 3 or greater. Thus, IPM/CS treatment achieved good results. Bacteriological studies showed that 3 out of 4 strains in the operated group and 16 out of 18 in the non-operated group were eliminated. Safety was evaluated in all patients. Two patients (2%) experienced side effects and two others (2%) showed abnormal clinical findings, but the symptoms were mild and resolved after discontinuation or completion of therapy. In conclusion, IPM/CS was very effective for treating respiratory infections in patients with lung cancer.

[Summer-type hypersensitivity pneumonitis in a family]

We encountered a family in which three of the five members (The parents and a daughter) had summer-type hypersensitivity pneumonitis that occurred in late summer. All three patients had a productive cough and shortness of breath. Chest roentgenograms of the mother and daughter (but not the father) showed diffuse small nodular shadows in both lung fields. Examination of bronchoalveolar lavage fluid from all three patients showed very high total cell counts, high percentages of T lymphocytes, and low ratios of CD4(+)-to-CD8+ cells. Microscopic examination of transbronchial biopsy specimens obtained from the daughter revealed infiltration of mononuclear cells with characteristic Masson bodies in alveolar septa, and granulomas in the interstitium. Both mother and daughter were positive for serum anti-Trichosporon cutaneum (serotype II) antibody, but the father, who was a current smoker was not. Thus, both mother and daughter were given the diagnosis of summer-type hypersensitivity pneumonitis, and in the father that diagnosis was strongly suspected.

A study of the advantages of elastic stockings for leg lymphedema

To assess the efficacy of compression therapy alone, we report herein the long-term results of leg lymphedema using elastic stockings. Between January 1965 and March 1993, 41 primary lymphedema and 74 secondary lymphedema of the lower extremities have been treated at our hospital. Ten patients had recurrence of cancer, and 5 patients had surgical therapy. The remaining 100 patients were analyzed for the clinical results following treatment with elastic stockings. During the follow-up period of 5 +/- 0.2 years, 3 of 39 limbs (8% or 30 patients) with primary lymphedema wearing elastic stockings experienced enlargement of limb circumference and 36 limbs (92% or 27 patients) showed decrease or no change. Without elastic stockings, 1 out of 13 limbs (8% or 8 patients) with primary lymphedema showed worsening of their symptoms. In contrast, only 1 of 61 limbs (1.7%) in 46 patients with secondary lymphedema who wore elastic stockings showed deterioration of their symptoms. Although elastic stockings did not influence the incidence of the lymphangitis, their effect in maintaining limb circumference was apparent in all the patients with inflammation caused by secondary lymphedema. Among 20 patients with secondary lymphedema who had recurrent lymphangitis, only 1 out of 19 limbs (5%) in 16 patients experienced deterioration of the symptom with the use of elastic stockings while 1 out of 4 limbs (25%) in 4 patients showed improvement or no change without elastic stockings. Our data demonstrate that compression stockings are associated with long-term maintenance of reduced limb circumference, especially in secondary lymphedema regardless of the association with recurrent lymphangitis.

An objective evaluation of muscle oxygen content in claudicants receiving drug therapy

The effects of medical treatment with a prostaglandin I2 analog (beraprost sodium) were evaluated in 19 of 120 cases studied with near-infrared spectroscopy (NIRS) from January 1993 to September 1994. The relative changes in oxygenated (Oxy) and deoxygenated (Deo) hemoglobin (Hb) in the calf muscle were measured during a treadmill walking test and the subsequent recovery period. After medical treatment in these 19 cases, recovery time of OxyHb decreased in 10 cases, increased in 7 cases and remained unchanged in two cases. Pressure studies did not facilitate the assessment of changes in the severity of claudication. Our results demonstrate that NIRS can provide objective information regarding the effects of medical therapy in claudicants.

[The combined effect of hyperthermia and irradiation on cultured human glioma cell line]

The effects of hyperthermia (HT) and irradiation (RT) on a cultured human glioma cell line (KC) was examined by a colony formation assay and immuno-histochemical methods using monoclonal antibody (MoAb) against bromodeoxyuridine (BrdU) and MoAb Ki-67. The colony formation assay revealed that HT inhibited the cell survival in time and temperature dependent fashion. RT also inhibited the cell survival depending on the irradiation doses. The combination of HT and RT showed an additive effect. The immunohistochemical examination indicated that both HT and RT reduced the BrdU labeling index and Ki-67 positive rate of the surviving cells. HT mainly affected the cells in the S-phase and RT seemed to affect the cells in the G2+ M phase. The combination of HT and RT also showed an additive effect. These results suggest that the combined therapy will be useful in the treatment of malignant gliomas.

[Histological grading and staging of IgA nephropathy]

The histological grading and staging (G-S system) is proposed in addition to the common histological diagnosis of IgA nephropathy, aiming the more precise understanding and appropriate therapeutic approach to the disease process. The histological grade (G) is estimated by the occurrence of acute glomerular and tubulointerstitial lesions, and histological staging (S) is evaluated by the increase of extra-cellular matrices (sclerosis) of the glomeruli and interstitial fibrosis. The evaluation of the G and S is expressed semiquantitatively for more helpful use in the clinical side. The G-S system may be beneficial for the management and therapeutic selection of patients of IgA nephropathy.

[Hemodynamic study for the assessment of atherosclerotic occlusive disease]

Of all modalities used for the assessment of the severity of ischemic limbs none has proved to be more simple, reliable and reproducible than Doppler ultrasonography. The critical level that endangers the leg in patients with arteriosclerosis obliterans will be defined around 0.3 of ankle brahcial index by Doppler pressure measurement. Concerning the evaluation of the severity of intermittent claudication Doppler study may provide some standards to predict the state of muscle ischemia after exercise from the value measured at resting state. Near infrared spectroscopy is capable of direct continuous monitoring for the change of the state of oxygenated haemoglobin and deoxygenated one in the ischemic calf muscle during exercise. NIRS can be a new modality to asses the muscle ischemia during exercise in ASO patients. The objective diagnostic techniques should be reproducible, capable of intrinsic standardization, easily employed, relatively rapid to perform, adaptable to current recording equipment, and applicable to studies during and after exercise.

Spontaneous perforation of a non-aneurysmal atherosclerotic abdominal aorta or femoral artery

The spontaneous perforation of a non-aneurysmal atherosclerotic abdominal aorta or femoral artery is reported. Over the past 14 years, four perforations have been found in the abdominal aorta and one in the femoral artery; the incidence of each was 1.1% and 5.9%, respectively. Computed tomography scanning was useful for diagnosing pseudoaneurysms in all cases, since it revealed haematoma outside the arterial wall. One of these cases presented with an aortoduodenal fistula. The arteries were severely atherosclerotic with calcification. All of the patients underwent a graft replacement. Operative findings confirmed pseudoaneurysm. One patient died from pneumonia 4 months after the operation, and the other four have remained well during the follow-up period ranging from 2-9 years.