Endoscopic and histopathological study on primary and secondary intestinal lymphangiectasia

Jejunal endoscopy and histopathological study of biopsied specimens were performed to clarify states of jejunal mucosa and the mechanism of enteric protein loss in six patients with protein-losing enteropathy, including four patients with intestinal lymphangiectasia, one patient with constrictive pericarditis associated with dilated lymphatics of the intestine, and one patient with Budd-Chiari syndrome. Three cardinal endoscopic findings, scattered white spots, white villi, and chyle-like substances covering the mucosa, were demonstrated in protein-losing enteropathy. Scattered white spots indicated markedly dilated lymphatics in the stroma of the villi. White villi seemed to be due to fats including chylomicrons or fat droplets in the absorptive cells, interepithelial spaces, and/or stroma, even though the biopsies were obtained in the fasting state. Therefore, white villi suggest impaired transport of fats from intestinal epithelial cells to intestinal lymphatics. These three cardinal findings are thought to be characteristic for protein-losing enteropathy secondary to lymphatic disorders.

Histoclinical long-standing follow-up study of hyperplastic polyps of the stomach

In a series of 2,013 gastric polyps in 1,201 patients, morphological and histopathological studies have been performed. Ninety-three hyperplastic polyps in 56 patients have been followed-up endoscopically and histopathologically for five to 12 years. The incidence of detection of gastric polyps has increased: 1.4% in 1967 to 8.7% in 1979 year by year. Thirty patients (54%) among the 56 showed changes in number, size or shape of polyps during follow-up. Twenty patients (37%) revealed numerical changes (increase in 16 patients, reversion in three patients and vanishing in two patients). Twenty-eight polyps (30%) showed morphological changes, six of them showed continuous enlargement, 18 lesions repeated enlargement, stationary or reduction stages, three lesions were reversed and two polyps disappeared. Histopathologically, three lesions showed transformation from the hyperplastic type to adenoma while demonstrating morphological enlargement. Two of these showed increase in cellular atypia, from the hyperplastic type through adenoma with severe atypia and finally to carcinoma in the polypectomy specimens. From this study, it was concluded that although hyperplastic polyps show changes in size, shape or number with passage of time, malignant changes occur in only a few cases.

Improvement of the preparation method for vaginal smears for the auto-cyto-screener

An improved method of preparing vaginal smears for use in the Auto-Cyto-Screener is reported. The main alterations from the previous technique were the substitution of 2% formaldehyde phosphate buffer (pH 7.4) for 50% ethanol as the preservative fluid, the use of homogenization in place of sonication for cell aggregate dispersion and the introduction of Ficoll-gradient sedimentation, which not only removes leukocytes and other elements from the suspensions but also concentrates the cancer cells to some extent. An examination of cell deposition techniques showed that optimal results were achieved with the use of filter paper, not rubber, and with centrifugation performed immediately after loading the suspension into the chambers.

Pathological and pathophysiological study on intestinal lymphatic system in fat absorption

Pathological and pathophysiological study on the intestinal lymphatics was carried out clinically and experimentally. Jejunal biopsy study revealed marked dilatation of intestinal lymphatics in liver cirrhosis with ascites and Behçet's disease as well as protein-losing enteropathy. Lymphangiographic study showed also abnormal findings in above-mentioned diseases. In cases of McKee dogs in which mechanism of blockade of lymphatic flow was already clarified, McKee dogs showed marked malabsorptive of fat. When lymphatic flow was blocked mechanically at the thoracic duct, fat accumulation was seen in the absorptive cells as well as in dilated intestinal lymphatics. In administration of colchicine to rats, fat accumulation was seen in the matrix of absorptive cells as well as in the endoplasmic reticulums and Golgi apparatus. However, amorphous substances instead of chylomicrons were seen in dilated intestinal lymphatics. These studies suggested that a tract of fat transportation from intestinal cells to the thoracic duct should be considered as a functional unit in fat absorption.

Lymphangiographic findings in Behçet's disease with lymphangiectasia of the small intestine

Bipedal lymphography was performed in 5 cases of Behçet's disease. In 4 of 5 cases, histologic examination of intestinal biopsy specimens showed lymphatic dilatation of the small intestine which were considered to be a characteristic finding of intestinal lymphangiectasia, a protein-losing enteropathy, but no patient with Behçet's disease showed reduced concentration of serum total protein as well as abnormal value of 131I-PVP test. Lymphograms showed an increase in number of iliopelvic and lumbar lymphatic vessels as a major finding, but they failed to demonstrate a hypoplasia or aplasia of lymphatic system or obstruction of thoracic duct. It is conceivable that the lymphatic dilatation of the small intestine in Behçet's disease may be related to increased flow of lymph due to excessive vascular hyperpermeability and may not be related to a block of lymphatic system which has been considered to be a cause of enteric protein loss in intestinal lymphangiectasia. The authors wish to emphasize that the dilatation of lymphatic vessel of the small intestine is not a sufficient finding to indicate the presence of protein-losing enteropathy.

Altered nutritional requirements associated with mutations affecting the structures of ribonucleic acid polymerase in Lactobacillus casei

Rifampin-resistant mutants were isolated from Lactobacillus casei S1 and examined for possible simultaneous alteration in nutritional properties. Among the 36 mutants obtained either spontaneously or after mutagenesis with 2-aminopurine, 22 were found to be altered with respect to the specific growth requirements. The majority (20 of 22) of the latter mutants were shown to require L-glutamine in addition to the nutrients required by the parental strain for maximal growth, whereas the remaining mutants had apparently lost the requirement for L-aspartate. Further studies with one of the glutamine-requiring mutants revealed that the rifampin resistance of this strain is due to the resistance of ribonucleic acid polymerase itself and that a single mutation is responsible for both rifampin resistance and the glutamine requirement. These results strongly indicate that a structural alteration of the ribonucleic acid polymerase caused by the rifampin resistance mutation somehow affected glutamine metabolism, possibly through change in selective transcription of the genes involved.

Genetic basis of nutritional requirements in Lactobacillus casei

In a study of the genetic basis of multiple nutritional requirements in Lactobacillus casei, systematic attempts were made to isolate mutants that can grow in the absence of a specific nutrient required by the parental organism. Such mutants have successfully been isolated with respect to seven of twelve amino acids (aspartic acid, leucine, isoleucine, lysine, methionine, serine, and threonine) and three of four vitamins (pantothenic acid, nicotinic acid, and pyridoxal) tested, after extensive screenings employing various mutagens. Mutants that can grow without tryptophan were not isolated, but those that can grow on anthranilate or indole as well as on tryptophan were obtained at a frequency expected for single-step mutations. Activity of tryptophan synthetase was demonstrated in extracts of these anthranilate-utilizing mutants, but not in the parental strain. These results suggest that the multiple nutritional requirements of L. casei are often, if not always, due to one or a few small lesions such as base substitution mutations rather than large deletions affecting the genes involved in each biosynthetic pathway. The data would also imply that many of the biosynthetic pathways that are not fully functional in L. casei were active at one time and became nonfunctional during evolution of the present species.

Histopathological and electron microscopic studies of lymphangiectasia of the small intestine in Behçet's disease

The gastrointestinal involvement and immunological findings in 16 patients with Behçet's disease are described. Four of 15 biopsy specimens of jejunal mucosa showed marked lymphangiectasia in the lamina propria similar to the appearance which was thought to be a characteristic finding in protein-losing enteropathy. None of the patients had hypoproteinaemia. Increases in serum immunoglobulin IgA were proved in six of 15 cases; in IgM, five of 15; and in IgG, one of 15. Electron microscopic studies showed that there were thousands of precipitated lymph protein bodies in the extracellular spaces of the lamina propria. Ulcers and healed ulcers of the large intestine were studied by light microscopy.