[A case of sacral chordoma presenting as urinary retention]

A 71-year-old man was referred to our hospital complaining of urinary retention. He noticed a small mass on his buttocks about one year ago. Computed tomographic (CT) scan and magnetic resonance imaging (MRI) showed a large mass of 10 cm in diameter located in the retrovesical space. The mass extended to the surface of his buttocks and contained many calcified deposits, and was accompanied with a sacral bone fracture. Transdermic biopsy revealed the presence of sacral chordoma. Chordoma is a rare tumor, arising from remnants of the notochord and is locally progressive. Both tumor resection and diverting colostomy were performed at another hospital. In that operation his spinal cord was protected down to the second sacral level. Unfortunately after the operation, the patient suffered total urinary incontinence. At 15 months after surgical treatment, the patient presented with lung and bone metastases, and at 2 years after his initial operation, he had local recurrence.

Acetone preservation: a practical technique for molecular analysis

In attempts to establish a convenient and reliable method for field collection and archival preservation of insects and their endosymbiotic microorganisms for molecular analysis, acetone, ethanol, and other organic solvents were tested for DNA preservability of the pea aphid Acyrthosiphon pisum and its intracellular symbiotic bacterium Buchnera sp. After 6 months' storage, not only the band of high-molecular-size DNA but also the bands of rRNA were well preserved in acetone, ethanol, 2-propanol, diethyl ether and ethyl acetate. Polymerase chain reaction (PCR) assays confirmed that the DNA of both the insects and their symbionts was well preserved in these solvents. In contrast, methanol and chloroform showed poor DNA preservability. When water-containing series of acetone and ethanol were examined for DNA preservability, acetone was apparently more robust against water contamination than ethanol. Considering that most biological materials contain high amounts of water, acetone may be a more recommendable preservative for DNA analysis than ethanol which has been widely used for this purpose. The DNA of various insects could be preserved in acetone at room temperature in good condition for several years. In addition to the DNA of the host insects, the DNA of their endosymbionts, including Buchnera and other mycetocyte symbionts, Wolbachia, and gut bacteria, was amplified by PCR after several years of acetone storage. The RNA and protein of the pea aphid and its endosymbiont were also preserved for several years in acetone. After 2 years' storage in acetone, proteins of A. pisum could be analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting, and the endosymbiotic bacteria were successfully detected by immunohistochemistry and in situ hybridization on the tissue sections.

Value of percutaneous transhepatic portography before hepatectomy for hilar cholangiocarcinoma

BACKGROUND

The diagnostic value of percutaneous transhepatic portography (PTP) for assessing cancer invasion of the portal bifurcation in patients with hilar cholangiocarcinoma has not been studied previously.

METHODS

From April 1977 to March 1998 combined hepatobiliary and portal vein resection was performed in 45 patients. In 25 patients, PTP was carried out before operation and the resected portal bifurcation was examined histologically. Correlation between portographic and microscopic findings at the portal bifurcation was studied retrospectively.

RESULTS

Portographic and microscopic findings were classified into three groups (type A, B or C, and grade 0, I or II respectively) according to the findings at the portal bifurcation. There was a significant correlation between the portographic type and degree of cancer invasion (P = 0.0001). In seven of the eight patients with type A portograms, there was no microscopic cancer invasion of the portal bifurcation. In 15 of the 17 patients with type B or C portograms, cancer invasion was found microscopically. All patients with microscopic grade II invasion had type C portograms.

CONCLUSION

PTP can be used to evaluate cancer invasion of the portal bifurcation with sufficient reliability for preoperative staging of hilar cholangiocarcinoma.

Two intracellular symbiotic bacteria from the mulberry psyllid Anomoneura mori (Insecta, Homoptera)

We characterized the intracellular symbiotic bacteria of the mulberry psyllid Anomoneura mori by performing a molecular phylogenetic analysis combined with in situ hybridization. In its abdomen, the psyllid has a large, yellow, bilobed mycetome (or bacteriome) which consists of many round uninucleated mycetocytes (or bacteriocytes) enclosing syncytial tissue. The mycetocytes and syncytium harbor specific intracellular bacteria, the X-symbionts and Y-symbionts, respectively. Almost the entire length of the bacterial 16S ribosomal DNA (rDNA) was amplified and cloned from the whole DNA of A. mori, and two clones, the A-type and B-type clones, were identified by restriction fragment length polymorphism analysis. In situ hybridization with specific oligonucleotide probes demonstrated that the A-type and B-type 16S rDNAs were derived from the X-symbionts and Y-symbionts, respectively. Molecular phylogenetic analyses of the 16S rDNA sequences showed that these symbionts belong to distinct lineages in the gamma subdivision of the Proteobacteria. No 16S rDNA sequences in the databases were closely related to the 16S rDNA sequences of the X- and Y-symbionts. However, the sequences that were relatively closely related to them were the sequences of endosymbionts of other insects. The nucleotide compositions of the 16S rDNAs of the X- and Y-symbionts were highly AT biased, and the sequence of the X-symbiont was the most AT-rich bacterial 16S rDNA sequence reported so far.

Endometrial cytology in postmenopausal hormone replacement therapy

Endometrial changes is postmenopausal hormone replacement therapy (HRT) were studied by comparing cytological and histological findings. Cytological and histological examinations were conducted on 138 benign cases and 26 abnormal cases, including 24 cases with disordered proliferative phase (DOP) and 2 cases with simple endometrial hyperplasia (SEH), for a total of 164 cases. Hormones were administered as follows: 1) single cyclic administration of estrogen only (Single-HRT) for 31 cases, 2) cyclic administration of estrogen and progestin (Cyclic-HRT) for 105 cases, and 3) continuous administration of estrogen and progestin (Continuous-HRT) for 28 cases. All of the 164 cases were studied cytologically as to shape, appearance, nuclear number on maximum diameter, and so on. The benign cases in each mode of administration as described above revealed the following: 1) Single-HRT, atrophy or the proliferative phase was noted histologically, and the copresence of the endometrial epithelium and the ciliated cell metaplasia was observed cytologically; 2) Cyclic-HRT, the first half of the administration term was of the proliferative phase histologically, and the linear and long glands were seen cytologically. In the latter half of the administration term the secretory phase was noted histologically and the curved/linear glands with subnuclear vacuolization were observed cytologically; and 3) Continuous-HRT, atrophy was noted histologically, and fewer glands and atrophic cells on the endometrial epithelium with wrinkles mixed therein were seen cytologically. On the other hand, cytological examinations of the abnormal cases revealed a mean average of 35 nuclei on the maximum diameter of the gland, protrusion and/or ramification of the glands, densely clustered glands, and back-to-back glands without fusion, as well as irregularly dilated tortuous glands in SEH. These abnormal findings were considered useful for early detection of endometrial disorders in the hormone replacement therapy by cytodiagnosis.

Isolation, inoculation to insect host, and molecular phylogeny of an entomogenous fungus Paecilomyces tenuipes

A parasitic fungus to moth larvae and pupae, Paecilomyces tenuipes, was isolated and cultured on liquid and agar media. Fruit bodies, or synnemata, with characteristics of P. tenuipes were successfully formed on the agar medium. When pupae of wax moth, Galleria mellonella, were incubated with the conidia, all the pupae were infected and the synnemata were formed out of them. Almost the entire length of 18S rDNA of P. tenuipes was amplified by PCR and directly sequenced. Molecular phylogenetic analysis demonstrated that it belongs to the subphylum Ascomycotina, the class Pyrenomycetes, the order Clavicipitales. This result is compatible with the suggestions that P. tenuipes may be the anamorph of an entomogenous fungus of the genus Cordyceps.

[A case of bilateral renal infarction]

A 67-year-old woman was admitted with aching pain in her left flank and nausea. Bilateral renal infarctions were noticed by CT scan and arteriography. Selective intra-arterial thrombolytic therapy was performed. Urokinase (UK) was administered through a balloon catheter embedded into the occlusive segment of the left renal artery selectively. UK (20,000 units/hour) was continuously infused after short-term high dose UK (360,000) infusion. In spite of recanalization of the occluded artery, CT scan and renoscintigraphy image did not suggest recovery of renal function. Conservative intra-arterial thrombolytic therapy is considered to be the most effective treatment for renal infarction.

Kinetic assay of serum and urine for urea with use of urease and leucine dehydrogenase

We describe a new kinetic assay for determining urea in serum or urine with use of urease (EC 3.5.1.5) and leucine dehydrogenase (EC 1.4.1.9). The latter enzyme is suitable for the kinetic assay of NH4+ because its Km value for NH4+ at pH 8.75 is large (approximately 500 mmol/L). Interference from endogenous NH4+ in serum or urine is obviated by subtraction of the assayed endogenous NH4+ value in a sample blank. For serum, within-assay CVs (n = 10) were 0.39-0.58%; day-to-day CVs (n = 10) were 1.56-2.30%. In urine, within-assay CVs (n = 10) were 0.86-1.15%. Analytical recovery of urea (0.893-71.4 mmol/L) added to patients' sera (urea 6.14 mmol/L) was 99.2-105.2%. The calibration curve for serum was linear through zero for urea concentrations up to 142.9 mmol/L and for urine up to 714.3 mmol/L. No influences of added ammonium ion, bilirubin, hemoglobin, ascorbic acid, or Intralipid were observed. The regression equations for this method (y) and conventional methods (x = Determiner-LUN for serum assays, Serotec UUR-R for urine) were: y = 1.016x - 0.12 mmol/L (r = 0.999, S(y/x) = 0.34 mmol/L, n = 100) for sera, and y = 1.070x - 12.6 mmol/L (r = 0.998, S(y/x) = 7.41 mmol/L, n = 100) for urine.

[A case of xanthogranuloma of the urinary bladder following herniorrhaphy]

We report a case of xanthogranuloma of the bladder following herniorrhaphy. The patient complained of urinary frequency, residual feeling, and presented with a solid mass located on the dome of the bladder. He had undergone previous inguinal herniorrhaphy. Transurethral biopsy revealed an inflammatory change. Partial cystectomy was carried out for en bloc removal of the tumor. The histological diagnosis was xanthogranuloma of the bladder. Postoperatively, the symptoms disappeared. This is the sixth case report of xanthogranuloma of the urinary bladder and the first case following herniorrhaphy in the Japanese literature.

Determination of anti-streptolysin O antibody titer by a new passive agglutination method using sensitized toraysphere particles

We developed a new method for determining the anti-streptolysin O (ASO) titer on the basis of a passive agglutination reaction. This new method uses Toraysphere particles sensitized with streptolysin O. This method was used to measure the ASO titer in 130 serum samples (from 31 patients with post-streptococcal glomerulonephritis, 26 patients with group A streptococcal pharyngitis, 5 patients with scarlet fever, 29 patients with non-group A streptococcal pharyngitis, 20 healthy children, and 19 healthy adults). The results were compared with those obtained simultaneously by two conventional methods, the Rantz-Randall and the NA-Latex-ASL methods. The results obtained by the Toraysphere method showed an excellent correlation with those obtained by each conventional method (correlation coefficients, 0.932 for the Rantz-Randall method and 0.913 for the NA-Latex-ASL method). The performance of each method was evaluated with respect to the clinical and microbiological diagnoses for each patient. The sensitivity, specificity, positive predictive value, and negative predictive value for the Toraysphere method were 76, 84, 81, and 79%, respectively. The corresponding values for the Rantz-Randall method were 48, 78, 67, and 62%, respectively, while those for the NA-Latex-ASL method were 60, 82, 76, and 69%, respectively. Because the Toraysphere method is simple and reproducible, has a short reaction time, and has a clear-cut endpoint for the analysis, we recommend it for routine use in determining the ASO titer in the clinical microbiology laboratory.

IgD monoclonal gammopathy of undetermined significance

We describe here a case of monoclonal gammopathy of undetermined significance (MGUS) of IgD type. A trace of serum M-protein was noticed on electrophoresis when a Japanese man visited his primary care physician for medical examination. However, he was asymptomatic. Serum immunoelectrophoresis showed IgD lambda M-protein. Bone marrow examination revealed normocellular marrow with 1.5% plasma cells. Renal function, serum calcium level and complete blood cell count were all within normal limits and a systemic bone survey disclosed no lytic lesions. He was followed for 26 months without chemotherapy, and no disease progression to overt myeloma nor development of systemic amyloidosis resulted. This is, to our knowledge, the third case of IgD MGUS and the first one reported from Japan.

Solid variant of an aneurysmal bone cyst (giant cell reparative granuloma) of the 3rd lumbar vertebra

A 9-year-old girl with a solid variant of an aneurysmal bone cyst in the 3rd lumbar vertebra showed a good response to low-dose radiation as the only treatment. The solid variant of aneurysmal bone cyst is thought to be a reactive response to intraosseous hemorrhage and is also called giant cell reparative granuloma or giant cell reaction. These lesions in the jaw and the short tubular bones of the hands and feet frequently recur after surgery. Aneurysmal bone cysts of the spine also show a fairly high recurrence rate after incomplete resection or radiation therapy. However, 7 previous cases of the solid variant of aneurysmal bone cyst in the spine and this case did not show recurrence after a mean follow-up period of 45 months. This difference in behaviour suggests that the solid variant should be recognized before surgery as being distinct from conventional aneurysmal bone cysts, especially in the spine.

[False-positive increase in 1,5-anhydro-D-glucitol due to Kampo (Japanese herbal) medicine]

We report a case presenting with a remarkable increase in blood 1,5-anhydro-D-glucitol (AG) upon taking a Kampo (Japanese Herbal) Medicine, Ninjin-Youei-To. The HPLC-analysis of the drug taken by the present case revealed 8.8 mg/g of AG in this Kampo (Japanese Herbal) Medicine. A similar increase in blood AG(maximum increase: 1.49 micrograms/mL/day) was observed when healthy normal volunteer's took Ninjin-Youei-To alone. Drug withdrawal led to a decrease in blood AG. No great change in diabetes-related items measured at the same time was noted, and glycosuria was always negative. These results led us to consider that the change in blood AG is not diabetic, but Ninjin-Youei-To-mediated. Ninjin-Youei-To is composed of 12 kinds of crude drugs, including Ginseng radix and Polygalae radix, and we made a search of the literature concerning these crude drugs. Polygalae radix, a component of Ninjin-Youei-To, was confirmed to contain AG. Where a change in blood AG does not accord with clinical symptoms and other laboratory findings, some influence or other of Kampo (Japanese Herbal) Medicine should be taken into account as a pre-analytical phase error.

Phylogenetic position of yeast-like symbiont of Hamiltonaphis styraci (Homoptera, Aphididae) based on 18S rDNA sequence

Almost all aphids harbor bacterial intracellular symbionts in mycetocytes. However, some Cerataphidini aphids do not harbor them but possess yeast-like extracellular symbionts in the abdominal hemocoel, suggesting that in a lineage of this group replacement of symbiont occurred from an intracellular bacterium to an extracellular fungus. To investigate the origin of the newly-acquired symbiont, the 18S rDNA sequence of the yeast-like symbiont of Hamiltonaphis styraci was determined by PCR direct sequencing. Molecular phylogenetic analyses indicated that the symbiont belongs to the subphylum Ascomycotina, the class Pyrenomycetes. It was also suggested that the yeast-like symbiont of H. styraci and that of planthoppers are phylogenetically very closely related to each other.

Apocrine carcinoma vs. apocrine metaplasia with atypia of the breast. Use of aspiration biopsy cytology

OBJECTIVE

To solve the problem of diagnosing apocrine carcinoma (APCA) through distinguishing it from benign apocrine metaplasia with atypia (APMA).

STUDY DESIGN

The study group consisted of five histologically confirmed cases of uncommon infiltrating apocrine carcinoma and a case of noninfiltrating apocrine carcinoma of the breast by aspiration biopsy cytology. The control group consisted of 103 cases of benign apocrine metaplasia with no atypia (APMN), 4 cases of APMA and 34 cases of common-type adenocarcinoma that were encountered in 662 breast aspirations from 1988 to 1992 at Hekinan Municipal Hospital.

RESULTS

In APCA the average age of patients (65 +/- 17.7 SD)(mean +/- SD) was more than 20 years older than APMA, and APCA generally measured > or = 2 cm or more in diameter as compared to < or = 2 cm in APMA lesions. In APCA the apocrine cells had high cellularity, with the cells occur singly and with syncytia in the background. Numerous degenerated apocrine cells and characteristic cell detritus were found. APCA was also characterized by apocrine cells with more marked nuclear abnormalities, including hyperchromasia and irregular nuclear shape, frequently with irregular nucleoli; more nuclei measure > or = 12 micron in diameter than in APMA. These findings, however, were present only to a mild degree in APMA, if at all. APMA may coexist with APCA.

CONCLUSION

If APMA is diagnosed, an open biopsy should be performed to distinguish it from APCA.

Serum cryoglobulin and chronic hepatitis C virus disease among Japanese patients

OBJECTIVES

Hepatitis C virus (HCV)-associated mixed cryoglobulins appear to be detected often in hepatitis C-related chronic liver disease. The association of the two phenomenon among Japanese patients is the subject of the present study.

METHODS

Serum levels of total hemolytic complement (CH50) and anti-C3d-binding immune complex, as well as the prevalence of cryoglobulins, were studied in 213 patients with chronic liver disease (hepatitis C, 155; hepatitis B, 58). Cryoprecipitates were tested for anti-HCV Ab and HCV RNA.

RESULTS

CH50 activity was significantly lower in patients with hepatitis C than in those with hepatitis B except in responders to interferon who showed a sustained loss of HCV RNA. Cryoglobulins were detected in 24 (37%) of 65 patients with hepatitis C; they generally consisted of polyclonal immunoglobulins but one case. Cryoglobulins were more frequently observed in cirrhotic patients and in those with a longer duration of disease. Cryoglobulinemia-related clinical signs such as vasculitis occurred in only three cases. Patients with cryoglobulins had lower CH50 activity and higher immune complex values than those without cryoglobulins. Anti-HCV Ab and HCV RNA were detected in all cryoprecipitates tested.

CONCLUSIONS

These findings suggest that HCV is a major cause of cryoglobulins and advanced liver damage. However, serum cryoglobulins with polyclonal immunoglobulins appear to be less frequent among Japanese patients than among those studied in Western countries.

Decreased interleukin-6 level in the cerebrospinal fluid of patients with Alzheimer-type dementia

We examined IL-6 levels in the cerebrospinal fluid (CSF) of patients clinically diagnosed with Alzheimer-type dementia (ATD) and with vascular dementia (VD) and of age-matched normal subjects. The IL-6 levels in the CSF of ATD, but not VD patients, were significantly decreased. In the early onset ATD patients (disease onset < 65 years), IL-6 levels were reduced to 21% of the control level. The IL-6 levels in the CSF were not associated with the severity of the dementia or the duration of the disease since the identification of the first symptoms.

[Early detection of hepatocellular carcinoma with lectin reactive alpha-fetoprotein]

Lens culimaris agglutinin A-reactive alpha-fetoprotein (AFP L3) and erythroagglutinating phytohemagglutin-reactive alpha-fetoprotein (AFP P4 + P5) were determined by a sensitive method using lectin-affinity electrophoresis coupled with antibody-affinity blotting, and the usefulness of this method for early detection of hepatocellular carcinoma (HCC) was examined. For 72 operated cases of the HCC group including 28 cases of small liver cancer, the AFP value was 124 +/- 198ng/ml (Mean +/- SD); the lectin fraction values for L3 and P4 + P5 were 12.2 +/- 17.9 and 17.9 +/- 17.9%, respectively, which were significantly higher compared with the chronic hepatitis (CH).cirrhosis (LC) group and showed an increasing tendency with an increase in tumor diameter. The cut-off values for distinguishing HCC from CH.LC, determined with the receiver-operating characteristic (ROC) plots, were 10.0 and 15.0% for the L3 and P4 + P5 fractions, respectively, and the positive rates in the patient with HCC were 33.3 and 48.6% for AFP L3 and AFP P4 + P5, respectively, and 59.7% with a combination assay. For small liver cancer, the positive rate was 17.9% with protein induced by vitamin K absence-II (PIVKA-II) and 46.4% with combination assay of AFP L3 and AFP P4 + P5. Also, for HCC below AFP 50ng/ml, a positive rate of 45.0% was obtained. In the CH.LC group, all cases were negative for AFP L3 and 2 of 44 cases (4.5%) were false-positive for AFP P4 + P5.

Differentiation of aphid clones by arbitrarily primed polymerase chain reaction (AP-PCR) DNA fingerprinting

Differentiation of aphid clones was attempted using AP-PCR which is a simple and rapid method to obtain DNA fingerprints of complex genomes. To establish optimal reaction conditions and examine reproducibility of the method, a laboratory-maintained clone of the pea aphid, Acyrthosiphon pisum, was used as test material. Under the reaction conditions employed, identical fingerprint patterns were obtained throughout a wide range of template DNA amount, from 5 to 800 ng, and irrespective of aphid instar. No changes in the patterns were seen throughout five parthenogenetic generations. When this method was applied to a wild population of the gall-forming aphid, Ceratovacuna nekoashi, five groups of insects originating from different galls formed on the same twig were successfully differentiated from one another by means of polymorphic fingerprint bands. In contrast, the fingerprints of the insects derived from the subgalls of the same gall were identical. These results indicated that in C. nekoashi: (i) members of a gall constitute a clonal population; (ii) a gall is founded by a single fundatrix; and (iii) intergall migration is absent or at least not frequent.

Immunohistochemical characterization of extracellular matrix components of granulosa cell tumor of ovary

In order to clarify the characteristics of granulosa cell tumors of the ovary, extracellular matrix components were investigated by immunohistochemical techniques. Twenty-three granulosa cell tumors (GCT; eight juvenile and 15 adult type) were studied in comparison with non-neoplastic granulosa cells of human ovaries. In all 23 cases of GCT, chondroitin 6-sulfate proteoglycan revealed with antibody 3B3 was characteristically observed in the extracellular matrix in the solid nest, as well as in microfollicles. In the juvenile cases, the extracellular matrix also contained large proteoglycan (PG) revealed with antibody 2B1. Macrofollicles as well as microfollicles contained PG chondroitin 6-sulfate side chains with a significant amount of chondroitin 4-sulfate. By biochemical analysis using high pressure liquid chromatography, it was also found that disaccharide composition of glycosaminoglycan fractions extracted from granulosa cell tumor tissues consisted mainly of 2-acetamide-2-deoxyl-3-O-(beta-D-gluco-4-enepyranosyluronic acid)-6-O-sulfo-D-galactose (delta Di-6S). The characteristic feature of granulosa cell tumors is the accumulation of chondroitin sulfate PG, especially chondroitin 6-sulfate PG, which may be synthesized by the tumor cells themselves. Immunohistochemical characterization of the extracellular matrix components (collagen, laminin, heparan sulfate PG, chondroitin 4-sulfate PG) was also studied in relation to chondroitin 6-sulfate PG localization.

Expression of plasminogen activators and their inhibitors in human pancreatic carcinoma: immunohistochemical study

Expression of plasminogen activators (PA), tissue type (t-PA) and urokinase type (u-PA), as well as PA inhibitors (PAI), type-1 (PAI-1) and type 2 (PAI-2), were investigated immunohistochemically in 97 human pancreatic carcinomas. u-PA expression predominated in pancreatic carcinomas, compared with t-PA [u-PA expression in 76 specimens (78.4%) and t-PA in eight specimens (8.2%)]. PAI-1 expression was detected in 80 carcinoma specimens (82.5%) and PAI-2 in 79 carcinoma specimens (81.4%). PAI-2 expression was significantly lower in carcinomas with peritoneal metastasis (p < 0.02). Strong PAI-2 expression was associated with significantly higher survival than negative or weak PAI-2 expression (p < 0.05). We conclude that immunohistochemical analysis of PAI-2 expression in pancreatic carcinomas may yield important prognostic information.