[Surgical treatment for impending rupture of distal aortic arch aneurysm: a case report using "elephant trunk" prosthesis]

A 75-year-old man with impending rupture of distal aortic arch aneurysm was operated on using the "elephant trunk" prosthesis. A long graft was anastomosed only to the proximal aortic stump and its distal free portion was inserted through the exit of the aneurysm into the descending aorta. Postoperative CT scan and MR image showed complete thrombosis formation in the dead space between the graft and the aneurysmal wall, which precluded necessity for further operation. However the graft was looped and kinked in the aneurysm. Furthermore the patient suffered from incomplete paraplegia, probably caused by the extremely long graft. In terms of promoting thrombosis formation in the aneurysmal inner space the longer prosthesis is feasible, but one should keep it in mind that an excessively long graft can lead to the kinking of the graft and paraplegia.

Immunohistologic studies of Kikuchi's disease

An immunohistologic study of lymph nodes from 21 patients with Kikuchi's disease (histiocytic necrotizing lymphadenitis) was performed. The cell components of the affected areas were mainly CD4-positive cells, CD8-positive T cells, alpha/beta T-cell gene receptor-positive T cells, and lysozyme-staining cells. CD3-positive or alpha/beta T-cell gene receptor-positive T cells were composed mainly of CD8-positive and CD11b-negative cytotoxic T cells. Double staining demonstrated that CD4-positive cells usually were positive for Ki-M1p, a marker of plasmacytoid monocytes, but negative for T-cell markers. Although some lysozyme and CD4 double-positive cells were recognized, most CD4-positive cells were negative for lysozyme. The results indicate that CD4-positive cells in the affected foci of Kikuchi's disease were mainly composed of plasmacytoid monocytes.

Immunohistochemical detection of carbohydrate determinant 19-9 (CA 19-9) in intracranial epidermoid and dermoid cysts

We evaluated carbohydrate antigen (CA) 19-9 levels of intracranial dermoid and epidermoid cyst in serum and intratumoral tissue. The preoperative serum levels were mildly to moderately higher than their normal ranges in four of seven patients. In four patients with high serum CA 19-9 levels, they returned to normal ranges in three who had the cyst resected totally and remained slightly high in one with residual cyst. Immunohistochemical studies using anti-CA 19-9 antibody demonstrated positively stained capsule and keratinous tissue. Serum CA 19-9 levels of intracranial dermoid or epidermoid cysts with more teratomatous components may be elevated above normal levels.

Phosphatidic acid-induced superoxide generation in electropermeabilized human neutrophils

The ability of phosphatidic acid to induce O2- generation was examined in intact and electropermeabilized neutrophils. In intact cells, after a long lag (approximately 11 min), 1,2-didecanoylphosphatidic acid (PA10, 10 microM) elicited O2- generation (30-40 nmol/min/10(7) cells at maximum) which lasted for 8-9 min. Electropermeabilization facilitated the response by shortening the lag (within 30 s) and enhancing the maximal rate (120-130 O2- nmol/min/10(7) cells). The induction by PA10 was concentration-dependent and the half-maximal concentrations for intact and permeabilized cells were 11 and 3 microM, respectively. In permeabilized cells, the rate of O2- release by PA10, which was similar to that by fMet-Leu-Phe or phorbol myristate acetate, was not enhanced by addition of dioctanoylglycerol. Also, the response was unaffected by propranolol, an inhibitor of phosphatidate-phosphohydrolase that converts phosphatidic acid to diacylglycerol. Phosphatidic acids with longer acyl chains (C12-C14) also activated the permeabilized cells, although the degree of activation decreased as the chain length was increased. These results indicate the ability of phosphatidic acid to induce respiratory burst independently of diacylglycerol and support the idea that phosphatidic acid can be an activator of NADPH oxidase in human neutrophils.

[Effects of induced hypotension on perioperative renal and hepatic functions]

Hypotensive anesthesia induced by trimethaphan was maintained at 70-79 mmHg of the systolic radial artery pressure for two hours in 35 patients undergoing spherical acetabul osteotomy. The creatinine clearance, free water clearance, fractional sodium excretion, urine volume, urinary excretion of NAG and levels of gamma-GTP, serum GOT and GPT were measured perioperatively. The creatinine clearance, free water clearance and urine volume decreased by 50% during surgery but recovered to normal values on the third day after surgery. The fractional sodium excretion remained unchanged during and after surgery. The urinary NAG activity increased from 3 +/- a (SD) to 10 +/- 5 U.g-1 and gamma-GTP activity increased from 23 +/- 7 to 33 +/- 13 U.g-1 during surgery, and these remained at high levels for three days after surgery. The serum GOT and GPT levels were within normal ranges for 21 postoperative days. The increase in urinary enzyme activities during and after surgery indicates that mild damage of renal tubular cells has occurred during hypotensive anesthesia.

Comparison of electron irradiation diets and gamma irradiation diets for reproductive effects on rats

Rats were maintained on 50 kGy electron irradiation diets. Effects of the diets on reproductive performance of parents and developmental performance of fetuses (F1 and F2) were studied by comparison with data in rats maintained on gamma irradiation diets, as control animals, and the background data of our facility. As the result, no specific changes were observed in the group maintained on electron irradiation diets. Electron irradiation diets sterilized under the condition of 50 kGy irradiation in the present study, as well as the existing gamma irradiation diets, were found to be useful for breeding and nursing rats.

T lymphoid/myeloid bilineal crisis in chronic myelogenous leukemia

We describe 2 cases of "bilineal" crisis in chronic myelogenous leukemia (CML) with T cell and myeloid phenotypes. In both cases, morphocytochemically distinct myeloid and T lymphoid blast populations proliferated simultaneously in the phase of blastic crisis--myeloperoxidase (MPO)-positive, CD7+/CD33+ myeloblasts in the peripheral blood, and MPO-negative, periodic acid Schiff (PAS)-positive lymphoblasts in the lymph nodes. In each case, common karyotypes containing Ph1 translocation were demonstrated in both the peripheral blood and the lymph node samples. In Case 1, the lymph nodes were occupied by > 90% lymphoblasts, which were positive for CD2, cytoplasmic CD3 (cCD3), CD5 and CD7 and terminal deoxynucleotidyl transferase (TdT), but negative for myeloid antigens. Myeloblasts and T lymphoblasts showed an identical rearrangement of the bcr gene by Southern blotting analysis, although the clonal rearrangement of the T cell receptor (TcR)-delta gene was seen only in T lymphoblasts. In Case 2, simultaneous proliferation of myeloblasts and lymphoblasts was documented morphocytochemically in the lymph node, and a flow cytometric analysis revealed the coexistence of CD7+/CD33+ and CD7+/CD33- blast populations. Each blast population was enriched by antibody-conjugated immunomagnetic beads; the former was positive for MPO by 64% but negative for cCD3 and TdT, whereas the latter was positive for cCD3 and TdT but negative for MPO (< 1%). CD7+/CD33+ myeloblasts and CD7+/CD33- lymphoblasts showed an identical rearrangement of the bcr gene. Neither TcR-beta, TcR-gamma nor the TcR-delta gene was clonally rearranged in either population. These observations clearly indicate that T lymphoid and myeloid blasts share common Ph1-positive progenitors, and that Ph1-positive T lymphoid/myeloid progenitors are probably involved in the development of blastic transformation in some percentage of CML patients.

Sinonasal malignant lymphoma of natural killer cell phenotype associated with diffuse pancreatic involvement

We report a case of sinonasal lymphoma with a natural killer (NK) phenotype. This 40-year-old man was admitted to our hospital because of left nasal obstruction. Physical examination and computed tomography of the skull revealed a tumor in the left nasal cavity and maxillary sinus. Histopathological examination revealed a diffuse proliferation of pleomorphic lymphoid cells. Imprint cytology showed that tumor cells contained some azurophilic granules, and expressed CD2, CD8, CD16, CD56 and HLA-DR antigens with little expression of other lymphoid or myeloid markers. Southern blot analysis revealed germline configuration for immunoglobulin heavy chain and T-cell receptor genes. These findings indicated that these cells were in fact NK cells. The patient's enlarged pancreas was also involved by lymphoma and the pattern of involvement simulated that seen in primary pancreatic lymphoma. Ulcerative colitis (UC) was also present, a rare finding in this disorder.

Retrograde gastric varices in a patient with total cavopulmonary shunt

Gastric varices formed in a patient who had undergone a total cavopulmonary shunt operation 7 years previously. The varices were found to be due to development of collaterals from high-pressure systemic vein to low-pressure portal vein. Bleeding gastric varix can be a late complication of total cavopulmonary shunt.

Role of Lys-110 of human NADH-cytochrome b5 reductase in NADH binding as probed by site-directed mutagenesis

Lys-110 of human NADH-cytochrome b5 reductase was replaced by Ala, Met, or Arg by site-directed mutagenesis to evaluate the role of the residue. Km values of purified Lys-110-->Ala and Lys-110-->Met mutants for NADH were approximately 200-fold and 1,100-fold higher than that of the wild-type, respectively, while the value of the Arg mutant was almost the same as that of the wild-type. These results indicate that the positive charge at position 110 is important for NADH binding. The kcat value of Lys-110-->Ala was not affected, indicating that the residue only participates in the binding process in the reaction by forming an ionic interaction with phosphoryl group of NADH.

Management of adult moyamoya disease

The surgical management of adult moyamoya disease was evaluated retrospectively. Eight of 10 patients with hemorrhagic stroke had no bleeding episodes and eight of 11 patients with ischemic stroke were asymptomatic postoperatively. Angiography demonstrated neovascularization via the external carotid artery (ECA) in 22 sites (88%) and reduced basal moyamoya vessels in 11 sites (44%) postoperatively. These symptomatic improvements and angiographic findings suggest that reconstructive surgery for adult moyamoya disease patients with hemorrhagic or ischemic stroke is effective in decreasing hemodynamic stress in the basal moyamoya vessels and increasing the cortical blood supply via the ECA.

Restriction of T cell receptor variable region in lymph nodes of adult T cell leukemia/lymphoma

Adult T cell leukemia/lymphoma (ATLL) is a mature T cell malignancy, especially derived from the CD4 positive T cell. To characterize the T cell, we examined the representation of T cell antigen receptor variable region, using the monoclonal antibodies [beta V 5 (a), beta V 5 (b), beta V 6 (a), beta V 8 (a), beta V 12 (a), alpha V 2 (a), alpha-beta V (a)]. Clinicopathologically we classified the lymph nodes of patients with ATLL into three states (1) human T cell leukemia virus type I (HTLV-I) associated lymphadenitis, reactive state; (2) incipient ATLL, early or pre-neoplastic state; and (3) ATLL, neoplastic state. The lymph nodes of all three states were composed of unvarying CD4 positive T cells. Most of the lymph nodes with ATLL consistently presented alpha V 2 antigen, but no others. In HTLV-I associated lymphadenitis, only a few cells reacted for alpha V 2, as in non-specific lymphadenitis without ATLL features. One of three cases with incipient ATLL presented alpha V 2. The selected expression of T cell antigen receptor V region might be associated with the presence of HTLV-I encoded superantigen, similar to human immunodeficiency virus (HIV).

Clinicopathologic, enzyme and histochemical studies of centrocytic (mantle cell) lymphoma: comparison with other types of low-grade B cell lymphoma based on the updated Kiel classification

Lymph nodes from 21 cases of malignant lymphoma of a centrocytic (mantle cell) type, (ML, cc (mc)) were examined. All the cases had monoclonal surface immunoglobulin (sig) M and/or D, but were negative for CD10 (CALLA), and CD11c (LeuM5). Lymphoma cells with CD25 (anti-Tac)+, CD5 (Leu1)+, and alkaline phosphatase (ALPase)- in eight cases showed bone marrow involvement (10-66% of the nucleated cells; mean 32 +/- 18%) but with no leukemic changes. These eight cases had a similar phenotype and were distributed by the lymphoma cells to the examined B-chronic lymphocytic leukemia. Seven cases showed an infiltration of CD25-, CD5+, and ALPase- lymphoma cells, in which only two cases showed focal bone marrow involvement. There was a close relationship between CD25 expression and bone marrow invasion by the lymphoma cells in ML, cc (mc). Three of the six CD25- and CD5- cases presented zonal proliferation of ALPase+ lymphoma cells with round nuclei and a high anti-proliferating cell nuclear antigen/cyclin (PCNA/c) rate in the mantle zone and paracortex, accompanied by a prominent interdigitating dendritic and histiocytic cell reaction. Examined CD25-, CD5- and ALPase+ lymphoma showed a neoplastic counterpart of so-called marginal zone lymphocytes, which was different from other cases of ML, cc (mc). Lymphoma cells in ML, cc (mc), except for those of the so-called marginal zone lymphoma, might be derived from slgM+, D+/-, CD25+/-, CD5+/-, ALPase-, CD10- and CD11c- lymphocytes present in the mantle zone and primary lymph follicles.(ABSTRACT TRUNCATED AT 250 WORDS)

Human herpesvirus-6 genomes in histiocytic necrotizing lymphadenitis (Kikuchi's disease) and other forms of lymphadenitis

The cervical lymph nodes of 27 patients with histiocytic necrotizing lymphadenitis (HNL) were examined, as were those of 9 patients with tuberculous lymphadenitis (Tb), 10 with reactive paracortical hyperplasia (RPH), and 10 with nonspecific lymphadenitis (NSL). Southern blot analysis, the polymerase chain reaction (PCR), and in situ hybridization were use to locate the human herpesvirus-6 (HHV-6) genome. Southern blot analysis showed that all cases were negative for HHV-6 genomes, although all but one HNL case expressed HHV-6 genome using PCR. On in situ hybridization all 10 HNL cases, 6 of the 10 RPH cases, 6 of the 10 NSL cases, and 2 of the 9 Tb cases showed HHV-6 DNA. These results indicate that the presence of HHV-6 genome is not specifically related to HNL, and that this virus could hibernate in a latent form in the cervical lymph nodes. In addition, we examined three different primers (A, B, and C) for PCR amplification of HHV-6 genomes.

Analysis of mutant NADH-cytochrome b5 reductase: apparent "type III" methemoglobinemia can be explained as type I with an unstable reductase

A patient in Kurobe, Japan, was previously reported to have a new class of hereditary methemoglobinemia, type III. In this patient, NADH cytochrome b5 reductase deficiency was observed in lymphocytes and platelets as well as in erythrocytes, but this was not associated with mental retardation. A base change was identified in the gene for NADH cytochrome b5 reductase, causing an amino acid substitution from Leu-148 to Pro. In the present study, the mutant enzyme (Leu-148-->Pro) was expressed in Escherichia coli, purified, and characterized. The mutant enzyme retained about 60% of the catalytic activity of the wild type, but was remarkably heat unstable. By incubating the mutant enzyme at 42 degrees C for 10 minutes, 80% of the enzyme activity was lost, whereas the wild-type enzyme lost < 20% activity after incubation at 50 degrees C for 30 minutes. Another mutant in which Leu-148 was replaced by Ala was prepared to establish the role of the residue. This mutant was apparently less heat stable than the wild type, implying a structural role for Leu-148. Reinvestigation of the enzyme activity in the blood cells and fibroblasts of the type III Kurobe patient, revealed that about 40% of the normal activity was detected in these cells, in contrast to the previous report. Thus, this patient reported previously as having hereditary meth-hemoglobinemia type III was shown to have type I.

Cytokine (interleukin-1 alpha, interleukin-1 beta, tumor necrosis factor alpha, and interleukin-6)-possessing cells in lymph nodes of malignant lymphoma

Interleukin (IL)-1 alpha, IL-1 beta, tumor necrosis factor (TNF) alpha, and IL-6 are the most important triggers in the response of the immune system to infection and neoplasia. We examined the histochemical distribution of cytokine-possessing cells in neoplastic lymph nodes of 68 malignant lymphomas. The HLA-DR positive interdigitating reticulum cells (IRCs), histiocytes/macrophages (H/Ms) and epithelioid histiocytes with these cytokines were frequently encountered in Hodgkin's disease, B cell lymphoma of lymphoplasmacytic/cytoid, centroblastic and immunoblastic types, and T cell lymphoma of Lennert's and anaplastic large cell types. In almost all cases of B cell lymphoma of chronic lymphocytic leukemia, centrocytic, follicular centroblastic/centrocytic, Burkitt's types and T cell lymphoma of lymphoblastic, angioimmunoblastic lymphadenopathy and pleomorphic types, the cytokine-possessing cells were rarely or occasionally present. These lymphomas with less cytokines had also few or occasionally encountered IRCs, while H/Ms were frequently or occasionally present. Well-developed dendritic reticulum cells in some types of lymphoma had few cytokines. The population of cytokine-possessing cells was related with histologic type of lymphoma and the volume of IRCs. The IRCs might act as an important initiator of reactive cells against tumor cells. In addition, neoplastic T cells influenced the cytokines' possession of IRCs and H/Ms. Although lacunar, Hodgkin's and Reed-Sternberg cells in Hodgkin's disease and the neoplastic cells in peripheral T cell lymphoma showed weak positive reaction of TNF alpha in one third of the cases, lymphoma cells in the majority might have few cytokines, especially IL-1s and IL-6.

Effects of thiols on prostaglandin synthesis in bovine bladder epithelium

The regulation of prostaglandin (PG) synthesis was characterized in microsomes of bovine bladder epithelium. Coenzyme A (CoA) and its metabolite cysteamine drastically decreased total PG synthesis. Furthermore, CoA inhibited solubilized cyclooxygenase which was precipitated by anti-cyclooxygenase antibody. Reduced glutathione (GSH) slightly increased total PG production and changed the pattern of PG synthesis. Other thiols, cysteine and ergothioneine, did not change total PG production. None of the thiols stimulated the incorporation of arachidonic acid into the phospholipid fraction. These findings suggest that CoA may directly regulate cyclooxygenase activity and GSH may subsequently change the pattern of PG production in bovine bladder epithelium.

Proliferating cells in histiocytic necrotizing lymphadenitis

The phenotypes of proliferating cells in histiocytic necrotizing lymphadenitis (HNL) were examined. The affected areas consisted mainly of CD 8-positive (suppressor/cytotoxic T-cells) and CD 4-positive (helper/inducer T-cells) in association with some CD 15-positive cells (monocytes). A marker of proliferating cells (Ki-67) and monoclonal antibodies for determining the phenotypes of cells (CD 4, CD 8, CD 15) in the affected areas were applied using a double-staining method. Ki-67-positive proliferating cells were mainly CD 8-positive. A few CD 4-positive cells and rare CD 15-positive cells were also Ki-67-positive. The percentage of CD 8-positive cells increased gradually over time and the ratio of CD 8-positive to proliferating cells did not decrease throughout the observation period of 6 weeks. These results suggest that the proliferation of CD 8-positive T-cells together with the accumulation of CD 4- and CD 15-positive cells is the main phenomenon occurring in HNL.

Immunohistological study of skin involvement in Kikuchi’s disease

Five patients with histiocytic necrotizing lymphadenitis (Kikuchi's disease) with erythematous or popular skin lesions were studied. All patients healed naturally within a few months like the patients with no skin involvement. Histological findings for the skin lesions mimicked cutaneous malignant lymphoma. The infiltrated mononuclear cells usually demonstrated positive reactions for Ki-M1p (20-63%), lysozymes (13-54%), MT-1 (18-64%), UCHL-1 (22-39%) and LN2 (17-36%). OPD-4 and L26 positive cells were few in number. These results suggest that the infiltrated cells in a Kikuchi's disease skin lesion are composed of the same components as the affected lesion in the lymph node.

Alpha-interferon in Kikuchi's disease

In Japan, histiocytic necrotizing lymphadenitis (Kikuchi's disease) is a relatively common reactive lesion affecting lymph nodes, but the histogenesis and pathogenesis of the disease have not been clarified. Alpha-interferon has a role in the body's defense against viral infections. Using a polyclonal antibody to human alpha-interferon, we found numerous cells, mainly histiocytes, containing alpha-interferon in affected foci in the lymph nodes from 24 patients with Kikuchi's disease. Tubuloreticular structures, thought by some authors to be associated with the production of interferon, were detected by electron microscopy in histiocytes, activated lymphocytes and vascular endothelial cells in the affected foci. These results suggested that the formation of tubuloreticular structures is a secondary phenomenon following stimulation by alpha-interferon. Further, the activity of 2'-5' oligoadenylate synthetase, which is induced by alpha-interferon and enhanced during the early or active stage of viral infection, showed increased levels of activity in the active stage of Kikuchi's disease and decreased to normal levels in the convalescent stage 2 weeks later. These results suggested the possibility of a viral etiology for Kikuchi's disease.

Enzymatic instability of NADH-cytochrome b5 reductase as a cause of hereditary methemoglobinemia type I (red cell type)

Nucleotide substitutions in the gene for NADH-cytochrome b5 reductase were identified in three independent probands of hereditary methemoglobinemia type I. Patients in Kagoshima and Okinawa in Japan were shown to possess the same base change, from guanine to adenine at codon 57, which results in amino acid substitution from Arg to Gln. This nucleotide change was the same as formerly found in a patient in Toyoake, Japan (Katsube, T., Sakamoto, N., Kobayashi, Y., Seki, R., Hirano, M., Tanishima, K., Tomoda, A., Takazakura, E., Yubisui, T., Takeshita, M., Sakaki, Y., and Fukumaki, Y. (1991) Am. J. Hum. Genet. 48, 799-808). A type I patient in Italy was shown to have a base change from guanine to adenine at codon 105 which causes substitution from Val to Met. To characterize the enzymes of type I patients, Arg-57----Gln and Val-105----Met mutant enzymes were overexpressed in Escherichia coli and purified to homogeneity. kcat/Km values (NADH) of these two enzymes were 25% in Arg-57----Gln and 14.5% in Val-105----Met compared with that of the wild type enzyme, while the value of type II (generalized, severe form of the disease) mutant enzyme was 3% of the normal value (Yubisui, T., Shirabe, K., Takeshita, M., Kobayashi, Y., Fukumaki, Y., Sakaki, Y., and Takano, T. (1991) J. Biol. Chem. 266, 66-70). The type I mutant enzymes were less heat-stable and more susceptible to proteinase treatment than the wild type. From these results we conclude that restriction of enzyme deficiency to red cells in hereditary methemoglobinemia type I may be generally derived from instability and increased proteolytic susceptibility of variant NADH-cytochrome b5 reductases due to a point mutation.