SECONDARY AMYLOIDOSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS: DIAGNOSTIC AND PROGNOSTIC VALUE OF GASTRODUODENAL BIOPSY

Upper gastrointestinal endoscopy was performed in patients withrheumatoid arthritis (RA) during the period 1989–1991,and biopsy specimens were obtained from the stomach and fromthe duodenum for examining amyloid deposits. Among 407 patients,gastrointestinal amyloidosis was confirmed in 54 (13.3%). Twenty-twopatients were regarded as having slight amyloid deposits, while32 patients were categorized as having marked amyloid deposits.The incidence of clinical manifestations suggestive of systemicamyloidosis was more frequent in the marked deposits group thanin the slight deposits group (47% vs 14%, P < 0.05). Amongthe patients who died of manifestations associated with amyloidosis,the survival period following endoscopy was shorter in the markeddeposits group than in the slight deposits group. These findingssuggest that gastroduodenal biopsies may be useful for diagnosingsecondary amyloidosis and that the degree of amyloid depositsseems to be correlated with the clinical manifestations of RA. KEY WORDS: Rheumatoid arthritis, Complications, Secondary amyloidosis, Diagnosis, Endoscopy, Biopsy, Prognosis     

A case of granular cell tumor of the bladder successfully managed with extraperitoneal laparoscopic surgery

Granular cell tumor is a benign neoplasm which frequently occurs in the oral cavity, skin, and subcutaneous tissue. Granular cell tumor of the bladder is an extremely rare disease, and only nine cases have been reported. We present here an additional case of granular cell tumor occurring in the bladder. Unlike the other tumors reported, this tumor extruded into the Retzius' cavity. Therefore, the tumor was successfully excised through extraperitoneal laparoscopic surgery. The patient was free from recurrence 40 months after surgery. The small tumor located in Retzius' cavity could be managed with extraperitoneal laparoscopic surgery.     

THE EFFECT OF ALTHESIN (CT1341) ON THE OXYHAEMOGLOBIN DISSOCIATION CURVE IN VITRO

Blood from non-smoking donors was incubated with Althesin andthe Po2 for half-saturation of haemoglobin at standard pH, Pco₂and temperature (P₆₀) was measured. The mean P₆₀ values of bloodwith blood concentrations of Althesin of 0.14ml/dl and 0.42ml/dl were greater (1.14 ± 0.31 (SEM) mm Hg (p< 0.005)and 2.22 ± 0.35 (SEM) mm Hg (P< 0.001), respectively)than that of control blood. These increases were dose-dependent(P< 0.05). Erythrocyte 2,3-diphosphoglycerate (2,3-DPG) concentrationswere not significantly different between the Althesin-treatedand the control blood. Although a decrease in the affinity ofhaemoglobin for oxygen in vitro in the presence of Althesinwas statistically significant, this would have no clinical significanceif the drug was being used for the induction of anaesthesiaonly.     

Primary liver cancer in non-cirrhotic liver. Epidemiological study based on autopsies performed in Trieste, Italy and Kurume, Japan

This study, aimed at elucidating the epidemiological features of primary liver carcinoma developing in non-cirrhotic livers, was based on 25,103 autopsies performed between 1975 and 1984 in Trieste, Italy. These autopsies correspond to approximately 70% of all deaths that occurred in this area. Various factors allegedly related to carcinomas were analysed in reference to our previous study on cirrhotic livers and in comparison with 5,603 autopsies in Kurume, Japan. There were 28 cases of hepatocellular carcinoma (HCC), 16 of cholangiocellular carcinoma (CCC) not associated with cirrhosis in Trieste, and 48 HCC and 19 CCC in Kurume. On the basis of our findings, it was concluded that cirrhosis, regardless of its cause, is the main pathogenetic factor in HCC; it is responsible for a much higher frequency (14.2:1) than in non-cirrhotic livers, as well as for early occurrence of tumours (an average of 6 years earlier in cirrhotic liver) in Trieste. Patients in Trieste were older than those in Japan, and the frequency of HCC among all autopsies was much greater in the latter. By contrast, the influence of cirrhosis on cholangiocellular carcinoma (CCC) was negligible, as such association appeared purely coincidental or absent. The incidence of CCC among autopsies was greater in Japan. Our data on CCC were not sufficient to demonstrate any clear aetiopathogenetic association between this tumour and alcohol abuse and hepatitis B virus (HBV) infection, except for a possible aetiological role of gallstones. The frequency of CCC relative to HCC was greater in Trieste than in Japan; the incidence of HCC was much less in Trieste, whereas CCC was more frequent in Japan.     

Delta infection in Japan: Immunohistological and immuno-electron microscopic study of delta antigen in liver tissue

Abstract Although the vast majority of hepatitis B surface antigen (HBsAg) carriers of the world inhabit South-east Asia, very little is known about delta infection in this area. Therefore, a serological and immunohistological study was made in the Tokyo-Chiba area. One of 58 (1.7%) HBsAg carriers had anti-delta antibody in a high titre in serum. Delta antigen was immuno-histologically localized in the liver in two of 146 (1.4%) HBsAg carriers studied. The antigen was strongly stained in the nuclei, and positive cells were diffusely scattered throughout the liver in both cases. Neither subject was an illicit drug user: one had travelled to Italy 10 years earlier and the other had a blood transfusion during a 5-year residence in Bangkok in the past.
Thus, there is delta infection among non-intravenous drug users in Japan. Delta infection has been linked to severe liver damage, occasionally fatal. Once introduced, it could become epidemic in a country where hepatitis B virus infection is endemic, and might spread among non-drug users.     

Discrepant effects of vasoconstrictors on the growth of early passaged cultured rat mesangial cells

Summary: Mesangial cell growth stimulation by endothelin (ET) and arginine vasopressin (AVP) has been reported, but only in studies using late (3 times) pasaged cells. In the present study, we examined the effects of ET, AVP and platelet activating factor (PAF) on the proliferation of early (<3 times) passaged cultured rat mesangial cells which maintained their original characteristics. Cell growth was estimated by [³H]-thymidine incorporation into DNA and by counting cell nuclei. After 48 h preincubation in minimal essential medium containing 0.5% fetal calf serum, ET-1 (1-100 nmol/L), AVP (100 pmol/L-1 μmol/L) or PAF (1–100 nmol/L) was added to the incubation medium. In contrast to studies using late passaged cells, ET-1 attenuated and AVP did not increase thymidine uptake (ET-1: 18.4% inhibition at 10 nmol/L) or cell counts in early passaged cells, while the growth stimulatory effects of these agents were reproduced in late passaged cells. Platelet activating factor showed definite stimulation of cell growth in both early and late passaged cells in a dose-dependent manner. These data strongly suggest that ET-1 attenuates, and AVP does not stimulate, the cell growth of original mesangial cells. the PAF-induced cell growth seems to be the constant feature of mesangial cells in vivo.     

Percutaneous ethanol injection for the treatment of small hepatocellular carcinoma. Study of 95 patients

Percutaneous ethanol injection (PEI) was applied to 120 lesions in 95 patients with hepatocellular carcinomas (HCC) smaller than 3 cm in the past 6 years. All main target tumours, in 67 patients who had been followed by sonography for more than 6 months after PEI, decreased in size; 28 tumours (41.8%) became undetectable and have remained so until now. The 1-, 2-, 3-, 4- and 5-year survival rates calculated by the Kaplan-Meier method were 93%, 81%, 65%, 52% and 28% respectively. These survival rates were better than those of patients with HCC smaller than 3 cm who did not receive anticancer treatment (P less than 0.01). The survival of patients of the Child's A or Child's B status was better than that of those with Child's C disease. Recurrence occurred in areas within the liver different from the original lesion in 34% in one year, 61% in two years and 66% in three years after PEI. PEI was then repeated in 61% of such patients.