IMMUNOPATHOLOGIC STUDIES OF RENAL GLOMERULAR CHANGE IN LIVER CIRRHOSIS WITH SPECIAL REFERENCE TO ITS PATHOGENESIS

The kidneys from 62 proven liver cirrhosis cases were examined by immunofluorescence (IF), and 94% of the cases were positive for some immune reactants deposition. Combined deposition of immunoglobulin(s), both or each one of Clq and C4, and further with C3 were observed in about 70% of all IF positive cases. The morphological alterations of the glomeruli correlated with the intensities of regional immune reactants depositions. Guinea pig C3 was frequently activated in vitro on the glomeruli of these cases. Immune reactants depositions in the glomeruli appeared to form immune complex locally. Smooth muscle and liver cell antigens in the immune complex at the glomeruli were examined by indirect method of IF using monospecific antibodies and positive cases concerning each antigen were found in about 1/3 of the kidneys from 21 liver cirrhosis cases. These facts suggest that the high rate of the occurrence of immune com.plex deposition type glomerulo-nephritis may be due to the glomerular deposition of some autoantigen-antibody complexes including smooth muscle and liver cell antigens. ACTA PATH. JAP. 29: 571–583, 1979.     

PATHOGENESIS OF PARAQUAT-INDUCED PULMONARY HEMORRHAGE IN HAMSTERS WITH SPECIAL REFERENCE TO ARTERIAL CONSTRICTION

Three dimensional reconstructions of pulmonary arteries and the bronchial tree were made to evaluate the cause of hemorrhage in the lungs of hamsters treated with a single intraperitoneal injection of paraquat at a dose of 15 mg/kg b.w. The hemorrhage corresponding to the respiratory bronchiolar segment formed the minimum hemorrhagic unit; larger hemorrhages were composed of conglomerations of such units. The respiratory bronchiolar segment was fed by a single respiratory bronchiolar arteriole which had a distinct muscular medial coat. No evidence of breakage of the arterial wall passing through the hemorrhagic lesion could be detected even by careful observation with serial histological sections. Accordingly, the cause of the lung hemorrhage was sought in the combined effects of paraquat toxicity to the capillary endothelium and vasoconstriction of the respiratory bronchiolar arterioles.     

PATHOLOGICAL STUDY ON THE CHANGES OF LYMPHATIC TISSUES IN SHOCK WITH SPECIAL REFERENCE TO SECONDARY NODULE LESIONS

The present authors carried out a pathological study on the changes in the lymphatic tissues of 38 autopsy cases associated with fatal shock. As a result, they confirmed that; (1) the microscopic lesion characterized by prominent destruction of the constituent cells of the secondary nodules appeared systematically in the lymphatic tissues of various regions, added by other occasional changes, such as coagulation necrosis, hemorrhages and transudation; (2) there occurred also marked atrophy of the secondary nodules in the cases with long duration of mild shock, or in those with temporary recovery from severe shock; and (3) the cellular destruction of the secondary nodules was closely correlated with the duration and severity of shock.     

ON THE VASCULAR LESIONS OF THROMBOTIC THROM-BOCYTOPENIC PURPURA WITH SPECIAL REFERENCE TO ITS PATHOGENESIS*

Morphological studies were made on the vascular lesions of five cases of thrombotic thrombocytopenic purpura and those of other diseases as control. The occurrence of thrombi at the bifurcations of arteriolocapillary junctions was characteristic of this disease. The side of thrombus attachment strongly suggested the important role of blood flow in the establishment of the thrombi. The granular nature, contraction and end-othelialization process of an early thrombus, together with the lack of evidence of an increased vascular permeability at the bases of early granular thrombi suggested that the mural thrombi characteristically observed in this disease were formed as a consequence of organization process of minute intravascular platelet aggregations established on the endothelial cells at the bifurcation. The possible mechanism of endothelial involvement at the bifurcation, probably a fundamental event in this disease, was discussed from the view of immune disorder of vascular endothelium.     

SUBACUTE SCLEROSING PANENCEPHALITIS WITH SPECIAL REFERENCE TO THE ULTRASTRUCTURE OF INCLUSIONS IN THE BRAIN AND LUNG

A 7-year-old boy, who was diagnosed as typical SSPE by clinical data and laboratory findings, was autopsied and observed by immunofluorescent techniques, light and electron microscope. The morphological characteristics in the brain were perivascular cuffings with plasma cells, lymphocytes and mononuclear cells, gliosis and a large number of intranuclear and intracytoplasmk inclusions in the neuroglias and nerve cells. Various kinds of intranuclear inclusions were elucidated by electron microscopy and the fine structures of these inclusions were described in detail. At least five types of intranuclear inclusions were regarded as specific in SSPE. The presence of intranuclear inclusions of mononuclear cells in the lungs resembling the inclusions in the neuroglias suggested that the disease was not localized in the brain but could be disseminated throughout the body.     

EXPERIMENTAL STUDIES ON THE CEREBELLUM WITH SPECIAL REFERENCE TO CALCIFICATION OF THE PURKINJE CELL DENDRITES

Changes produced by intracerebral injection of alum phosphate and by administration of lead carbonate via maternal milk in the cerebellum of rats and rabbits were examined by light and electron microscopy.
Two different types of degeneration of Purkinje cells were described. The first type of change was of Alzheimer's neurotibrillary change and was found in the cerebellum of alum-treated rabbits. It appeared as a focal cytoplasmic clearing of the Purkinje cell bodies and their major dendrites. The areas of clearing displayed marked argentophilia.
The second type of change in Purkinje cells was calcification of Purkinje cell dendrites. It was found both in animals with alum and lead encephalopathy. In routinely stained sections, it appeared as collections of tiny granules, rounded and club-shaped bodies, or it had a bushy appearance (P entschew ) in the molecular layer. By electron microscopy this formation appeared as dense aggregates. The agglomerations were found to consist of small dense spheres, amorphous oval bodies and occasionally of closely packed needle-shaped crystallines. It was suggested that calcification starts from the most peripheral portion of the Purkinje cell dendrites and extends later over the large areas of the cytoplasm. Abnormalities were also found in the synaptic connections of the Purkinje cell dendrites with axon terminals of the surrounding neuropil.     

A STATISTICAL SURVEY OF DEEP MYCOSES IN JAPAN, WITH PARTICULAR REFERENCE TO AUTOPSY CASES OF CRYPTOCOCCOSIS

Two thousand four hundred and fifty-four autopsy cases of various mycoses were reported during the twelve-year period from 1958 to 1969. These account for 1.203 % of all cases reported in the Annual of the Pathological Autopsy Cascs in Japan during the said period.
The results of a statistical survey of deep mycoses in Japan as viewed from findings in a long series of autopsy cases are briefly described. It is noteworthy that (1) there is a nation-wide distribution of mycoses throughout the country, where the most frequently affected organ was noted to be the esophagus for Candida and the lungs for Aspergillus and Cryptococcus, respectively; (2) common mycoses show a trend toward progressive increase in incidence whereas mucormycosis displays a tendency to decrease; and (3) frequently coexistent conditions which underlie secondary deep mycoses, especially leukemia, malignant lymphoma and aplastic anemia, were observed to show a conspicuous trend to diminish in incidence when viewed from ratios to total numbers of autopsy cases of respective diseases.     

ENACTMENTS IN THE COUNTERTRANSFERENCE: WITH SPECIAL REFERENCE TO RESCUE FANTASIES WITH HYSTERICAL PATIENTS

abstract    This paper describes enactments in the countertransference – spanning fantasies, actions, words and sexual responses to patients. It will explore the origins and reverberations of the analyst's enactments in an effort to understand whether they have obstructed progress or created special moments in the therapy where shifts in the patients' inner world, or further understanding on the part of the analyst could be created.
Clinical vignettes will be used from work with several patients, although the analyst will focus mainly on work with patients who present with hysterical personality. The paper is an endeavour to tease out what, if any, differences there may be in working with hysterical patients, as opposed to patients with other personality types, in the nature of countertransference enactments. The author examines the role of rescue fantasies in the c reation of an enactment.     

HISTOPATHOLOGICAL STUDIES ON THE TUMOURLET OF THE LUNG WITH SPECIAL REFERENCE TO THE CYTOGENESIS OF PROLIFERATING CELLS

Eight foci of tumourlets of the lung and one allied lesion obtained from autopsy cases were histologically examined. The tumourlet of the lung consisted of epithelial cells and was considered to be a benign lesion. Small sized-lesion, uniformity of proliferating cells with very few mitosis and existence of associated lung lesions were documented as characteristic findings. However, the histopathogenesis of the tumourlet was not fully clarified.
It was found that proliferating cells of tumourlets often show argyro-philia and contain numerous neurosecretory-like granules in their cytoplasm. These characteristics are very similar to Kultschitzky-like cells of the lung.     

THE PATHOLOGY OF ASTHMA, WITH SPECIAL REFERENCE TO CHANGES IN THE BRONCHIAL MUCOSA

The pathological features of 20 cases dying in status asthmaticus have been studied. In gross sections the lungs showed no emphysema, but mucus plugs in the air passages and focal areas of collapse were outstanding features. Five cases showed cystic bronchiectasis which was of a similar distribution to the focal areas of collapse, occurring in the upper lobes as commonly as in the lower lobes.     

STUDIES ON LYMPHOCYTE SUBSETS IN THYMIC TISSUE AND FUNCTIONS OF PERIPHERAL LYMPHOCYTES IN PATIENTS WITH TUMOROUS THYMUS WITH SPECIAL REFERENCE TO MYASTHENIA GRAVIS

In order to obtain a better understanding of the immunological abnormalities present in myasthenia gravis (MG), which is often accompanied by thymoma or thymic hyperplasia, we investigated lymphocyte subsests and their functions using samples of thymoma or thymic hyperplasia tissues from 11 patients (6 cases with MG), and peripheral blood from 6 patients (4 cases with MG). In most thymic tissues from patients with MG, a maturating tendency of lymphocytes was generally observed. Especially in the medulla of thymic hyperplasia, an entirely peripheral blood type of T-lymphocytes, which were Leu-6⁻ and either Leu-2a⁺ or 3a + 3b⁺, were encountered abundantly. Therefore, the presence of abnormal maturation of lymphocytes in the thymus or destruction of the barrier between the thymus and the peripheral blood in MG cases was indicated. In cases without MG, no such tendency was noted. As to the peripheral blood in patients with MG, concanavalin A-induced suppressor cells were significantly decreased (p<0.01). All of these changes were considered to be intimately related to the appearance of MG.     

ERYTHREMIA WITH SPECIAL REFERENCE TO SIDEROBLASTIC ANEMIA

An autopsy case of erythremia with sideroblastic tumor cell proliferation is described. A 60-year-old man was admitted to the hospital due to general fatigue and anorexia. Bone marrow aspiration revealed abnormalities in erythropoiesis (megaloblasts, 4%; sideroblasts, 84%; ring-formed, 39%, and PAS-positive, 5%). Therapy was directed to pulmonary tuberculosis. Anemia was not improved despite repeated whole blood and platelet transfusions. Serum iron and percentage saturation of the total iron-binding capacity rose during the course. Administration of vitamin B₁₂, B₆ or folic acid was ineffective. INAH was replaced by its derivative, IHMS, during the course, but the population of sideroblasts especially of ring-sideroblasts was invariably large (78%-100% and 39%-65% for total sideroblasts and ring-sideroblasts, respectively). He died with increasing abdominal pain and jaundice after three months'hospitalization. Main autopsy findings were: diffuse proliferation of atypical erythroblasts in the bone marrow, systemic lymph nodes, liver, spleen and kidneys. Most of the cells positively stained with iron. Tuberculosis of lungs with cavity formation. Discussion is focussed on the relationship between erythremia and sideroblastic anemia.     

NODULAR SCLEROSING TYPE OF HODGKIN'S DISEASE IN THE MEDIASTINUM, WITH PARTICULAR REFERENCE TO ITS PATHOGENESIS

A 29-year-old female was proved to have nodular sclerosing type of Hodgkin's disease in the mediastinum, apparently originating from the thymus and spreading to both supraclavicular lymph nodes. There has been a considerable dispute as to whether this kind of tumor should be regarded as Hodgkin's disease or as a thymic carcinoua (granulomatous type). Based on the presumption, presented by T aylor and S tein et al. recently, that Hodgkin's disease is a neoplasm of transformed lymphocytes and also on exclusion of a possible participation of epithelial components of the thymus, an effort was made in order to simplify an overall complexity of Hodgkin's disease seen particularly in the thymus.     

EXPERIMENTAL APPROACH IN STUDIES ON PATHOGENESIS OF BACILLARY DYSENTERY: WITH SPECIAL REFERENCES TO THE INVASION OF BACILLI INTO INTESTINAL MUCOSA*

Pathogenic behaviors of Shigella and Shigella-like group of enteropa-thogenic Escherichia coli, which are equally causative organisms in bacil-lary dysentery, were demonstrated in experimental infection in monkeys and other experimental systems. From these observations it is concluded that virulent strain of Shigella and enteropathogenic E. coli show specific affinity to epithelial cells and their invasion into those cells of colonic mucosa in the initial stage is an indispensable factor by which the later process of the infection can be established. The importance of hypersensitivity as a factor to determine the development of bacillary dysenteric colitis was emphasized. ACTA PATH. JAP. 20: 261 - 277, 1970.