Synchronous Multicentric Thymona: Report of a Case

We report a case of multiple thymoma with different histological subtypes, not associated with myasthenia gravis. We describe the histological findings, especially the results of immunohistochemical staining, which support the possibility of multicentric thymoma. The validity of extended thymectomy is also discussed.     

Abnormal erythroid differentiation in neonatal bcl-6-deficient mice

OBJECTIVE: The bcl-6 proto-oncogene is ubiquitously expressed in various tissues. Since we found out the smaller number of TER119(+) cells in the spleen of neonatal bcl-6-deficient (bcl-6(-/-)) mice compared with that of control (bcl-6(+/+)) littermates, we studied functions of bcl-6 in differentiation of erythroid lineage cells. MATERIALS AND METHODS: Erythroblasts in the definitive erythropoiesis were separated into four subsets using anti-TER119 and anti-CD71 mAbs. The cell number and property of these four subsets in spleens of neonatal bcl-6(+/+) and bcl-6(-/-) mice were examined using a flow cytometry. RESULTS: bcl-6 mRNA expression was detected in the TER119(high)CD71(high) subset, which is morphologically equivalent to basophilic erythroblasts, by reverse-transcribed polymerase chain reaction. High percentages of cells in the TER119(low)CD71(high) and TER119(high)CD71(high) subsets were in the cell cycle. The cell number of the TER119(high)CD71(high) subset in the spleen and the percentage of reticulocytes in the peripheral blood of neonatal bcl-6(-/-) mice were significantly lower than those of neonatal bcl-6(+/+) mice. However, the percentage of apoptotic cells and that of cells in the cell cycle in the TER119(high)CD71(high) subset of bcl-6(-/-) mice were similar to those of bcl-6(+/+) mice. CONCLUSION: bcl-6 detected in the TER119(high)CD71(high) subset of erythroblasts in the spleen of neonatal mice may be required to retain the erythroblasts in the cell proliferation stage.     

Intracranial dural venous anomalies in familial cervical cystic hygroma

This report describes a 3-year-old male with a familial cervical cystic hygroma and intracranial dural venous abnormalities consisting of a falcine sinus between the superior sagittal and the straight sinus with a rudimentary posterior part of the superior sagittal sinus; a prominent occipital sinus with narrowed transverse sinuses; and no intraparenchymal vascular abnormality. We hypothesize that a genetic factor that resulted in familial cervical cystic hygromas may also have caused the intracranial dural venous anomalies.     

Clinical significance of home blood pressure measurements for diagnosis of hypertension in the elderly

Systolic blood pressure elevates with increase in age. The frequency of white-coat hypertension and masked hypertension also increase with increase in age. Elderly persons tend to have abnormal circadian rhythm of blood pressure. Home blood pressure measurements are very useful to determine such pathophysiological conditions. Home blood pressure is useful not only for diagnosis of hypertension but also for treatment and management of hypertension; i.e. choice and titration of antihypertensive drugs. A minimal antihypertensive effect and duration of action of antihypertensive drugs are determined by home blood pressure measurements: the latter is established by the comparison of the antihypertensive effect of the drug in the morning with that in the evening, i.e. morning-evening ratio (ME ratio).     

StAR and progesterone producing enzymes (3beta-hydroxysteroid dehydrogenase and cholesterol side-chain cleavage cytochromes P450) in human epithelial ovarian carcinoma: immunohistochemical and real-time PCR studies

Steroidogenic acute regulatory protein (StAR), P450 side-chain cleavage enzyme (P450scc) and 3 beta-hydroxysteroid dehydrogenase enzyme (3beta-HSD) are all involved in the transport of cholesterol and production of progesterone. In situ production of sex steroids including progesterone have been considered to play important roles in pathogenesis and/or development of common epithelial ovarian carcinomas. In this study, StAR, P450scc, and 3beta-HSD were immunolocalized in 100 cases of ovarian carcinoma and results were then correlated with clinicopathological and prognostic parameters of individual patients including status of progesterone receptor (PR) in tumor cells. Results of immunohistochemistry were further characterized by real-time PCR analysis in 20 cases of epithelial ovarian carcinomas in which frozen tissues were available for examination. StAR, P450scc, and 3beta-HSD immunoreactivity was detected predominately in the cytoplasm of carcinoma cells. Results of real-time PCR analysis were correlated with those of immunohistochemical studies. StAR, P450scc, and 3beta-HSD H scores demonstrated significant inversed statistical correlation with FIGO stage, residual size of the tumor, and Ki67 LI. A positive statistically significant correlation was detected between StAR H score and PR-B LI. Multivariate statistical analysis demonstrated that the status of intratumoral StAR, FIGO stage, and residual tumor size all turned out to be independent prognostic factors for the clinical outcome of the patient. The presence of StAR, a cholesterol transporter for steroidogenesis in human epithelial ovarian carcinoma, may reflect the ability of these tumors to produce progesterone in situ that could influence biological behavior of these tumors, especially through progesterone dependent inhibition of tumor cell proliferation.     

Multiple meningeal tuberculomas recurring after 18-month anti-tuberculous chemotherapy--case report

A 26-year-old man with multiple intracranial masses widely attached to the dura presented with hypopituitarism and sexual impotence. Magnetic resonance imaging showed the lesions were isointense on the T1-weighted and hypointense on the T2-weighted images, and involved the bilateral sphenoid ridges, the convexity, and tentorial incisura. The lesion was partially removed via the right pterional approach. Histological examination identified tuberculoma associated with giant cells and caseous necrosis. Although his neurological and radiological signs worsened paradoxically during anti-tuberculosis therapy, he recovered spontaneously upon continuation of the anti-tuberculous treatment. However, he suffered recurrence as tuberculous meningitis, after administration of anti-tuberculous therapy for 18 months. Additional anti-tuberculous treatment for 12 months stabilized the disease. Tuberculoma should be included in the differential diagnosis of enhanced intracranial mass lesions. Anti-tuberculous therapy may require extended periods of up to 36 months to stabilize the disease.     

Preclinical assessment of a transaortic venting catheter for percutaneous cardiopulmonary support

Left ventricular unloading and energy charge as effects of transaortic catheter venting (TACV) during venoarterial bypass (VAB) in normal and failing hearts has been reported previously. The aim of this study was to assess the effectiveness and safety of a special multipurpose catheter for TACV during percutaneous cardiopulmonary support (PCPS) in a preclinical setting. Six adult pigs underwent PCPS with or without the TACV. With standard hemodynamic monitoring, LV volume and function were assessed by direct ultrasonic cardiography (UCG) in each condition. PCPS was smoothly established and the TACV catheter was safely introduced in all cases. As compared with isolated PCPS, the TACV combined with PCPS maintained significant blood flow with LV venting and systemic perfusion: the heart rate of the native heart, systemic arterial pressure, and central venous pressure were stable. Also the additional TACV led to a significant reduction of LV preload during PCPS, and the reduction was 25-30% of LVDd and 20-35% of LVAd. The results of this investigation suggest that clinical application of the TACV technique with a clinical PCPS circuit would be feasible and additional TACV might be use-ful for LV recovery during PCPS in patients with severe heart failure.