Dual surface makers and HTLV-I proviral DNA in a cutaneous tumour nodule in a case of adult T cell leukaemia/lymphoma

The phenotypic and morphological profiles of atypical cells in a case of adult T cell leukaemia/lymphoma were studied using a panel of monoclonal antibodies and electron microscopy. Retroviral sequence restriction analysis showed the presence of human T cell leukaemia/lymphoma virus type I (HTLV-I) in the skin lesion. Our case showed several unique features in the clinical, haematological, histopathological and immunohistochemical findings. An erythematous plaque and tumour nodules in the skin were found without any abnormal lymphocytes such as flower cells in the peripheral blood and bone marrow HTLV-I proviral DNA was detected in the skin tumour cells but not in the peripheral blood lymphocytes, and in the tumour nodule, atypical cells showed a distinct difference in morphology between cerebriform cells in the upper dermis and large lymphoid cells in the lower dermis. The cerebriform cells had, immunohistochemically, a T helper/inducer (Th/i) phenotype whereas the large lymphoblastoid cells possessed both the Th/i and T suppressor/cytotoxic (Ts/c) phenotypes. Ki-I antigen was detected in the large lymphoblastoid cells, but not in the cerebriform cells.     

Regulation of β2-adrenergic receptors in keratinocytes: glucocorticoids increase steady-state levels of receptor mRNA in foetal rat keratinizing epidermal cells (FRSK cells)

Glucocorticoids increase the beta-adrenergic adenylate cyclase response of epidermal keratinocytes. Using FRSK cells, a cultured cell line of foetal rat keratinocytes, the regulatory mechanism of the beta-adrenergic augmentation effect was investigated. Treatment with dexamethasone (1 x 10(-6) M increase by 1.5-fold the beta-adrenergic adenylate cyclase response of FRSK cells. The effect was observed at 6 h incubation and remained for at least 48 h. The prostaglandin E-adenylate cyclase response was also increased 1.5-fold by glucocorticoid treatment. Neither the adenosine-adenylate cyclase response nor cholera toxin- or forskolin-induced cyclic AMP accumulations were altered. Northern blot hybridization showed that levels of the beta 2-adrenergic receptor mRNA increased within 3 h, while actin-, Gs-alpha, Gi-2 alpha, Gi-3 alpha mRNA levels were unchanged. Testosterone, 17 beta-oestradiol, and progesterone had no effect on either the beta 2-adrenergic adenylate cyclase response or the expression of beta 2-adrenergic receptor mRNA. The increase in the numbers of the beta-adrenergic receptors was visualized by immunofluorescence with an antibody specific for the beta 2-adrenergic receptor. Our results indicate that glucocorticoids regulate the beta 2-adrenergic adenylate cyclase response of FRSK cells through the enhanced expression of the receptor.     

Exact Location of the Branching Bundle in the Living Heart

Aims: The His bundle electrogram is believed to reflect the exact location of the His bundle. However, the distinction between distal His bundle potential and proximal right bundle branch potential is challenging. The aim of this study was to pinpoint the location of the branching point of the His bundle, and to compare that site with the site of recording of the largest His bundle electrogram (LH) during sinus rhythm.
Methods: We hypothesized that the site of earliest His activation (EH) during retrograde conduction via the left bundle branch is the branching point. We studied 15 nonconsecutive patients (mean age = 40 ± 22 years; eight men). We performed a programmed stimulation from right ventricular apex until retrograde right bundle branch block appeared. At that point we measured (1) the distance between antegrade LH site and retrograde EH site and (2) the atrial-to-ventricular amplitude ratio (A/V ratio) at both sites.
Results: EH was recorded at the proximal electrode of the His bundle catheter in all patients. Mean distance between EH and LH was 9.8 ± 2.5 mm. The mean A/V ratios at the EH site and the LH site were 1.01 ± 0.42 and 0.08 ± 0.06, respectively.
Discussion: This study showed that the EH site is located approximately 10-mm proximal to the LH site. The mean A/V ratio at the EH site during sinus rhythm is approximately 1.0. These observations suggest that the majority of His potentials reflect proximal right bundle activation. Before delivering radiofrequency energy in the para-Hisian area, attention should be paid to the presence of a His potential and to the A/V ratio, rather to the amplitude of the His electrogram.     

Results of Prospective Cohort Study on Symptomatic Cerebrovascular Occlusive Disease Showing Mild Hemodynamic Compromise [Japanese Extracranial-Intracranial Bypass Trial (JET)-2 Study]

The purpose of this study is to determine the true threshold of cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) for subsequent ischemic stroke without extracranial-intracranial (EC-IC) bypass surgery in patients with hemodynamic ischemia due to symptomatic major cerebral arterial occlusive diseases. Patients were categorized based on rest CBF and CVR into four subgroups as follows: Group A, 80% < CBF < 90% and CVR < 10%; Group B, CBF < 80% and 10% < CVR < 20%; Group C, 80% < CBF < 90% and 10% < CVR < 20%; and Group D, CBF < 90% and 20% < CVR < 30%. Patients were followed up for 2 years under best medical treatment by the stroke neurologists. Primary and secondary end points were defined as all adverse events and ipsilateral stroke recurrence respectively. A total of 132 patients were enrolled. All adverse events were observed in 9 patients (3.5%/year) and ipsilateral stroke recurrence was observed only in 2 patients (0.8%/year). There was no significant difference among the four subgroups in terms of the rate of both primary and secondary end points. Compared with the medical arm of the Japanese EC-IC bypass trial (JET) study including patients with CBF < 80% and CVR < 10% as a historical control, the incidence of ipsilateral stroke recurrence was significantly lower in the present study. Patients with symptomatic major cerebral arterial occlusive diseases and mild hemodynamic compromise have a good prognosis under medical treatment. EC-IC bypass surgery is unlikely to benefit patients with CBF > 80% or CVR > 10%.     

Spatial Relationship between Hypoglossal Schwannoma and the Vertebral Artery Using the Far-Lateral Approach

In hypoglossal schwannoma removal via the far-lateral approach needs care as the vertebral arteries are usually adjacent to the tumors. Thus, it is important to understand their location respective to schwannoma to conduct a safe surgery. We reviewed the data of eight patients with hypoglossal schwannoma who underwent surgery in Keio University Hospital in 2005–2013. There were five males and three females (mean age at initial presentation was 48.6 years, range 38–72 years). We especially focused on the spatial relationship between the vertebral artery and the tumor, and evaluated their spatial relationship from intraoperative findings. All eight hypoglossal schwannomas included in the current study were type B according to Kaye’s classification. As for spatial relationship between the tumor and the vertebral artery, in six out of eight cases, the vertebral artery was located inside or beneath the tumor; in contrast, in the other two cases, it was pushed out by the tumor and identified just after dural opening. Through the far-lateral approach, we found that the vertebral artery was located inside or beneath in most hypoglossal schwannoma; however, the vertebral artery was occasionally located on the tumor surface. From an anatomical perspective, we speculate this unique location of the vertebral artery in these cases is due to the unusual course of the hypoglossal nerve of tumor origin.     

Phase II Study of UFT in Patients With Advanced Non-Small Cell Lung Cancer

A phase II study of UFT (a mixture of uracil and tegafur; molarratio of uracil to tegafur = 4) was undertaken in 21 patientswith advanced non-small cell lung cancer (NSCLC). UFT was administeredorally at a dose of 400 mg/m² every day, for more than fourweeks. Of 16 adequately treated patients, one (6.3%) showed a partialresponse. Toxic effects included minimal myelosuppression, anorexia,nausea, vomiting and epigastralgia. Gastrointestinal toxicitywas well tolerated. Considering the poor response and mild toxicity,a further phase II study of higher-dose UFT is necessary forpatients without prior therapy.     

Hepatocellular Carcinoma with Metastasis to the Duodenum: —A Case Report—

Abstract: A case of hepatocellular carcinoma with metastasis to the duodenum is reported on together with a review of the literature. A 61-year-old male was admitted with hematemesis and melena. An endoscopic examination revealed a large hemorrhagic ulcer at the duodenal bulbi. A biopsied specimen taken from the bottom of the ulcer revealed an infiltrating hepatocellular carcinoma. The postmortem examination revealed a hepatocellular carcinoma with metastasis in the duodenum. This is the third report of hepatocellular carcinoma with metastasis in the duodenum.