Studies on the relationship between quantitative histometry and obstetric complications

Quantitative histometry of the placenta seems to make it possible to correlate the histopathological changes with various obstetric complications and disorders more precisely. In the present paper, the relationship between the histopathological changes in the placenta and the obstetric complications was investigated by quantitative histometry based on the standardized categories with uncomplicated normal cases as the controls. Among the obstetric complications, special emphasis has been placed on the pregnancies complicated by toxemia of pregnancy and diabetes mellitus. The obstetric disorders of postmature pregnancy and prolonged delivery have also been related to the quantitative histometry. It was revealed that the cytotrophoblast proliferation associated with the formation of syncytial knots was a very common finding both in toxemia and in these obstetric disorders. However, there was a great difference between the two in that impairment of the vasculature was highly specific in the placentae in the case of toxemia. The most conspicuous histopathological change recognized in the placentae due to diabetes was villous edema, which would be due to the osmotic imbalance. However, it is so unusual to find cases complicated by severe diabetes that typical villous edema is rarely observed. The quantitative approaches in the field of histopathology may leave some problems in that the specimens taken from the organ could not always be representative of the whole organ. However, quantitative histometry based on the fairy standardized categories has been shown to offer more promising information on the relationship between the histopathological changes in the placentae and the obstetric disorders.     

Evaluation of the measurement of serum carcinoembryonic antigen (CEA) levels using monoclonal antibody

We measured serum carcinoembryonic antigen (CEA) levels in 164 cancer patients, 153 patients with benign diseases and 45 healthy controls using monoclonal antibody and compared CEA levels by monoclonal antibody (m-CEA) with those by polyclonal antibody (p-CEA). There was a good correlation between m-CEA and p-CEA, especially in cancer patients. The positively of m-CEA was almost the same as that of p-CEA in cancer patients. But, false-positive cases by m-CEA were less common than by p-CEA in non-cancerous patients. Thus, the measurement of m-CEA was not less useful than that of p-CEA.     

Application of serum PSA to identify acute bacterial prostatitis in patients with fever of unknown origin or symptoms of acute pyelonephritis

BACKGROUND: Exclusion of prostatitis in screening for prostate cancer (Cap) is a matter of concern in the prostate-specific antigen (PSA) era. Yet, the identification of acute bacterial prostatitis (ABP), intentionally utilizing PSA in patients with pyrexia has been scarcely reported. METHODS: In total, 39 men, who presented at our department with a fever higher than 38.3 degrees C, were randomly selected. We investigated the fraction of patients who had serum PSA levels higher than 4.0 ng/ml and categorized them according to an initial diagnosis of pyelonephritis, ABP, other urogenital infections, and fever of unknown origin (FUO). RESULTS: Six of nine cases initially diagnosed as pyelonephritis, presented with elevated PSA levels between 9.5 and 75.1 ng/ml. All six cases of clinically diagnosed prostatitis had PSA elevated between 4.1 and 13.6 ng/ml. In 8 of 18 FUO cases, PSA was elevated between 5.1 and 77.0 ng/ml. PSA levels significantly correlated with age (P < 0.005). All 20 patients with elevated PSA received antibiotics, and serum PSA was significantly reduced in all cases (P < 0.001) together with the alleviation of fever and normalization of CRP. CONCLUSIONS: PSA is a prompt and steady diagnostic tool for identifying ABP that might be missed or misdiagnosed. We recommend the measurement of PSA in cases not only with urologic infection but also puzzling pyrexia.     

False-positive and true-negative hilar and mediastinal lymph nodes on FDG-PET —Radiological-pathological correlation—

OBJECTIVE: To compare histological findings of FDG-PET false-positive and true-negative hilar and mediastinal lymph nodes. METHODS: Sixty-seven lymphnode areas in 11 patients who were diagnosed to have N3 lymph nodes by FDG-PET and underwent surgery were histologically examined, and the histopathological findings in false-positive and true-negative lymph nodes were compared. Lymph nodes with higher accumulation of FDG than the surrounding mediastinum level were judged as positive. On histological sections, proportions of macrophages and lymphocytes, amount of coal dust deposit, presence of silicotic nodules, long- and short-axes of the largest node, and volume of macrophages and lymphocytes were evaluated. Correlations between the above-mentioned factors and FDG accumulation were evaluated. RESULTS: FDG uptake was not correlated with the proportion of macrophages and lymphocytes, coal dust amounts, or the presence of silicotic nodules. The long- and short-axes of the largest node in the false-positive areas were significantly longer than those in the true-negative areas (p = 0.01, and 0.001, respectively). Volumes of lymph nodes (mean +/- SD: 150 +/- 190 mm3) and macrophages (78 +/- 71 mm3) in false-positive areas were markedly larger than those in true-negative areas (68 +/- 87 mm3, p = 0.0009 and 34 +/- 54 mm3, p = 0.0001, respectively). The volume of lymphocytes was also larger in false-positive areas but less markedly. CONCLUSION: Our study suggested that false-positive results of FDG-PET in hilar and mediastinal lymph nodes were closely related to the size of lymph node and the volume of macrophages.     

Olfactory groove schwannoma--case report

A 30-year-old man presented with a 2-year history of intermittent headache. No neurological deficit was detected. Computed tomography (CT) and magnetic resonance imaging showed a tumor with a diameter of 2.5 cm in the left anterior skull base associated with bone scalloping on three-dimensional CT. Angiography showed a hypovascular tumor. Craniotomy demonstrated a tumor in the region of the left olfactory groove attached to the anterior part of the cribriform plate. The histological diagnosis was schwannoma. Schwannoma arising from near the olfactory groove is rare, with only 13 other cases reported. The precise origin of these tumors is not well understood, but the tumor in this case probably arose from the fila olfactoria, because the olfactory bulb was involved in the tumor, whereas the olfactory tract remained intact.     

A study of spike-density on EEG in West syndrome

To elucidate the pathophysiology of spasms in series, the distribution and density of spikes on hypsarrhythmia were studied in 13 patients with West syndrome by excluding slow waves from EEG using a digital filter. (1) Interictal spikes were mostly multifocal and dominant over the bilateral posterior head area with very few diffuse discharges. Therefore, spikes on hypsarrhythmia were demonstrated to occur actually depending on the brain regions although they appeared random. (2) The dominant region of interictal spikes did not correspond to the underlying focal cortical lesion in many patients, and was indicated to reflect the general process of cerebral maturation in infancy. (3) There were far fewer inter-spasm spikes, especially during the middle phase of a series of spasms, than interictal spikes. It was implied that the cortical activity of hypsarrhythmia was interfered with by the abnormal subcortical function, which might be related to the generation of spasms. (4) The dominant region of inter-spasm spikes tended to coincide with a focal cortical lesion shown by MRI and the focus of associated partial seizures.     

Very fast rhythmic activity on scalp EEG associated with epileptic spasms

PURPOSE: Very fast activity was investigated on the ictal EEGs of epileptic spasms to elucidate the pathophysiology of West syndrome (WS) and related disorders from a novel point of view. METHODS: The traces of scalp ictal EEG of spasms temporally were expanded in 11 patients whose clinical diagnosis was symptomatic WS in six, cryptogenic WS in two, Aicardi syndrome in one, and symptomatic generalized epilepsy after WS in the remaining two. Time evolution of averaged power spectra of the ictal fast activity also was analyzed in each patient. RESULTS: Rhythmic gamma activity with frequency ranging from 50 to 100 Hz was detected in a total of 345 of 537 spasms. Fast activity was seen bilaterally in nine patients, was lateralized to one hemisphere in another, and appeared independently on each hemisphere in the remaining infant with Aicardi syndrome. Power spectra showed a clear peak corresponding to spasm-associated gamma rhythm, with frequency centering approximately 65 Hz and ranging from 51 to 98 Hz. The morphology and spectral characteristics of ictal gamma rhythm were completely different from those of muscle activity or alternating current (AC) artifacts. CONCLUSIONS: Spasm-associated gamma activity was clearly detected on the scalp. This observation may provide a clue to the pathophysiology of spasms.