A case report of epithelioid hemangioendothelioma metastasizing to the tonsil

Epithelioid hemangioendothelioma is an extremely rare, difficult-to-diagnose vascular tumor mainly originating from the lung or liver. Primary tumors in the head and neck are very rare. A 40-year-old man admitted for right throat pain had been found in biopsy elsewhere to have squamous cell carcinoma. Based on a diagnosis of mesopharyngeal cancer, he underwent radical surgery, reporting cough, sputum, and hemosputum postoperatively. Epithelioid hemangioendothelioma was first diagnosed histopathologically from a biopsy of scalp tumors. Lung specimens at open biopsy 4 years earlier showed the same histological features indicating he had had epithelioid hemangioendothelioma lesion since that time. We assumed this epithelioid hemangioendothelioma had originated in the lung and metastasized to the right tonsil. These tumors are typically progressive and aggressive, and this patient had a poor prognosis. We discuss tumor features and review them clinically and histologically.     

Development of normal retinal organization depends on Sonic hedgehog signaling from ganglion cells

The adult retina is organized into three cellular layers--an outer photoreceptor, a middle interneuron and an inner retinal ganglion cell (RGC) layer. Although the retinal pigment epithelium (RPE) and Müller cells are important in the establishment and maintenance of this organization, the signals involved are unknown. Here we show that Sonic hedgehog signaling from RGCs is required for the normal laminar organization in the vertebrate retina.     

Familial inclusion body myositis: a report on two Japanese sisters

Familial occurrence of inclusion body myositis is extremely rare, and only a few cases in Western countries have been reported. In these reports, a strong association of this disease with DR3 (DRB1*0301/0302) and the efficacy of immunosuppressants suggested that an immune pathomechanism is involved in the disease. We, for the first time, report two Japanese sisters who suffered myopathy clinicopathologically similar to inclusion body myositis. One sister received corticosteroid and azathioprine and the therapy relieved dysphagia. Both of our patients had DR15(2)/4 (DRB1*1502/0405), suggesting a distinct genetic association with the disease in the Japanese population.     

The role of donor CD4(+) T cells in the reconstitution of oral immunity by herpes simplex virus type 1 in severe combined immunodeficiency mice

Severe combined immunodeficiency (SCID) mice with ill-developed Peyer's patches develop neither antibodies nor protection against lethal herpes simplex virus type 1 (HSV-1) infection by oral immunization. However, SCID mice carrying spleen cells from immunocompetent BALB/c mice had serum anti--HSV-1 antibody; anti--HSV-1 IgA antibody was detected in eye wash samples, and the mice were protected against lethal HSV-1 infection (88% survival rate). Western blotting showed that antibodies in SCID mice carrying spleen cells from BALB/c mice recognized 60-kDa HSV-1. The effector cells in transferred spleen cells were CD4(+), not CD8(+), T cells. Donor T cells were detected in the submucosal layer of the gut in SCID mice 1 day after transfer. Rapid movement of donor T cells to the gut may have a role in mucosal immunity to HSV-1. Thus, the normal environment for mucosal immunity develops in SCID mice without prior presence of CD4(+) T cells.     

Clinical effects of long-term administration of pranlukast, a leukotriene receptor antagonist, on adult patients with bronchial asthma

Eighty-one adult patients with bronchial asthma who suffered from an unstable peak expiratory flow rate (PEFR) and asthmatic attacks that developed at irregular intervals in spite of inhaling beclometasone dipropionate (CAS 5534-09-8, BDP) in excess of 400 micrograms/day were treated with pranlukast (CAS 103177-37-3, Onon) 450 mg/day for 1 to 2 years and the clinical effects of its long-term administration were studied. The patients were divided into 3 groups: Group I with drug effect seen on peak expiratory flow rate (PEFR) in a short-term; Group II showing long term PEFR improvement; and Group III with no sustained improvement in PEFR. Those in the first two groups continued oral medication for 2 years, while those of the third group withdrew from medication after one year and their clinical course was observed. The evaluation parameters were: PEFR, frequency of beta 2-stimulant inhalation, number of night time visits to health service facilities, quantity of inhalation steroids used, amount of oral steroids used at fixed intervals, peripheral eosinophil count, serum eosinophil cationic protein (ECP) concentration and FEV1.0. In Group I, the frequency of beta 2-stimulant inhalation, number of night time visits to health service facilities, quantity of inhalation steroids used, and the amount of oral steroids used at fixed intervals were reduced; and after two years, the frequency of beta 2-stimulant inhalation and quantity of inhalation steroids used were further reduced. In Group II, reductions were seen in the peripheral eosinophil count and serum ECP level. The asthmatic severity shifted from step 3 to 2 in 12 patients and from step 4 to 3 in 4 patients in Group I; and from step 3 to 2 in 3 patients in Group II. In Group III, an increase in the number of night time visits to health service facilities after the medication was interrupted and a rise in the serum ECP concentration were recognized.     

The intubating laryngeal mask for a patient with cerebrospinal fluid rhinorrhea and pneumocephalus

A 53-year-old male was scheduled for repairs of cerebrospinal fluid (CSF) rhinorrhea and pneumocephalus under general anesthesia. He had undergone a neck clipping for a ruptured anterior communicating aneurysm 13 days before. As he had a difficult airway, Trachlight was used for successful tracheal intubation. To avoid tension pneumocephalus, an intubating laryngeal mask (ILM) was inserted with rapid sequence induction without positive pressure ventilation. A 7.0 mm ID straight silicone reinforced tube was then inserted through the ILM using a fiberscope. A fiberscope guided tracheal intubation via the ILM is recommended for patients with CSF rhinorrhea and pneumocephalus especially when the trachea is difficult to intubate under direct laryngoscopy.     

Multidetector-row CT analysis of time-dependent changes in lung fields after chest irradiation: usefulness of precision scans

Time-dependent changes in lung fields after chest irradiation were analyzed using multidetector-row CT. Routine scans at 3-mm raw thickness and 8-mm recon thickness and precision scans at 0.5-mm raw thickness and 0.5-mm recon thickness were compared with respect to the number of each finding and the time-dependent changes in the rate of each finding. Among the findings visualized by these scans, ground-glass opacity (GGO) showed the highest overall appearance rate. Precision scans exceeded routine scans in the rates of all findings except GGO and confluent shadows, and the two types of scans showed the greatest difference in the rate of GGO. Since we found that GGO tended to be overestimated on routine scans, we confirmed it by a phantom experiment. Precision scans were similar or superior to routine scans in the rates of findings except 3 months after irradiation. We consider that the concomitant use of precision scans is useful in that it allows more accurate evaluation of various post-irradiation changes in lung fields including GGO, in which the lesion is in a reversible stage.     

Ingestion of water-soluble soybean fiber prevents gastrectomy-induced iron malabsorption,anemia and impairment of voluntary running exercise performance in rats

We examined the effects of feeding water-soluble soybean fiber (WSSF), a highly fermentable dietary fiber, on gastrectomy-induced iron malabsorption, anemia and impairment of exercise performance in rats in two separate experiments. The study was designed as a 2 x 2 factorial arrangement with operation (total gastrectomy) and diet (WSSF) under sedentary (Experiment 1) and exercised (Experiment 2) conditions. In Experiment 1, gastrectomy reduced net iron absorption, hemoglobin concentration, hematocrit and hemoglobin regeneration efficiency (P < 0.01). However, in rats fed a WSSF diet (50 g/kg diet), iron absorption and the hematological variables of the gastrectomized rats were comparable to those in the sham-operated rats, demonstrating that ingestion of WSSF promotes iron absorption and prevents anemia after gastrectomy. Feeding WSSF increased pools of organic acids and soluble iron in cecal contents and decreased the pH of the cecal contents (P < 0.001). Of the many cecal variables measured, net iron absorption in gastrectomized rats was most closely correlated (r = 0.614, P < 0.01) with the short-chain fatty acid pool in the cecum. Cecal fermentation of WSSF may contribute to improvements in gastrectomy-induced nutritional defects. In Experiment 2, we examined voluntary running exercise performance in totally gastrectomized rats fed diets with or without WSSF. Total gastrectomy severely impaired running performance (P < 0.001), and WSSF feeding largely restored the lowered performance. We conclude that feeding WSSF improves anemia and impaired voluntary running performance in totally gastrectomized rats.