Appearance of basophils in the sputum of patients with bronchial asthma

A total of 108 samples of sputum obtained from twenty patients with bronchial asthma were examined for appearance of basophils and eosinophils. Both cell types are present in sputum during an asthmatic attack and disappear at the conclusion of the attack. Their presence correlates with the severity of the disease. It has previously been demonstrated that the blood basophils count falls during attacks of bronchial asthma, and the present study suggests that basophils move from the blood stream into bronchial tissue during the acute phase of an asthmatic attack.     

Defective response to thrombopoietin and impaired expression of c-mpl mRNA of bone marrow cells in congenital amegakaryocytic thrombocytopenia

Congenital amegakaryocytic thrombocytopenia (CAMT) is an uncommon disorder in newborns and infants, characterized by isolated thrombocytopenia and megakaryocytopenia in the first year without physical anomalies. The defect of thrombopoiesis is not well understood. Recently, thrombopoietin (TPO), the ligand for the c-mpl receptor, was cloned. Accumulating evidence from in vitro and in vivo studies indicate that TPO plays a key role in the regulation of megakaryocytopoiesis. In this study we examined the effect of TPO on megakaryocyte colony formation from a patient with CAMT using a plasma-containing methylcellulose clonal culture. The in vitro results demonstrated a defective response to TPO in megakaryocyte colony formation from bone marrow mononuclear cells (MNC) of the patient, although interleukin-3 (IL-3) but not stem cell factor (SCF) induced only a small number of megakaryocyte colonies. These findings indicated that thrombocytopenia in CAMT could not be corrected by administration of TPO in vitro. Additionally, clonal cultures containing SCF, IL-3, IL-6 and erythropoietin showed decreased numbers of erythroid and myelocytic progenitors in the bone marrow of the patient. The serum TPO level measured by enzyme-linked immunosorbent assay was significantly higher than that in healthy controls. By PCR, marrow MNC from healthy children and from a patient with essential thrombocytosis expressed c-mpl mRNA, whereas no c-mpl mRNA was detected in marrow MNC from the patient with CAMT. There was no difference in the CD34 expression and c-kit mRNA between the CAMT patient and healthy children. The results of this study suggest that the pathophysiology in CAMT may be a defective response to TPO in haemopoietic cells through impaired expression of c-mpl mRNA.     

HYPERMINERALOCORTICISM WITHOUT ELEVATION OF PLASMA ALDOSTERONE: DEOXYCORTICOSTERONE-PRODUCING ADRENAL ADENOMA AND HYPERPLASIA

Two female patients were admitted for evaluation of hypertension and hypokalaemia. Plasma renin activity was suppressed and plasma aldosterone levels were within the normal value in a 52-year-old woman and below the normal value in the other patient, a 62-year-old woman. Plasma 11-deoxycorticosterone (DOC) levels were as high as 1.13 and 1.47 nmol/l, respectively. Adrenal scintigram and abdominal CT scan clearly showed a right adrenal tumour in the 52-year-old woman. After adrenalectomy plasma DOC level decreased to the normal level of 0.12 nmol/l, and her blood pressure and serum potassium became normal. Abdominal CT scan revealed no finding of adrenal tumour in the older woman. These results indicate that these two patients had hypermineralocorticism with elevation of plasma DOC. One patient had a DOC-producing adrenal adenoma, and the other probably had bilateral adrenal hyperplasia.     

Cystic hamartoma of the renal pelvis

Cystic hamartoma of the renal pelvis is a rare benign tumor in the same category as mixed epithelial and stromal tumors. We present a 33-year-old woman with a solid and cystic intrarenal tumor extending into the renal pelvis. She underwent radical nephrectomy and ureterectomy under the diagnosis of renal tumor or renal pelvic tumor. Histopathologically, the tumor was composed of a biphasic proliferation of epithelial and mesenchymal elements. We believe the present case is best classified as a cystic hamartoma of the renal pelvis in the category of mixed epithelial and stromal tumors because of the coexistence of hamartomatous lesions, such as the proliferation of adipose cells and well to poorly differentiated fibromuscular lesions.     

Primitive neuroectodermal tumor of the adrenal gland

We report a rare case of primitive neuroectodermal tumor arising from adrenal gland in adulthood, diagnosed preoperatively as having non-functional adrenocortical adenoma. Laparoscopic adrenalectomy was performed. Immunohistological examination revealed the definite diagnosis as primitive neuroectodermal tumor of the adrenal gland. Although primitive neuroectodermal tumor is a highly malignant neoplasm, there is no evidence of local recurrence and distant metastasis 16 months after surgery.     

Emergence of basophils at sites of local allergic reactions using a skin vesicle test

Vesicular exudate, produced by the application of cantharides plaster over normal skin and sites of intradermal allergen injection, was examined for the presence of basophils and eosinophils in normal subjects and patients with bronchial asthma. In comparison with the normals, the asthmatic group demonstrated a high rate of basophil appearance in vesicular fluid derived from areas of untreated skin. Basophil appearance was even more prominent in vesicular fluid from skin injected intradermally with various allergens. Modest numbers of basophils appeared at skin sites injected with house dust, but relatively large numbers appeared in areas injected with Candida, ragweed or tuberculin extracts. Patients with severe, intractable asthma frequently demonstrated large numbers of basophils in vesicular exudates. Intradermal injections of anti-IgE caused the greatest number of basophils to appear in the vesicular fluid, The numbers of eosinophils migrating into such vesicular lesions were not statistically significant though their numbers were proportional to those of the basophils. A significant correlation was shown to exist between both basophil and eosinophil blood counts and the numbers of these cells appearing in cutaneous vesicular fluid. This study demonstrates that basophil leukocytes, together with eosinophils, migrate from blood into extravascular tissues at sites of allergic reaction—especially reaginic hypersensitivity. The skin vesicle technique described is simpler than the skin window technique and may be of use in detection of allergens and evaluation of allergic disease states.     

A Case of Pseudomyxoma Peritonei with Bilateral Pleural Metastases

A case of pseudomyxoma peritonei that was first recognized bydyspnea and abnormal shadows on chest X-ray film is reported.The patient is a 67-yr-old woman who was found to have an abnormalshadow on chest X-ray filni on routine physical examinationwhen she was 47 yr old (1960). She had been asymptoniatic untilabout 2 yr before admission when she began to experience dyspneawith increased severity. On admission, the chest X-ray filmand com puted tomography showed bilateral pleural thickening.Drainage and decortica tion was carried out, and multiple cystsfilled with a gelatinous substance were found bilaterally inthe thoracic cavity. On the 66th hospital day, pan- peritonitisfollowing perforation of the appendix occurred and an emergencyoperation was performed. The patient died of acute renal failureon the 13th postoperative day. Pseudomyxoma peritonei originatingfrom pseudomucinous cystadenocarcinoma of the appendix was diagnosedon the basis of the findings of the histopathological examination.At autopsy, the gelatinous substance was found in both pleuralcavities, the right subphrenic area, and part of the large omentum.The case presented here is a very rare case of pseudomyxoniaperitonei, because dyspnea was the main feature and abdominalsymptoms such as abdominal distension and pain were lacking.Then high level of serum carcinoenibryonic antigen seen in thiscase is also pointed out.     

Effect of drinking on the outcome of cirrhosis in patients with hepatitis B or C

Survival rates were calculated for 251 patients with cirrhosis of the liver but without hepatocellular carcinoma, primary biliary cirrhosis, or autoimmune cirrhosis who underwent laparoscopy during the past 21 years at the authors' hospital. The survival rates were calculated by the Kaplan-Meier method. Stored serum was assayed for hepatitis B surface antigen (HBsAg) and antibodies to the hepatitis C virus (HCV). Patients with alcoholic cirrhosis had significantly better survival rates than patients with HBsAg, HCV, or both. Differences in survival rates between patients with hepatitis B and C were insignificant. In both groups, habitual drinkers had a significantly lower survival rate. The results suggested that alcohol accelerates liver damage in subjects with viral hepatitis.     

Malignant pheochromocytoma of the urinary bladder: Effectiveness of radiotherapy in conjunction with chemotherapy

A 34-year-old Japanese man with malignant pheochromocytoma of the bladder underwent surgical resection and chemoradiotherapy for a local recurrence of lymph node metastasis. Radiotherapy seemed to be effective, indicated by the growth inhibition of the irradiated tumor, decreases in serum and urinary catecholamine levels and a clinical improvement in the refractory stage of the combined chemotherapy.