Lung Cancer in Chromate Workers--Analysis of 11 Cases

We have experienced 11 cases of lung carcinoma in workers ata chromate factory during the past 14 years. All patients weremales. The age of onset ranged from 41 to 68 years. Ten of the11 were heavy smokers. The time of exposure to chromate wasfrom 17 to 29 years and the average was 23.9 years. Seven patientshad perforation of their nasal septa. The primary sites of thecancers were from the lobar to the subsegmental bronchi. Therewere nine squamous cell carcinomas and three small cell carcinomas.Four squamous cell carcinomas were hilar type early stage cancersand two of them were found in one patient at the same time.The chromium content of the lung tissue in the seven patientstested was from 13.9 to 2,368.4 µg/g of dry tissue andwas higher than that of lung cancer or non-lung cancer caseswithout chromate exposure. There was no severe dysplasia ofthe bronchial epithelium in these 11 patients.     

An estimation of human bile metastability: Clinical application of a sensitive cholesterol crystal growth assay

The formation of cholesterol monohydrate crystal initiates cholesterol gallstone formation. The nucleation time (NT), a light microscopy method, is used currently to estimate human bile metastability. Recently, a cholesterol crystal growth (CCG) assay utilizing photometric turbidity to quantitate cholesterol crystallization was developed using model bile systems. The object of this study was to determine whether this novel CCG assay was applicable to the quantitative assessment of native human bile metastability. Human gall-bladder bile samples were collected from patients undergoing cholecystectomy. There were five patients with cholesterol gallstone and five stone-free patients. A significant correlation between the onset time measured by the CCG assay and the NT observed by light microscopy was found in our modified assay condition where interference by bilirubin was negligible (P < 0.01). Also, the growth rate measured by the CCG assay significantly correlated with the NT (P < 0.05). These results indicate that the CCG assay is applicable to quantitative assessment of human bile metastability reflected by cholesterol crystal nucleation and that the cholesterol crystal growth is also conveniently estimated by this method.     

Treatment of Resistant Port-Wine Stains with a Variable-Pulse Pulsed Dye Laser

BACKGROUND: The conventional pulsed dye laser (PDL), operating at a wavelength of 585 nm and a pulse duration of 0.45 ms, usually does not achieve complete clearance in the majority of port-wine stains (PWSs). OBJECTIVE: In this study, we demonstrate the efficacy of a variable-pulse pulsed dye laser (VPPDL) equipped with cryogen spray cooling (CSC) in the treatment of PWS that have become resistant to PDL treatment. METHODS: Forty Asian patients with Fitzpatrick skin types III to IV were enrolled in this study. All patients had previously been treated by the PDL at least eight times (mean, 12.8+/-5.9) and had reached a treatment plateau. A VPPDL with a wavelength of 595 nm and a spot size of 7 mm was used. The patients were treated with fluences between 9 and 15 J/cm(2) and pulse durations of 1.5 to 10 ms. Four treatments were administered at 8-week intervals for each lesion. Three months after the last treatment, all patients were evaluated for the degree of improvement by two independent clinicians. RESULTS: Eight patients had excellent improvement, 9 had good improvement, 11 had fair improvement, and 12 had poor improvement. No complications were observed during the course of laser treatment. Vessels larger than 30 microm were not seen in the biopsy specimens obtained after the final treatment. CONCLUSION: The VPPDL is more effective than the PDL and the VPPDL should be used for treating PDL-resistant PWSs. Nonetheless, vessels less than 30 mum in diameter are resistant to both PDL and VPPDL treatment.     

Evoked EMG of masseter and temporal muscles in man

Following a percutaneous stimulation on the mandibular notch skin, two kinds of responses were recorded in the ipsilateral masseter and temporal muscles in man. The two responses had their proper stimulating points. The early response appeared with about a 2 ms latency and the late one with about a 6 ms latency which was shorter than that of T wave of the same muscle by about 1 ms. No responses were induced in the contralateral masseter and temporal muscles. Regarding the recovery process of the late response following double stimuli, a testing late response was released about 100% from the effect of conditioning shock at a longer interval than 80 approximately 95 ms. It might be safe to consider that the previous assumption, i.e. those two responses seemed to be M and H waves respectively, had been fortified. H response evoked in muscles tested seems to be sensitive enough to show the difference between excitatory states of its reflex arc.     

IN SITU POROCARCINOMA: A CASE WITH MALIGNANT EXPRESSION IN CLEAR TUMOR CELLS

A healthy 84-year-old man visited our clinic with elevated lesions on the dorsal aspect of the left hand (Fig. 1). The previous year, he had been in a traffic accident in which he had received an injury to the hand. This injury had since repeatedly shown erosion, but the present lesions had appeared a month before the first clinic visit. These lesions consisted of a tumor, about 2 × 3 cm in size, with neighboring satellite nodules. They were asymptomatic, slightly reddish and yellowish, and had scales. Histopathologic examination revealed the following features: (1) a tongue-like tumor mass connected to the epidermis. The tumor foci were localized in the epidermis, from which they were sharply demarcated. Cell infiltration and senile elastosis were found in the stroma. (2) The tumor consisted of deeper layers of basaloid cells and of superficial layers of large cells with clear cytoplasm (Fig. 2A). The clear tumor cells showed prominent cellular and nuclear atypia: they were disordered, of unequal size, had irregular chromatin straining, and were marked by mitotic figures and cell clumping (Fig. 2B). The basaloid cells showed nuclei that stained intensely with hematoxylin and displayed less prominent atypia than the clear cells. (3) On PAS staining of clear cells, PAS-positive granules were digested with diastase. (4) Several duct-like structures were seen in the tumor nests. The tumor cells seemed to be proceeding from outer cells around the lumen of these structures. (5) The basement membrane between the tumor and the dermis was intact. No invasion by tumor into the dermis was seen. These findings were all consistent with porocarcinoma in situ. Immunohistochemically, epithelial membrane antigen (EMA) was strongly positive in the cell membrane of the clear cells. However, staining of basaloid cells was only weakly positive or negative (Fig. 3). These results and the previously reported results of EMA staining⁴ suggest that the appearance of the clear tumor cells in porocarcinoma indicate malignancy.     

Comparative electromyographic study of elevator muscles in patients with complete dentures and natural dentition

An analysis of integrated electromyographic (IEMG) activity of masseter and anterior temporal muscles was undertaken in fifteen patients with complete dentures and eight adult subjects with natural dentition. Bipolar surface electrodes were used for IEMG recordings during maximal voluntary clenching and saliva swallowing in the inter-cuspal position. The IEMG activity of both muscles during maximal voluntary clenching was significantly lower in patients with complete dentures than in subjects with natural dentition. During saliva swallowing the activity in both muscles was similar in both groups. This may have a great clinical significance in the maintenance of the functional state of the different structures of the stomatognathic system in complete denture wearers, since the process of swallowing is a 24-h function repeated about 600-2400 times each day.     

Amount of Helicobacter pylori in gastric mucus during anti-H. pylori treatment

Helicobacter pylori is present in infected patients not only on the gastric epithelial cell surface but also in gastric mucus. We developed a competitive polymerase chain reaction (cPCR) method for quantitative measurement of H. pylori in gastric mucus. The aim of this study was to determine the number of H. pylori in gastric mucus before and after anti- H. pylori treatment. Patients with duodenal ulcer were treated with lansoprazole alone ( n =11) or lansoprazole and amoxycillin ( n =12). The amount of H, pylori in gastric mucus was measured over time by a cPCR assay. Helicobacter pylori infection was also tested for using histology, culture, and the rapid urease test (RUT). Although most patients treated with lansoprazole alone had become H. pylori -negative by the end of treatment when tested by histology, RUT, and culture, a large number of H. pylori organisms were found in the gastric mucus at that time by cPCR. These patients returned to being H. pylori positive 1 to 12 months later on the basis of histology, RUT, and culture. However, cPCR results indicated eradication of H. pylori by the end of treatment in eight of the 12 patients treated with lansoprazole and amoxicillin, and these patients remained H. pylori negative on histology, RUT, culture, and cPCR 1 to 12 months later. Testing for H. pylori in gastric mucus is thus useful for precise determination of the success or failure of H. pylori eradication therapy.     

2‘,5’-oligoadenylate synthetase activity and T cell subset in the cerebrospinal fluid and peripheral blood of aseptic meningitis

2′,5′-oligoadenylate synthetase activity, which is assumed to be induced by interferon, is reported to be one of the useful markers reflecting interferon activity. The enzyme activity of patients with aseptic meningitis and febrile convulsion were compared in order to evaluate interferon activity as one of the local immuno-defense mechanisms of aseptic meningitis. The surface antigen of mononuclear cells in cerebrospinal fluid and peripheral blood of some patients with aseptic meningitis was also measured. The enzyme activity of patients with aseptic meningitis was 191.4 pmol/dL in the cerebrospinal fluid and 395.8 pmol/dL in the serum during the acute phase, while that of patients with febrile convulsion was 45.2 pmol/dL in the cerebrospinal fluid and 326.0 pmol/dL in the serum. The enzyme activity of the former patients significantly decreased during the recovery phase in both the cerebrospinal fluid and serum. CD3 positive cells in the peripheral blood were 56.3% of the total mononuclear cells during the acute phase and 65.2% during the recovery phase, whereas in the cerebrospinal fluid mononuclear cells, they were 87.1 and 85.5%, respectively. During the acute phase, CD4 positive cells were the predominant T lymphocyte subset in the cerebrospinal fluid cells, while CD8 positive cells were predominant during the recovery phase. The relative proportions of CD4 positive and CD8 positive cells during the acute and recovery phase in the cerebrospinal fluid mononuclear cells were quite high compared to the recovery phase, although that ratio of peripheral blood mononuclear cells was not changed throughout the course. It was concluded that T lymphocytes and increased 2′,5′-oligoadenylate synthetase activity in the cerebrospinal fluid may be one of the important components in the local inflammatory process independent of the systemic host defense mechanism in aseptic meningitis.