Intra-bone marrow-bone marrow transplantation facilitates hemopoietic recovery including dendritic cells

In this report, we provide evidence using a serial bone marrow transplantation (BMT) protocol that intra-bone marrow (IBM)-BMT (IBM-BMT) can efficiently reconstitute the hemopoietic system with cells of donor origin, in contrast to conventional intravenous (IV)-BMT (IV-BMT). Furthermore, the hematolymphoid system of secondary recipients that had received bone marrow cells (BMCs) from primary recipients treated with IBM-BMT recovered earlier than that of the secondary recipients of BMCs from primary recipients treated with IV-BMT. This was the case when the Lin-/c-kit+ progenitor cells of the secondary and tertiary recipients were examined. These findings indicate that IBM-BMT can facilitate the development of not only cells of various lineages but also the effective generation and, more importantly, the maintenance of the progenitor cells. Furthermore, we show that IBM-BMT can reconstitute the dendritic cell (DC) subsets (myeloid and lymphoid DCs), which are critical for the initiation of both adaptive and innate immune responses. The frequency of both myeloid and lymphoid DC subsets was approximately equal to that of normal age-matched untreated controls and, after second and third BMT, this ratio was close to that observed in the normal controls. However, the lymphoid DCs were clearly reduced in the secondary and tertiary recipients of BMCs from mice that had received IV-BMT. Therefore, the development of DC subsets is also normally maintained in the IBM-BMT group.     

Intramural sarcoma of the carotid artery with adventitial inflammation and fibrosis resembling 'inflammatory aneurysm'

A rare case Is descrlbed of an Intramural sarcoma of the rlght common carotld artery coexistlng wlth adventitial inflammation and flbrosls, resembllng 'inflammatory aneurysm', which was resected from a 33-yearold Japanese woman who had presented with a pulsatile mass on the rlght side of the anterior neck. Grossly, the wall of the carotld artery showed an intimal tear with dlssectlon of the medla filled with thrombus. A graylsh area, abutting directly onto the dlssected space and Involving the media and inner adventltia, was composed of a-smooth muscle actin-positive and desmln-negative polygonal and splndle cells with large bluntended nuclei and coarse granular chromatin arranged Into a well-organized Interlacing bundle pattern. This portlon was thus considered to represent lelomyosarcoma. White to yellow-tan fibrotic tissue present in the adventitial area consisted of extensive lamellar fibrosis wlth scattered focl of lymphoplasmacytlc aggregates and obliterated arteries, and lacked atypical spindle and polygonal cells. These changes accorded with the histopathologlcal findlngs hitherto described in cases of 'inflammatory aneurysm', which is known to almost exclusively involve the abdominal aorta. We conslder this case unique In that the leiomyosarcoma involved an artery other than the aorta, wlth an 'inflammatory aneurysm'-like reaction in the same she. The posslble relatlonship between these two condltions Is dlscussed.     

PRIMARY MALIGNANT FIBROUS HISTIOCYTOMA OF THE ENDOMETRIUM

Malignant fibrous histiocytoma (MFH) has become one of the most common malignancies occurring in soft tissue. To our knowledge, the present case is the first of MFH occurring in the endometrium. The uterus removed from a 47-year-old woman demonstrated a large multinodular endometrial lesion with gross invasive foci in the myometrium and the left oviduct. Microscopically, the endometrial tumor and the invasive lesions were composed of dense sheets of markedly pleomorphic cells consisting of fibroblast-like cells, histiocyte-like cells, foamy histiocytes, benign appearing multinucleated giant cells resembling either osteoclasts or Touton giant cells, and bizarre tumor giant cells. Some of the tumor cells showed phagocytic activities. The tumor cells were oriented in a random or haphazard fashion and classical storiform and fascicular patterns were not observed. The tumor was diagnosed as MFH consisting exclusively of so-called pleomorphic pattern. The patient is alive without evidence of disease, months following total hysterectomy and bilateral salpingo-oophorectomy.     

Lymphoid follicles appearing in gastric mucosa, especially in reactive lymphoid hyperplasia and malignant lymphoma

Histopathological analysis of reactive lymphoid hyperplasia (RLH) and malignant lymphoma (ML) of the stomach was made based on the observations of lymphoid follicles appearing in gastric mucosa. The materials used for study consisted of 28 stomachs without RLH or tumor obtained from either operation or autopsy, 18 stomachs with RLH, and 46 stomachs with ML. Lymphoid follicles appeared soon after birth, increased with mucosal atrophy, and decreased in mucosa with intestinal metaplasia. They possessed a sinusoidal structure and appeared in the muscularis mucosae intimately related to the lymphatic flow. Excepting for the significant proliferative nature, the structural evolution of lymphoid follicles in RLH was similar to that in atrophic mucosa. They showed, however, a wide spectrum of changes containing cases with simple reactive changes to those with prelymphomatous changes. As to ML, the large cell type demonstrated a destructive proliferation, while both small and medium-sized cell types showed proliferation and infiltration preserving their original structure. In the superficial type, ML was frequently accompanied by RLH and mucosal atrophy. The histological features of ML consisted of not only the characteristics of tumor cells but also the proper mucosal changes including lymphoid follicles.     

Relation between yawning behavior and central serotonergic neuronal system in rats

Summary Subcutaneously (s.c.) administered apomorphine (0.0125–0.4 mg/kg) or physostigmine (0.025–0.4 mg/kg) to rats elicited yawning. The dose-response curves were bellshaped. The peak effects of apomorphine and physostigmine were observed with a dose of 0.1 mg/kg of each drug. Yawning elicited by apomorphine (0.1 mg/kg) or physostigmine (0.1 mg/kg) was reduced by intraperitoneally (i.p.) administered 5-hydroxytryptophan (5-HTP, 50–200 mg/kg, given 30 min before). Yawning elicited by apomorphine but not by physostigmine was enhanced by p-chlorophenylalanine (p-CPA, 25–400 mg/kg i.p., given 24 h before). Apomorphine elicited but not physostigmine-elicited yawning was enhanced by pretreatment with 5,7-dihydroxytryptamine (5,7-DHT, 8 g/rat, given 14 days before into the dorsal raphe). This treatment led to a 35% depletion of serotonin (5-HT) in the striatum. 5-HTP, p-CPA or 5,7-DHT given alone did not elicit yawning. Bilateral, intrastriatal microinjection of apomorphine (1.5 –50 g/site) but not physostigmine (5–50 g/site) elicited yawning. The dose-response curve was also bell-shaped. These results indicate that central serotonergic pathways play an important role in modulating drug-elicited yawning in rats. Send offprint requests to S. Okuyama at the above address     

A new method of primary engineering of esophagus using orthotopic in-body tissue architecture

PurposeTissue engineering of esophagus is required for management of long-gap esophageal atresia (LGEA). Collagenous connective tissue membranes fabricated by in-body tissue architecture (iBTA), called biosheets, can repair esophageal defects and generate tissues similar to native esophagus. However, iBTA requires second-stage surgery because of heterotopic preparation of biosheets. Our aim was to develop orthotopic iBTA for primary engineering of the esophagus by interposing a tubular mold to the esophageal defect.MethodThe cervical esophagus of six rats was transected. An acrylic tube (internal diameter 2.6 mm, length 7.0 mm) was inserted and fixed between the ends of the upper and lower esophagus, and a 3 mm-long esophageal defect was created. Four weeks later, the rats were sacrificed for histological analysis.ResultsPostoperatively the rats could intake liquid food. After four weeks, the esophageal defects were filled with regenerated tissues. Histologically the new esophageal walls stained positive for collagen type I. The inner surfaces were covered with stratified squamous epithelium that expressed pan-cytokeratin. In only one of six rats, regeneration of muscular-like tissue was suggested by positive immunohistochemical staining for desmin.ConclusionOrthotopic iBTA can regenerate a substitute esophagus with esophageal epithelium and collagenous wall. This technique may be a novel treatment for esophageal atresia with gaps of various lengths including LGEA.     

Evaluation of conventional weaning criteria in patients with acute respiratory failure

We evaluated the reliability of conventional weaning criteria from a ventilator during 33 weaning trials on 25 patients with acute respiratory failure (ARF). Of 13 criteria, a ratio of maximal voluntary ventilation to minute ventilation (MV) 2, a vital capacity 12ml·kg^–1, a spontaneous respiratory rate 25 breaths·min^–1, and a MV 10l·min^–1 appeared to be useful for predicting successful weaning outcome. However, even using those criteria, there were many falsely-negative cases. The alveolar-arterial P_{O 2} gradient 350mmHg at an Fi _{O 2} 1.0 was not useful as a predictor of weaning outcome. The present study demonstrates that conventional criteria are frequently inaccurate for predicting weaning outcomes and suggests that the use of some of these criteria may unnecessarily prolong the length of ventilator support. Since ventilation of most patients with poor oxygenation can be successfully discontinued by placing them on a continuous positive airway pressure system, these results suggest that the improvement of oxygenation is not an indispensable prerequisite for weaning from mechanical ventilators.(Okamoto K, Iwamasa H, Dogomori H, et al.: Evaluation of conventional weaning criteria in patients with acute respiratory failure. J Anesth 4: 213–218, 1990)