Scanning electron microscopy of nasal arterioles effected by vasoactive agents

Summary Morphological changes in nasal blood vessels induced by - and -adrenergic and cholinergic agonists were studied under a scanning electron microscope after removal of extracellular connective tissue and the basal lamina. Arterioles were constricted and dilatated following topical application of -adrenergic and cholinergic agonists. Distinctive morphological changes were observed on their smooth muscle cells. Smooth muscle cells of constricted arterioles had a rugged surface with numerous fine invaginations. However, in dilatated arterioles the cells had a smooth surface and intercellular spaces were clearly revealed. No remarkable changes were produced in smooth muscle cells by the -adrenergic agonist. It is concluded that nasal arterioles are sensitive to -adrenergic and cholinergic stimulation but not to -adrenergic stimulation.     

Changes of ground substance in the inner ear in Alloxan diabetic mice

Summary One of the important substances in the ground substance is acidic glycosaminoglycans (AGAGs). Changes of AGAGs in the inner ear and in other organs were investigated using alloxan diabetic mice in order to contribute to the understanding of diabetic hearing impairment. In the diabetic group, gradual increases of AGAGs were observed in each tissue. On the 60th day after alloxan injection, AGAG values were increased 3.5-fold in the cochlea, 2.5-fold in the brain, 13-fold in the liver, twofold in the kidney, and fivefold in the pancreas compared with the control values. It is interesting to note that both the cochlea and pancreas showed continuous increases of AGAGs.This research was supported by grant no. 757202 from the Ministry of Education. A part of this paper was read at the 16th workshop on Inner Ear Biology, Bern, Switzerland     

A Case of Nephrotic Syndrome With Tetany

Abstract A 7-year-old girl with nephrotic syndrome had several attacks of tetany during the relapses. The attacks, acccompanied by hyperventilation, responded to re-breathing with a vinyl bag. However, other episodes of attacks which were not accompanied by hyperventilation, did not respond to re-breathing but responded to the intravenous administration of calcium gluconate. The serum concentrations of total calcium and ionized calcium were low and no calcium-binding protein was found in the serum from the patient, using chromatographic study. The serum concentration of 1, 25(OH)₂ vitamin D was within the normal range, but showed a tendency for the value to be lower in relapse than in remission. Urinary, Ca/Cr ratio in relation to serum calcium was high in this patient and a low threshold of calcium excretion in the kidney was demonstrated.
It is suggested that the impaired vitamin D metabolism and calcium loss in the urine might have contributed to tetany in this patient.
Administration of a calcium preparation and vitamin D may be necessary for a frequentrelapser on long-term glucocorticoid therapy.     

Local T cell subsets in mumps meningitis.

In the acute phase of mumps meningitis, more than 85% of the cells in cerebrospinal fluid (CSF) were OKT 3 positive, while 76% of the peripheral mononuclear cells (PMN) were OKT 3 positive. The ratio of OKT 4:8 positive cells in CSF was significantly lower than that in PMN, showing that suppressor/cytotoxic T cells had selectively accumulated in CSF. In addition, 58% of CSF cells were immune associated (Ia) positive, probably activated T cells.     

Cytological findings on endometrial carcinoma and endometrial hyperplasia

The usefulness of endometrial cytology was studied for the purpose of early diagnosis of endometrial carcinoma in 423 patients. In the cytological examination, 15 patients were either "suspicious" or "positive". Histological findings revealed adenomatous hyperplasia in 6, atypical hyperplasia in 3 and endometrial carcinoma in 3 patients. All of these patients with positive histological findings had "suspicious" or "positive" in cytological examination. None had false negative. "Suspicious" or "positive" endometrial cytology was delineated in histologically positive lesions including endometrial carcinoma, atypical hyperplasia and adenomatous hyperplasia. Many cells with various acinous patterns were observed in patients with diseases more serious than atypical hyperplasia. The nuclei became larger and irregular in proportion to the progression of the lesion, though hypercytochromia of the nuclear chromatin was most marked in patients with adenomatous hyperplasia. There was a significant difference in the number of nucleoli between cells of adenomatous hyperplasia and those of atypical hyperplasia and endometrial carcinoma. Also, there was an apparent difference in the size and irregularity of the nucleoli between atypical hyperplasia and endometrial carcinoma. Phagocytosis of white blood cells was frequently observed in patients with endometrial carcinoma. Therefore, it is believed that endometrial cytology is useful not only in screening endometrial carcinoma and related diseases but also to some degree in the estimated diagnosis of these lesions.     

Therapy-related acute myeloid leukemia following double autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma

A 29-year-old male was diagnosed as having non-Hodgkin's lymphoma (NHL, diffuse, large cell, B-cell, stage IV) in June 1999. He underwent 7 courses of chemotherapy and double autologous peripheral stem cell transplantation (total dose: CPA 13,000 mg, BUS 892 mg, L-PAM 150 mg, MCNU 870 mg, MTX 60 mg, Ara-C 160 mg, DXR 350 mg, VP-16 11,190 mg, VCR 8 mg, CBDCA 700 mg, and MIT 22 mg) for NHL and obtained complete remission in April 2000. In September 2000, he suffered from progressive general malaise. Laboratory findings showed marked leukocytosis with 85% leukemia cells, which were positive for alpha-naphthyl butyrate esterase. Surface-marker analysis of the leukemia cells showed positive results for CD11b, CD11c, CD13, CD15, CD33, CD56, CD64, CD65, CD71 and HLA-DR, and chromosomal analysis revealed add(8) (p11), add(9) (p13). He was diagnosed as having AML (M5a) and was still in complete remission for NHL. He did not respond to chemotherapy and died in December 2000, believed to be from therapy-related leukemia induced by the VP-16 used for treating NHL, judging by the patient's short clinical course and monocytic type of leukemia.     

Prognostic value of mechanical efficiency in ambulatory patients with idiopathic dilated cardiomyopathy in sinus rhythm

OBJECTIVES: The purpose of this study was to determine, by analyzing the pressure-volume relationship, the prognostic value of parameters related to myocardial energetics for predicting mortality in patients with dilated cardiomyopathy (DCM) in sinus rhythm. BACKGROUND: The relationship between the myocardial energetics and the prognosis of patients with DCM in sinus rhythm remains unclear. METHODS: We followed 114 ambulatory patients with nonischemic DCM in sinus rhythm for a mean period of 5.8 +/- 3.9 years. Over 70% of our patients were in New York Heart Association functional class I and class II. Pressure-volume data were obtained by the conductance method, and myocardial oxygen consumption per beat (VO(2)) measurements were obtained. RESULTS: The 3-, 5-, and 10-year cumulative survival rates were 88.6%, 80.0%, and 73.9%, respectively. Of the 114 patients, 47 were selected randomly to assess their myocardial energetics. By univariate analysis, the mechanical efficiency (ME, external work/VO(2)), left ventricular (LV) ejection fraction and the LV end-diastolic pressure were statistically associated with cardiac death. The ME was the strongest predictor of survival in a Cox proportional-hazards analysis (p = 0.011). The best cutoff point of ME identified by the receiver-operating curve was 11%. This value had a sensitivity of 100%, a specificity of 87% and an overall predictive accuracy of 88% to distinguish survivors from nonsurvivors. CONCLUSIONS: This study clearly demonstrates that ME is a powerful clinical predictor for cardiac death in patients with mild to moderate heart failure and with sinus rhythm. Whether these conclusions apply to patients with more severe heart failure requires further investigations.     

Lupus cystitis in the course of Evans syndrome

A 50-year-old woman with a 4-year history of Evans syndrome was admitted to our hospital because of progressive nausea, appetite loss, body weight loss, diarrhea and abdominal pain. Abdominal ultrasonography revealed pleural effusion, ascites, bilateral hydronephrosis, dilatation of the bilateral ureter, and irregular wall thickness of the urinary bladder. Immunological studies revealed decreased complement components (C3; 72 mg/dl, C4; 7 mg/dl, CH50; 28.8 mg/dl), a x 80 antinuclear antibody titer (homogeneous pattern), antibody against single-stranded DNA 19 U/ml, anti-SS-A antibody over 500 U/ml and negativity for antibody against double-stranded DNA (anti-dsDNA Ab). Although the patient did not fulfill the criteria for systemic lupus erythematosus (SLE), we diagnosed her as having lupus cystitis. Bolus methylprednisolone (mPSL) therapy (1,000 mg mPSL over 3 days, div) was administered, followed by 60 mg PSL, and this led to immediate improvement of the patient's symptoms and laboratory data. Later, anti-dsDNA Ab became positive, and the patient thereby fulfilled the criteria for SLE. Lupus cystitis following Evans syndrome has rarely been reported. The present such case was treated successfully with bolus mPSL therapy.     

Intradural recurrence of multiple myeloma during the hematological complete remission

In December 1997, a 55-year-old man presented with left-sided back and arm pain. Pretreatment examination revealed IgG-lambda type M-protein, Bence-Jones protein and the posterior mediastinum tumor. Bone marrow examination revealed hypercellular marrow with 73.6% plasma cells. He was diagnosed as having multiple myeloma with extramedullary lesion. As a result of VAD, MP, interferon and radiation therapy, he had a hematological complete remission. After 21 months, he developed intradural relapse at cauda equina and cerebrum. Many plasma cells and IgG-lambda type M-protein were detected in the cerebrospinal fluid. Laboratory examinations showed a complete remission except for cerebral and meningeal involvement. The myeloma cells might have infiltrated the intradural space at diagnosis and expanded in the central nervous system despite chemotherapy. Because reported cases with cerebral and meningeal myeloma are increasing according to the recent advance of treatment, we must pay attention to the meningeal myeloma.     

Pathology and pathophysiology of chronic obstructive pulmonary disease

A variety of pathological changes have been observed in the central airways, peripheral airways and lung parenchyma of patients with chronic obstructive pulmonary disease (COPD). The characteristic changes in the central airways include inflammatory cellular infiltration into the airway wall and mucous gland enlargement. In the peripheral airways, various morphological changes are observed, including mucous plugging, epithelial abnormalities, inflammatory cellular infiltrates, fibrosis and distortion; these changes lead to airway narrowing. In the lung parenchyma, emphysema defined as alveolar destruction and airspace enlargement is present. Although the major sites of airflow limitation in patients with COPD are most likely the peripheral airways, lesions in both the peripheral airways and the lung parenchyma contribute to chronic airflow limitations.