Cellular characteristics of neoplastic angioendotheliosis

Summary Neoplastic angioendotheliosis (NAE) is a rare, mostly fatal disease characterized by proliferation of large blastoid cells in small vessels of various organs. The origin of neoplastic cells remain undetermined. In this study, cell markers were studied immunohistologically on paraffin sections of six cases of NAE, by applying avidin-biotin-peroxidase (ABC) method and five antibodies which can demonstrate marker antigens on formalin fixed and paraffin embedded specimens. It was shown that the neoplastic cells were heavily stained with an anti-B lymphocyte monoclonal antibody LN-1 (6/6), moderately stained with another anti-B lymphocyte antibody LN-2 (5/6) and heavily stained with a monoclonal antibody which reacts with all levels of leukocytes (Dako-LC) (6/6). The cells did not show positive reaction with an anti-myelomonocytic antibody anti-Leu M1. The reaction against anti-Factor VIII, which can depict endothelial cells, was mostly negative, and if positive, was faint and undefinite, leading to an assumption that the reaction was against antigens in serum and not against neoplastic cells. These results suggest that the neoplastic cells of NAE are in the B lymphocyte lineage.     

A case of total aortic replacement in a patient with Marfan's syndrome]

A 32-year-old male with Marfan's syndrome was admitted to our Department in June, 1989 due to severe back pain that was diagnosed as type III-b dissecting aneurysm. His infrarenal abdominal aorta and bilateral iliac arteries had been replaced in another clinic in 1984 due to true aortic aneurysm. Two years later, Carbrol's operation was performed in our Department for the late development of DeBakey type II dissecting aneurysm. DSA and CT studies indicated the need for total replacement of the entire remaining aorta, since diffuse and extensive dilatation of the false lumen and the presence of an intimal tear at the origin of the left carotid artery were demonstrated. The arch and upper descending thoracic aorta were replaced in June, 1989, and replacement of the total remaining thoracoabdominal aorta was carried out under left heart bypass on September 26, 1989. Abdominal branch arteries and intercostal arteries of the 9th to 11th levels were reattached to the graft as onlay patches. Hoarseness of voice was the only complication. The patient recovered uneventfully and returned to his job after discharge. Although the native aorta had been completely replaced, ambulatory monitoring of the patient's pressure and ECG, performed two months after the operation, showed the normal reflex.     

PILAR ACANTHOMA

A pilar acanthoma is reported. The tumor consisted of acanthotic epidermis similar to that of inverted follicular keratosis, and a dilated cystic cavity with surrounding tumor masses similar to those seen in sebaceous trichofolliculoma. The tumor was tentatively diagnosed as pilar acanthoma.     

Direct flowmetry of the mitral valve. A simple approach in the experimental study

A flow probe for direct measurement of blood flow of the mitral valve was devised. It was useful for acute experiment, particularly concerning pathophysiology of the mitral valve function. Insertion of the probe into the left atrium and fixation to the left atrial wall and thus to the mitral orifice were readily and satisfactorily performed without disturbance of blood flow and valvular function. It must also be emphasized that support with cardiopulmonary bypass was not necessary at the time of insertion of the probe. Effectiveness of the procedure has been confirmed through simultaneous observation of echocardiogram and mitral blood flow of the dog's heart with ruptured chordae tendineae.     

Surgical treatment of annuloaortic estasia: experience in 7 consecutive patients.

Seven patients with annuloaortic ectasia were treated according to the method described by Bentall and De Bono. A Björk-Shiley valve in a composite graft was the prosthesis of choice and was used in all patients except 1, who received a Starr-Edwards valve. Profound topical cooling without selective coronary perfusion was applied in 5 patients for myocardial preservation during aortic occlusion.There was 1 operative death and 1 late death, the latter from cerebral thromboembolism. Five survivors have been followed from 1 year 5 months to 2 years 10 months with an average follow-up of 2 years. Excellent results were obtained in all survivors, their physical capabilities putting them in Class I of the New York Heart Association Functional Classification. Postoperative aortograms showed no signs of kinking or compression of vascular prostheses nor abnormalities of prosthetic valves. A modified technique to secure graft fixation is discussed.     

Mechanism for producing a neoglottal fricative [h] in tracheoesophageal speech]

BACKGROUND: Over the past 24 years, we have been performing the tracheoesophageal (TE) fistulization for voice restoration following a total laryngectomy. The principle of this technique is to divert the exhaled air through the TE fistula into the hypopharynx, where the thyropharyngeus muscle forms the retropharyngeal prominence on which the neoglottis is located. In TE speech, the electromyographic (EMG) activity of the thyropharyngeus muscle decreases for voiceless positive production. This neoglottic articulatory adjustment plays an important role in opening the neoglottis. It has been previously reported that the glottis is open for the glottal fricative ([h]) sound produced with laryngeal articulatory adjustment and that turbulence through the glottis produces the [h] sound in laryngeal speech. Of all the voiceless consonants in the Japanese language, [h] is the most difficult to produce in TE speech. This suggests that other adjustments in addition to the neoglottic articulatory adjustment are necessary to produce the [h] sound in TE speech. This study was designed to clarify the mechanism by which the neoglottal fricative ([h]) sound is produced. SUBJECTS AND METHODS: Eight speakers who could pronounce [h] were included in this investigation, a fiber optic examination of the neoglottis, aerodynamic study, and an EMG examination of the thyropharyngeus muscle during the production of words containing voiceless fricative [h] and [s] sounds were performed in each subject. The two groups were classified according to the subject's success or failure in producing words with initial [h] and medial [h] sounds. Out of 80 TE speakers who could not pronounce [h], 4 subjects were selected as the control group. RESULTS: Fibroptic examination revealed a transient neogottal opening during the production of [h] and [s] sounds. The median of the average opening time was 0.26 seconds for initial [h] sounds and 0.19 seconds for medial [h] sounds. No significant difference in opening time was observed for [h] and [s] sounds. The aerodynamic investigation demonstrated a transient increase in supraneoglottal pressure and airflow through the neoglottis and a transient decrease in subneoglottal pressure for [h] production, while no changes were observed in the control group. The EMG study demonstrated that the activity of the thyropharyngeus muscle decreases in cooperation with a transient decrease in subneoglottal pressure only for [h] production. As a result of the transient decrease in subneoglottal pressure, the EMG activity for [h] decreased more strongly than that for [s]. CONCLUSIONS: These findings indicate that both neoglottic adjustment and pulmonary adjustment are required for [h] production in TE speech.