Immunohistologic attempt to find carcinogenesis from hepatic progenitor cell in hepatocellular carcinoma

AIM: To clarify whether hepatocellular carcinoma (HCC) originates from hepatic progenitor cells and whether there is any correlation with the clinicopathologic factors of HCC, we reviewed 217 resected HCC specimens. METHODS: Immunohistochemical examination of cytokeratin (CK) 7, CK19, CD34, and CD117 (c-KIT) was performed. Overexpression of CK7 and CK19 indicates differentiation from cholangiocellular and hepatic progenitor cells, while overexpression of CD34 and CD117 indicates hepatic stem cells. Fresh specimens were obtained from 20 HCC patients for mutation of the c-KIT gene. RESULTS: CK7, CK19, and CD117 were positive in 41, 9.7, and 0.9% of the HCC specimens, respectively, and CD34 was never positive. None of the fresh HCC specimens demonstrated a c-KIT mutation. CK19 positivity was significantly correlated with a positive hepatitis B core antibody, and with poor survival outcome, and tended to correlate with poor histologic differentiation. CONCLUSION: These results suggest that: (i) about 10% of HCCs with typical histologic features originate from an intermediate hepatic progenitor cell, such as the canal of Hering and oval cells in the rat, or acquire the characteristics of cholangiocellular epithelium by metaplasia; (ii) HCC with typical histologic features rarely originates from hepatic stem cells, and (iii) patients with CK19-positive HCC have a poor prognosis.     

Fetal/neonatal outcome in abruptio placentae during preterm gestation

The purpose of this study was to evaluate the fetal/neonatal outcome and to determine the important factors in that outcome, including the use of ultrasonography and fetal heart rate monitoring, in abruptio placentae during preterm gestation. A case-control study was performed using a logistic regression model. Adverse outcome was defined as neonatal death before hospital discharge or a diagnosis of cerebral palsy in surviving neonates. Stillbirth (group 1) occurred in eight of 50 cases of abruptio placentae (16%). Adverse outcome was seen in 11 survivors (11 of 42; 26.2%). The obstetrical disseminated intravascular coagulation (DIC) score in group 1 (11.8 +/- 7.1) was higher than that in the adverse (5.7 +/- 1.3) and satisfactory (5.3 +/- 2.4) outcome groups. A low Apgar score (< 7) at 5 minutes (odds ratio, 19.8; 95% confidence interval, 2.0 to 197.8) was associated with increased risk of adverse outcome in the logistic regression model. Although the obstetrical DIC score was high and may reflect the severity of maternal complications in the stillbirth group, there were no typical ultrasonographic findings and fetal heart rate patterns in abruptio placentae during preterm gestation predicting adverse outcome among survivors.     

Transplacental transmission of maternal B-cell lymphoma

We report a case of maternal malignant lymphoma transferred to the fetus during pregnancy. A 29-year-old woman developed lymphoma at 29 weeks' gestation, and her infant developed malignant lymphoma at 8 months. Immunohistochemical examinations revealed lymphoid cells of similar characteristics in the maternal, placental, and infant tissues.     

Endovascular stent-graft treatment for thoracic aortic aneurysms: short- to midterm results

PURPOSE: To evaluate short- and midterm results of the endovascular repair of thoracic aortic aneurysm (TAA) with the use of custom-made stent-grafts. MATERIALS AND METHODS: Between May 1997 and May 2003, 40 patients with TAA (26 degenerative/atherosclerotic, seven dissection-related, three traumatic, two mycotic, one anastomotic, and one penetrating ulcer) underwent endovascular stent-graft placement. The mean age of the patients (29 male and 11 female) was 67.2 years. Twenty-four of the 40 patients (60%) were judged not to be good candidates for conventional open repair. Stent-graft placement was performed in the angiography suite with general anesthesia and transient cardiac arrest or induced hypotension. Custom-made stent-grafts were used in all patients. Four of the 40 patients (10%) underwent preliminary extra-anatomic bypass surgery to provide a sufficiently long landing zone. The mean follow-up period was 16.7 months (range, 1-65 months). RESULTS: The technical success rate was 97.5% and the early mortality rate was 2.5% (one out of 40 patients). There were four late deaths (two procedure-related). Survival rates were 84.2%+/-6.6% at 1 year and 84.2%+/-6.6% at 2 years. Survival rates were not significantly different between surgical candidates and non-surgical candidates (P =.423). Intraprocedural complications included access artery complications in nine patients and bleeding in three patients. Postoperative complications included early aneurysmal expansion in one patient, pneumonia in one patient, wound infection in one patient, stroke in three patients, paraplegia in one patient, respiratory insufficiency in two patients, aortoesophageal fistula in one patient, and late aneurysmal expansion in three patients. The rates of freedom from first additional intervention were 91.0%+/-6.7% at 1 year and 74.5%+/-11.9% at 2 years. The rates of freedom from second additional intervention was 100% at 2 years. The rates of freedom from treatment failure were 84.7%+/-7.6% at 1 year and 69.3%+/-11.6% at 2 years. CONCLUSION: Endovascular repair of TAA with a custom-made stent-graft is a safe and effective alternative to open repair and continues to play an important role. However, careful follow-up is mandatory to manage complications.     

Nonoprerative management of obstructive jaundice caused by a benign hepatic cyst

A 64-year-old man with a 9.0 cm benign hepatic cyst near the hepatic hilum presented with obstructive jaundice caused by the compression of the hepatic ducts. The cyst was aspirated percutaneously, and minocycline hydrochloride was instilled as a sclerosant through a catheter inserted into the cyst. The cyst gradually became smaller, relieving the obstructive jaundice. There were no complications or side-effects. The instillation of minocycline hydrochloride is a useful alternative to ethanol instillation for treating benign hepatic cysts, even when the cyst is causing obstructive jaundice.     

Comparison of neonatal outcome including cerebral palsy between abruptio placentae and placenta previa

OBJECTIVE: Our purpose was to evaluate the neonatal prognosis after abruptio placentae and placenta previa during pre-term gestation. STUDY DESIGN: A case-control study was performed using a logistic regression model. A poor outcome was defined as neonatal death occurring before hospital discharge or a diagnosis of cerebral palsy. RESULTS: A poor outcome was more frequent in cases of abruptio placentae (11/42, 26.2%) than in placenta previa (2/72, 2.8%) and pre-term labor (1/120, 0.8%). The difference was mainly due to the incidence of cerebral palsy. A significant association of abruptio placentae (odds ratio (OR) 61.0, 95% confidence interval (CI 3.4-1084), delivery at <31 weeks of gestation (OR 19.0, CI 2.8-128.8), and low Apgar score (<7) at 5min (OR 70.8, CI 16.5-304.9) with increased risk of poor outcome was found in the logistic regression model that controlled for confounding effects. In abruptio placentae, a low Apgar score (<7) at 5min (OR 19.8, CI 2.0-197.8) was associated with increased risk of poor outcome in the logistic regression model. CONCLUSION: From the standpoint of poor perinatal outcome including cerebral palsy, abruptio placentae was the most significant clinical entity in pre-term gestation.     

Adenosine A(2A) receptors mediate hypoxic inhibition of fetal breathing in sheep

OBJECTIVE: Hypoxia inhibits fetal breathing through activation of central adenosine (ADO) receptors that modulate fetal behavioral state. This study was designed to determine whether adenosine A(1) and/or A(2A)receptor subtypes mediate the depressant effects of hypoxia. STUDY DESIGN: In 14 chronically catheterized fetal sheep (>0.8 term), hypoxemia was induced by having the ewe breathe a gas mixture of 9% oxygen for 1 hour. During hypoxia, the fetus was infused intra-arterially with a vehicle or an antagonist for adenosine A(1) or A(2A) receptors. Statistical analysis was performed by using analysis of variance with Tukey's least significant difference criterion. RESULTS: Fetal isocapnic hypoxemia (PaO(2): control, approximately 24 mm Hg; hypoxia, approximately 14 mm Hg) virtually eliminated rapid eye movements and breathing when the fetus was infused with vehicle or the A(1) receptor antagonist. In contrast, adenosine A(2A) receptor blockade abolished the hypoxia-induced arrest of rapid eye movements and breathing. CONCLUSION: Hypoxic inhibition of rapid eye movements and breathing is critically dependent on activation of adenosine A(2A) receptors.     

Eosinophilic enteritis presenting as acute intestinal obstruction: a case report and review of the literature

A 37-year-old man was admitted to our hospital complaining of severe abdominal pain and vomiting. His abdomen was distended, and there was diffuse tenderness and guarding in all four quadrants. Laboratory examinations revealed leukocytosis without eosinophilia. Abdominal radiograph revealed air-fluid levels in the small intestine. Computed tomography confirmed a dilatation of the small intestine and the presence of ascites. An emergency laparotomy was performed for a diagnosis of peritonitis due to intestinal obstruction. A large amount of yellow transudate was present in the abdominal cavity. An area of induration in the ileum was identified about 40 cm from the ileocecal valve. The ileum proximal to the induration was dilated, and the site of obstruction seemed to be the indurated segment. A partial iliectomy was performed. Histologically, dense infiltration of eosinophils was found transmurally, and eosinophilic enteritis was diagnosed. One year later, the patient was free of gastrointestinal symptoms. The relevant literature on eosinophilic gastroenteritis is discussed.