Sarcomatoid carcinoma of the urinary tract

Sarcomatoid carcinoma is a rare variant of malignant tumor arising from the urinary tract. This tumor had been termed carcinosarcoma because of its carcinomatous and sarcomatous components. There is still some confusion in the terminology between true carcinosarcoma and sarcomatoid carcinoma; however, the latter is now regarded as primarily a malignant epithelial tumor with pseudosarcomatous transformation.
Four cases of sarcomatoid carcinoma arising from the urinary tract are reported. The patients were a 77 year old female, and three males aged 62, 69 and 80 years. All but the eldest patient complained of gross hematurla. Surgical removal was performed in the younger three cases, and an autopsy was done in the remaining case. All the tumors were macroscopically polypoid. Histopathologic examination revealed fasciculated spindle-cell tumors with myxold stroma or malignant fibrous histiocytoma-like spindle cell tumors. The epithelial nature was proven in these sarcomatous cells by immunohistochemical andlor electron-microscopic examinations. Only a small amount of squamous cell carcinoma components was also evident in the latter three cases. Although the younger three patients were alive at 44, 23 and 39 months'follow-up, respectively, constant careful monitoring Is recommended.     

Increased migration of neutrophils to granulocyte-colony stimulating factor in rat carrageenin-induced pleurisy: Roles of complement,bradykinin, and inducible cyclooxygenase-2

Administration of human recombinant granulocyte colony-stimulating factor (G-CSF, 100 g/kg/day, s.c) to rats for 4 days significantly increased circulating neutrophil counts (by 1130%), together with an increase in mononuclear leukocyte counts (by 119%). Infiltrated pleural neutrophil counts in G-CSF-treated rats (G-CSF-r) 5h after the intrapleural injection of zymosanactivated serum were significantly higher (by 155%) than those in control rats (Vehicle-r). In carrageenin-induced pleurisy, counts of infiltrated pleural neutrophils in G-CSF-r 5 and 7h after carrageenin were significantly higher (by 119% and 116%) than those in Vehicle-r. G-CSF treatment increased the volume of pleural exudate and the plasma exudation rate by 122% and 226%, compared to values in Vehicle-r 5h after carrageenin. Cobra venom factor (75 g/kg, i.v.) significantly reduced pleural neutrophil migration in G-CSF-r (by 53%) and Vehicle-r (by 49%). Bromelain (10 mg/kg, i.v.) and aspirin (100 mg/kg, p.o.) reduced pleural neutrophil migration and reduced exudate volume and plasma exudation. Intrapleural bradykinin-(1–5) and prostaglandin E₂ levels were significantly higher in G-CSF-r than in Vehicle-r. The increased neutrophil migration in G-CSF-r may be atributed to enhanced activation of the complement system facilitated by increased plasma exudation due to bradykinin and prostaglandins.accepted by M. J. Parnham     

Genetic verification of the role of CCK-AR in pancreatic proliferation and blood glucose and insulin regulation using a congenic rat carrying CCK-AR null allele

A number of studies have indicated that cholecystokinin type A receptor (CCK-AR) plays a crucial role in postnatal pancreatic proliferation and blood glucose regulation through stimulating insulin secretion. The Otsuka Long-Evans Tokushima Fatty (OLETF) rat has been shown to possess poor pancreatic proliferation (PPP) capability after pancreatectomy (Px). Here we have constructed a congenic strain which introgressed an OLETF-derived 18.5 cM genomic fragment identified in our previous quantitative trait locus (QTL) analysis as a locus responsible for PPP into normoglycemic F344 genetic background The introgressed region includes CCK-AR null mutation. After Px, the congenic rat showed weak pancreatic proliferation equivalent to that of the OLETF rat. Furthermore, post-surgery non-fasting blood glucose levels for the congenic rats are significantly higher in comparison with the F344 rats. At 28 days after Px, the congenic rats also showed lower blood insulin levels than the F344 rats. These results further provide the genetic evidence that 1) CCK-AR is essential for pancreatic regeneration; 2) impaired pancreatic proliferation mediates the development of hyperglycemia.     

DETECTION OF HBsAg IN THE PANCREAS

Hepatitis B surface antigen (HBsAg) has been reported to be present in other organs than the liver.^3,9 So far as our knowledge is concerned, however, any report of cases dealing with pancreatic diseases induced by hepatitis B virus (HBV) has not been described in the English and Japanese literature. We report an autopsy case with a pancreatic lesion characterized by damage of both exocrine and endocrine epithelial cells with inflammatory response, which were immunohistochemically found to be positive for HBsAg, and electron-microscopically to possess core-like particles In the nucleus and cytoplasm.     

Villous capillary lesions of the placenta: distinctions between chorangioma, chorangiomatosis, and chorangiosis

Chorangioma (CA), chorangiosis (CH), and chorangiomatosis (CM) are incompletely understood and overlapping villous capillary (VC) lesions believed by some to be related to hypoxia. In this study, we reviewed all cases of CA (n = 36, 0.51%) and CM (n = 39, 0.55%) diagnosed in 7,062 placentas examined at our institution between 1990 and 1999. CH was evaluated in a subsample of 689 cases (n = 46, 6.67%). Controls were derived from cases in the subsample (n = 639) without any VC lesions. Most CA were incidental findings measuring less than 0.5 cm. Nodular and multinodular morphologic variants were otherwise similar. CA were most frequently located under the chorionic plate and at the placental margins and occasionally showed nonspecific trophoblast hyperplasia (Ki-67-positive) similar to that seen in partial moles. CA and CM shared associations with preeclampia, multiple gestation, and premature delivery at 32 to 26 weeks and had a significant co-occurrence rate. Cases of CM were separated into focal, segmental, and diffuse multifocal subgroups. Diffuse multifocal CM (n = 16) showed associations with extreme prematurity (<32 weeks), congenital malformations, IUGR, delayed villous maturation, avascular villi, and placentomegaly, which were not seen in the other 2 localized subgroups. CH lacked the associations noted for CA and CM, was not increased in placentas with CA or CM, and was most frequent at greater than 37 weeks. CH was positively associated with maternal diabetes, placentomegaly, delayed villous maturation, and chronic villitis. Finally, CH lacked the continuous perivascular layer of muscle-specific actin (MSA)-positive pericytes and the multifibrillar lattice-like reticulin pattern seen in both CA and CM. In conclusion, CA and localized CM are clinically and morphologically similar lesions distinct from CH. Diffuse multifocal CM is morphologically similar to CA and localized CM, but has a distinct clinicopathologic profile.     

Synergistic effect of lymphokines and lipopolysaccharides on macrophage chemiluminescence. Appearance of spontaneous chemiluminescence and its correlation with cytotoxicity

A new type of chemiluminescence (CL) was observed in thioglycolate-elicited ICR mouse peritoneal macrophages which had been incubated for 24 h in medium containing lymphokines (LK) and lipopolysaccharides (LPS), and then exposed to a CL reagent solution containing luminol and phorbol myristate acetate (PMA). The new CL, which was clearly distinguishable from PMA-induced CL, appeared immediately after the addition of the CL reagent solution, reaching a maximal level at about 30 s, and disappeared rapidly. We have called the new CL 'spontaneous CL', since it appeared spontaneously without PMA triggering. When the macrophages were incubated with LK in the presence of 10 ng/ml of LPS, the spontaneous CL began to appear after about 4 h incubation, the maximal level being reached at about 12 h, after which it decreased gradually on further incubation. After 48 h, it could not be observed at all. The spontaneous CL could be observed only in macrophages simultaneously treated with LK and LPS, as in the case of cytotoxicity. The correlation between spontaneous CL and cytotoxicity was suggested by the following; they showed a similar dose dependency to LK, and neither of them could be induced in aged macrophages which had been incubated in vitro for 1 day before exposure to LK and LPS. These results suggest that spontaneous CL measurement could possibly replace the cytotoxicity test as a simple method for the determination of macrophage activating factor.     

Effects of drug adherence on patient outcomes to early treatment for Japanese cedar pollinosis]

Drug adherence is one of the important aspects in caring for patients with allergic rhinitis. To improve clinical efficacy of early treatment for Japanese cedar pollinosis (JCP), we evaluated the effect of drug adherence on patients' outcomes. Patients were randomly selected from 16 ENT clinical sites in Osaka and Wakayama between February 24 and March 8, 2003 (peak pollen season). Efficacy was assessed using patients' ratings of nasal and ocular symptoms and overall assessment in their condition compared with previous season ones. Costs include direct costs of the drugs used for treatment to JCP from January to February. Five hundred one patients taking early treatment were enrolled. Compared to low adherence patients, those who reported higher level of adherence significantly improved overall health condition, and achieved better symptom relief of rhinorrhea and nasal congestion. In multiple logistic regression analysis, the following factors were independent risk factors for low adherence: student (p=0.002), using OTC medications (p=0.006), and short-duration of medication (p=0.001). Low costs were also risk factor for low adherence. We conclude that taking medications for JCP for 22-28 days is the best way to enhance patients' outcomes.     

Analgesic action of loperamide,an opioid agonist,and its blocking action on voltage-dependent Ca2+ channels

We investigated the relationship between the antinociceptive effect of the opiate agonist loperamide at the spinal level and its inhibitory effect on calcium influx. Intrathecal administration of loperamide showed a significant antinociceptive effect in the formalin test, which was not prevented by naloxone. On the other hand, no significant effects were observed by nicardipine, an L-type specific blocker, or by BAY K8644, an L-type specific agonist, suggesting no significant role of L-type calcium channels in nociceptive signal transduction. Loperamide suppressed the calcium influx in dorsal root ganglion neurons. As the antinociceptive effect of loperamide was not affected by naloxone or other calcium channel blocking toxins, and loperamide showed a direct inhibitory effect on calcium-influx, the analgesic effect of intrathecally injected loperamide might be due to its blockade of the voltage-dependent calcium channels at the terminals of the primary afferent fibers.