Three cases of polymyositis/dermatomyositis complicated by pneumomediastinum.

Pneumomediastinum is a rare complication of dermatomyositis (DM) and Polymiositis (PM). We report here three cases of PM/DM who developed pneumomediastinum. First case was 61 years old woman with amyopathic dermatomyositis (aDM). Her aDM was complicated with skin ulceration due to vasculopathy, but complicated interstitial pneumonia was not severe. She developed subcutaneous emphysema and pneumomediastinum. Second case was 57 years old woman with DM, who had intractable skin phenomena and mild interstitial pneumonia. The patient became subcutaneous emphysema and pneumomediastinum following severe vasculopathy of skin. The last case was 63 years old man with PM. His PM was complicated with interstitial pneumonia. He had intractable respiratory symptom. Ten years later, he became subcutaneous emphysema and pneumomediastinum following pneumothorax. First and second cases suggest that their pneumomediastinum were due to vasculopathy. On the other hand, pneumomediastinum of the last patient seemed to be associated with interstitial pneumonia and steroid.     

New treatment of a visible linear scar in the scalp: multiple hair-bearing flap technique.

Scars on the scalp have no hair, and can be conspicuous even when narrow. Alopecia, especially in the whorl of hair at the back of the parietal region, is very difficult to camouflage. We present a new technique using multiple hair-bearing flaps harvested from near the area of alopecia, each flap including 10-15 hairs. We treated 24 patients who were suffering from alopecia, with scar sizes ranging from 2 cm to 17 cm in length and from 0.5 cm to 2 cm in width. Between three and 12 flaps per patient were used to complete the treatment. All wounds healed without complications, and satisfactory results were achieved in 20 patients. Hair loss from the flap was rare. The scar could be hidden by the hair immediately after the operation. In four patients, a visible scar remained or was created at the donor site. These patients required a secondary repair. The major advantages of this technique are that the dense hair bundles in the flap are studded here and there in the scar, the scar can be reduced and the residual scar can be hidden by the flap hair. This technique is most useful for the parietal and occipital areas, especially near the whorl of hair.     

The effect of the dosage and route of manganese administration on manganese concentration in rat brain

We investigated the differences in manganese concentration and distribution in the brains of rats administered MnCl2 perorally, intravenously and intraperitoneally for one week. Forty two male Wistar rats were divided into eight groups, designated A to H. Groups A (n = 5) and B (n = 7) were maintained with synthetic diets, with 50 and 1000 mg manganese per kg diets, respectively. Groups C (n = 5), D (n = 5) and E (n = 5) were administered manganese intravenously with dosages of 0.088, 0.88 and 2.2 mg/kg.b.w./day, respectively. Groups F (n = 5), G (n = 5) and H (n = 5) were administered manganese intraperitoneally with dosages of 0.088, 0.88 and 2.2 mg/kg.b.w/day, respectively. Four brain regions (cerebrum, cerebellum, basal ganglia and the remainder) were analyzed by atomic absorption spectrophotometry for manganese. The manganese concentrations in basal ganglia were increased proportionally to the administration dosages in intravenous administration groups (C, D and E). At the highest dosage of manganese administration, manganese concentrations in cerebrum and basal ganglia were higher with intravenous administration of manganese than with intraperitoneal administration. In addition, manganese concentrations were hardly increased in peroral administration groups. Therefore, we suggested that basal ganglia are vulnerable to manganese exposure and that liver and intestine might play the important roles in the reduction of manganese accumulation in the central nervous system.     

Establishment of knockdown of superoxide dismutase 2 and expression of CYP3A4 cell system to evaluate drug-induced cytotoxicity

Drug-induced hepatotoxicity is a major problem in drug development, and oxidative stress is known as one of the causes. Superoxide dismutases (SODs) are important antioxidant enzymes against reactive oxygen species (ROS). Mitochondria are the major source of superoxide production, and SOD2 is mainly localized in mitochondria and, with other SODs, plays an important role in scavenging superoxide. In this study, we established SOD2-knockdown cells. An adenovirus vector with short hairpin RNA against rat SOD2 (AdSOD2-shRNA) was constructed, and infection of AdSOD2-shRNA to rat hepatic BRL3A cells resulted in significant decreases of SOD2 mRNA and protein by 60%, and SOD2 activity by 50% after 3 days infection. We previously constructed an adenovirus expressing cytochrome P450 3A4 (AdCYP3A4). Co-infection of AdSOD2-shRNA and AdCYP3A4 to BRL3A cells was carried out to evaluate the superoxide- and CYP3A4-mediated formation of active metabolites, and mitochondrial toxicity, ROS and superoxide radical production and lipid peroxidation were selected to assess the cell viability. Albendazole, carbamazepine, dapsone, flutamide, isoniazid, nifedipine, sulfamethoxazole, trazodone, troglitazone, and zidovudine demonstrated significant increases of SOD2- and CYP3A4-mediated cytotoxicity. In conclusion, we constructed a highly sensitive cell system to evaluate oxidative stress and CYP3A4 mediated cytotoxicity that could be useful in preclinical drug development.     

A resected case of endobronchial metastasis from breast carcinoma

A 54-year-old woman, who had received left radical mastectomy 12 years previously, was admitted with persistent cough and hemoptysis. Plain chest X-ray film showed no abnormality but fiberoptic bronchoscopy revealed that a polypoid lesion occluded the right truncus and the surrounding bronchial mucosa was firm and edematous. Biopsy specimen demonstrated adenocarcinoma. Right middle and lower sleeve bilobectomy was performed. The tumor occupied mainly the outer and submucosal layer of the bronchial wall. Histologically, this tumor showed scirrhous adenocarcinoma with the same pathologic appearance as the primary breast lesion. It is considered that endobronchial metastasis from breast carcinoma is not particularly uncommon, therefore any patient with a past history of breast cancer and respiratory symptoms should undergo fiberoptic bronchoscopy, particularly when the chest X-ray is normal or shows non-specific changes.     

Significance of Concurrent Chemoradiotherapy as Primary Treatment in Patients with Metastatic Cervical Cancer

(1) This study investigated the prognostic impact of tumor size in patients with metastatic cervical cancer. (2) Methods: Seventy-three cervical cancer patients in our institute were stratified into two groups based on distant metastasis: para-aortic lymph node metastasis alone (IIIC2) or spread to distant visceral organs with or without para-aortic lymph node metastasis (IVB) to identify primary tumor size and concurrent chemoradiotherapy. (3) Results: The overall survival (OS) for patients with a tumor >6.9 cm in size was significantly poorer than that for patients with a tumor ≤6.9 cm in the IVB group (p = 0.0028); the corresponding five-year OS rates in patients with a tumor ≤6.9 and >6.9 cm were 53.3% and 13.4%, respectively. In the multivariate analysis, tumor size and primary treatment were significantly associated with survival in metastatic cervical cancer. (4) Conclusions: Tumor size ≤6.9 cm and concurrent chemoradiotherapy as the primary treatment were favorable prognostic factors for patients with metastatic cervical cancer.     

Immunohistochemical analysis of CYP2A13 in various types of human lung cancers

Human CYP2A13, which is expressed in the respiratory tract, is the most efficient enzyme for the metabolic activation of tobacco‐specific nitrosamines such as 4‐(methylnitrosamino)‐1‐(3‐pyridyl)‐1‐butanone (NNK). The relevance of CYP2A13 in carcinogenicity and toxicity in the respiratory tract has been suggested, but the expression of CYP2A13 protein in lung cancer tissues remains to be determined. We first prepared a mouse monoclonal antibody against human CYP2A13. The antibody showed no cross reactivity with the other CYP isoforms including CYP2A6. Using the specific antibody, we performed immunohistochemical analysis for human lung carcinomas. In adenocarcinomas (n = 15), all specimens were positive for the staining and five samples showed strong staining. In squamous cell carcinomas (n = 15) and large cell carcinomas (n = 15), each 14 samples were positive for the staining and two and three samples showed strong staining, respectively. In small cell carcinoma samples (n = 15), eight samples were negative for the staining and five samples showed weak or moderate staining. In conclusion, we first found that the expression of CYP2A13 was markedly increased in non‐small cell lung carcinomas. The high expression might be associated with the tumor development and progression in non‐small cell lung carcinomas. (Cancer Sci 2010; 101: 1024–1028)     

A case of adult neuronal ceroid-lipofuscinosis with the appearance of membranous cytoplasmic bodies localized in the spinal anterior horn

Summary An autopsy case of adult neuronal ceroid-lipofuscinosis was examined. The clinical picture was charaterized by gait disturbance, bulbar palsy and dementia. Histopathologically, diffuse neuronal loss was found throughout the central nervous system. The remaining neurons, predominantly in the motor nuclei of the spinal cord and brain stem, were swollen with storage material. Observed under the electron microscope the storage material showed various ultrastructures, such as lipofuscin-like bodies, pleomorphic lipid bodies, curvilinear profiles and finger-print profiles, in different regions of the central nervous system. In the ballooned neurons of the spinal anterior horn, many membranous cytoplasmic bodies and curvilinear profiles were intermingled within the same cell and were continuous with each other. Biochemically,N-acetyl neuraminic acid content was significantly increased in the spinal anterior horn. These findings suggest the localized increase of ganglioside in that region.     

Serological distinction of A antigen between red blood cells and saliva in blood grouping of blood and body fluid stains

A antigens of red blood cells and body fluids such as saliva, semen and sweat could be serologically distinguished using rabbit or guinea pig immune anti-A. As for antisera specific for red blood cell A, A+ rabbits were intravenously immunized with A group red blood cells. The resulting antisera were absorbed with O and B red cells and with A. Se saliva. The absorbed anti-A reacted with A red cells (titer 1:32) and was not inhibited with A. Se saliva. Guinea pigs were intramuscularly injected with A. Se saliva. Crude antisera contained agglutinins to human red cells which were abolished by absorption with A red cells. After absorption with O. Se saliva, the antisera were proved to have agglutinin activity with A group saliva using latex coated with A. Se saliva. A antigens from blood or body fluid stains could be distinguished by the elution method with these anti-A sera.