Functional and morphological analysis on GH producing adenomas with quantitative immunohistochemical method

We studied functioning cells of GH-producing pituitary adenoma quantitatively by the immunohistochemical method using anti GH antibody and compared the result with clinical hormonal data by discussing a clinical significance of the immunohistochemical study of pituitary adenoma. Fifteen acromegalics with pituitary adenoma, who underwent surgical operation followed by immunohistochemical study, were subjected. Volume of the adenoma was calculated on the basis of thin coronal cut CT scanning. The specimen was stained after PAP method. The quantitative analysis was done by investigating the ratio of anti GH antibody positive area in 30 fields (SAR). Using the value obtained, stained volume (SV) was calculated by multiplying total volume by SAR. The SV was regarded as total volume of GH positive cells. These values were compared to the preoperative serum GH levels. The results were as follows: (1) Immunohistochemically, the adenomas were classified into two types, the sporadic type and the diffuse type, by incidence of GH positive cells. SAR ranged from 0.2% to 52.4%, and means of the types were 3.0% and 24.8%, respectively. (2) All the eosinophilic adenomas demonstrated to be the diffuse type and the mean SAR was 23.7%. On the contrary, 75% of chromophobe adenomas were the sporadic type and the mean SAR was 4.9%. (3) There was no significant correlation between the serum GH level and the volume of the adenoma. There was an especially high correlation between the serum GH level and SV with a correlation constant of 0.971. (4) In fibrous adenomas the serum GH level was extremely low for their total volume.     

Functional innervation patterns in the corpus spongiosum and glans in the dog

The neural control of smooth muscle cells in the corpus spongiosum, helicine artery and bulbus glandis of the dog was investigated in relation to the mechanism involved in erection, using isometric tension recording and micro-electrode methods. In the corpus spongiosum, field stimulation evoked twitch-like contractions followed by relaxations. These relaxations were enhanced and prolonged by neostigmine and partly suppressed by atropine. Guanethidine abolished the twitch-like contractions and increased muscle tone. The relaxations observed after pre-treatment with guanethidine were abolished by tetrodotoxin (TTX), thereby indicating that these muscles are innervated by adrenergic excitatory, cholinergic and non-adrenergic non-cholinergic inhibitory nerves. In the helicine artery and bulbus glandis, field stimulation evoked contractions and these contractions were abolished by guanethidine or TTX, indicating that these muscles are innervated by adrenergic excitatory nerve fibres. After pre-treatment with guanethidine and atropine, muscle relaxation appeared in response to field stimulation in the helicine artery but not in the bulbus glandis, indicating that the helicine artery in the corpus spongiosum is also innervated by non-adrenergic non-cholinergic inhibitory nerves in addition to the excitatory adrenergic nerves. In the smooth muscle cells of the corpus spongiosum, slow potential changes were correlated with spontaneous contractions and field stimulation evoked excitatory or inhibitory junction potentials. The neural mechanism involved in erection is discussed in relation to the topical difference in the autonomic innervation patterns in the corpus spongiosum, helicine artery and bulbus glandis.     

Radiotherapy for malignant fistula to other tract

Radiotherapy was applied to 14 esophageal carcinomas with respiratory tract fistulas using various treatment regimens. Closure of the fistulas was observed in four cases after irradiation at a daily dose of 1.5 Gy. The period of closure was transient in two cases but long-term in the other two. One long-term closure case underwent low-dose rate telecobalt therapy (LDRT)(1 Gy per hour, 7 Gy per day; a total dose of 28 Gy) as a boost. His cancer has been well controlled and he is still alive without recurrence at 74 months after fistula formation.     

Effect of OPC-8212 (2(1H)-quinolinone), a new inotropic agent, on myocardial energy metabolism in patients with coronary heart disease

We examined the effects of a new inotrope, OPC-8212 (OPC: 2(1H)-quinolinone), on coronary sinus flow (CSF), myocardial oxygen consumption, myocardial lactate extraction ratio (LER), cardiac index (CI) and pulmonary arterial diastolic pressure (PADP) in eleven patients with prior myocardial infarction. Measurements were taken before (control) and 8 hours after administration of OPC (480 mg, p.o.). A cardiac function curve was obtained in each stage with rapid intravenous administration of 500 ml of saline (loaded state) after baseline measurements. There was a significant increase in the cardiac index and decrease in the pulmonary arterial diastolic pressure in the loaded state after OPC. Thus the ventricular function curve was shifted to the left and showed a steep incline, indicating an increased inotropic state. On the other hand, myocardial oxygen consumption and myocardial lactate extraction ratio were unchanged. Thus we concluded that OPC improved cardiac performance without increasing myocardial oxygen consumption.     

Osteogenic sarcoma of the tibia in a patient with epidermolysis bullosa dystrophica

An osteogenic sarcoma of the tibia occurred in an eight-year-old boy with epidermolysis bullosa dystrophica hereditaria (EBDH) (Hallopeau-Siemens type). The patient had had the congenital skin disease since the time of birth. A painful swelling appeared in the proximal portion of his right tibia, which was diagnosed as osteogenic sarcoma on biopsy study. The patient died of massive pulmonary metastases and cachexia four months after the onset of the tumor. Osteogenic sarcoma in a patient with EBDH seems not to have been previously reported. EBDH has been known to be occasionally associated with squamous cell carcinoma. Whether an impairment of the patient's defense mechanism by the chronic skin disease might have enhanced the rapid progression of the associated bone malignancy is unknown.