Small cell carcinoma of the gall-bladder with intestinal metaplastic epithelium

A case of small cell carcinoma of the gall-bladder Is described. lmmunohistochemically, the tumor cells were positive for chromogranin A, synaptophysin and neuronspecific enolase, which suggests that they derived from neuroendocrine cells. The overlying and surroundlng epithelium of the tumor showed intestinal metaplasia including goblet cells, pseudopyloric glands, Paneth's cells, and chromogranin A and synaptophysin-positive endocrine cells. Definite adenocarcinoma was absent. The endocrine cells in the epithellum were more numerous In the vicinity of the tumor. The present case supports the supposition that endocrine cell tumor (including small cell carcinoma) of the gall-bladder may develop from endocrine cells of the intestinal metaplastic lesion.     

An immunohistochemical study of copper, zinc-containing superoxide dismutase detected by a monoclonal antibody in gastric mucosa and gastric cancer

The immunohistochemical localization of copper, zinc-superoxide dismutase (Cu,Zn-SOD) in human gastric mucosa and gastric cancer was studied using a monoclonal antibody. In gastric mucosa, parietal cells, pyloric glandular cells and foci of intestinal metaplasia showed positive staining in the cytoplasm and/or nucleus. The wide distribution of Cu, Zn-SOD in the gastric mucosa suggests cell function may be vulnerable to active oxygen species. In gastric cancer, 34 of 70 cases showed a positive reaction for Cu, Zn-SOD. There was a relationship between the grade of Cu,Zn-SOD immunoreactivity and the histological type of gastric cancer, well-differentiated types of gastric cancer being more frequently positive. The positive cases of poorly-differentiated adenocarcinoma were characterized by a pattern of diffusely infiltrative invasion. These results suggest that some types of gastric cancer are resistant to active oxygen species.     

Carcinoembryonic Antigen in the Management of Gastric Cancer Patients

The usefulness and limitations of the determination of carcinoembryonicantigen (CEA) levels were investigated in 226 cases of gastriccancer. Pre-operatively, elevated CEA levels were found in 23.9%.As the stage of cancer progressed, CEA elevation was found inhigher percentages. In particular, in patients with liver metastasisan incidence as high as 68.8% was obtained. Elevated CEA levelswere also observed more frequently in patients with unresectabletumors than in those with resectable ones and in those undergoingnoncurative surgery more frequently than in those undergoingcurative surgery. In most patients with preoperative elevated CEA levels, thelevels returned to normal by one month after curative resection,while the levels rarely returned to normal after noncurativeresection, showing the usefulness of CEA determination for evaluatingthe effect of surgery. CEA levels were determined serially before and after surgeryin patients with unresectable tumors, liver metastasis or peritonealdissemination. In most patients with preoperative elevated CEAlevels, the levels increased with postoperative tumor enlargement.Postoperative CEA levels increased to above the normal rangein some of the patients with normal preoperative CEA levels. Serial measurement of CEA levels was useful for observing thecourse of the disease even in patients with normal preoperativelevels.     

A Randomized Comparison of the Straight Linear Approach with Electrogram Mapping Focal Approach in Selective Slow Pathway Ablation

HAYASHI, M., et al. : A Randomized Comparison of the Straight Linear Approach with Electrogram Mapping Focal Approach in Selective Slow Pathway Ablation. The aim of this study was to evaluate the efficacy and safety of the anatomic linear approach in selective AVN slow pathway ablation, in comparison to the widely used electrogram mapping focal approach. It remains undetermined whether or not anatomic linear ablation has a greater potential for eliminating slow pathway conduction than does focal ablation. Fifty consecutive patients (21 men, 29 women, age  56 ± 14  years) with common type AVNRT were randomly assigned to the linear approach (25 patients) or local electrogram mapping approach (25 patients). A linear lesion was created between the tricuspid annulus, at the midlevel of the coronary sinus (CS) ostium, and the anterior aspect of the CS infundibulum. In 22 (88%) patients in the linear group, the AVNRT was successfully eliminated by  1.5 ± 0.8  linear RF applications without any complications. All 25 patients in the focal group satisfied the endpoint criteria after  3.8 ± 2.4  focal RF deliveries. The success rate did not significantly differ between the two groups. Out of the 22 patients with a successful outcome in the linear group, 17 (77%) attained complete abolition of the slow pathway conduction, whereas this was observed in only eight (32%) patients in the focal group (  P < 0.005  ). The session time was significantly shorter in the linear group. Recurrence of the tachycardia was not documented in any patient during a mean follow-up of  18 ± 8  months except one with residual slow pathway conduction in the focal ablation group. In conclusion, the anatomic linear approach can be performed safely and possesses a greater potential for slow pathway interruption compared to the electrogram mapping focal approach.     

Vanillylmandelic Acid, Homovanillic Acid, and Catecholamines in Urine of Infants with Neuroblastoma 6- to 11-Month-Old

The amounts of vanillylmandelic acid (VMA), homovanillic acid(HVA), and catecholamines (adrenalin, noradrenalin, and dopamine)in 24-hr urine specimens of 10 infants with neuroblastoma detectedthrough mass screening in Sapporo City (patient group) werecompared with those of 24 healthy infants (control group). The ages of the infants of both groups ranged from 6 to 11 months,which agrees with the age when mass screening is performed. For VMA and HVA, the mean value plus two or three times thestandard deviation of the control group clearly separated thetwo groups in the units of mg/day, /µg/mg of creatinine,mg/kg/day, and mg/m²/day. The cut off values of 24 /µg/mg of creatinine for VMAand 25 µg/mg of creatinine for HVA are now being usedby us for assaying 24-hr urine specimens. No significant difference was found between the groups in levelsof catecholamines, but their data were thought to be usefulas normal values, since few published data regarding their normalvalues are available.     

Short-segment Internal Trapping for Symptomatic Thrombosed Large Fusiform Vertebral Artery Aneurysms (Bird’s Nest Trapping): A Technical Note

Internal trapping with coils is an established treatment of symptomatic large non-branching thrombosed fusiform vertebral artery aneurysms (VAA). However, when perforators arise near the aneurysm neck, parent artery occlusion has a high risk of causing medullary infarction. As an alternative treatment, we performed short-segment internal trapping of the artery using n-butyl-2-cyanoacrylate (NBCA) and coils (bird’s nest trapping). Before treatment, perianeurysmal perforators are carefully detected using high-resolution three-dimensional rotational angiography (3DRA). Double microcatheters are advanced to the distal portion of the aneurysm through a balloon guiding catheter where coils are deployed without tight packing. Then, NBCA is injected into the coil mass, taking care to preserve perforators and significant branches. The same maneuver is repeated in the proximal portion of the aneurysm. Coil placement is avoided within the middle of the aneurysm; however, if necessary, only a small number of coils are placed to prevent worsening of mass effect. Two quinquagenarian males presented with a large thrombosed fusiform VAA that caused symptoms due to mass effect. In each case, perforators arose from the parent artery and short-segment internal trapping with NBCA and coils was performed. Symptoms improved after treatment and follow-up imaging confirmed aneurysm shrinkage with no long-time recurrence. In symptomatic large fusiform VAAs where the distance from the lesion to important perforators is extremely short, internal trapping using a combination of NBCA and coils can be more useful than conventional internal trapping.     

Localization of non-specific esterase and endogenous peroxidase in the murine epidermal Langerhans' cells

The localization of the enzymatic activity of non-specific esterase and endogenous peroxidase of the Langerhans’ cells in murine epidermal sheets separated with EDTA was observed by means of light and electron microscopy. The Langerhans’ cells exhibited non-specific esterase activity in the outer portion of the plasma membrane and endogenous peroxidase activity in the nuclear envelope and the endoplasmic reticulum.     

Histological and immunological studies on eosinophilic granuloma of soft tissue, so-called Kimura's disease

Increase of serum IgE with frequent localization of IgE in the germinal centres, mast cell hyperplasia in lymph nodes and changes of specific granules in the infiltrated eosinophils, such as roughness of the matrix and appearance of tubular structures together with fusing and disappearance of the core, were demonstrated in eosinophilic granuloma of the soft tissue, so-called Kimura's disease, in association with increase of anti-Candida IgE antibody. It is suggested that this disease may be due to atopic allergy to Candida albicans.     

Identification of the Slow Conduction Zone in Idiopathic Left Ventricular Tachycardia

The mechanism of verapamil sensitive idiopathic left ventricular tachycardia (ILVT) is considered to be reentry. However, the nature of the reentry circuit, including the location of the slow conduction zone, is unclear. We sought the local electrical activity that would reflect slow conduction by precise mapping around the tachycardia exit (TE) in nine patients with ILVT (mean age, 28 ± 10 years) undergoing radiofrequency catheter ablation (RFCA). The TE was defined as the earliest discrete spiky potential (SP) recorded during the tachycardia, or as a complete configuration-matched pacemap 12-lead electrocardiogram (ECG). In all patients, the TE was located at the mid or inferior distal portion of the septum. The SP at the TE preceded the surface QRS by 20 ± 9 ms. The pacemap score at the TE was 11.4 ± 0.6 points. In three patients, fractionated potentials (FP) were recorded during the tachycardia. The onset of the FP preceded the surface QRS by 47 ± 8 ms and was earlier than the SP at the TE (P < 0.01). The sites where an FP was detectable were restricted to a small area, and were at a distance of 14 ±4 mm from the TE. The direction of the FP site from the TE was more basal in two patients and inferior in one, Pacemap ECGs at the sites with an FP showed poor matching (9 ± 1 points), presumably because of predominant capture of the local ventricular muscle rather than an electrically isolated reentry circuit. Successful RFCA was achieved at the site of the FP in all three patients in which one was recorded, and at the TE in the other six patients. The FP, which has been shown to reflect the slow conduction of the ventricular tachycardia circuit in structural heart disease, was also detected in ILVT in the present study, and it is likely to reflect electrical excitation of the distal rim of the slow conduction zone.     

Tissue Carcinoembryonic Antigen in Colorectal Cancer

In patients with colorectal cancer, the carcinoembryonic antigen(CEA) levels of cancerous tissue were quantified by radioimmunoassayto determine the relationship among the location of the tumor,the histological type and the blood CEA. In 14 patients withcolorectal cancer, the CEA level in the cancerous tissue wassignificantly higher than in noncancerous tissue. In 15 patientswith sigmoid colonic cancer, the tissue CEA was significantlyhigher than in 22 patients with rectal cancer. Twenty-two patientswith normal blood CEA and 19 with elevated blood CEA were comparedin terms of their tissue CEA. There was no significant differencebetween them. There was no significant difference in tissueCEA between 35 patients with well-differentiated adeno-carcinomaand five with moderately differentiated adenocarcinoma. In patientswith liver metastasis from colorectal cancer, the frequencyof blood CEA levels above 20 ng/ml was significantly higherthan that in patients without liver metastasis. The relationbetween the tissue CEA and the blood CEA was studied in sevenpatients with colorectal cancer with liver metastasis, fromwhom specimens of primary tumor and liver metastasis were available.In patients who had liver metastasis and normal blood CEA, therewas only one liver metastatic lesion and it was very small.In patients with elevated blood CEA, there were many liver metastaticlesions and they were large. The CEA level in liver metastaticlesions was not always higher than in the primary lesion. Itwas considered that the levels of CEA in the blood in patientswith liver metastasis are affected by the degree of liver metastasisas well as by the CEA level of the primary lesion and the livermetastatic lesion.