Heterogeneity of Epstein-Barr virus infection in angioimmunoblastic lymphadenopathy type T-cell lymphoma

To investigate the relationship of Epstein-Barr virus (EBV) and angioimmunoblastic lymphadenopathy with dysproteinemia, we performed DNA analysis using the polymerase chain reaction (PCR), Southern blot, in situ hybridization, and immunohistochemical analysis of lymph nodes in five patients who were followed up and biopsied more than once. In the course of the disease, nodal architecture diminished, cellular atypia worsened, and clear cells increased in number. In the DNA analysis of the receptor genes, the clonal population increased in number. EBV nucleic acid sequences were found by either PCR or in situ hybridization in all examined nodes. The number of EBV-positive cells varied widely among the cases and throughout the course of the disease in the same patients. The analysis of EBV terminal repeats or lymphocyte-determined membrane antigen genes showed polyclonal populations of EB-infected cells. EBV-positive cells possessed intermediate- to large-sized nuclei, and the cells with large nuclei, especially, expressed latent membrane protein of EBV. These large cells varied in number among the cases. Double-labelling immunohistochemistry/in situ hybridization studies demonstrated that most of the EBV-positive cells expressed B-cell antigen (CD20). The presence of EBV seems to be associated with the selective defects of the immune system, rather than with the direct pathogenesis of angioimmunoblastic lymphadenopathy.     

Demonstration of the inner structure of a right atrial myxoma by transoesophageal echocardiography

We report a case of a large right atrial myxoma. With the useof transoesophagal echocardiography, several cysts were idntifieldwithin the tumour and necrotic tissue was differentiated frommyxomatous tissue according to its echo-level. Transoesophagealechocardiography was very useful for the precise diagnosis ofcardiac tumour and demonstration of the inner structure.     

Endoscopic Diagnosis of Early Malignant Lymphoma of the Stomach

Abstract: The findings and results obtained by endoscopies and direct vision biopsies carried out in 13 patients with early primary gastric lymphoma, were compared with those of 8 patients with RLH, 28 with depressed type of early gastric carcinoma, and 10 patients with benign gastric ulcers, to deal with problems inherent to endoscopic diagnosis of early primary gastric lymphoma The first endoscopy attained a correct diagnosis in only 1 patient (7.7%) but in 7 patients (53.8%) with the final endoscopy. Endoscopic features of early gastric lymphoma characteristically yielded a cobblestone appearance and reticulated erosion when they were compared with that of RLH, early carcinoma and benign ulcer. Furthermore, early gastric lymphoma presented ill demarcated margins associated with discoloration of the mucosa more frequently comparing with that of early gastric carcinoma. Also, hemorrhage, lustrous nodules, regulalr and white-coated ulcer were the findings more frequently seen in early gastric lymphoma but redness was less frequent in early gastric carcinoma. Dye endoscopies provided a more detailed appearance of the lesion and margins than conventional endoscopies. In addition, dye endoscopies made visible the lesions that were not visible by conventional endoscopies, in areas repelling dye solution. In this paper, the importance to pay an attention to the endoscopic findings described above and an application of dye endoscopy was emphasized for detection of an early gastric lymphoma.     

A Case of Duodenal Crohn's Disease Associated with Ampullar Insufficiency and Cholangitis

Abstract: A 67-year-old Japanese woman with duodenal Crohn's disease developed cholangitis. Radiographic and endoscopic examinations revealed a marked stenosis of the third portion and a dilatation of the second portion of the duodenum. The endoscopic and histopathological observations showed this disease affected the Vater's papilla. Duodenoscopic manometry indicated a reduced pressure of the phasic sphincter of Oddi, indicating ampullar insufficiency. E. coli was found in the bile culture as the infecting organism. The authors suggest that the cholangitis in this patient was caused by the reflux of duodenal contents into the biliary tract.     

Early experience of laparoscopic radical nephrectomy for T3b renal cell carcinoma

We report our experience with laparoscopic radical nephrectomy for a 79-year-old man who had renal cell carcinoma (RCC) with a renal vein thrombus. For the transaction of the renal vein with the thrombus, we used an endoscopic gastrointestinal anastomosis stapler. The operating time was 4 h and blood loss was 400 mL. The patient could walk and drink on the first postoperative day. He recovered normal activity 30 days postoperatively. There were no intraoperative and postoperative complications. The present report demonstrates the feasibility of laparoscopic radical nephrectomy in patients with T3b RCC who suffer from tumor thrombus in the renal vein.     

Hematoma with High Oxygen Partial Pressure Resulting from Injection Sclerotherapy for Esophageal Varices — Report of a Case

Abstract: Endoscopic injection sclerotherapy (EIS) was performed on a 44-year-old Japanese male, who had been suffering from risky esophageal varices due to cirrhosis of the liver. Blood gas analysis at the beginning of therapy showed that the partial pressure of oxygen at the variceal (PO2) and arterial blood (PaO2) were 47.2 mmHg and 64.1 mmHg, respectively. Sclerosant with contrast medium was injected into the varices and the left gastric vein was embolized; this was always confirmed by endoscopic varicealography during injection scleorotherapy (EVIS). During the fifth EIS session, there was evidence of pooling of contrast medium with sclerosant and an intramural hematoma had developed, which could not be reduced by puncture. The blood gas analysis showed a drastic increase in PO2 (107.9 mmHg), whereas PaO2 remained mostly unchanged (58.8 mmHg). To our knowledge, this is the first report of blood gas analysis during hematoma and the high PO2 compared with PaO2 indicated that there was a substantial inflow of oxygen-rich blood, possibly from the pulmonary vein into the varices. This inflow of blood into the varices may have contributed to the formation of the large hematoma in small varices following EIS. (Dig Endosc 1999; 11: 55–61)     

Laparoscopic Findings in Primary Sclerosing Cholangitis

Abstract: The laparoscopic appearance of the liver surface in patients with primary sclerosing cholangitis (PSC) has not been fully delineated. We examined 5 patients with PSC and reviewed 35 previously reported cases. Intense white markings in a mesh-like pattern were characteristic of PSC. The findings varied depending on the histologic stage and affected site. Red patches which have also been seen in primary biliary cirrhosis (PBC), green patches indicating cholestasis, and dilatation of the terminal bile ducts were also observed. The red patches were wider than those in PBC. The white markings were less well defined in the red patches than in other areas. The severity of the fibrosis and histologic damage was judged to be mild at the red sites. The green patches were caused by localized cholestasis. This indicated that PSC unevenly affects the liver. Severe obstruction may be present between the interlobular bile ducts and the septal bile ducts in anicteric stages. (Dig Endosc 1999; 10: 37–41)     

酵母双杂交筛选锥虫早老素蛋白相互作用蛋白

目的 筛选寻找锥虫早老素蛋白相互作用蛋白,以了解锥虫早老素蛋白功能.方法 体外表达锥虫早老素蛋白片段,装入pGBKT7诱饵质粒,与随机肽库系统共转化酵母,筛选阳性克隆并测序,通过与基因库锥虫功能序列比较,推导可能的相互作用蛋白.结果 获得108个阳性克隆,对其中50个进行了序列测定和比较,获得最有可能的4个候选基因,分别为:丝/苏氨酸性磷酸酶2b催化亚基A2;钙激活蛋白,含锚蛋白重复序列蛋白以及一个具有与APP跨膜区结合位点特征序列的功能未知蛋白.结论 成功利用随机肽库酵母双杂交系统筛选锥虫早老素蛋白相互作用基因,其相互作用仍有待进一步确认.     

Primary cutaneous T-cell lymphoma with an angiocentric growth pattern: association with Epstein-Barr virus

Summary We report a case of primary cutaneous T-cell lymphoma with an angiocentric growth pattern. The lesions had been confined for about 2.5 years to the skin, but there had been a gradual progression of the disease both clinically and histologically. We assessed the neoplastic clonality and the presence of Epstein-Barr (EB) virus genome in this case using immunohistochemistry. Southern blot analysis and RNA in situ hybridization. Clonal proliferation of a CD4⁺αβT-cell phenotype was demonstrated. In addition, the clonal population harboured the EB virus genome, which suggested that the virus was involved in the pathogenesis of the disease. The patient has remained in remission for 10 months, and has received treatment with cyclophosphamide and prednisone.