bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between skeinoid fibers and stromal matrix in gastrointestinal stromal tumors: Morphometric analysis with quick‐freezing and deep‐etching method
Authors: Hemmi Akihiro , Inaniwa Yoshimi , Ohno Shinichi , Fujii Yasuhisa , Terada Nobuo , Mitsumata Masako , Nemoto Norimichi
Published: March 2003

Our previous study of a gastrointestinal autonomic nerve tumor with skeinoid fibers (SF) using the quick‐freezing and deep‐etching method, suggested that the distance between one radix and a neighboring radix (DRNR) in pre‐existing meshwork structures around the tumor cells is consistent with the periodicity of the SF. Therefore, measurement of the DRNR in the meshwork could clarify the significance of the pericellular matrix for SF development. In the present study, we analyzed the meshwork in three cases of gastrointestinal stromal tumor (GIST), which showed different immunohistochemical stainings, but confirmed to have smooth muscle differentiation (SMD) by immunohistochemistry and/or electron microscopy. The DRNR from the three cases of GIST showed similar histogram patterns (a peak of 20–30 nm, mean values of 28.02, 25.74 and 26.45 nm), which were significantly shorter than the periodicity of SF (a peak of 40–45 nm, mean value of 42.14). Although we need further studies with additional GIST cases, we speculate that the pericellular matrix of GIST with SMD is not suitable for SF development.
Epstein–Barr virus infection, drug resistance and prognosis in Korean T‐ and NK‐cell lymphomas
Authors: Jung Chan Kwon , Lee Kyo Young , Kim Yonggoo , Han Kyungja , Shim Sang In , Kim Byung Kee , Kang Chang Suk
Published: March 2003

T‐cell lymphomas are a biologically heterogeneous group of diseases with varying clinical presentations and outcomes. We tried to understand the effect of Epstein–Barr virus (EBV) on lymphogenesis, prognostic factors and drug resistance of T‐cell lymphomas, and to establish their relationship with international prognostic factors. Formalin‐fixed paraffin‐embedded tissue sections from 35 patients (12 women and 23 men) with T‐cell lymphomas were examined to detect the presence of EBV using RNA in situ hybridization for EBV‐encoded small nuclear RNA (EBER) 1/2 and immunohistochemical stain for latent membrane protein (LMP)‐1. We also tried to establish the expression of p53 and P‐glycoprotein (P‐gp) using immunohistochemistry. The distribution according to the subgroup was: two T‐lymphoblastic lymphomas, 13 NK/T‐cell lymphomas, one angioimmunoblastic T‐cell lymphoma, 17 peripheral T‐cell lymphomas, unspecified, and two anaplastic large cell lymphomas. The EBER was detected in 15 of 35 T‐cell lymphomas (42.9%) and among these it was detected in five of 17 nodal lymphomas (29.4%) and 10 of 18 extranodal lymphomas (55.6%). There was close correlation between EBER positivity and NK/T‐cell lymphoma (P= 0.032). Expression of LMP was found in a proportion of tumor cells in seven of the 15 EBER‐positive cases (46.7%). There was no correlation between EBER expression and complete response (CR rate), but coexpression of EBER and p53 was associated with treatment failure (P= 0.047). The 18 patients (51.4%) with p53 expression had significantly poorer outcomes compared with the 17 patients without p53 expression (CR rate, P< 0.0005; overall survival, P= 0.0102). Twenty of 35 patients (57.1%) were positive for P‐gp expression. P‐gp expression was significantly associated with treatment failure (P= 0.001) and overall survival (P= 0.0089). Seventeen of 35 patients (48.6%) treated with systemic chemotherapy or radiation therapy achieved a CR after initial treatment. When the prognostic factors were grouped using the international prognostic index, the CR rate was 58.8% for the low risk group, 50.0% for the low–intermediate risk group, 14.3% for the high–intermediate risk group, and 0% for the high risk group. In conclusion, high incidence of EBV was detected among Korean patients with T‐cell lymphomas. Our study supports the prediction that patients who express p53 and P‐gp have a poorer prognosis than those who do not and this should be considered when treatment strategies for individual patients are selected.
3‐D analysis of vascular and capsular invasion in thyroid follicular carcinoma
Authors: Aida Naritaka , Yamada Nobutaka , Asano Goro , Tanaka Shigeo
Published: March 2003

To clarify the mechanism of vascular invasion (VI) and capsular invasion (CI) in thyroid follicular carcinoma (FC), 3‐D reconstruction of tumor tissues, vessels and capsules was performed from serial sections in five FC and three follicular adenomas (FA). Outflow veins in the lesions were well developed under the capsule, narrowed just beneath the capsule, and dilated within the capsule. Both VI and CI were observed at the poststenotic intracapsular dilated part of outflow veins. The tumor tissue extended along the intracapsular horizontal veins which flowed in parallel with the capsule in VI, or along the vertical veins which directly flowed outside the capsule in CI. There was tumor tissue in the subendothelial layer of the outflow veins within the capsule. Intravascular tumor nests and nodular lesions within the capsule continued from the main tumors. It can be concluded from these results that most VI and CI may not be true invasions but pre‐invasive lesions.
Composite glandular–endocrine cell carcinoma of the common bile duct
Authors: Edakuni Genichiro , Sasatomi Eizaburo , Satoh Toshimi , Tokunaga Osamu , Miyazaki Kohji
Published: March 2003

A rare case of composite glandular–endocrine cell carcinoma of the common bile duct is presented. Histologically, this tumor consisted of adenocarcinoma and small‐cell neuroendocrine carcinoma, with a transition between the two components. The two distinct areas of the tumor were immunohistochemically different, whereas the transitional zone exhibited characteristics of both areas. These features suggest that the tumor arose from a multipotential stem cell. Although it has been reported that the presence of neuroendocrine differentiation in carcinomas indicates a poor prognosis, the patient in the present case was well at the time of writing this report. This may be due to the fact that adenocarcinoma, which characteristically has a low proliferative activity, constituted the majority of the tumor.
Neurofibromatosis type 1‐associated unusual pleomorphic astrocytoma displaying continual malignant progression
Authors: Yokoo Hideaki , Kamiya Makoto , Sasaki Atsushi , Hirato Junko , Nakazato Yoichi , Kurachi Hiroshi
Published: March 2003

Patients with neurofibromatosis type 1 (NF1) often have gliomas as a complication, most of which are benign pilocytic astrocytomas which have arisen in optic pathways. In the present case, a 17‐year‐old girl (at death) with stigmata of NF1, initially had a bulky tumor mass in the left thalamus, developing into the lateral ventricle, at 13 years of age. Partially resected tissue samples showed pleomorphic astrocytoma with abundant xanthoma cells and degenerative structures such as Rosenthal fibers (RF) and eosinophilic granular bodies. Fine eosinophilic granules identical to RF, both immunophenotypically and ultrastructurally, were also seen. The residual tumor was subtotally resected 6 months later, and the tumor histology was essentially similar as before, accompanying the regenerative structures; this was believed to be a good prognostic indicator. However, several anaplastic features such as mitosis, necrosis and vascular proliferation appeared even in areas rich in the regenerative structures. After a 2‐year, disease‐free interval, multiple tumor relapse occurred in June 1997. Partially resected tumor tissues were composed of monotonous small anaplastic cells with prominent proliferative activity. Surprisingly, the tumor cells had retained eosinophilic granules within the cell bodies. Postoperative chemotherapy with procarbazine, MCNU and vincristine (PCV) suppressed the residual tumor dramatically, but the regrowing tumor finally became uncontrollable, leading to the patient's death. TP53 mutation was not detected, while p27 immunopositivity was constantly high during malignant progression, suggesting acquisition of proliferative activity to overcome p53 and p27 inhibitory functions. A review of previously published reports failed to reveal any cases of this type.
Establishment and characterization of cell line TNMY1 derived from human malignant fibrous histiocytoma
Authors: Nakatani Tetsuya , Marui Takashi , Yamamoto Tetsuji , Kurosaka Masahiro , Akisue Toshihiro , Matsumoto Keiji
Published: March 2003

Although malignant fibrous histiocytoma (MFH) is one of the most common soft tissue sarcomas, its pathogenesis remains unclear. In this study, a cell line derived from human MFH, TNMY1, was established from a metastatic chest‐wall lesion of a 60‐year‐old woman with MFH. The TNMY1 cell line was passaged 95 times, and it still retained the biological characteristics of the original tumor. TNMY1 consists of spindle‐shaped cells and pleomorphic cells associated with multinucleated giant cells. Immunohistochemical studies showed that the spindle‐shaped and pleomorphic cells were positive for vimentin, CD68 and α‐smooth muscle actin, but negative for epithelial membrane antigen, desmin, muscle actin, α‐sarcomeric actin, myoglobin, lysozyme and S‐100 protein. The cells expressed collagen types I, III and V. These results indicate that MFH may originate from mesenchymal stem cells with the potential to differentiate into either fibroblasts or histiocytes. An elevated level of collagen type V mRNA expression is considered to support a diagnosis of MFH.
Localized pleural malignant mesothelioma
Authors: Erkılıç Suna , Sarı .Ibrahim , Tunçözgür Bülent
Published: March 2003

Pleural malignant mesothelioma (PMM) is a rare tumor and it is commonly seen in the form of multiple nodules or a diffuse tumor. A localized tumor mass in the pleura is extremely rare. Only seven cases have been reported. In this report, we present an additional case of localized PMM and describe the immunohistochemical and flow cytometric findings. A 61‐year‐old woman, without a history of smoking or asbestos exposure, presented with a severe pain in her right shoulder and arm. Chest radiography showed a solitary mass in the right upper lung field. Computed tomography showed a 5 cm right upper lung mass. Magnetic resonance imaging showed that the mass extended to the wall of the thorax. The patient underwent surgery for total removal of the tumor. Pathology revealed a localized malignant mesothelioma. Immunohistochemical analysis showed that the tumor was strongly and diffusely positive for cytokeratins with high and low molecular weight, and focally positive for vimentin and epithelial membrane antigen (EMA), but it was negative for carcinoembryonic antigen, Factor VIII, α‐fetoprotein and Leu‐M1. Flow cytometry showed an aneuploid DNA content in the tumor. The final diagnosis was localized malignant mesothelioma (epithelial type). The patient showed signs of local recurrence 5 months after surgery, and radiotherapy was given.
The values of intratumoral mast cell count and Ki‐67 immunoreactivity index in differential diagnosis of uterine smooth muscle neoplasms
Authors: Yavuz Ekrem , Güllüoˇglu Mine G. , Akbas˛ Nimet , Tuzlalı Sıtkı , Ilhan Rıdvan , Iplikçi Altan , Akhan Süleyman E.
Published: March 2003

In this study, the role of the count of intratumoral mast cells was examined and compared with the proliferative activity exhibited by Ki‐67 indices in the differential diagnosis of uterine smooth muscle tumors. Sixteen cases of leiomyosarcoma, nine cases of atypical leiomyoma and 16 cases of ordinary leiomyoma were included. The pathological features of the cases were determined by reviewing the archive materials including the patient records and hematoxylin‐eosin‐stained sections. Toluidine blue stain was used to highlight the intratumoral mast cells and they were counted in at least 40 high power fields. A standard streptavidin–biotin method was applied to the sections to highlight the Ki‐67 immunoreactive tumor cell nuclei. These proliferative cells were counted in at least 10 high‐power fields. Atypical leiomyomas tended to have a higher quantity of intratumoral mast cells than leiomyosarcomas and ordinary leiomyomas (P= 0.027 and P= 0.021, respectively). Leiomyosarcomas
tended to have higher Ki‐67 immunoreactivity rates than atypical leiomyomas, although
the difference was not statistically significant (P= 0.82). We concluded that the quantity of intratumoral mast cells is useful in the differential diagnosis between leiomyosarcomas and atypical leiomyomas, while the cell proliferation rate expressed by Ki‐67 immunoreactivity has a limited value.
Primary carcinosarcoma of the vagina
Authors: Shibata Rie , Umezawa Akihiro , Takehara Kyoko , Aoki Daisuke , Nozawa Shiro , Hata Jun‐ichi
Published: March 2003

Primary carcinosarcoma of the vagina is a very rare tumor, with only eight cases diagnosed as carcinosarcoma in the literature that we are aware of. We recently encountered a case of primary carcinosarcoma of the vagina in a 75‐year‐old woman. The patient had a history of hysterectomy and bilateral ovariectomy for uterine corpus cancer at 55 years of age. Recurrence of the cancer was suspected 17 years after the operation and irradiation therapy was performed, but the patient died 3 years after the recurrence. Autopsy revealed a mass lesion in the pelvic cavity that originated in the vagina. Histological examination showed that the tumor contained anaplastic carcinoma, rhabdomyosarcoma, leiomyosarcoma and chondrosarcoma components, and it was diagnosed as carcinosarcoma. The histological diagnosis of the uterine corpus cancer was well‐differentiated adenocarcinoma, and there was no sarcomatous component. The carcinosarcoma occurred 17 years after the hysterectomy, and it was concluded to be a primary carcinosarcoma of the vagina. This is the first case of primary vaginal carcinosarcoma in which the epithelial and sarcomatous components were clearly identified histologically and immunohistochemically.
Immunohistochemical analysis for histopathological subtypes in pediatric medulloblastomas
Authors: Son Eun‐Ik , Kim Il‐Man , Kim Dong‐Won , Yim Man Bin , Kang Yu‐Na , Lee Sang‐Sook , Kwon Kun‐Young , Suh Seong‐Il , Kwon Taeg‐Kyu , Lee Jung‐Jeung , Kim Dong‐Sug , Kim Sang‐Pyo
Published: March 2003

Medulloblastomas occurring in children represent a histological spectrum of varying anaplasia and nodularity. In order to determine whether immunohistochemical markers might be useful parameters in subclassifying these tumors, 17 pediatric medulloblastomas, including nine diffuse/non‐anaplastic, four diffuse/anaplastic, three nodular/non‐anaplastic and one nodular/anaplastic subtypes, were studied. In the present report, we investigate the expression of neural cell adhesion molecule (NCAM), nerve growth factor receptor (NGFR), neurofilament (NF), synaptophysin (SYN), glial fibrillary acidic protein (GFAP), S100, Bcl‐2, and Ki‐67 by using the immunohistochemistry against specific antibodies. This study showed that NGFR, NF, GFAP and S100 were not detected in anaplastic subtypes of medulloblastomas (0/5), while non‐anaplastic subtypes were mainly expressed within the nodules. All 17 tumors were reactive for NCAM, SYN and Bcl‐2. In addition, Ki‐67 labeling indices for anaplastic subtypes (39.0 ± 7.42%) were significantly higher than that of non‐anaplastic medulloblastomas (11.4 ± 8.04%; P < 0.0001). These results suggest that immunohistochemical markers are a useful adjunct in characterizing subtypes of pediatric medulloblastomas.
Ovarian carcinoid exhibiting double function
Authors: Utsumi Nanae , Hayasaka Tadashi , Motoyama Teiichi
Published: March 2003

A case of a 58‐year‐old woman with ovarian carcinoid exhibiting double function is reported. She had suffered from constipation and hirsutism before surgery. Pathological examination revealed that many carcinoid tumor cells were immunohistochemically positive for peptide YY, which inhibits intestinal motility and many peripheral steroid cells. After surgery the patient recovered from constipation immediately. Although the serum level of testosterone also immediately decreased, hirsutism remained for about 2 years. These clinical manifestations are considered to be due to peptide hormone‐producing tumor parenchymal cells and testosterone‐producing functioning stromal cells. This is the first report of clinically manifested double‐functioning ovarian carcinoid; one function is due to tumor cells themselves and another function is due to stromal cells.
Amphidiniopsis uroensis sp. nov. and Amphidiniopsis pectinaria sp. nov. (Dinophyceae): Two new benthic dinoflage llates from Japan
Authors: Toriumi Saburo , Yoshimatsu Sadaaki , Dodge John D.
Published: March 2003

Two new armoured, heterotrophic sand‐dwelling marine dinoflagellates, Amphidiniopsis uroensis Toriumi, Yoshimatsu et Dodge sp. nov. and Amphidiniopsis pectinaria Toriumi, Yoshimatsu et Dodge sp. nov. were collected from Japanese sandy beaches, and their morphological features observed by light microscopy and scanning electron microscopy (SEM). The cell size of A. uroensis is 28–31 μm in length and 23–28 μm in width. The plate formula is Po 3′, 3a, 6″, 3c, 4s (+1 acc.), 5″′, 2″″. The thecal surface is ornamented with small processes, pores and spines, however, the surface of plate 2a is smooth. The epitheca possesses a narrow ridge that is extended along on the suture between 1′ and 3′. Plate 1″ connects with the right sulcal (Sd) and right sulcal accessory (Sda) plates, so the cingulum is incomplete. A nucleus is situated in the central part of the cell. There are a few small spines at the antapex. There are no stigma or chloroplasts. Amphidiniopsis pectinaria cells are 33–40 urn in length and 29–35 μm in width. The plate formula is Po 4′, 3a, 7″, 3c, 4s (+1 acc.), 5″′, 2″″. Plate 1″ connects directly with Sd and Sda plates, so the cingulum is incomplete. The thecal surface is ornamented with small processes, spines and pores. The epitheca is provided with a narrow ridge that is extended along on the suture between plates 1′, 4′ and 7″. The ornamentation on the antapical plates is unique. It is arranged in 10 straight rows on the hypotheca; each row has a strong spine at its posterior end. In addition, there is a long spine at the antapex. There are no stigma or chloroplasts. A nucleus is located in the central part of the cell.
A diary form quality of life questionnaire for Japanese patients with lung cancer and summarization techniques for longitudinal assessment
Authors: Ishihara Yoko , Sakai Hiroshi , Nukariya Naotaka , Kobayashi Kunihiko , Yoneda Shuichi , Matsuoka Rokuro , Hohjo Tadahiko , Nishiwaki Yutaka , Hoshi Akira , Kuratomi Yuhshiro , Nagai Atsushi , Kagawa Jun , Kitamura Satoshi
Published: March 2003

The aim of this study was to confirm the validity and reliability of a new diary‐type quality of life (QOL) self‐rating questionnaire tailored for use by Japanese inpatients with lung cancer receiving chemotherapy. Two kinds of summary statistics were tested in QOL analysis.

The questionnaire has a four‐scale structure; physical, psychological, daily activity and global scales. Fifty‐three patients were enrolled to test the reliability and validity. Summary statistics were assessed using indices of the area under the curve (AUC) and the maximum fluctuations of QOL scores (Dif max) in patients receiving cisplatin or carboplatin.

The questionnaire had satisfactory reliability and validity. The physical, psychological and global scales scores changed to the worst levels after treatment, continuing for 1 week in the cisplatin group, whereas those of the carboplatin group began to worsen from day 3, but returned to pre‐ chemotherapy levels by day 9. The cisplatin group showed significant decrease of QOL compared with the carboplatin group in the AUC of psychological and two global scales, in the Dif max of psychological and linear analogue global scales.

These results suggested that this questionnaire reflects differences in the influence of chemotherapy, and that AUC and Dif max may be useful indices for the analysis of QOL as measures to assess multidimensional QOL.
Effects of inhaled corticosteroid on bone turnover in children with bronchial asthma
Authors: Chay OM , Goh A , Lim WH , Leong KH , Lou J
Published: March 2003

Long term usage of systemic steroids is associated with multiple side effects. One of the major morbidities is due to its effect on bone metabolism leading to bone loss and resulting in skeletal fractures. This study was conducted to determine the effects of inhaled steroids on bone mineral density (BMD) and biochemical bone markers. Twenty‐four children with frequent episodic or mild persistent asthma who satisfied the clinical criteria for starting on inhaled corticosteroids (ICS) were enrolled into the study. The BMD scan was done using dual energy X‐ray absorptiometry, prior to starting ICS therapy and 6 months later. Biochemical markers of bone metabolism, (i) serum osteocalcin as a bone formation marker, and (ii) urinary deoxypyridinoline (Upd) as a bone resorption marker, were taken prior to ICS treatment and at 2 monthly intervals. The biochemical markers were all taken in the morning. Twenty‐four, age‐ and sex‐matched children with mild episodic asthma, not requiring ICS, were used as controls for the BMD measurements. The BMD scan was done upon enrolment into the study and 6 months later. Twenty‐four children on ICS and 24 controls completed the study. The subjects were on a mean dose of beclomethasone dipropionate (BDP) 0.4 mg/day. One subject needed a short course of Prednisolone in the early treatment period. None of the controls needed oral steroid therapy. One child in the control group sustained a greenstick fracture after an accidental fall. The mean rate of change of BMD was 1.8% ± 12.3 in the subjects on BDP. This was lower than the 6.1% ± 10.6 among the control subjects. However, this difference did not reach statistical significance (P = 0.16). There was a significant increase in serum osteocalcin level after 6 months of BDP treatment from 66.83 ± 22.71 ng/mL to 81.61 ± 24.66 ng/mL (P < 0.005). There was a decline in Upd from 36.2 ± 47.1 nmol/mmol creatinine to 21.4 ± 6.92 nmol/mmol creatinine. However, this did not reach statistical significance. There was no difference in the statural gain between the subjects on ICS and their controls. This study showed that 6 months of ICS therapy (mean dose 0.4 mg/day) had no significant adverse effect on bone metabolism in asthmatic children.
Effects of nasal continuous positive airway pressure on pulmonary haemodynamics and tissue oxygenation in patients with obstructive sleep apnoea
Authors: Akashiba Tsuneto , Minemura Hiroshi , Yamamoto Hitoshi , Itoh Daisuke , Kosaka Naoko , Saitoh Osamu , Horie Takashi
Published: March 2003

We investigated the acute effects of nasal continuous positive airway pressure (CPAP) on pulmonary haemodynamics and tissue oxygenation in eight men with obstructive sleep apnoea (OSA) by means of right heart catheterization. They were tested at four dosage levels of nasal CPAP: 0, 5, 10, and 15 cmH2O. Nasal CPAP significantly reduced the cardiac index at the 10 and 15 cmH2O doses. The mean pulmonary artery pressure was significantly elevated with 10 and 15 cmH2O, and pulmonary capillary wedge pressure was significantly increased with 15 cmH2O of nasal CPAP. Pulmonary vascular resistance was significantly increased with 10 cmH2O of nasal CPAP. The 5 cmH2O dose of nasal CPAP did not affect significantly these parameters. Mixed venous oxygen tension was unchanged at any pressure. We conclude that tissue oxygenation was maintained in the OSA patients during administration of nasal CPAP, even though a high CPAP clearly affected pulmonary haemodynamics.
Tuberculous laryngitis in a child
Authors: Ng Daniel Kk , Hui Yau , Law Albert Kw , Ho Jackson Cs
Published: March 2003

We report the case of an 8‐year‐old girl suffering from pulmonary tuberculosis complicated by tuberculous laryngitis. She presented with acute onset of fever and stridor with previous apparent good health. Her tuberculous laryngitis and pulmonary tuberculosis responded well to systemic steroid and anti‐tuberculosis treatment. Steroid inhalation was found to be effective when stridor recurred after treatment with systemic steroid was stopped. Tuberculous laryngitis is now a rare disorder and only a few publications on childhood tuberculous laryngitis were found in a MEDLINE search from 1966 to 1996. Our patient is one of the youngest patients with tuberculous laryngitis during the past three decades. Paediatricians must remain alert to this disorder as tuberculosis is endemic in this region. The effectiveness of corticosteroid inhalation in relieving the stridor in this patient encourages further study on this aspect.
Fulminant psittacosis requiring mechanical ventilation and demonstrating serological cross‐reactivity between Legionella longbeachae and Chlamydia psittaci
Authors: Soni Rajeev , Seale J , Young Iven
Published: March 2003

Chlamydia psittaci infection typically causes a mild respiratory illness in humans. Severe respiratory failure requiring mechanical ventilation or intensive care therapy is an uncommon development. The aetiological agents causing severe community acquired pneumonia often remain undetermined. Serological tests may aid in diagnosis. We present two cases of fulminant psittacosis, one demonstrating early cross‐reactivity with Legionella longbeachae.
Malignant fibrous histiocytoma of the trachea
Authors: Vinod Shalini K , Macleod Craig A , Barnes David J , Fletcher Julie
Published: March 2003

Primary tracheal sarcomas are rare. Only 23 cases have previously been reported in the English literature. The present case describes a 72‐year‐old woman with a malignant fibrous histiocytoma of the trachea. She underwent an endoscopic resection followed by radiotherapy and is well at 12 months follow up. Other cases are reviewed. Tracheal resection is the standard care. However, local resection with postoperative radiotherapy remains an option. Adjuvant chemotherapy may improve local control. Long‐term survival has been documented.
Characterization of immunoglobulin binding factor in sputum from patients with chronic airway diseases
Authors: Ichikawa Waka , Ogushi Fumitaka , Tani Kenji , Maniwa Koji , Kamada Masaharu , Ohmoto Yasukazu , Sakatani Mitsunori , Sone Saburo
Published: March 2003

Objective:

Immunoglobulin binding factor (IgBF) is known to bind immunoglobulin, to interact with anti‐Fcγ‐III antibodies and to be present in the lower respiratory tract of normal healthy subjects. In this study, in order to clarify the role of IgBF in vespiratory diseases, we investigated whether IgBF exists in the airway of patients with chronic airway diseases.

Methodology: IgBF was measured in the sputum of 28 normal subjects and 59 patients with chronic airway diseases including 37 cases of chronic bronchitis, 18 bronchiectasis, and four diffuse panbronchiolitis by enzyme‐linked immunosorbent assay.

Results: Immunoglobulin binding factor concentration in the sputum of patients with chronic airway diseases (purulent sputum, 50.2 ± 8.2 μg/mL; mucoid sputum, 88.6 ± 12.8 μg/mL) was higher than that in induced sputum of normal subjects (6.3 ± 5.5 μg/mL; P < 0.001). Immunoglobulin binding factor level in mucoid sputum was significantly higher than that in purulent sputum (P < 0.05). A significant inverse correlation was shown between the IgBF level and the elastase activity in sputum, and the concentration of IgBF purified from seminal plasma was decreased by treatment with neutrophil elastase, indicating that IgBF might be degraded by elastase. In the gel filtration chromatography of both types of sputum, IgBF was eluted in a region corresponding to a molecular weight of 27 kDa as a single peak. Western blot analysis with a monoclonal antibody to IgBF indicated that IgBF in both types of sputum had a molecular weight of 27 kDa under non‐reducing conditions and of 16 kDa under reducing conditions.

Conclusion: These results demonstrate that a high level of IgBF is present in the respiratory tract of patients with chronic airway diseases and may be related to the pathogenesis of these diseases.
Do subjects with asthma have greater perception of acute bronchoconstriction than smokers with airflow limitation?
Authors: Massasso David H , Salome Cheryl M , King Gregory G , Seale J Paul , Woolcock Ann J
Published: March 2003

Objective:

Smokers who develop chronic airflow limitation (CAL) do not usually present for medical attention until their lung disease is well advanced. In contrast, asthmatic subjects experience acute symptoms and present for care early in the course of their disease. The aim of this study was to determine whether subjects with asthma differ from smokers with CAL in their ability to perceive acute methacholine‐induced bronchoconstriction.

Methodology: Thirteen subjects with diagnosed asthma and 10 current smokers with CAL, defined as forced expiratory volume in 1 s (FEV1) < 75% predicted and FEV1/forced vital capacity < 80%, with no previous diagnosis of asthma, were challenged with methacholine. Symptom severity was recorded on a Borg scale. Lung volumes were measured before challenge and after the FEV1 had fallen by 20%.

Results: After methacholine falls in FEV1 were similar in the asthmatic subjects and smokers. The regression lines relating change in FEV1 to symptom score were significantly steeper in asthmatic subjects than smokers (0.13 ± 0.04, 0.03 ± 0.04, respectively, P < 0.01). At 20% fall in FEV1 there were no significant differences between asthmatic subjects and smokers in the magnitude of change of lung volumes.

Conclusions: In asthmatic subjects, symptoms are closely related to change in FEV1. In smokers with CAL, symptoms change little during bronchial challenge despite large changes in FEV1. The differences in perception between the two subject groups are not due to differences in acute hyperinflation during challenge. We propose that heavy smokers may adapt to poor lung function, or may have damaged sensory nerves as a result of prolonged cigarette smoking.
Bronchoscopic findings of endobronchial vascular lesions in patients with haemoptysis
Authors: Park Gye Young , Lee Kye Young , Yoo Chul Gyu , Kim Young Whan , Han Sung Koo , Shim Young‐Soo
Published: March 2003

Cases of endobronchial vascular lesions observed with bronchoscope are presented. These lesions tend to be diagnosed erroneously as true endobronchial tumours so that biopsies are tried frequently. Consequently, a catastrophic accident of massive bleeding can complicate the condition if endobronchial vascular lesions are injured during bronchoscopic biopsy or brushing. We present three types of endobronchial vascular lesion: tubular bulging type, mass‐like type and haemangioma type. Because bronchoscopic findings of submucosal tubular structure and visible pulsation are highly suggestive of endobronchial vascular lesion, there must be extreme caution to prevent fatal bleeding.
Increased circulating CD16+ CD14dim monocytes in a patient with pulmonary alveolar proteinosis
Authors: YOSHIOKA Yasuko , OHWADA Akihiko , HARADA Norihiro , SATOH Naotake , SAKURABA Shoko , DAMBARA Takashi , FUKUCHI Yoshinosuke
Published: March 2003

Pulmonary alveolar proteinosis (PAP) is characterized by filling of the alveoli with a periodic acid‐Schiff‐positive proteinaceous material. Although the pathogenesis of primary or idiopathic PAP remains unknown, it has been proposed that a deficiency or loss of responsiveness of the monocyte/macrophage lineage to granulocyte–macrophage colony stimulating factor (GM‐CSF) is involved in PAP. Secondary PAP is associated with haematological malignancies, especially in myeloid disorders. Herein, we report on an adult with PAP associated with myelodysplastic syndrome (MDS). The CD16+ CD14dim monocytes comprise 5–10% of circulating monocytes in healthy volunteers. Flow cytometric analysis of the patient in the present study revealed increased CD16+ CD14dim monocytes in the peripheral blood. It has been demonstrated that the expression of CD16 and CD14 is regulated by macrophage colony stimulating factor (M‐CSF) and GM‐CSF. Hence, serum cytokines were analysed in our patient and the concentration of serum GM‐CSF was found to be less than the lower limit of the assay. In addition, serum M‐CSF and granulocyte colony stimulating factor levels were only slightly increased above the normal range. These results suggest that the increase in the CD16+ CD14dim subpopulation in the circulation of our patient indicates another pathogenetic mechanism for secondary PAP, such as hyperresponsiveness of the monocyte/ macrophage lineage to these cytokines.
Influenza‐associated encephalopathy in Japan: Pathogenesis and treatment
Authors: Sugaya Norio
Published: March 2003

Abstract It is estimated that more than 100 children die of influenza‐associated encephalopathy (influenza encephalopathy) every year in Japan. Influenza encephalopathy is distinct from Reye’s syndrome. Specifically, 20% of influenza encephalopathy patients exhibit bilateral thalamic necrosis on neuroimaging, a lesion referred to as acute necrotizing encephalopathy (ANE). Influenza encephalopathy may develop by the same pathogenetic mechanisms as ANE, possibly via vasoactive substances or a process leading to vasoconstriction in the central nervous system (CNS). A novel substitution at the receptor‐binding site (Tyr 137 to Phe) was reported to be found exclusively in influenza type A (H3N2) viruses isolated from patients with influenza encephalopathy, suggesting that encephalopathy may be caused by a variant influenza type A (H3N2) virus. Recently, it has been reported that cytokines may mediate the disease and that a high plasma concentration of interleukin‐6 could be an indicator of progression to encephalopathy. Although it is unknown whether influenza virus invades the CNS, amantadine therapy for influenza encephalopathy has been tried in Japan, in patients in whom influenza type A infection has been demonstrated by rapid antigen detection tests.
Effects of heart rate and right ventricular pressure on right coronary arterial flow and its systolic versus diastolic distribution in a variety of congenital heart diseases in children
Authors: Watanabe Naoyuki , Awa Shoichi , Akagi Michio , Ando Yasushi , Oki Naoki , Waragai Tadashi , Hosaki Akira , Kawamata Hikari , Kamisaka Keiko
Published: March 2003

Abstract Background and Methods: In order to elucidate the underlying adjusting mechanism of human right coronary arterial (RCA) flow to increased right ventricular pressure (RVP) in children, we recorded RCA flow velocity in 24 pediatric cardiac patients at the orifice of its main trunk at the time of heart catheterization using the Doppler guidewire.

Results
: The ratio of diastolic flow (DF)/total flow (TF), or the proportion of the DF time integral over a total of one cardiac cycle, had a negative correlation with heart rate (HR; r=–0.58, n=11) in children with normal right ventricular systolic pressure (RVSP; RVSP <35 mmHg). In contrast, the DF/TF ratio had a good correlation (r=0.88, n=24) with RVSP in all patients under study. The ratio of diastolic area (DA)/total area (TA), defined as the ratio of an area encircled by the aortic pressure curve above and the RVP curve below for diastole, over a total of one cardiac cycle, representing the overall effect of both HR and transcoronary pressure difference, also correlated well (r=0.89, n=24) with DF/TF. Total volume flow of the RCA also increased (r=0.76, n=24) with increases in RVSP, first by an increase in flow velocity through the RCA, during both systole and diastole, then by widening of the RCA lumen at very high pressures. These changes were initially more dependent on diastole with increasing RVSP because: (i) of a more marked augmentation of flow velocity in diastole compared with systole; and then (ii) of a significant decrease in flow velocity in systole at very high pressures.

Conclusions
: We clarify how the RCA manages to increase flow through it at different HR as a function of chronic RVP overload in pediatric cardiac patients.
Contact pressure distribution in the supine position in low‐birth weight infants analyzed by a photoelastic method
Authors: Fujimatsu Mariko , Fujita Takehisa , Hashimoto Kiyoshi , Nakagawa Hirofumi
Published: March 2003

Background
: Contact pressure distribution patterns in the supine position in low‐birth weight (LBW) neonates were analyzed by the use of a photoelastic method.

Methods
: A total of 61 subjects (LBW neonates, mature (bodyweight >2500 g at birth) neonates, normal infants and Down syndrome (DS) infants) were selected for the study. Infants were placed on a photoelastic measuring table. Photoelastic images generated in the contact regions of the body were photographed with a camera and printed on monochrome paper. The coefficient of variation in the pressure distribution value (Pcv) and the top and bottom ratio (μ) of the trunk at the center of pressure were calculated.

Results
: The Pcv value was significantly lower in DS than LBW (P<0.001), mature (P<0.002) and normal infants (P<0.01). The μ value in LBW and mature neonates was 48.9 and 50.2%, respectively. Normal infants had a μ value of 44.0%, which was significantly lower than that in LBW neonates. However, there was no significant difference between LBW and DS infants.

Conclusions
: Neurological impairment specifically affects the data obtained by photoelastic analysis.
Epidemiology of Helicobacter pylori infection in children: A serologic study of the Kyushu region in Japan
Authors: Yamashita Yasuhiro , Fujisawa Takuji , Kimura Akihiko , Kato Hirohisa
Published: March 2003

Background
: The prevalence of Helicobacter pylori infection in children varies as a function of socioeconomic development, with low rates in developed countries and high rates in developing countries. The prevalence of H. pylori infection in Japanese children is unknown.

Methods
: The present study examined the effect of living conditions on the prevalence of H. pylori infection in children. We determined the prevalence of H. pylori infection in healthy children of the Kyushu region in Japan and compared it with the prevalence in institutionalized children with severe neurologic illness. Serum concentrations of anti‐H. pylori IgG antibody were measured by an enzyme‐linked immunosorbent assay in 336 healthy children and 56 patients with severe neurologic impairment. An antibody concentration >50 units/mL was taken as evidence of infection.

Results
: The prevalence of H. pylori seropositivity in healthy children increased with age (P<0.0001) and was 29% in children 15–19 years of age. This value is slightly higher than prevalences reported in developed countries (5–15%), but is lower than in developing countries (30–60%). Seropositivity did not vary with respect to gender, water supply or location of housing. Helicobacter pylori seropositivity was more prevalent among institutionalized children aged 5–19 years than their healthy counterparts (P<0.005).

Conclusions
: The intermediate prevalence of H. pylori seropositivity in healthy children between that measured in developed and developing countries is consistent with the socioeconomic ‘westernization’ of Japan.
Early intervention for infants with autistic spectrum disorders in Japan
Authors: Kobayashi Ryuji , Takenoshita Yuka , Kobayashi Hiromi , Kamijo Atsushi , Funaba Kunimi , Takarabe Morihisa
Published: March 2003

Abstract

Background
: To date, many researchers in Japan have assumed that the cause of autistic spectrum disorders is attributable to some disorder in the ability of the child. However, we have been working on the premise that autistic spectrum disorders are brought about by relationship disturbances in early infancy and have been attempting to validate this hypothesis through early intervention.

Methods
: We have examined the developmental process of affective communication in infants with autistic spectrum disorders. We have postulated that approach–avoidance motivational conflict (Richer) is the primary factor impeding the development of affective communication and have focused therapeutic intervention on this perspective.

Results
: As a result, attachment behavior was markedly improved in children, but affective communication with their mothers was not. Examing the mothers’ images of themselves in infancy in mother–infant psychotherapy, problems that the mothers had themselves in infacy with attachment behavior to their own mothers affected the mothers’ internal representation of their children, leading to active evolution of mother–child interaction and development of affective communication between the mother and child.

Conclusions
: In this context, the basis and significance of the internal representation of both parties being determinants in the quality of mother–child communication are discussed. Our goal in early intervention is not the elevation of a child’s linguistic–cognitive abilities, but the creation of a comforting relationship in which both parent and child can live securely, without strain.
Postnatal depression in Japanese mothers and the reconsideration of ‘Satogaeri bunben’
Authors: Yoshida Keiko , Yamashita Hiroshi , Ueda Motoko , Tashiro Nobutada
Published: March 2003

Abstract

Background
: Postnatal depression occurs in 10–15% of Western women. In Japan, there is a traditional support system for perinatal women and there have been few prospective studies on postnatal depression in terms of cross‐cultural studies.

Methods
: First, a cross‐cultural study on postnatal depression was performed. Ninety‐eight Japanese women living in England and 88 Japanese women living in Japan were recruited and followed up to 3 months postnatally. The Edinburgh Postnatal Depression Scale (EPDS) and Schedule for Affective Disorder and Schizophrenia were used as a self‐report questionnaire and psychiatric diagnostic interview. Diagnoses of depression were made by Research Diagnostic Criteria. Second, a study on ‘Satogaeri bunben’ (a traditional ritual (support system) for perinatal women in Japan; ‘Satogaeri’ means returning to the original family town or house and ‘bunben’ means delivery) was undertaken. Seventy‐five mothers were asked to answer the questionnaire 6 months postnatally. The questionnaire was devised by the authors about the choice of Satogaeri bunben and the reasons for the decision.

Results
: The incidence of postnatal depression was 12 and 17% in the English and Japanese groups of mothers, respectively. However, subjects from both groups supressed expression of their depressed mood in answering the EPDS. Satogaeri bunben itself did not lower the incidence of postnatal depression. In the study on Satogaeri bunben, 23 of 75 women did not choose Satogaeri bunben; moreover, seven of these women did not have good support from their own mothers.

Discussion
: Having found that postnatal depression is not uncommon in Japanese women, a screening system should be developed, in particular because Japanese women would not naturally express their emotions, and Satogaeri bunben needs to be reconsidered qualitatively.
Evolution of the perinatal care system
Authors: Suzuki Hiroko
Published: March 2003

Abstract

Background
: The perinatal support system for mothers and babies, which has evolved over the past 6 years at the Morioka Red Cross Hospital, is described.

Methods
: Between July 1995 and August 1999, 1864 puerperal mothers at the Morioka Red Cross Hospital responded to the Maternity Blues Scale (MB) and the Edinburgh Postnatal Depression Scale (EPDS) at 1 month, each with an open comment form.

Results and Discussion
: There was a significant difference in each MB item between individuals who scored above 9 points and those who scored lower in the EPDS. Those who later scored high in the EPDS had responses to a preceding MB where we had checked items of ‘confusion’, ‘experience of crying’, ‘anxiety’, ‘exhaustion’, ‘feeling depressed’, ‘nervousness’, ‘agitation’ and ‘forgetfulness’. Administration of the MB and provision of a free comment form significantly decreased EPDS scores. Ensuring that the views of mothers are acknowledged within the context of an adequate care system is central to effective perinatal care.
Nitric oxide inhalation and nitric oxide synthase inhibitor supplement for endotoxin‐induced hypotension
Authors: Suzuki Satoshi , Togari Hajime , Yamaguchi Nobuyuki , Haas Kelly Mullins
Published: March 2003

Abstract

Background
: This study was performed to determine whether a combined therapy of nitric oxide (NO) inhalation and nitric oxide synthase (NOS) inhibitor is effective in experimental animals with endotoxin‐induced refractive hypotension accompanied by pulmonary hypertension.

Methods
: Escherichia coli lipopolysaccharide (1 mg/kg) was administered to 10 newborn piglets to induce endotoxemia. The experiment then began 60 min later, when the systemic arterial pressure dropped. The inhalation of 20 p.p.m. NO at 60 and 120 min of endotoxemia created a control group. Another group was also administered N w‐nitro‐L‐arginine (L‐NNA; 5 mg) after the first NO inhalation at 60 min of endotoxemia (the L‐NNA group). Pulmonary arterial pressure, systemic arterial pressure and cardiac output were measured and compared among the groups.

Results
: Three of the 5 piglets in the control group died of hypotensive shock, while in the L‐NNA group the systemic arterial pressure recovered to pre‐endotoxin administration levels. The L‐NNA group produced a further increase in pulmonary arterial pressure against which NO inhalation was effective.

Conclusion
: Nitric oxide inhalation alone carries a potential risk of further lowering systemic arterial pressure in a piglet with hypotension induced by endotoxin, whereas the combined therapy resulted in the recovery of the blood pressure to pre‐endotoxin levels. The combined therapy was simultaneously effective against pulmonary hypertension.
Spontaneous labor increases nitric oxide synthesis during the early neonatal period
Authors: Endo Akihiko , Izumi Hiroyuki , Ayusawa Mamoru , Minato Michiyoshi , Takahashi Shigeru , Harada Kensuke
Published: March 2003

Abstract

Background
: This paper aimed to assess the influence of spontaneous labor upon endogenous nitric oxide (NO) and endothelin 1 (ET‐1) during transition to extrauterine life.

Methods
: The serum levels of NO metabolites (the sum of nitrites and nitrates (NOx)) and the plasma level of ET‐1 were determined in 53 healthy full‐term infants (spontaneous labor group; n=40, cesarean delivery group; n=13). In both groups, blood samples were obtained from a cord vein at birth and from a peripheral vein at 5 days of age.

Results
: The differences in serum NOx concentrations between the spontaneous labor group and the elective cesarean group were not significant at birth. By the age of 5 days, serum NOx concentrations had risen significantly in the spontaneous labor group to become significantly higher in the elective cesarean group.

Conclusion
: It is speculated that spontaneous labor might enhance endogenous NO synthesis at 5 days of age.