bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypnotic prescriptions in a university hospital: Analysis of data from the computer‐ordering system
Authors: MIYAMOTO MASAYUKI , HIRATA KOICHI , MIYAMOTO TOMOYUKI , IWASE TOSHIYASU , KOSHIKAWA CHIAKI
Published: March 2003

Abstract The computer‐ordering system (COS) database was used to investigate hypnotic prescriptions issued to outpatients at various medical departments at the Dokkyo University School of Medicine. Hypnotics were prescribed for 3428 patients (1613 men, 1815 women), with a mean age of 56 years (range 8–91 years). The number of prescriptions was 3.5% of the total number of prescriptions (123 518). Although hypnotics were prescribed most often to patients in their 60s, generally, the incidence was higher for younger‐aged patients. Physicians in all specialty areas tended to prescribe short‐acting benzodiazepine hypnotics. The issuance of hypnotic prescriptions should be investigated to determine the prevalence of insomnia in various medical specialties.
Wisconsin Card‐Sorting Test performance does not discriminate different patterns of premorbid behavioral abnormalities in schizophrenic patients
Authors: ROSSI ALESSANDRO , POLLICE ROCCO , STRATTA PAOLO , ARDUINI LUCA , MARINANGELI MARIA GRAZIA , DANELUZZO ENRICO
Published: March 2003

Abstract It is well documented that premorbid behavior abnormalities precede the onset of schizophrenia in a large number of patients. The research findings suggest that there are differences in the type and severity of these premorbid dysfunctions. Another research field has shown impairment of preschizophrenic patients in several cognitive domains. The present study reports retrospective childhood and adolescence neurobehavioral assessment in 31 patients with schizophrenia by the Child Behavior Checklist (CBCL) and current Wisconsin Card‐Sorting Test (WCST) evaluation in order to investigate whether specific behavioral abnormality (BA) patterns are related to executive function as evaluated by the WCST. Cluster analysis was conducted on the childhood premorbid behavior ratings for the schizophrenic patients and two subgroups emerged: (i) Cluster I with an initial low level of BA that increased over the years; and (ii) Cluster II with a high level of BA that remained relatively stable until early adulthood. Furthermore, Cluster II showed more severe current negative and total symptoms, but the two groups did not differ in WCST performance. Our results show that the patterns and severity of CBCL upon retrospective evaluation are not related to WCST performance, which seems to be a feature inherent to the disease process. Different factors could be responsible for cognitive and behavioral disturbances in schizophrenia.
Parent–infant relationship global assessment scale: A study of its predictive validity
Authors: AOKI YUTAKA , ZEANAH CHARLES H. , HELLER SHERRYL SCOTT , BAKSHI SUDHA
Published: March 2003

The Parent–Infant Relationship Global Assessment Scale (PIRGAS; Zero to Three, 1994) provides a continuously distributed scale of infant–parent relationship adaptation, raging from ‘well‐adapted’ to ‘dangerously impaired’. The present study examines the predictive validity of the PIRGAS in a high‐risk sample by coding relationship adaptation level from a single sample of 10 min of unstructured free play between mothers and their 20‐month‐old infants and examining its relationship to subsequent interaction with mothers and behavior problems at 24 months. Relationship adaptation assessed reliably from observations of only 10 min of free play between mothers and their infants at 20 months of age using PIRGAS predicted subsequent mother– infant interaction in a laboratory based problem‐solving paradigm (Crowell procedure) at 24 months and internalizing symptomatology of Child Behavior Checklist at age 24 months. These results contribute to the predictive validity of the PIRGAS as a measure of mother–infant relationship adaptation.
A behavior therapy program combined with liquid nutrition designed for anorexia nervosa
Authors: OKAMOTO AKIKO , YAMASHITA TATSUHISA , NAGOSHI YASUHIDE , MASUI YUKO , WADA YOSHIHISA , KASHIMA AKIKO , ARII ICHIRO , NAKAMURA MICHIHIKO , FUKUI KENJI
Published: March 2003

We have introduced behavior therapy as standard in‐patient treatment for anorexia nervosa and have modified the treatment program. At first, we used Fukamachi's activity restriction therapy (FT), followed by Token economy therapy (TET), which combined token economy with FT. Finally, we have developed Kyoto Prefectural University of Medicine Behavior Therapy (KPT). According to KPT, only liquid formula is given in the early stages of hospitalization and a target weight is not set at admission. We examined the effect of these three programs with respect to bodyweight gain. Thirty‐five anorexic patients participated in these three programs in our hospital: seven completed FT, seven completed TET and 21 coompleted KPT. We compared the effects of these three programs on body mass index (BMI). Furthermore, the effects of these three programs on BMI were compared at admission, 1 month after admission and at discharge, 6 months after discharge. In addition, the rate of increase of BMI for the following three periods was investigated: 1 month after admission, total hospitalization (from admission to discharge) and from admission to 6 months after discharge. The result is that KPT was the most effective of the three programs with regard to both the amount and the rate of increase of BMI at all points and there is a significant difference between KPT and FT. This effectiveness may be attributable to the use of an oral liquid formula, the setting of target weight at a later stage of hospitalization and the release of activity restriction based on weight gain.
Four cases of panic disorder successfully treated with Kampo (Japanese herbal) medicines: Kami‐shoyo‐san and Hange‐koboku‐to
Authors: MANTANI NAOKI , HISANAGA AKITO , KOGURE TOSHIAKI , KITA TOSHIAKI , SHIMADA YUTAKA , TERASAWA KATSUTOSHI
Published: March 2003

Kampo medicines have been used to treat patients with psychogenic disorders from ancient times. In the present report the cases are described of four patients with panic disorder successfully treated with Kampo medicines. These four patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for panic disorder with agoraphobia. The Kampo medicine Kami‐shoyo‐san (TJ‐24) relieved panic attacks, anticipatory anxiety and agoraphobia in two patients, and Hange‐koboku‐to (TJ‐16) relieved these symptoms in the other two patients. The patients in whom Kami‐shoyo‐san was effective were older and complained of more symptoms than those in whom Hange‐koboku‐to was effective. These Kampo medicines may be useful as additional or alternative treatments for panic disorder.
Mass family hysteria: A report from India
Authors: MATTOO SURENDRA K. , GUPTA NITIN , LOBANA APRAJITA , BEDI BALRAJ
Published: March 2003

The case of a 31‐member family displaying mass hysteria in up to 10 members at one time is reported. The mass hysteria emerged in the context of the strong religious and cultural beliefs held by this closely knit family. The varied presentations included somatoform disorder, recurrent vomiting, conversion, dissociative and possession attacks. Two members had bipolar affective disorder that was recognized by the family as a ‘medical’ illness in contrast to other problems attributed to religiosity. The rarity of mass hysteria in a family and issues related to its medical and social management are highlighted.
Actigraphic assessment of the circadian rest–activity rhythm in elderly patients hospitalized in an acute care unit
Authors: Vinzio Stéphane , Ruellan Anne , Perrin Anne‐Elisabeth , Schlienger Jean‐Louis , Goichot Bernard
Published: March 2003

Abstract Hospitalization for acute illness is a major risk factor of rest–activity rhythm disturbance among elderly subjects. The rest–activity rhythm is disturbed by the acute illness, aging and hospital environment. The purpose of this study is to assess the rest–activity rhythm and light exposure (using a wrist worn actigraph) of 10 patients (mean age 81 years, seven females) admitted on an acute care unit, suffering from cardiac, respiratory or renal acute disease. A non‐parametric method was used to analyze activity data. With an improvement of the underlying diseases, the mean relative amplitude of rhythm increased from 0.31 ± 0.19 for the first 5‐day period after admission to 0.54 ± 0.21 for the second period before discharge (P < 0.05). The amount of time at night spent above a lighting threshold of 50 lux decreased from 31.4 to 12.3 min between the two periods. The rhythm of elderly subjects hospitalized in the acute care unit is severely altered during the initial period and is progressively resynchronized following clinical improvement. Under the acute underlying disease and/or aging, environmental conditions (light, noise) should be considered to maintain regular rest–activity rhythm.
Gene expression of gastric type mucin (MUC5AC) in pancreatic tumors: Its relationship with the biological behavior of the tumor
Authors: Yonezawa Suguru , Horinouchi Michiko , Osako Masahiko , Kubo Masaaki , Takao Sonshin , Arimura Yoshiko , Nagata Koji , Tanaka Sadao , Sakoda Koro , Aikou Takashi , Sato Eiichi
Published: March 2003

Previously it has been found that the MUC2 gene for intestinal type secretory mucin is highly expressed in intraductal papillary mucinous tumors (IPMT), which are characterized by non‐invasive growth and a favorable outcome. In contrast, MUC2 mRNA is rarely expressed in invasive ductal carcinomas (IDC), which have poor outcomes. The gastric type secretory mucin, MUC5AC, is strongly expressed in the surface mucous cells of gastric mucosa. As both MUC2 and MUC5AC mucins share the characteristics of forming highly viscous gels, it is expected that not only MUC2 mucin expression but also MUC5AC mucin expression may be associated with a favorable prognosis in patients with pancreatic tumors. MUC5AC mucin gene expression was examined in 24 cases of IPMT and 38 cases of IDC by in situ hybridization using a digoxigenin‐labeled oligonucleotide. The results were compared with MUC2 mucin gene expression. Neither MUC5AC mRNA nor MUC2 mRNA was detected in normal pancreatic tissues. MUC5AC mRNA was expressed in 20 of 24 cases of IPMT (83%) and in five of 38 cases of IDC (13%). In contrast, MUC2 mRNA was expressed in 14 of 24 cases of IPMT (58%) and in none of the 38 cases of IDC (0%). The expression rates of MUC5AC mRNA and MUC2 mRNA in IPMT were significantly higher than those in IDC (P < 0.001, respectively). Intraductal papillary mucinous tumors are characterized by three histological types: (i) villous dark cell type; (ii) papillary clear cell type; and (iii) compact cell type. The villous dark cell type generally expressed both MUC5AC+ and MUC2+ genes. Alternatively, the papillary clear cell type and the compact cell type usually showed MUC5AC+ and MUC2− expression. Patients with MUC5AC mRNA expression had a significantly better survival prognosis than those with no MUC5AC mRNA expression (P < 0.005). In conclusion, MUC5AC gene expression occurs in a majority of IPMT cases, even in those with no MUC2 production. MUC5AC expression can be correlated with tumors that demonstrate an expansive growth pattern and lower levels of invasion and metastasis.
Esophageal adenocarcinoma that probably originated in the esophageal gland duct: A case report
Authors: Endoh Yasushi , Miyawaki Motohiko , Tamura Gen , Watanabe Hidenobu , Motoyama Teiichi
Published: March 2003

A case of primary esophageal adenocarcinoma in a 64‐year‐old man is reported. An ulcerating tumor was located in the middle intrathoratic esophagus. Histopathological examination revealed a moderately differentiated adenocarcinoma, which had invaded down to the adventitia. The cancerous tubuli were lined by flattened cuboidal cells with eosinophilic cytoplasm, which were analogous with the esophageal gland ducts and syringoma of the skin. The carcinoma was spread widely in the lamina propria mucosae without intraepithelial neoplastic elements. An immunohistochemical profile of individual cytokeratins and other epithelial markers in the carcinoma was similar to that of the esophageal gland ducts. Barrett’s metaplastic epithelium or ectopic gastric mucosa was not found around the tumor. It is strongly suggested that this unique carcinoma is derived from the esophageal gland ducts.
An autopsy case of hepatoid carcinoma of the ovary with PIVKA‐II production: Immunohistochemical study and literature review
Authors: Senzaki Hideto , Kiyozuka Yasuhiko , Mizuoka Hiroshi , Yamamoto Daigo , Ueda Satoshi , Izumi Haruaki , Tsubura Airo
Published: March 2003

A case of hepatoid carcinoma of the ovary in a 61‐year‐old Japanese woman, who showed high serum levels of α‐fetoprotein and CA125, is reported. Grossly, the left ovarian tumor, which measured 12 × 9 cm, was solid and multinodular. Histologically, the tumor resembled hepatocellular carcinoma by its architectural and cytological features. Liver cell differentiation was indicated functionally by the immunohistochemical detection of α‐fetoprotein and protein induced by vitamin K absence or antagonist II (PIVKA‐II) and by positive bile production, and the hepatocellular differentiation was structurally in accord with keratin 7, 8 and 18 expression. CA125 expression, commonly present in ovarian surface epithelial carcinomas, suggested that this neoplasm originated from ovarian common epithelial cells. There are only nine such cases in the literature. A review of these cases reveals that hepatoid carcinoma of the ovary occurs exclusively in postmenopausal women (mean age, 62.7 years) and that the prognosis is poor.
Thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst
Authors: Matsumoto Koshi , Watanabe Yoshimasa , Asano Goro
Published: March 2003

A case of papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst is described. A 46‐year‐old woman presented with a 2.0 × 2.0 cm mass in her left lateral neck. The excised mass showed a cystic lesion with a thyroid papillary carcinoma. Following a lateral cervical cystectomy, subsequent thyroid gland and lymph nodes dissections were performed. Pathological examination showed an adenomatous goiter and no primary carcinoma in the thyroid gland, as well as metastatic papillary carcinoma in the lymph nodes. Two cases of thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cyst have been reported previously, but no lymph node metastases were recognized. The first case of papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst, and accompanied by lymph node metastasis is presented.
Uterus‐like mass of the small bowel mesentery
Authors: Horie Yasushi , Kato Masako
Published: March 2003

A case of a uterus‐like mass arising from the mesentery is reported. A mass measuring 14 × 11 cm was noted in the small bowel mesentery of a 59‐year‐old woman. Histologically, the lesion consisted of endometrial‐type and fallopian tube‐type mucosa surrounded by thick bundles of smooth muscle cells. Since the first report by Cozzutto in 1981, 10 cases of uterus‐like mass, that included seven ovarian and three extraovarian cases, have been reported. To our knowledge, the present lesion was the first case originating from the mesenteric region. Three hypotheses of this rare lesion: (i) congenital anomaly; (ii) metaplasia; and (iii) heterotopia theories are reviewed.
A quantitative model using mean and standard deviation for evaluation of interobserver agreement in nuclear atypia scoring of breast carcinomas in a protocol study
Authors: Tsuda Hitoshi , Akiyama Futoshi , Kurosumi Masafumi , Sakamoto Goi , Watanabe Toru ,   for the National Surgical Adjuvant Study of Breast Cancer Pathology Section
Published: March 2003

A quantitative model was devised for the purpose of evaluating interobserver agreement in the judgment of the nuclear atypia score of cancer cells in protocol studies. In this model, the mean nuclear atypia score (μ) among observers was considered to approximate the ‘true’ nuclear atypia score of the tumor, and with an identical μ the strength of interobserver agreement was evaluated by the difference between the ideal standard deviation (σ) and the observed σ in the slide conference session. This model was applied to the data of a total of 216 invasive ductal carcinomas acquired at eight slide conference sessions held for the standardization of nuclear atypia scoring and monitoring of interobserver agreement level for enrolled cases in a surgical adjuvant protocol on breast cancer. Compared with conventional percentage interobserver agreement and κ statistics, the present model, named the λ model, was more sensitive in detecting the improvement of interobserver agreement in nuclear atypia scoring with repetition of slide conference sessions. The λ model was particularly effective for evaluating the session which included many intermediate cases with a score between 1 and 2 or between 2 and 3. Percentage interobserver agreement and κ statistics could estimate the agreement irrespective of the number of observers, but the agreement tended to be underestimated when these intermediate cases were in the majority. The present method was considered to be complementary to conventional methods for evaluating interobserver agreement of cancer histology in protocol studies.
An animal model for Epstein–Barr virus (EBV)‐associated lymphomagenesis in the human: Malignant lymphoma induction of rabbits by EBV‐related herpesvirus from cynomolgus
Authors: Hayashi Kazuhiko , Akagi Tadaatsu
Published: March 2003

It is very important to develop and analyze animal models of Epstein–Barr virus (EBV)‐associated tumors in the human. However, only a few reports on the animal models of EBV infection have been reported. Here we review those previous models and describe the details on our newly developed rabbit model of malignant lymphoma induced by EBV‐related virus from cynomolgus. In brief, Si‐IIA‐EBV or Cyno‐EBV induced T‐cell lymphomas in rabbits inoculated intravenously (77–90%), orally (82–89%), subcutaneously (3/3) and intraperitoneally (2/3) about 2–5 months later. EBV‐DNA was detected in peripheral blood by polymerase chain reaction 2 days after oral inoculation of Cyno‐EBV while antiviral capsid antigen immunoglobulin G (IgG) was raised 3 weeks after the inoculation. Rabbit lymphomas and their cell lines contained EBV‐DNA and expressed EBV‐encoded small RNA‐1 and EBV‐associated nuclear antigen. Rabbit lymphoma cell lines, some of which have specific chromosomal abnormality, showed tumorigenicity in nude mice. The significance and further research subjects of this animal model will be discussed. We believe that the present rabbit model of lymphoma with specific chromosomal abnormalities is very useful for clarifying the role of EBV in human EBV‐associated lymphoma and provides a means for studying prophylactic and therapeutic regimens.
Solitary infantile myofibromatosis in the femur
Authors: Yamamoto Tetsuji , Mizuno Kosaku , Hanioka Keisuke
Published: March 2003

We report on a case of the solitary type of infantile myofibromatosis of the right femur in an 11‐month female. Radiographically, a well‐defined osteolytic lesion was seen in the diaphysis of the right femur. Pathological study revealed that the spindle‐shaped cells with eosinophilic cytoplasm were arranged in a fascicular and intertwining fashion. The cleft‐shaped vascular spaces were observed between tumor nodules. Immunohistochemical staining caused many tumor cells to react for vimentin, α‐smooth muscle actin and desmin. Ultrastructural study revealed numerous thin and intermediate types of filaments in the cytoplasm of the cells. To our best knowledge, this is the third reported case of solitary infantile myofibromatosis of long bones.
Peripheral primitive neuroectodermal tumor of the small bowel mesentery: A case showing perforation at onset
Authors: Horie Yasushi , Kato Masako
Published: March 2003

A case of peripheral primitive neuroectodermal tumor of the small bowel mesentery with an uncommon clinical onset is reported. A 40‐year‐old man was admitted to hospital because of acute severe abdominal pain. Chest X‐ray revealed a free air sign beneath the diaphragm. At emergency surgery a mass measuring 11.0 × 8.0 cm with perforation was located in the jejunal mesenteric region. Histologically the resected lesion consisted of sheets of undifferentiated small round cells forming abortive Homer Wright rosettes. Some spindle‐shaped cells showed perivascular pseudorosettes. Immunohistochemical study revealed that the tumor cells expressed positivity against CD99 (MIC2), neuron‐specific enolase, synaptophysin and vimentin. To the authors’ knowledge this is the first documentation of peripheral primitive neuroectodermal tumor of the small bowel mesentery with perforation at onset.
Reactive follicular hyperplasia in the lymph node lesions from systemic lupus erythematosus patients: A clinicopathological and immunohistological study of 21 cases
Authors: Kojima Masaru , Nakamura Shigeo , Morishita Yasuyuki , Itoh Hideaki , Yoshida Katsue , Ohno Yoshihiro , Oyama Tetsunari , Asano Shigeyuki , Joshita Takashi , Mori Shigeo , Suchi Taizan , Masawa Nobuhide
Published: March 2003

To clarify the clinicopathological and immunohistological findings of reactive follicular hyperplasia in systemic lupus erythematosus (SLE) lymphadenopathy, we examined 21 such cases, including four males and 17 females. Three main patterns could be delineated: pattern A, histological features of Castleman’s disease (n= 6); pattern B, follicular hyperplasia with pronounced arborizing vasculature in the paracortex resembling T‐zone dysplasia with hyperplastic follicles (n= 6); and pattern C, follicular hyperplasia without any other specific findings (n= 9). The patients who showed patterns A and B on histology were all female with a median age of 36 years, and presented with the lymphadenopathy within 4 months, some before a definitive diagnosis could be made. The group with pattern C included four males and five females with an age ranging from 20 to 58 years (mean, 37 years). In seven of them, the lymphadenopathy was noted 6 months or more after the therapy had been initiated. In a virological study, a small to moderate number of the lymphoid cells were positive for the Epstein–Barr virus‐encoded small RNA in five of 10 cases examined. Human herpesvius 8 was not detected in the four cases examined by polymerase chain reaction and immunohistochemistry. The present study demonstrated that SLE lymphadenopathy showed histological variety and occasionally represented histopathological findings of multicentric Castleman’s disease or findings similar to T‐zone dysplasia with hyperplastic follicles in the biopsied specimens. We emphasize that careful attention to these morphological features, together with clinical and laboratory examinations, should allow a firm diagnosis of SLE to be made, providing information that is pertinent to the treatment of the disease. Moreover, disarray of the follicular dendritic cell (FDC) network, which could be easily detected by immunohistochemistry, was found in approximately 60% of our series. SLE lymphadenopathy should be listed as one of the diseases occasionally associated with disarray of the FDC network, although its clinicopathological significance remains unclear.
Alpha‐fetoprotein producing uterine corpus carcinoma: A hepatoid adenocarcinoma of the endometrium
Authors: Toyoda Hiroshi , Hirai Takeshi , Ishii Eiko
Published: March 2003

A case of alpha‐fetoprotein (AFP) producing endometrial carcinoma in a 60‐year‐old Japanese woman is presented. The patient complained of abnormal vaginal bleeding of 10 days’ duration. On admission a uterine corpus mass and high serum AFP concentration (31950 ng/mL) was noted. There was no tumorous lesion in any other organ radiographically and endoscopically. Histologically, the biopsy specimen taken from the uterine mass showed a poorly differentiated endometrial carcinoma and a radical hysterectomy was subsequently performed. The postoperative serum AFP value transiently decreased with chemotherapy, however, lung metastases were found and the patient died 12 months following surgery. The resected uterus had a necrotic tumor, 6 × 5 × 4 cm in size, filling the endometrial cavity, characterized by exophytic growth with infiltration in the myometrium. Histologically, the tumor was composed of the main medullary carcinoma area with microcysts and admixed small areas of well‐differentiated endometrioid adenocarcinoma, accompanied by a smooth transition with one another. In both the areas, the tumor cells had immunoreactive AFP, alpha‐1‐antitripsin, albumin, transferrin, carcinoembryonic antigen, CA19‐9, and epithelial membrane antigen. There was no histologic evidence for a germ cell tumor. Based on these findings, this uterine corpus tumor was regarded as hepatoid variant of endometrial carcinoma. Although the histogenesis remains controversial, we assume the hypothesis that the tumor may arise in the endometrium per se in association with abnormal differentiation of muellerian duct elements.
Thymidine phosphorylase expression causes both the increase of intratumoral microvessels and decrease of apoptosis in human esophageal carcinomas
Authors: Okamoto Eiji , Osaki Mitsuhiko , Kase Satoru , Adachi Hironobu , Kaibara Nobuaki , Ito Hisao
Published: March 2003

Thymidine phosphorylase (dThdPase)/platelet‐derived endothelial cell growth factor, is expressed at higher levels in tumor tissues compared to the adjacent normal tissues in a variety of human carcinomas. The higher expression is associated with an increase of intratumoral microvessel density (IMVD) and an unfavorable patient prognosis. We examined the role of dThdPase in apoptosis, IMVD, P53 expression and patient prognosis of human stages II and III esophageal squamous cell carcinomas (SCC). dThdPase expression was noted in 52 of the 78 esophageal SCC (66.7%), regardless of tumor stages and histologic grades. Mean IMVD was 117.9 ± 32.6 in the dThdPase‐positive cases and 103.1 ± 21.5 in the dThdPase‐negative cases, the value being significantly higher in the former (P < 0.05). Similarly, median (range) apoptotic index (AI: percentage of apoptotic cells) was significantly lower in the dThdPase‐positive SCC, 1.8 (0.4–6.5), than in the dThdPase‐negative SCC, 3.7 (0.6–7.0) (P < 0.01). AI and IMVD showed a significant inverse correlation (r= − 0.31, P = 0.005). There was also no significant difference in the frequency of P53 expression between the dThdPase‐positive SCC and the negative SCC. No statistical difference was noted regarding the postoperative survival rate between the dThdPase‐positive and the negative SCC. Although dThdPase expression was not associated with patient prognosis, the expression provided an advantage for tumor growth of human esophageal SCC, not only by increasing the intratumoral microvessels, but also attenuation of apoptosis, which might occur via a p53 gene‐independent pathway.
HHV8‐negative primary effusion lymphoma of the peritoneal cavity presenting with a distinct immunohistochemical phenotype
Authors: Tanaka Shinya , Katano Harutaka , Tsukamoto Kenichi , Jin Mooran , Oikawa Sumie , Nishihara Hiroshi , Sawa Hirofumi , Sawada Kenichi , Shimizu Michio , Sata Tetsutaro , Fujioka Yasunori , Nagashima Kazuo
Published: March 2003

Primary effusion lymphoma (PEL) has been recognized as a body‐cavity‐based lymphoma that was originally reported to be associated with human herpes virus 8 (HHV8) infection, and was frequently found in human immunodeficiency virus‐positive (HIV) patients. Here we describe an autopsy case of PEL of the peritoneal cavity in an immunocompetent patient. Cytological analysis of tumor cells within ascites revealed immunocytochemical features of keratin positivity and CD45 negativity. At autopsy, the presence of a massive volume of ascites as well as diffuse tumor cell infiltrates within the serosa of the intestine and mesenterium were observed. Tumor cells were morphologically similar to anaplastic large‐cell lymphoma, but were immunohistochemically positive for keratin and epithelial membrane antigen (EMA). They also showed no reactivity to representative lymphocyte surface markers including CD45, in addition to being negative for CD30 and p80NPM/ALK. Molecular analysis of the tumor cells revealed monoclonality of the immunoglobulin heavy‐chain gene rearrangement which demonstrated a lymphoma of the B‐cell lineage. Furthermore, HHV8 was not detected by immunohistochemical analysis, PCR or nested PCR technique. Based on these results, we consider the present case to be an HHV8‐negative PEL with keratin and EMA positivity.
Ataxia telangiectasia with vascular abnormalities in the brain parenchyma: Report of an autopsy case and literature review
Authors: Kamiya Makoto , Yamanouchi Hideo , Yoshida Takatomo , Arai Hanako , Yokoo Hideaki , Sasaki Atsushi , Hirato Junko , Nakazato Yoichi , Sakazume Yuka , Okamoto Kouichi
Published: March 2003

A 25‐year‐old man was admitted to the Department of Neurology, Gunma University Hospital, in June 1997. He had an intellectual disability and had suffered from repeated infection since childhood. Cerebellar ataxia had developed at 19 years of age and he had been clinically diagnosed with ataxia telangiectasia (AT) comprising cerebellar ataxia and oculocutaneous telangiectasia at 24 years of age. He died from pneumonia and renal failure at 26 years of age. Neuropathological examination revealed Purkinje cell loss and atrophy of the dentate nuclei in the cerebellum, anterior horn‐cell atrophy and demyelination of the gracile fasciculi in the spinal cord, and the existence of nucleocytomegalic cells in the anterior pituitary gland. These neuropathological findings correlated with previously reported cases of AT. In addition, spongy degeneration was found, predominantly around the blood vessels in the cerebral cortex. Diffuse spongy degeneration and multiple foci of coagulative necrosis with calcification were noted in the white matter. Abnormal vasculature was noted in both degenerative and necrotic areas in the cerebral cortex and in the white matter. The vessels at the center of the areas of spongy degeneration in the cerebral cortex had irregularly arranged and enlarged smooth‐muscle‐cell nuclei and a distorted, narrow lumen. The vessels present in the white matter were hyalinized. To our knowledge, these vascular abnormalities in the brain parenchyma have not been reported previously.
Extra‐abdominal desmoid tumor presenting as an intrathoracic tumor: Case report and literature review
Authors: Takeshima Yukio , Nakayori Fumio , Nakano Tomohiro , Shimizu Katsuhiko , Yamashita Yoshinori , Toge Tetsuya , Inai Kouki
Published: March 2003

A case of an extra‐abdominal desmoid tumor presenting as an intrathoracic tumor (intrathoracic desmoid tumor) in a 46‐year‐old woman is reported. The tumor originated in the left chest wall and protruded into the left pleural cavity. Simple resection was carried out. The tumor, measuring 13 × 9 × 7 cm, was solid, gray–tan in color, and covered with parietal pleura. Histologically, the tumor was composed of a hypocellular arrangement of spindle‐shaped cells with a fibromyxoid background. In some areas, keloid‐like hyalinized collagen fibers proliferated, and a perivascular hypercellular area was seen. Immunohistochemical analysis showed that the cytoplasms of the tumor cells were strongly positive for vimentin, and some tumor cells were positive for α‐smooth muscle actin, but all tumor cells were negative for CD34. These findings were consistent with the characteristics of an intrathoracic desmoid tumor. The differential diagnoses, in particular solitary fibrous tumor and tumors with a myofibroblastic nature, are discussed.
Uterine angiomyolipoma: Case report and review of the literature
Authors: Yaegashi Hiroshi , Moriya Takuya , Soeda Syu , Yonemoto Yukinori , Nagura Hiroshi , Sasano Hironobu
Published: March 2003

Extrarenal angiomyolipomas (AML) have been reported at various anatomical sites, but infrequently in the gynecological region. In the uterus, only a few cases have been described. We describe a uterine angiomyolipoma occurring in a 40‐year‐old woman without evidence of tuberous sclerosis. The tumor arose on the right wall of the uterine body and was partially cystic, and it was associated with marked degeneration. It was composed of mature adipose tissue, anomalous blood vessels and non‐vascular smooth muscle cells. Immunohistochemistry revealed that non‐ vascular smooth muscle cells were positive for α‐smooth muscle actin (α‐SMA), desmin, vimentin, antihuman muscle actin (HHF35) and progesterone receptor (PR), and negative for cytokeratin, antihuman melanoma (HMB45), CD34, S‐100 and estrogen receptor (ER). It is of particular interest that non‐vascular smooth muscle cells were negative for HMB45, in contrast to renal and other extrarenal AML in which HMB45 immunoreactivity has been demonstrated in these cells.
New markers for pancreatic islets and islet cell tumors
Authors: Tomita Tatsuo
Published: March 2003

Islets of Langerhans account for 2 g of endocrine tissue in the pancreas, comprising approximately one million islets, with each containing 1000 endocrine cells. The major hormone secreted from the islets is insulin, which regulates blood glucose, the main fuel of the body. Islets also secrete glucagon, somatostatin and pancreatic polypeptide and all are involved in the paracrine mechanism. Islet cells can be stained immunohistochemically for the general endocrine markers, chromogranin A, synaptophysin, neuron‐specific enolase and Leu7. Beta islet cells are well equipped with glucose transporter 2, which binds to glucose and regulates diffusion of glucose through the beta cell membrane. As all four islet hormones are initially synthesized as prohormones, all islet cells are equipped with prohormone convertase 1/3 and 2. In addition, islet cells also contain zinc‐containing matrix metalloproteinases and their inhibitors, metallothionein, cyclin‐dependent kinases and insulin‐like growth factors, and many more hormones, peptides and enzymes. Thus, islets not only secrete insulin and other pancreatic hormones but are a complex organ whose major function is glucose homeostasis.
Quantitative immunohistochemical evaluation of MIB‐1 labeling index in adult soft‐tissue sarcomas by computer‐assisted image analysis
Authors: Hasegawa Tadashi , Yamamoto Seiichiro , Matsuno Yoshihiro
Published: March 2003

We have found that the MIB‐1 grade, based on tumor differentiation/histological type, necrosis and Ki‐67 (MIB‐1) score, is a valid and reproducible prognostic system for adult soft‐tissue sarcomas. However, there are limited data available on Ki‐67 labeling indices (LI) from adult soft‐tissue sarcomas for testing the validity of quantitative image analysis . In this study, the records of 146 adult patients with soft‐tissue sarcomas of the extremities and trunk were retrieved, and MIB‐1 immunostaining was carried out for the grading. The counted MIB‐1 LI values and the scores estimated from microscopic observation were defined as the gold standard. The correlation between MIB‐1 LI as assessed by computer‐assisted image analysis and by microscopic observation was determined. The image analysis ‐based MIB‐1 LI was highly correlated with the microscopic observation‐based MIB‐1 LI (r = 0.87, 95% confidence interval (CI) = 0.82–0.92). In addition, agreement between the MIB‐1 scores was very high (kappa statistic = 0.83, 95% CI = 0.75–0.91), as was the percentage agreement (89%, 95% CI = 82.8–93.6%) between the results from image analysis and microscopic observation. We conclude that quantitative immunohistochemical evaluation of MIB‐1 LI by image analysis enables pathologists to improve interobserver agreement in the assessment of MIB‐1 score, and can help to objectively assign the correct histological grade to cases of adult soft‐tissue sarcoma, resulting in optimal clinical management.
Reassessment and clinicopathological prognostic factors of malignant fibrous histiocytoma of soft parts
Authors: Oda Yoshinao , Tamiya Sadafumi , Oshiro Yumi , Hachitanda Yoichi , Kinukawa Naoko , Iwamoto Yukihide , Tsuneyoshi Masazumi
Published: March 2003

Recently, the category of malignant fibrous histiocytoma (MFH) has been under discussion and new entities resembling MFH have appeared. To clarify the recent situation regarding MFH, we reassessed previously diagnosed MFH cases in accordance with the most up‐to‐date diagnostic criteria, which included allied tumors. We carefully reassessed 428 cases that had been diagnosed in our institute during the past 28 years. Moreover, we searched for clinicopathological prognostic factors among the cases that were finally diagnosed as MFH. Among the 428 cases, 138 cases had their diagnoses changed. The revised cases included 78 leiomyosarcomas (57%; ordinary leiomyosarcoma, 45 cases; pleomorphic leiomyosarcoma, 23 cases; myxoid leiomyosarcoma, 10 cases), 12 liposarcomas (9%; pleomorphic liposarcoma, 11 cases; dedifferentiated liposarcoma, one case), seven dermatofibrosarcoma protuberans (5%), six unclassified sarcomas (4%), five primary or metastatic carcinomas (4%), four low‐grade fibromyxoid sarcomas (3%), four inflammatory myofibroblastic tumors (3%), three rhabdomyosarcomas (2%), three malignant peripheral nerve sheath tumors (2%), three acral myxoinflammatory fibroblastic sarcomas (2%) and two atypical fibroxanthomas (1.5%). Among the 1974 soft tissue sarcomas registered in our institute, MFH (428 cases) had been the most common sarcoma, followed by liposarcoma, leiomyosarcoma and rhabdomyosarcoma. However, after reassessment, leiomyosarcoma proved to be the most common soft tissue sarcoma (322 cases), followed by 290 MFH, 273 liposarcomas and 202 rhabdomyosarcomas. Among these 290 cases finally diagnosed as MFH, survival data were available in 189 cases. Tumor location in the abdominal cavity, the retroperitoneum or the head and neck (P = 0.0024), tumor size of 5 cm or more (P < 0.0001), deep tumor location (P < 0.0001), high histological grade (grade 3) based on the French Federation of Cancer Centers’ grading system (P = 0.0007), and high stage (stage III or IV) based on the American Joint Committee on Cancer (AJCC) staging system (P < 0.0001) were significantly worse prognostic factors by univariate analysis. In multivariate analysis, deep tumor location and high AJCC stage were independent adverse prognostic factors. We conclude that leiomyosarcoma is the most important differential diagnosis for MFH, especially pleomorphic leiomyosarcoma from storiform–pleomorphic type and myxoid leiomyosarcoma from myxoid type. Tumor depth and AJCC stage are the most important predictive prognostic factors in MFH.
Prognostic value of combined analysis of cyclin D1 and estrogen receptor status in breast cancer patients
Authors: Hwang Tae Sook , Han Hye Seung , Hong Yun Chul , Lee Hun Jae , Paik Nam‐Sun
Published: March 2003

The amplification of cyclin D1, located on chromosome 11q13, in breast cancer patients has been found to be associated with reduced relapse‐free and overall survival; however, there still exists strong controversy about these findings. In order to evaluate the prognostic value of cyclin D1 and other prognostic variables in human breast cancers, we have assessed estrogen receptor (ER) status, cyclin D1, c‐erbB2 and p53 overexpression in 175 primary breast carcinomas, and investigated the relationships of prognostic variables to the patient clinical outcome and the association between cyclin D1 overexpression and other prognostic variables. There was some degree of variability in staining intensities and proportions within the same tumor. The overexpression of both cyclin D1 and ER revealed a significantly prolonged survival in univariate analysis (P = 0.020). Among the various prognostic variables, distant metastasis showed a statistically significant association with overall survival. A significant correlation was observed between cyclin D1 overexpression and small size of the primary tumor (P = 0.031), low Bloom and Richardson's histological grade (P = 0.001), and positive ER status (P = 0.000). In contrast to what was previously expected, the present study suggests that the overexpression of cyclin D1 has a tendency to have a positive clinical outcome and a potential role in identifying a subset of patients predicting a good prognosis, particularly when ER is coexpressed.
Pulmonary capillaritis associated with the antiphospholipid antibody syndrome and rapid response to plasmapheresis
Authors: Waterer Grant W , Latham Bruce , Waring Justin A. , Gabbay Eli
Published: March 2003

Objective:

Pulmonary capillaritis is an uncommon complication of antiphospholipid antibody syndrome but has important therapeutic implications.

Case Report:

A patient with antiphospholipid antibody syndrome presented with haemoptysis and respiratory failure. Investigation including open lung biopsy, demonstrated vasculitis as the underlying pathology, rather than thrombosis. The patient responded promptly to methyprednisolone, cyclophosphamide and plasmapheresis.

Conclusion: Plasmapheresis has not previously been described in this setting and the rapid response suggests that it should be considered in severe disease.
Computed tomography or ultrasonically guided pigtail catheter drainage in multiloculated pleural empyema: A recommended procedure?
Authors: Maier Alfred , Domej Wolfgang , Anegg Udo , Woltsche Michael , Fell Birgit , Pinter Hans , Smolle‐JÜttner Freyja M.
Published: March 2003

Objectives:

The role of image‐guided pigtail catheter drainage in the treatment of pleural empyema is associated with different outcomes, dependent on the stage of the disease. No agreement concerning its use exists.

Methodology: Fourteen patients at a fibropurulent stage of pleural empyema initially treated with computed tomography (CT) or ultrasonically guided pigtail catheter drainage were reviewed. All patients were admitted with clinical symptoms of sepsis. Chest X‐ray, CT scan and/or ultrasonography and thoracentesis with biochemical examination revealed multiloculated pleural empyema. Despite the diagnosis of multiloculated empyema, CT or ultrasonically guided pigtail catheter drainage was performed. However, septic symptoms deteriorated and all cases proceeded to thoracotomy with decortication.

Results: Image‐guided drainage failed in all patients. Septic symptoms disappeared within 24– 48 h after decortication. The patients recovered without sequela, were discharged 6–15 days (mean: 9.2 days) postoperatively and were able to return to normal physical activity.

Conclusions: Computed tomography or ultrasonically guided pigtail catheter drainage can not be recommended in the case of a fibropurulent stage of empyema thoracis.
Reperfusion lung injury after unilateral pulmonary artery occlusion
Authors: Permpikul Chairat , Wang Huan‐You , Kriett Jolene , Konopka Ronald G. , Moser Kenneth M. , Spragg Roger G.
Published: March 2003

Objective:

To test the hypothesis that reperfusion of the canine lung after 1 week of vascular occlusion results in acute injury of the reperfused lung with concurrent impairment in gas exchange.

Methodology: In 11 conditioned dogs, the left pulmonary artery was completely occluded by a vascular clip placed at thoracotomy. One week later, at repeat thoracotomy, the clip was removed in six animals (reperfused group) but left in place in five (sham group). Bronchoalveolar lavage fluid (BAL) components, gas exchange, haemodynamics and histological alterations were examined.

Results: During occlusion, the mean pulmonary artery pressure and pulmonary vascular resistance increased significantly, and after 6 days there was a significant increase in ventilation to high ventilation perfusion ratio (V/Q) areas. With reperfusion, the previously occluded lung demonstrated, in comparison to the contralateral lung, a significant increase in BAL cellularity and neutrophil fraction, gross and histological evidence of oedema, and impaired surfactant activity. Shunt fraction, measured by the inert gas technique, also increased only after reperfusion, although mild hypoxaemia occurred in both groups. Endothelial abnormalities and perivascular oedema were noted in both groups, but were more marked in the reperfused lungs.

Conclusion: Reperfusion of the canine lung after 1 week of complete occlusion resulted in evidence of mild acute lung injury. The aetiology of this injury was multifactorial.
Management and treatment perceptions among young adults with asthma in Melbourne: The Australian experience from the European Community Respiratory Health Survey
Authors: Reid David , Abramson Michael , Raven Joan , Walters Haydn E.
Published: March 2003

Objectives:

As part of the European Community Respiratory Health Survey (ECRHS) in 1992–1993 we assessed management practices and treatment perceptions among young asthmatic adults in Melbourne, Australia.

Methodology:

We conducted a postal questionnaire survey of 4500 randomly selected adults (aged 20–44 years), drawn from three electoral districts, of whom 3200 (71%) subjects responded. A randomly selected sample of 1642 respondents, ‘enriched’ by a further 433 symptomatic subjects, was invited to complete a second phase respiratory questionnaire.

Results:

The questionnaire was completed by 757 subjects who underwent laboratory testing. A further 119 subjects who were unable to attend the laboratory completed an identical questionnaire by telephone interview (42% response rate). In the second phase, 16% of subjects reported ‘current asthma’ (group I) as defined by physician confirmation and a recent attack (within 1 year), 10% had confirmed asthma but reported no recent attack (group II) and 74% did not have asthma (group III). Inhaled corticosteroid use was significantly higher in group I than in group II subjects (45%vs 24%, P < 0.01), but only 11% of asthmatic subjects overall reported daily prophylactic use. Regular treatment in any form was considered to be ‘bad’ by 65% of asthmatic subjects and only 43% took medication as prescribed all of the time.

Conclusion:

Despite national education campaigns, the majority of young asthmatic adults in Melbourne did not adhere to prescribed treatment, but continued to rely upon β2‐agonists alone with neglect of regular inhaled corticosteroid which has probably contributed to Australia's continued high asthma morbidity and mortality rates.
Clinicopathological features of chronic hypersensitivity pneumonitis
Authors: HAYAKAWA HIROSHI , SHIRAI MASAHIRO , SATO ATSUHIKO , YOSHIZAWA YASUYUKI , TODATE AKIHITO , IMOKAWA SHIRO , SUDA TAKAFUMI , CHIDA KINGO , TAMURA RYOJI , ISHIHARA KYOUSUKE , SAIKI SHIGEKI , ANDO MASAYUKI
Published: March 2003

Objective: Only limited information exists concerning the clinical and pathological features of chronic hypersensitivity pneumonitis (HP) in Japan and elsewhere. We present data on clinicopathological features of chronic HP obtained through a Japanese nationwide survey.

Methodology: We studied the clinical and pathological findings in 10 patients with chronic HP who underwent surgical lung biopsy or postmortem examination.

Results: There were three types of clinical course: six of the 10 patients had persistent symptoms followed by repeated acute episodes; two showed a subacute onset with persistent symptoms; and two exhibited an insidious onset. Five patients made no attempt to avoid antigen exposure and they all had progressive disease. Pathological findings indicated that lesions were mainly centrilobular with or without epithelioid cell granulomas in specimens obtained during the acute or subacute stage. In contrast, most patients in the chronic stage predominantly showed interstitial fibrosis with a usual interstitial pneumonia pattern.

Conclusions: The pathological findings of chronic HP depend on the stage of the disease at tissue sampling.