bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of bright light at lunchtime on sleep in patients in a geriatric hospital II
Authors: Fukuda Noriko , Kobayashi Riko , Kohsaka Masako , Honma Hiroshi , Sasamoto Yoichi , Sakakibara Satoshi , Koyama Emi , Nakamura Fumihiro , Koyama Tsukasa
Published: March 2003

Inpatients with sleep disturbances in a geriatric hospital received 1 h of exposure to approximately 8000 lx bright light per day for 3 weeks. Polysomnogram was recorded for four female patients. Two (aged 68 and 87 years) were non‐demented patients with weak cataracts and the other two (aged 92 and 93 years) were demented patients with severe cataracts. Electroencephalogram results showed that light exposure decreased the proportion of Stage W, while increased the proportion of Stage 2, and these effects continued for at least 3 weeks after the cessation of light exposure. These results suggest that exposure to bright light is effective in improving the disturbed sleep of patients.
The effects of oral melatonin on the autonomic function in healthy subjects
Authors: Kitajima Tsuyoshi , Kanbayashi Takashi , Saitoh Yasushi , Ogawa Yuriko , Sugiyama Tomonari , Kaneko Yoshihiko , Sasaki Yoshiko , Aizawa Rika , Shimisu Tetsuo
Published: March 2003

We investigated the influence of melatonin on the human autonomic functions by measuring muscle sympathetic nerve activity (MSNA). Five healthy male volunteers took 3 mg of melatonin, and their plasma melatonin concentration, blood pressure, heart rate, and burst rate of MSNA were then recorded. The peak level of melatonin concentration showed a marked interindividual variation. Blood pressure was reduced significantly, while heart rate and burst rate of MSNA did not change significantly. These results indicate that melatonin has a hypotensive effect on blood pressure, and the central cardiovascular regulatory mechanism such as lowering of the baroreflex setpoint would be involved in the effect.
Olanzapine versus haloperidol in the treatment of patients with chronic schizophrenia: Results of the Japan multicenter, double‐blind olanzapine trial
Authors: Ishigooka Jun , Inada Toshiya , Miura Sadanori
Published: March 2003

Abstract This randomized double‐blind trial was conducted to test the efficacy and safety of olanzapine in Japanese patients with schizophrenia. Importantly, this study also represents the first large clinical trial of olanzapine conducted in an Asian population. Patients (n = 182) were randomly assigned to treatment with olanzapine or haloperidol over a period of 8 weeks. The primary analyses included: (i) a test of non‐inferiority of olanzapine compared with haloperidol in efficacy using the Final Global Improvement Rating (FGIR); and (ii) comparison between the treatment groups in extrapyramidal symptom severity using the Drug‐Induced Extrapyramidal Symptoms Scale (DIEPSS). Olanzapine was comparable to haloperidol in efficacy in treating positive symptoms and significantly superior in treating negative symptoms. Extrapyramidal symptom severity was significantly improved for olanzapine‐treated patients versus haloperidol‐treated patients. Olanzapine was shown to be more effective and better tolerated than haloperidol in the treatment of Japanese patients suffering from chronic schizophrenia.
Differential judgement of static facial expressions of emotions in three cultures
Authors: Huang Yueqin , Tang Siu , Helmeste Daiga , Shioiri Toshiki , Someya Toshiyuki
Published: March 2003

Judging facial expressions of emotions has important clinical value in the assessment of psychiatric patients. Judging facial emotional expressions in foreign patients however, is not always easy. Controversy has existed in previous reports on cultural differences in identifying static facial expressions of emotions. While it has been argued that emotional expressions on the face are universally recognized, experimental data obtained were not necessarily totally supportive. Using the data reported in the literature, our previous pilot study showed that the Japanese interpreted many emotional expressions differently from USA viewers of the same emotions. In order to explore such discrepancies further, we conducted the same experiments on Chinese subjects residing in Beijing. The data showed that, similar to the Japanese viewers, Chinese viewers also judged many static facial emotional expressions differently from USA viewers. The combined results of the Chinese and the Japanese experiments suggest a major cross‐cultural difference between American and Asian viewers in identifying some static facial emotional expressions, particularly when the posed emotion has negative connotations. The results have important implications for cross‐cultural communications when facial emotional expressions are presented as static images.
Muscle weakness in a Japanese family of Arg1239His mutation hypokalemic periodic paralysis
Authors: Kusumi Masayoshi , Kumada Hiroko , Adachi Yoshiki , Nakashima Kenji
Published: March 2003

Abstract Familial hypokalemic periodic paralysis is an autosomal dominant disorder. Recently, three predominant mutations were found in the muscle dihydropyridine‐sensitive calcium channel alpha 1‐subunit gene. We present a Japanese family that displays one of these, the Arg1239His mutation. All the affected individuals of this family displayed this mutation. Two cases had a history of recurrent episodes of muscle weakness and difficulty in running before their first paralytic attack. It is suggested that there are no racial differences with this mutation, and that mild muscle weakness occurs not only after but also preceding the first attack.
Global intellectual deterioration in Alzheimer’s disease and a reverse model of intellectual development: An applicability of the Binet scale
Authors: Shimada Masumi , Meguro Kenichi , Inagaki Hiroki , Ishizaki Junichi , Yamadori Atsushi
Published: March 2003

Abstract Since intellectual deterioration in Alzheimer’s disease (AD) might be considered to demonstrate a reverse of the intellectual development of children, we herein investigated the applicability of the Tanaka‐Binet Intelligence scale (TB scale). This scale can assess the mental age (MA) and the lower‐limit age (LLAge) values, and was reported to be correlated with the tasks determining Piaget’s developmental stages of intelligence. Thirty AD patients and 30 age‐matched normal control subjects were examined with the scale. We found that the mean MA values of the AD patients and controls were 97.4 and 150.3 months, respectively. In the control group, there were significant correlations between the MA and chronological age, and between the MA and years of education. In the AD patients, there was a significant correlation between the MA and the MMSE score. Regarding the LLAge for the AD patients, similar to the theory of Piaget, there was a tendency that they could be classified into three LLAge groups. We consider that the TB scale is useful in assessing the intellectual function in AD patients.
Mental health of two communities of Japanese‐Brazilians: A comparative study in Japan and in Brazil
Authors: Miyasaka Lincoln Sakiara , Otsuka Koichiro , Tsuji Keisuke , Atallah Alvaro Nagib , Kunihiro Joseph , Nakamura Yoshikazu , Kato Satoshi , Abe Yu , Kamada Yoshiro
Published: March 2003

Abstract The aim of the present study was to assess the mental health status of Japanese‐Brazilians
living in Kiyoharadai, Japan and compare the findings with the Japanese‐Brazilians
living in Bauru, Brazil. A comparative community‐based mental health survey was conducted
from November 1997 to April 1999 on a randomly selected sample of Brazilians of Japanese
descent living in Bauru, Brazil (n = 213) and on the entire Brazilian community
of Kiyoharadai, Utsunomiya, Japan (n = 158), using the self‐reporting questionnaire
(SRQ‐20). Analysis was done by χ2, Fisher and multiple logistic regression. Scores indicating probable cases of minor psychiatric disorders, were found in 3.2% of the community in Bauru city and 17.8% (OR = 7.01) of the community in Kiyoharadai. The sociodemographic data indicated that those with high SRQ‐20 scores were most likely to be female (OR = 2.98), smokers (OR = 2.76), and those whose former occupation was student when living in Brazil (OR = 9.57). The mental health status of the Japanese‐Brazilians living in Kiyoharadai, Japan is significantly worse than that of the community living in Bauru, Brazil, particularly among women, smokers and those who were students when living in Brazil. Further research concerning the mental health of this community is necessary and assistance provided.
Decreased blood flow of the left thalamus during somnolent episodes in a case of recurrent hypersomnia
Authors: NOSE IWAO , OOKAWA TOSHIHIDE , TANAKA JUNJI , YAMAMOTO TAKASHI , UCHIMURA NAOHISA , MAEDA HISAO , KUWAHARA HIROO
Published: March 2003

Abstract A 24‐year‐old male with recurrent hypersomnia associated with decreased blood flow in the thalamus on single photon emission computed tomography (SPECT) is reported. In the hypersomnolent period, the decrease of blood flow in the left thalamus was revealed in the SPECT and slow waves appeared sporadically or sometimes as a burst on the electroencephalogram (EEG). In a phase of insomnia in the convalescent period there were almost no slow waves in the resting EEG but many slow waves appeared on hyperventilation EEG and the power spectrum at this hyperventilation resembled the power spectrum at the resting EEG in the hypersomnolent period. In the remission period there was no abnormal data in these testings.
Napping predicts responsiveness to hypnotics in patients with primary circadian rhythm disorder
Authors: NAKAJIMA TORU , KAJIMURA NAOFUMI , KATO MASAAKI , WATANABE TSUYOSHI , HORI TORU , TAKAHASHI KIYOHISA
Published: March 2003

Abstract It is hypothesized that one of the primary abnormalities of primary circadian rhythm

disorder (PCRD) is the strong link between any episode of sleep and circadian rhythm.

To test this hypothesis, the relationship between napping and responsiveness to hypnotics

was examined in 12 patients with PCRD. A significant association was found (P

= 0.04, χ2 test). Patients with PCRD who napped were all responders to hypnotics. The results suggest a strong link between episodes of sleep and circadian rhythm in some patients with PCRD, and might also suggest the heterogeneity of PCRD. Napping in patients with PCRD may be a predictor for responsiveness to hypnotics. In addition, napping and responsiveness to hypnotics might have a clinical value to differentiate PCRD from secondary CRD.
Studies on fetal forelimb movements by using a wrist actigraph in sheep
Authors: ZHANG SHI‐QING , KOZUMA SHIRO , TANAKA MIO , LING DONGHUI , KITANO YOSHIHIRO , FUJII TOMOYUKI , BABA KAZUNORI , TAKETANI YUJI
Published: March 2003

Abstract The purpose of this study was to investigate whether an actigraph can be a tool for measuring fetal movements in sheep. Actiwatches™ were placed on a fetal forelimb and the maternal uterine wall in near‐term pregnant sheep. No significant correlation was found between fetal and maternal activity counts for periods of 1 min. The patterns of fetal activity counts were characterized by ultradian rhythms, with bursts of activity every 20–30 min; however, there was no evidence of diurnal changes in fetal activity counts. The results suggest that fetal movements can be measured by using an actigraph in chronically prepared fetal sheep.
Brain potentials associated with the onset and offset of rapid eye movement (REM) during REM sleep
Authors: OGAWA KEIKO , NITTONO HIROSHI , HORI TADAO
Published: March 2003

Abstract The relationship between dreaming and rapid eye movements (REM) during REM sleep is still controversial. This study records the brain potentials time‐locked to the onset and offset of REM in 11 healthy young volunteers. Before the onset of REM, no presaccadic readiness potential was found. Conversely, two positive potentials (P1 and P2) appeared following the offset of REM. The latter potentials were dominant in the parieto‐occipital area. These findings suggest that REM is initiated without preparation but elicits some information‐processing activities that were speculated to occur in the cortical visual area. The data support the activation–synthesis or association hypothesis of dreaming rather than the scanning hypothesis.
Prevalence of insomnia in various psychiatric diagnostic categories
Authors: OKUJI YASUKO , MATSUURA MASATO , KAWASAKI NAOKO , KOMETANI SINOBU , SHIMOYAMA TAKAKO , SATO MITSUGU , OGA KENTARO , ABE KOICHI
Published: March 2003

Abstract Sixty percent of 536 new referrals to a psychiatric clinic at a general hospital complained of insomnia. Prevalence was high in all psychiatric categories, especially in physiologic disorders, somatoform disorders and mood disorders, followed by epilepsy. Complaints of difficulty in falling asleep were high in the physiologic and somatoform disorder groups. Complaints of nocturnal awakening were high in the anxiety and physiologic disorder groups, while complaints of early morning awakening were high in the organic and mood disorder groups. Prescription rates of hypnotics was most prevalent in the mood and adjustment disorder groups, whereas a non‐pharmacological approach, including psychological education and behavioral therapy, was applied mainly to the physiologic disorder group.
Sleep health and lifestyle of elderly people in Ogimi, a village of longevity
Authors: TAIRA KAZUHIKO , TANAKA HIDEKI , ARAKAWA MASASHI , NAGAHAMA NAOKI , UZA MIYOKO , SHIRAKAWA SHUICHIRO
Published: March 2003

Abstract The study was conducted in the Prefecture of Longevity, Okinawa, on the elderly living in the village of Ogimi. It was revealed that those in the good sleep health group took short naps, a significantly fewer number fell into dozes, and a significantly greater number exercised regularly or walked. A significantly greater number of this group maintained regular eating habits over a 10‐year span, and consumed more seaweed and fish. Participation in senior citizens’ clubs was higher, reflecting high emotional adaptability. The study’s results indicates a relationship between lifestyle and sleep health among the elderly, and suggest that deterioration of sleep health is related to physical and mental health.
Serial magnetic resonance angiography in cerebral infarction after varicella infection
Authors: KIMURA MASAHIKO , HASEGAWA YUKI , SEJIMA HITOSHI , INOUE MAKOTO , YAMAGUCHI SEIJI
Published: March 2003

The case of a 1‐year‐8‐month‐old‐boy with cerebral infarction after varicella infection is reported here. Brain magnetic resonance (MR) angiography revealed segmental narrowing of the left middle cerebral artery which became normal 8 months later. The MR angiography well demonstrated the time course of the vascular involvement in the present patient. In cerebral infarction after varicella infection, the proximal portion of the main cerebral arteries were frequently damaged therefore MR angiography is useful for diagnosis and therapeutic decision‐making. Moreover, serial MR angiographic studies can clarify the natural course of vascular changes in varicella virus‐related cerebral infarction.
Long‐, intermediate‐ and short‐acting benzodiazepine effects on human sleep EEG spectra
Authors: Tan Xin , Uchida Sunao , Matsuura Masato , Nishihara Kyoko , Kojima Takuya
Published: March 2003

Abstract The effects of 10 mg haloxazolam (HAX), 4 mg flunitrazepam (FNZ), and 0.5 mg triazolam (TRI), each administered for seven consecutive nights were studied in the sleep electroencephalograms (EEG) of 17 (six HAX, five FNZ and six TRI) healthy male student volunteers. Recordings of C3–A1 EEG data from one baseline night, three drug nights (first, fourth and seventh) and two withdrawal nights (second and fourth) were analyzed using a fast Fourier transformation method. All three drugs induced similar changes in the 0.5 Hz to 40 Hz power spectrum; namely (i) higher frequency (including the sigma and beta bands) activity increased and lower frequency activity reduced on the drug nights; (ii) the enhancement of sigma activity peaked during non‐rapid eye movement sleep following the first administration and was maintained at high levels on all drug nights; (iii) beta activity increased through the night after administration of HAX and FNZ, but not TRI, which suggests a blood concentration level dependent increase of beta activity; and (iv) only HAX showed a residual effect on the fourth withdrawal night. These results indicate that (i) chronic administration of these three benzodiazepine derivatives produce similar profiles in sleep EEG spectral changes, with some differences depending on their half‐lives and doses; (ii) the mechanism of sigma enhancement is sensitive to even the initial administration night of BDZ; and (iii) frequencies below and above the sigma band are less sensitive to BDZ and also show an increase through the night after administration, suggesting differences in the mechanisms reflected by these EEG frequency bands.
Psychological distress among evacuees of a volcanic eruption in Japan: A follow‐up study
Authors: Ohta Yasuyuki , Araki Kenichi , Kawasaki Naomi , Nakane Yoshibumi , Honda Sumihisa , Mine Mariko
Published: March 2003

Abstract Psychological distress in 248 evacuees from a volcanic eruption was evaluated using a 30‐item General Health Questionnaire (GHQ‐30) at four time points after evacuation: 6 months, 12 months, 24 months and 44 months. The proportion of evacuees with psychological distress (defined as a GHQ score ≥ 8) significantly decreased from 66.1% (6 months) to 45.6% (44 months). The GHQ mean score significantly improved from 12.6 to 8.9. Investigation of each factor on the GHQ showed progressive improvement over time in ‘anxiety, tension and insomnia’ and ‘anergia and social dysfunction’. However, ‘depression’ began to improve only after 44 months and ‘interpersonal dysfunction’ started to worsen after 12 months. The dysfunction in interpersonal relationships continued at 44 months. Examination of the relation between GHQ mean scores and age group showed that recovery from psychological distress was more difficult in middle‐aged and older evacuees than in younger evacuees.
Renal adenomatosis associated with carcinoma of the lower urinary tract: A case report with immunohistochemical study
Authors: Kizaki Tomohiko , Ugai Kazuhiro , Hirano Hiroshi , Gohji Kazuo , Fujii Akio
Published: March 2003

A case of renal adenomatosis of the left kidney associated with a carcinoma of the ipsilateral ureter in a 49‐year‐old man is examined. One hundred and eight adenomas, which were smaller than 15 mm in diameter, and a single microcarcinoma, which measured 1 mm in diameter, were found in the kidney. Further, there were more than 800 hyperplastic lesions which could be classified into three groups: (i) 792 of distal origin; (ii) 24 of proximal origin; and 10 of collecting duct origin. The serial sections obtained from 19 paraffin blocks were stained using Leu M1 as the proximal marker and epithelial membrane antigen (EMA) as the distal/ collecting marker to assist in determining the origins. Ten of the small adenomas (15 lesions), which did not exceed 3 mm in diameter, were predominantly positive for EMA and five were predominantly positive for Leu M1. Further, hyperplastic lesions of distal and collecting duct origins were diffusely positive for EMA and sporadically positive for Leu M1. The lesions of proximal origin were predominantly positive for Leu M1 and sporadically positive for EMA. These findings suggest that a progression from hyperplasia and a direct transition from a single tubule to adenoma occurred multifocally in different segments of the nephrons throughout the left kidney.
An evaluative system for the response of antibacterial therapy: Based on the morphological change of Helicobacter pylori and mucosal inflammation
Authors: Wen Min , Zhang Yali , Yamada Nobutaka , Matsuhisa Takeshi , Matsukura Norio , Sugisaki Yuichi
Published: March 2003

The diagnostic standard is an important factor in the evaluation of the antibacterial effect to Helicobacter pylori (H. pylori). Few studies have evaluated the bacterial morphological change. In the present study, H. pylori was examined by means of electron microscopy (EM), light microscopy (LM) and immunohistochemical staining. Patients were followed up from 6 weeks to more than 1 year after treatment for H. pylori, and the results of the 13C‐urea breath test (UBT) were compared. A ‘4‐L’ evaluative system was used for histological diagnosis; that is, complete, significant, partial and negative response for H. pylori treatment. Complete response showed no H. pylori in histology, and positive 13C‐UBT and negative response showed positive in both diagnoses. A significant response showed the morphology of H. pylori was thick walled by EM, that there was no obvious active inflammation, and was negative for C‐UBT. These H. pylori showed a coccoid form and possibly static bacteria, which was resistant to further antibacterial therapy. The ‘4‐L’ system could evaluate the antibacterial effect, suggesting the necessity for a second line of therapy for H. pylori. It is suggested that this sensitive evaluative system is suitable for clinical applications for antibacterial therapy.
Preservation of pathological tissue specimens by freeze‐drying for immunohistochemical staining and various molecular biological analyses
Authors: Matsuo Shinji , Sugiyama Taketoshi , Okuyama Takazo , Yoshikawa Kiyotsugu , Honda Kazuo , Takahashi Rei , Maeda Sakan
Published: March 2003

Conditions of preserving DNA, RNA and protein in pathological specimens are of great importance as degradation of such macromolecules would critically affect results of molecular biological analysis. The feasibility of freeze‐drying as a means of preserving pathological tissue samples for molecular analysis has previously been shown. In the present study, further tests on long‐term storage conditions and analyses of freeze‐dried samples by polymerase chain reaction (PCR), reverse transcriptase (RT)‐PCR, western blotting and immunohistochemistry are reported. Rat chromosomal DNA of freeze‐dried samples stored for 4 years showed slight degradation while RNA degradation was more prominently seen at an earlier stage of storage. However, these 4 year DNA and RNA samples were still able to serve as a template for some PCR and RT‐PCR analyses, respectively. Overexpression of c‐erbB‐2 and p53 protein was demonstrated by western blotting and immunohistochemical staining using freeze‐dried human breast cancer tissues. Although macromolecules in freeze‐dried samples degrade to some extent during the preservation period, they should still be of value for certain molecular biological analyses and morphological examination; hence, providing more convenient and inexpensive ways of pathological tissue storage.
Degenerative processes of elastic fibers in sun‐protected and sun‐exposed skin: Immunoelectron microscopic observation of elastin, fibrillin‐1, amyloid P component, lysozyme and α1‐antitrypsin
Authors: Suwabe Hisako , Serizawa Akihiko , Kajiwara Hiroshi , Ohkido Muneo , Tsutsumi Yutaka
Published: March 2003

Degenerative processes of elastic fibers in sun‐protected and sun‐exposed skin were analyzed by light and electron microscopic (post‐embedding) immunocytochemistry using antisera to elastin, fibrillin‐1, amyloid P component, lysozyme and α1‐antitrypsin. To assess the effect of aging and sun exposure, biopsy specimens of sun‐protected skin (back) and severely and moderately sun‐exposed skin (face and forearms) were obtained from a young age group (1–27 years), an adult group (31–56 years) and an old aged group (61–100 years). Elastin and fibrillin‐1 were the essential components of elastic fibers; elastin being localized in the electron‐lucent matrix and fibrillin‐1 in the dense microfibrillar strands. Aging and sun exposure provoked degenerative condensed spots, which represented widened dense microfibrillar strands, in the matrix of altered elastic fibers in the reticular dermis. Amyloid P component was first deposited on the peripheral microfibrils, and then in the intermediate density zone of the spots. Lysozyme was observed in both the electron‐dense core and in the intermediate density zone of the spots. Deposition of lysozyme correlated with basophilic degeneration of the elastic fibers. In the severely photodamaged facial skin of the aged, which showed solar elastosis in the upper reticular dermis, fibrillin‐1 immunoreactivity was lost from the thickened and vacuolated elastic fibers that lacked condensed spots, and amyloid P component, lysozyme and α1‐antitrypsin were diffusely deposited in the elastin‐positive matrix. It seemed that amyloid P component deposition on the elastic fibers was closely associated with aging, while immunoreactive lysozyme was related to sun exposure. Vertically oriented, thin, elastic (oxytalan) fibers in the papillary dermis tended to decrease with age, with frequent deposition of amyloid P component but no lysozyme. In the facial skin of the aged, dermal papillae disappeared, with the formation of degenerative elastic globules beneath the dermal–epidermal junction. The present study demonstrated an intimate relationship between ultrastructural alterations and deposition of exogenous substances on the degenerative elastic fibers in sun‐exposed and/or aged skin.
Clinicopathological findings of virus‐associated hemophagocytic syndrome in bone marrow: Association with Epstein‐Barr virus and apoptosis
Authors: Ohshima Koichi , Shimazaki Kae , Sugihara Midori , Haraoka Seiji , Suzumiya Junji , Kanda Motomu , Kawasaki Chika , Kikuchi Masahiro
Published: March 2003

Non‐neoplastic hemophagocytic syndrome (HPS), also called virus‐associated hemophagocytic syndrome (VAHS), has been thought to be a distinct clinical entity. A spontaneous recovery is common, but the prognosis of Epstein‐Barr virus (EBV)‐associated VAHS is poor. However, the role of EBV has yet to be clearly elucidated. A retrospective study of the bone marrow of 30 cases, in which the diagnosis of non‐neoplastic VAHS was clinicopathologically confirmed, was performed. We were unable to histologically confirm the presence of neoplastic lesions, especially lymphoma cell infiltration. Ten of the patients were children (aged less than 15 years) and young adults (aged under 20 years; median age, 10 years). Twenty patients were adults (aged over 21 years; median age, 48 years). Twelve of these patients died, while 18 showed a spontaneous recovery. We performed immunological staining and in situ hybridization (ISH) for EBV. To clarify the presence of apoptosis, an in situ apoptosis detection (tunnel) method was used. In situ hydridization showed an EBV‐presence in 16 of the 30 patients. In addition, the EBV‐presence was confined in the lymphocytes, especially T lymphocytes in double stainings. The number of EBV‐infected cells varied; however, the EBV presence was associated with ages. Nine of the 10 children and young adults showed an EBV‐presence, while EBV was detected in seven of the 20 adults. Especially in 10 patients aged over 49 years, no EBV was detected. According to the in situ apoptosis detection, apoptotic cells were increased in number and considered to be lymphoid cells, but not myeloid or histiocytic cells. Some apoptotic cells were phagocyted with histiocytes. Histologically, apoptosis may be one of the factors that induced phagocytosis.
Ameloblastoma with basal cell carcinoma‐like feature emerging as a nasal polyp
Authors: Kato Noriko , Endo Yasushi , Tamura Gen , Motoyama Teiichi
Published: March 2003

A case of a 63‐year‐old man with ameloblastoma with basal cell carcinoma (BCC)‐like features clinically emerging as a nasal polyp is reported. The left nasal cavity was filled with a solid mass, which seemed to be a sinusitis‐associated nasal polyp. The polyp was covered by parakeratotic squamous epithelium which was directly connected to the BCC‐like tumor nest. The BCC‐like features gradually changed to adamantinoid features. The polyp was connected with a huge mass filling the maxillary sinus and the molar area, which consisted of conventional ameloblastoma features. Although the tumor was finally diagnosed as an ameloblastoma of the maxilla, the biopsy specimen forced us to face the problem of differential diagnosis, ameloblastoma with BCC‐like features or adamantinoid basal cell carcinoma (BCC). Immunohistochemical examination revealed that tumor cells of the ameloblastoma reacted with anticytokeratin antibody KL‐1 but not with antiepithelial antibody Ber‐EP4, and these reaction patterns were completely contrary to those of BCC. It is emphasized that immunohistochemical examination using anticytokeratin antibody KL‐1 and antiepithelial antibody Ber‐EP4 is a good tool for distinguishing ameloblastoma with BCC‐like features from adamantinoid BCC.
Low‐grade malignant perineurioma of the paravertebral column, transforming into a high‐grade malignancy
Authors: Karaki Shino , Mochida Joji , Lee Yoon Hwan , Nishimura Kazuhiro , Tsutsumi Yutaka
Published: March 2003

A demarcated 6 × 5 cm right paravertebral tumor at the level of T6 in a 39‐year‐old male was removed surgically. Histologically, the tumor consisted of monomorphous benign‐looking, low‐cellular spindle cells embedded in desmoplastic stroma. Ten years later, the tumor recurred locally with metastasis to systemic organs, including the occipital skin. Malignancy was histologically evident by the increased cellularity, cellular atypia and mitotic activity. The patient died of respiratory failure at the age of 49. Retrospectively reviewed, the primary lesion was low‐grade fibrosarcoma‐like spindle cell tumor, with secondary transformation into a highly malignant form. The differential diagnoses included sclerosing epithelioid fibrosarcoma, low‐grade fibromyxoid sarcoma and malignant peripheral nerve sheath tumor. Immunohistochemically, the spindle cells in the primary and recurrent tumors consistently expressed epithelial membrane antigen, vimentin, type 4 collagen and laminin. The tumor cells in the present case showed a differentiation toward perineurial cells, which are normally positive for these immunohistochemical markers. Hence, the appropriate diagnostic term should be ‘malignant perineurioma’, a subtype of malignant peripheral nerve sheath tumor.
Adenocarcinoma at the esophageal gastric junction arising in an 11‐year‐old girl
Authors: Sasaki Hideyuki , Sasano Hironobu , Ohi Ryoji , Imaizumi Masue , Shineha Ryuzaburo , Nakamura Megumi , Shibuya Daisuke , Hayashi Yutaka
Published: March 2003

Gastric adenocarcinoma is one of the most common gastrointestinal (GI) malignancies, especially among Japanese adults, but represents only 0.05% of all malignant pediatric GI tumors. We report a case of gastric adenocarcinoma arising at the esophageal gastric junction of an 11‐year‐old girl. The tumor was polypoid, measuring 3.0 × 3.0 × 1.2 cm and was light gray and partially red in color with a stalk. Light microscopic examination of the lesion demonstrated adenocarcinoma of variable degrees of both architectural and nuclear atypia with invasion into the submucosa. Immunohistochemical findings of cytokeratin subtypes revealed positive immunoreactivity for cytokeratin subtypes 8, 19 and 20 and negative for 5/6/18, 7, 13 and 14, which is consistent with those of gastric adenocarcinoma. The patient was alive and well 12 months postoperatively.
Duodenal somatostatinoma: A case report and review of 31 cases with special reference to the relationship between tumor size and metastasis
Authors: Tanaka Sayuri , Yamasaki Shigetaka , Matsushita Hiroshi , Ozawa Yasunori , Kurosaki Atsuko , Takeuchi Kazuo , Hoshihara Yoshio , Doi Takehiko , Watanabe Gorou , Kawaminami Katsuhiko
Published: March 2003

Somatostatinomas are rare functioning neoplasms usually arising in the pancreas and duodenum. We report a case of somatostatinoma in a 42‐year‐old male with neither neurofibromatosis nor somatostatinoma syndrome. A large tumor in the descending duodenum had given rise to multiple lymph node metastases. An additional 31 duodenal somatostatinoma cases were also reviewed. Most originated in the descending part of the duodenum, with the ampulla and peri‐ampullary area as the most common sites (60%). Frequent manifestations were abdominal pain (25%), jaundice (25%), or cholelithiasis (19%), the latter two reflecting obstruction of the bile duct by tumors. Only two cases showed a possible somatostatinoma syndrome (6%). The tumors with metastases, lymph nodes (10) and liver (2), were significantly larger than average than those without (2.91 ± 1.49 cm vs 1.36 ± 0.71 cm, P< 0.05). With a cut‐off point of 2.0 cm, diagnostic accuracy for metastasis was 77.78% with 87.50% specificity and 63.64% sensitivity. The smallest tumor with metastases was 0.8 cm and the largest without metastases was 3.0 cm. These results indicate that duodenal somatostatinomas are malignant by nature and the risk of metastasis significantly increases with tumors larger than 2.0 cm.
Ovarian gonadoblastoma with mixed germ cell tumor in a woman with 46,XX karyotype and successful pregnancies
Authors: Zhao Shumei , Kato Noriko , Endoh Yasushi , Jin Zhe , Ajioka Youichi , Motoyama Teiichi
Published: March 2003

An extremely rare case of unilateral gonadoblastoma with mixed germ cell tumor arising in the ovary of a 27‐year‐old woman with 46,XX karyotype and two successful pregnancies is reported. The mixed germ cell tumor was composed of choriocarcinoma, embryonal carcinoma, yolk sac tumor, immature teratoma and dysgerminoma. The patient has been well, without evidence of disease for over 10 years since her first surgery and adjuvant chemotherapy.
Participation of macrophages in glomerular sclerosis through the expression and activation of matrix metalloproteinases
Authors: Shiozawa Satoshi
Published: March 2003

In order to investigate the role of macrophages in glomeruli in the progression of glomerular sclerosis, methyl‐cellulose (MC) was administered intraperitoneally to Wistar rats, in addition to intravenous injection of anti‐thy1‐1 antibody. In this group of rats (Thy‐1 + MC group), many macrophages infiltrated in the lytic mesangium accompanied by rupture of capillary loops at an early stage and stayed with abundant deposition of mesangial matrices until day 35, whereas the proliferative lesions following mesangiolysis almost vanished in the rats treated with anti‐thy1‐1 antibody alone (Thy‐1 group). In immunostaining, matrix metalloproteinase (MMP)‐9 was expressed along regenerating capillaries of the Thy‐1 group and in extracapillary lesions of the Thy‐1 + MC group after day 7. In gelatin zymography, the gelatinolytic band for MMP‐9 was expressed much more strongly in the Thy‐1 + MC group than in the Thy‐1 group at day 3, but it was expressed a little more strongly in the Thy‐1 group than in the Thy‐1 + MC group at day 7. The bands for an active form of MMP‐2 were more strongly expressed in the Thy‐1 + MC group than in the Thy‐1 group throughout the experimental period. These results suggest that persistent accumulation of macrophages in mesangium induces glomerular sclerosis through expression and activation of MMP.
Chondrosarcomatous differentiation in metastatic deposit of serous papillary cystadenocarcinoma
Authors: Domoto Hideharu , Mano Yoshinori , Kita Tsunekazu , Kikuchi Yoshihiro , Sato Kimiya , Aida Shinsuke , Tamai Seiichi
Published: March 2003

A rare case of serous papillary cystadenocarcinoma of the ovary showing chondrosarcomatous differentiation in a metastatic deposit late in the clinical course is reported. A 49‐year‐old female underwent a total abdominal hysterectomy with bilateral salpingo‐oophorectomy for bilateral ovarian tumors. Histological diagnosis was serous papillary cystadenocarcinoma of both ovaries with lymph node metastasis. After six courses of chemotherapy, she was confirmed to be in complete remission following a second laparotomy. Following additional chemotherapy, a third laparotomy disclosed swollen left inguinal lymph nodes. In one of these nodes, approximately 5.0 cm in greatest diameter, the predominant histological features were: chondrosarcoma of the bone and soft tissue, with small foci of serous papillary adenocarcinoma and squamous epithelium. A histological transition between mesenchymal and epithelial areas was identified. Immunohistochemical positivity for broad‐spectrum cytokeratin (AE1/AE3), vimentin, epithelial membrane antigen, and S‐100 protein was observed in both chondrosarcomatous and epithelial areas. The current evidence may suggest that the chondrosarcomatous differentiation was derived from the metastatic epithelial component.
Sclerosing encapsulating peritonitis and non‐occlusive mesenteric infarction found at autopsy in a man who had undergone continuous ambulatory peritoneal dialysis: A histochemical and immunohistochemical study
Authors: Ohmori Takaaki , Ohnishi Sachiko , Okada Kazuyo , Arita Norimasa
Published: March 2003

This is a report of a post‐mortem histological, histochemical, and immunohistochemical examination of a rare case of sclerosing encapsulating peritonitis (SEP) and non‐occlusive mesenteric infarction (NOMI), two serious complications of continuous ambulatory peritoneal dialysis (CAPD), with which a man suffering hepatitis C virus (HCV)‐induced liver cirrhosis for 7 years and trauma‐induced paraplegia for 50 years had been treated for 1 year. The direct cause of death was encephalopathy caused by extreme hyperammonemia (11 250 μg/dL in serum). The autopsy revealed that the SEP had drastically reduced the length of the small intestine to 210 cm, 180 cm of which presented acute ischemic enteritis with Gram‐negative bacterial infection. Histological examination of the SEP revealed that the exterior was composed of normal serosal elastic lamina, but with a cocoon‐like appearance remarkably thickened by fibrosis to 3–8 times that of the normal subserosal layer and consisting of spindle cells and blood vessels, with some infiltration of mast cells and lymphocytes. The immunohistochemical examination of the spindle cells revealed few AE1/AE3(+) cells, HHF35(+) cells, and CD34(+) cells, many CD117(+) cells with slight proliferative activity based on MIB‐1 positivity (proliferation index <1%), but no CD44(+) cells. It was concluded that either the few CD34(+) and/or the many CD117(+) cells were mesenteric stem cells that had originated from the serosa, proliferated, then differentiated into myofibroblasts or fibroblasts, producing collagen and hyaluronic acid in the matrix, leading to the gradual formation of the SEP, which was induced by the continual irritation of CAPD.
Microsatellite instability and alteration of E2F‐4 gene in adenosquamous and squamous cell carcinomas of the stomach
Authors: Woo Dong Kyun , Lee Won Ae , Kim Yong Il , Kim Woo Ho
Published: March 2003

Microsatellite instability (MSI) due to defective DNA mismatch repair (MMR) is a form of genomic instability underlying the tumorigenesis of various human neoplasms. To evaluate the roles of MSI in the pathogenesis of gastric carcinomas with squamous differentiation, 17 primary stomach cancer patients (15 adenosquamous and two squamous cell carcinomas) were examined for MSI frequency using five microsatellite markers and the criteria for MSI recommended by the National Cancer Institute Workshop. The molecular causes and consequences of MSI in these neoplasms were further researched through the immunohistochemistry of MMR proteins and the mutational analysis of cancer‐associated genes targeted by MSI, respectively. Two of the 17 (12%) cases demonstrated MSI at the most examined loci and were classified as having high level MSI (MSI‐H). These tumors also exhibited frame‐shift mutations at mononucleotide repeats in the target genes, including TGFβRII, IGFIIR, BAX, and hMSH6. It is interesting to note that the mutations of the serine (AGC)13 repeats within the E2F‐4 gene were found only in the squamous cell carcinoma portions of them, whereas such alterations were not detected in any of the adenocarcinomatous portions. This suggests that E2F‐4 might be implicated in the transformation of adenocarcinoma into squamous cell carcinoma and further studies are needed to understand its role in squamous differentiation.
Corresponding distributions of increased endothelin‐B receptor expression and increased endothelin‐1 expression in the aorta of apolipoprotein E‐deficient mice with advanced atherosclerosis
Authors: Kobayashi Tsutomu , Miyauchi Takashi , Iwasa Satoshi , Sakai Satoshi , Fan Jianglin , Nagata Michio , Goto Katsutoshi , Watanabe Teruo
Published: March 2003

Endothelin (ET)‐1 causes proliferation of vascular smooth muscle cells (VSMC). Although it has been reported that stimulation of ETB receptors as well as ETA receptors promote proliferation of VSMC, the precise distribution of each receptor subtype in atherosclerotic vessels is unknown. Previous studies demonstrated that apolipoprotein E (apoE)‐deficient mice have hypercholesterolaemia and develop severe atherosclerosis. To investigate the pathophysiological roles of vascular ET system in atherosclerosis, we examined preproET‐1 messenger ribonucleic acid expression in the aorta of apoE‐deficient mice, and performed immunohistochemical staining for ET‐1 and each ET receptor subtype (ETA and ETB receptors) in the atherosclerotic lesions of these mice. The level of preproET‐1 mRNA in the aorta was significantly higher in the apoE‐deficient mice than in the control mice. Strong ET‐1 staining was observed in the macrophage‐foam cells, intimal and medial VSMC in the atherosclerotic lesions of the apoE‐deficient mice. In addition, in the atherosclerotic lesions, strong ETB receptor staining was observed in the macrophage‐foam cells, intimal and medial VSMC, which distribution corresponded closely to that of ET‐1. ETA receptor staining was observed in the medial VSMC of both groups, but not in the macrophage‐foam cells of the apoE‐deficient mice. ETA receptor staining in the medial VSMC was stronger in the apoE‐deficient mice than in the control mice. These results suggest that the vascular ET system, including ET‐1 and ET receptors, is activated in the atherosclerotic lesions of apoE‐deficient mice. Since the distribution of strong ETB receptor staining corresponded closely to that of ET‐1, it is suggested that the ET system, mediated by ETB receptors, has an important role in the pathophysiology of the atherosclerotic lesions of apoE‐deficient mice.
Ultrastructure of early phase hepatic metastasis of human colon carcinoma cells with special reference to desmosomal junctions with hepatocytes
Authors: Shimizu Sadatoshi , Yamada Nobuya , Sawada Tetsuji , Ikeda Kazuo , Nakatani Kazuki , Seki Syuichi , Kaneda Kenji , Hirakawa Kosei
Published: March 2003

To demonstrate ultrastructural events in the early phase of hepatic metastasis of human colon carcinoma, we intrasplenically injected a highly metastasizable, human colon carcinoma cell line LM‐H3 (1 × 106 cells) into nude mice, and electron microscopically investigated the hepatic metastasis. At 24 h, tumor cells adhered to the endothelial wall of terminal portal venules and periportal sinusoids. At 48–72 h, after extravasation, they deeply invaded the hepatic cell plate and the interstitial tissue of the portal tract, in which they underwent proliferation and made the metastatic foci. Tumor cells were linked with each other or with surrounding hepatocytes by desmosomes. Desmosomes were maintained during the mitosis. When invading tumor cells were exposed to the bile canaliculi, they generated microvilli on the surface. Microvilli were also formed at the luminal surface of intracytoplasmic inclusions. In the interstitial tissue of the portal tract, tumor cells were closely associated with fibroblasts. However, no junctional specializations were seen between them. The present study demonstrated that human colon carcinoma cell line LM‐H3 formed desmosomes with hepatocytes soon after invasion of the hepatic cell plate, suggesting the regulatory role of an interaction with hepatocytes in the growth of metastatic foci within the liver parenchyma.
INDETERMINATE RESULTS IN CORE BIOPSIES OF BREAST FROM MAMMOGRAPHICALLY DETECTED LESIONS: OUTCOMES OF EXCISION BIOPSY
Authors: J Harvey , GF Sterrett , FA Frost
Published: March 2003

INTRODUCTION: Protocols for excision of mammographically detected lesions following core biopsy include all diagnoses of atypical ductal hyperplasia (ADH) or intraductal atypia of uncertain significance (AUS). The aims of this study were to look at: i) the prevalence of reporting ADH and AUS, ii) the proportion of cases where excision revealed breast carcinoma, iii) whether any cases could be downgraded to hyperplasia on review.

METHODS: Breast core biopsy reports from the SCGH Breast Centre for the years 1999–2000 were retrieved. The results of excision biopsy were obtained and slides reviewed.

RESULTS: There were 1048 core biopsies from 911 women. Breast carcinoma was diagnosed in 197 samples (18.8%) including 88 with invasive carcinoma (8.4%), 109 with ductal carcinoma in situ (10.4%) and 3 samples (2.9%) suspicious of invasive carcinoma. The suspicious cases all proved to be invasive carcinomas. There were 53 samples (5.1%) with a diagnosis of ADH or AUS. 46 were excised, showing 7 invasive carcinomas 15 DCIS, 11 ADH, 2 lobular carcinoma in situ (LCIS), 1 mucocoele‐like lesion, 1 fibroadenoma and 9 fibrocystic change (FCC). The 22 malignancies represented 47.8% of the excised lesions. At review, 8 of the 53 original diagnoses were downgraded to benign hyperplasia; 5 underwent excision; 2 showed ‘incidental’ invasive carcinomas, 1 ‘incidental’ LCIS, 1 ADH and 1 FCC.

CONCLUSIONS: There was a low prevalence of reporting of ADH and AUS in core biopsies (5.1%) and a high rate of carcinoma (47.8%) in subsequent excision biopsies. Very few diagnoses of ADH/AUS were downgraded at review. Current protocols for excision of lesions with a core biopsy diagnosis of ADH/AUS appear to be justified.
Pathogenesis of β2‐microglobulin amyloidosis
Authors: Ohashi Kenichi
Published: March 2003

Hemodialysis‐related amyloidosis is a relatively new form of systemic amyloidosis, with β2‐microglobulin (B2M) being identified as the major constituent protein. Most of the clinical findings are related to amyloid deposition in osseo‐articular tissues. B2M amyloid deposits first appear in the cervical intervertebral discs, which are well known to be susceptible to mechanical stress. A close relationship between changes of microenvironment caused by such stress and amyloid deposition is highly suggested. In advanced cases, an inflammatory reaction composed of macrophages, multinucleated giant cells, and granulation tissue, is observed around the amyloid deposits. Purified amyloid protein is native B2M, and mutations and proteolysis are not believed to be important for its deposition. Plasma levels of B2M are elevated as much as 5–10 times because of the inability of hemodialysis equipment removal of B2M from blood plasma, the duration being very important for B2M amyloid fibrillogenesis. Heparan sulfate proteoglycans, perlecan, is increased at the same sites of amyloid deposits from the early stages. In B2M amyloidosis, an increase of heparan sulfate proteoglycans is observed in the vascular wall and synovium, but in the discs, ligaments and cartilage, there is an increase of chondroitin sulfate proteoglycans predominantly. B2M has an affinity for heparan sulfate proteoglycans, although it is weaker than that for laminin and type IV collagen. This is related to the interactions between negative charges of sulfate groups of proteoglycans and positive charges of basic amino acids in N‐terminal side of B2M. Increased cytokines production in the synovium, induced by advanced glycation end products as well as elevated plasma levels, is also linked to inflammatory reactions. Increased expression of matrix metalloproteinases (MMP), especially MMP‐1 and ‐9, is related to the destructive changes of the bone and cartilage. The decrease of plasma levels by high flux membrane and control of inflammatory reactions are very important for prevention of B2M amyloidosis.