bluuebunny/crossref_metadata_2025 huggingface dataset:
Potassium depletion in a healthy north‐eastern Thai population: No association with tubulo‐interstitial injury
Authors: LELAMALI KUMTORN , KHUNKITTI WIRUT , YENRUDI SAOWANEE , PANICHAPHONGSE VIRATT , HUIPRASERT LEANG , SITPRIJA VISITH , TUNGSANGA KRIANG
Published: March 2003

SUMMARY:  Potassium depletion prevails among the healthy population of north‐east Thailand, as well as among patients with certain metabolic disorders such as upper urinary tract stones, the sudden unexplained death syndrome, distal renal tubular acidosis and hypokalaemic periodic paralysis. However, definite proof of the relationship of potassium depletion and these metabolic disorders is lacking. We prospectively studied muscle and kidney potassium content including renal tissue pathology in three groups of healthy adult Thai subjects who died of vehicular accidents. Group 1 (n = 24) were Bangkok city dwellers; groups 2 (n = 10) and 3 (n = 22) lived in north‐eastern Thailand in the metropolitan area and in the villages, respectively. The muscle potassium content of group 1 (338.5 ± 9.6 mEq/kg dry weight (DW)) were similar to group 2 (307.9 ± 11.9 mEq/kg DW), but was greater than group 3 (295.4 ± 9.1 mEq/kg DW; P < 0.01). The kidney potassium content of group 1 (208.6 ± 7.8 mEq/kg DW) was significantly higher than group 3 (175.9 ± 6.3 mEq/kg DW, P < 0.05). In group 3, the muscle potassium correlated linearly with the kidney potassium (r = 0.455, P = 0.33). None of the group 3 patients had renal histopathological change compatible with a diagnosis of focal or diffuse interstitial nephritis.This study confirms that potassium depletion is common among healthy rural dwellers in north‐east Thailand. This deficit was probably chronic. However, there was minimal renal tubulo‐interstitial change.
Effect of haemodialysis on visual‐evoked potential parameters
Authors: DERICI ULVER , NAZLIEL BIJEN , İRKEÇ CEYLA , SINDEL ŞUKRU , ARINSOY TURGAY , BALI MUSA
Published: March 2003

SUMMARY: Different papers have emphasized the presence of visual‐evoked potential (VEP) abnormalities in metabolic disorders. The aim of this study was to perform pattern VEP (PVEP) recordings in patients with chronic renal failure just before and 24 h after dialysis to test the effect of this procedure on visual pathway generated parameters. Twenty‐four haemodialysis patients (M/F:14/10; mean age: 48.8 ± 14.1 years) were examined. None of them were complaining from visual difficulties or from visual loss. The recording sessions were performed just before and 24 h after dialysis. The control group consisted from 27 healthy subjects matched for age and sex. Eight (33%) patients demonstrated abnormal P100 latency prolongation in at least one tested eye (six patients in one tested eye, two in both eyes) in the recording session just prior to dialytic treatment. In the post‐treatment session, it was found that the abnormal P100 latencies that were present in six patients (75%) before dialysis had returned to normal, while in the remaining two (25%), the latency abnormality persisted. No correlation was found between VEP parameters and dialysis duration, serum blood urea nitrogen (BUN), creatinine, parathyroid hormone and haematocrit levels. However, a positive correlation in the intradialytic percentage variation of bodyweight with P100 latencies was found. Visual evoked potential is a reliable, simple and non‐invasive technique that can be used for the investigation and follow up of subclinical involvement of visual pathways in patients with chronic renal failure. Detected abnormalities in some uraemic patients are reversible by using dialysis.
An autopsied case of Creutzfeldt‐Jakob disease with the lateral geniculate body lesion showing antagonizing correlation between periodic synchronous discharges and photically induced giant evoked responses
Authors: Aoki Tatsuyuki , Kobayashi Katsuji , Jibiki Itsuki , Muramori Fumihiko , Hayashi Masahiro , Miyazu Kenji , Kobayashi Eiji , Koshino Yoshifumi , Yamaguchi Nariyoshi
Published: March 2003

We reported an necropsy finding of a patient with Creutzfeldt‐Jakob disease (CJD) who showed photo‐stimulated giant spikes that simultaneously suppressed periodic synchronous discharges (PSD) and the loss of pupillary light reflex during the course of the illness. The necropsy revealed extensive gray and white matter lesions, and both the lateral geniculate body (LGB) and pregeniculate body were primarily affected. The superior colliculus, optic nerve and tracts were not affected. The cerebral cortices particularly of the occipital lobe were severely damaged. The Gennari line, however, was spared from lesion. The primary involvement of the LGB has been reported infrequently in CJD, however, it appears to be associated with the unusual electroencephlograph (EEG) feature of the present case. The pregeniculate lesion contributed to the loss of pupillary reflex. This finding indicates that the visual pathway may be involved in the mechanism of the generation of PSD in CJD.
Electroencephalographic findings in functional psychoses: State or trait indicators?
Authors: SENGOKU AKIRA , TAKAGI SHUNSUKE
Published: March 2003

The clinical significance of electroencephalographic (EEG) changes in patients with functional psychoses is not yet clearly defined, particularly whether these changes are state indicators or trait indicators. In the present review, the EEG abnormalities in schizophrenia are discussed. In early EEG studies of schizophrenics, the various specific EEG patterns were suggested to be trait indicators, but those findings were not confirmed. The EEG patterns of some patients with catatonic schizophrenia, especially periodic catatonia, were thought to be episode or state indicators, and some of the patients diagnosed as having atypical psychoses in Japan were suggested to show state indicator EEG findings. As the computerized and spectral analyses of EEG have advanced, the contradictory findings of EEG in schizophrenia have been reported, interpreted as `hyperstable' or `hypernormal' EEG findings and `hypofrontal' EEG findings (slow waves in the frontal region). However, no conclusion can be made as to whether these EEG findings are state or trait indicators. On the borderland of functional psychoses, the behavioral changes in temporal lobe epilepsy were described as a trait indicator, and the psychotic states in non‐convulsive generalized status epilepticus and acute confusional states were suggested to be state indicators. Further studies of EEG abnormalities in schizophrenia are necessary from multi‐dimensional perspectives, including in comparison with the symptomatic psychoses.
Sleep patterns during 20‐m nitrox saturation dives
Authors: Seo Yoojin , Matsumoto Kazuya , Park Youngman , Mohri Motohiko , Matsuoka Shigeaki
Published: March 2003

The sleep patterns were examined through three simulated 20‐m nitrox saturation dives. The standard polysomnography of 12 divers was recorded respectively for a total of 204 nights, as were patterns of change or consistency in sleep variables. For the 11 divers in their 20s and 30s there was nothing unusual about their sleep variables. However, a reduction of total sleep time in accordance with the lengthening of sleep latency was observed. This was recognized from the latter part of the bottom period to the postdive period. This tendency was notable for the diver in his 50s. These findings suggest that the decompression environment and the psychological stress of the long‐term closed environment of a hyperbaric chamber have effects on divers’ sleep.
Cognitive therapy for a major depressive episode in residual schizophrenia
Authors: Inoue Kazuomi , Kawabata Shigeo
Published: March 2003

The present paper describes cognitive approaches to the treatment of a major depressive episode in a patient with residual schizophrenia. The goal of therapy was to increase and stabilize the patient’s physical activity through decreasing dysfunctional cognition pertinent to inertia. A therapeutic strategy of ‘scheduling activities’ was first selected, but to no effect. The vicious circle of alternating excessive activity and total inertia remained unchanged. Based on a revised cognitive case conceptualization, a second strategy, ‘scheduling inertia’, was then introduced, in which the patient was asked to stay in bed or take a rest for planned periods of time every day. This intervention helped the patient to counteract her perfectionist beliefs. The results suggest that ‘scheduling inertia’ may be a useful strategy for improving inactivity in a major depressive episode during the residual phase of schizophrenia.
Characteristics of bipolar II patients with interpersonal rejection sensitivity
Authors: Benazzi Franco
Published: March 2003

Abstract The study aim was to find the characteristics of bipolar II patients with the DSM‐IV atypical feature ‘interpersonal rejection sensitivity’ (IRS), a personality trait. A total of 145 bipolar II outpatients were interviewed using the Structured Clinical Interview for DSM‐IV and depression rating scales. Among the variables studied (age, age at onset, duration of illness, severity, gender, recurrences, psychosis, chronicity and comorbidity), age and age at onset were significantly lower, females more common, and psychotic features less common in bipolar II patients with IRS, suggesting that bipolar II disorder with IRS was not more severe.
A new adaptive temporal filter: Application to photosensitive seizure patients
Authors: Nomura Masahide , Takahashi Takeo , Kamijo Ken‐Ichi , Yamazaki Toshimasa
Published: March 2003

Abstract A new adaptive temporal filtering (ATF) technique was developed to prevent heath hazards due to flicker stimuli from televisions, videos or other displays. This ATF method could reduce frame‐to‐frame or field‐to‐field flicker stimuli at around 10–30 Hz which are particularly risky for photosensitive individuals. The present ATF efficacy with a computer simulation was studied in 11 photosensitive epilepsy patients. In order to control visual stimuli and induce photoparoxysmal response (PPR), we employed a problematic scene of the Pocket Monster incident containing 12 Hz red/blue flicker images lasting for 4 s. This image, shown with a 14‐inch television set 2 m in front of subjects, promptly elicited generalized PPR in all cases, while the filtered image did not induce any PPR. These results suggest that the present ATF method may be useful as a preventive measure of photosensitive seizures triggered by stimulative images from televisions or other displays.
Neurobiological basis of behavioral and psychological symptoms in dementia of the Alzheimer type
Authors: Shinosaki Kazuhiro , Nishikawa Takashi , Takeda Masatoshi
Published: March 2003

Abstract Recent dementia studies indicate that behavioral and psychological symptoms of dementia (BPSD) are not merely an epiphenomenon of cognitive impairment, but could be attributed to specific biological brain dysfunction. We describe findings from different research modalities related with BPSD (psychopathological, neuropsychological, neurochemical, and psychophysiological strategies), and attempt to reconcile them into the more integrated form. Characteristics of delusions in dementia patients should be studied in more detail from a psychopathological aspect, aiming for the integration of psychopathology and neurobiology. Imperfect integration of memory function and cognitive function, assigned to the limbic systems and association areas, respectively, may result in BPSD. More intimate collaboration of psychopathological and neurobiological study would be fruitful to promote the research in psychological basis of BPSD. Neurochemical studies indicated that density of extracellular tangles and/or PHF‐tau protein have relationships with delusion or misidentification. These changes in neurochemical parameters should be the key to understanding the pathogenesis of BPSD. More importantly, neurochemical and psychological study could be linked by the research in psychophysiology. Computer‐assisted electroencephalogram analysis suggests that the right posterior hemisphere shows significant age‐associated change earlier than the left in the elderly. Cerebral metabolic rate by positron emission tomography study indicates that paralimbic, left medial temporal, and left medial occipital area are involved in pathogenesis of BPSD in some dementia patients.
Haplotype analyses with the human leucocyte antigen and tumour necrosis factor‐alpha genes in narcolepsy families
Authors: Hohjoh Hirohiko , Terada Natsuko , Miki Tetsuro , Honda Yutaka , Tokunaga Katsushi
Published: March 2003

Abstract Our previous study suggested that the tumour necrosis factor‐alpha gene with thymine residue at position –857 in its promoter region [TNF‐α(–857T)] could be associated with human narcolepsy independently of a strong association of the human leucocyte antigen (HLA)‐DRB1*1501 with the disorder. To understand the relationship of DRB1*1501 with TNF‐α(–857T) in narcoleptic patients, we investigated 28 members of four Japanese narcolepsy families and determined the haplotypes with the HLA‐B, TNF‐α(–857C/T) and HLA‐DRB1 in the members. The resultant haplotypes indicated that not only the DRB1*1501‐TNF‐α(–857C) haplotype but also the DRB1*1501‐TNF‐α(–857T) haplotype, which is rare in healthy individuals and may have a strong predisposition to the disorder, were present in the affected members. From the chromosomal recombination observed in a few members, it is possible that chromosomal recombination could play a role in the generation of the rare DRB1*1501‐TNF‐α(–857T) haplotype.
Epileptic seizures and sleep–wake rhythm
Authors: Horita Hideki
Published: March 2003

The subjects were 25 children, including West syndrome, Lennox–Gastaut syndrome, childhood absence epilepsy (CAE) and localization‐related epilepsies. Clinical seizures occurred only during waking state in 14 patients (including the cases of West syndrome, CAE and epilepsy with myoclonic absences (EMA)), only during sleeping state (especially during non‐REM sleep in five patients, including the case of benign epilepsy with centrotemporal spike), and diffusely during waking and sleeping states in six patients (including the case of early infantile epileptic encephalopathy with suppression burst). These three types were observed in the cases of Lennox–Gastaut syndrome and localization‐related epilepsies. Subclinical ictal discharges occurred during REM sleep in West syndrome, and during REM and non‐REM sleep especially during non‐REM sleep in CAE and EMA.
Spatiotemporal changes of slow wave activities before and after 14 Hz/12 Hz sleep spindles during stage 2 sleep
Authors: Ueda Kazutaka , Nittono Hiroshi , Hayashi Mitsuo , Hori Tadao
Published: March 2003

The present study examined the spatiotemporal changes of slow wave (delta and theta bands) activities before and after 14 Hz/12 Hz sleep spindles during stage 2 sleep, using topographic mapping of electroencephalogram (EEG) power. Both types of sleep spindles appeared after slow wave activities of background EEG decreased. Moreover, the appearance of sleep spindles provided increasing EEG slow wave activities in the subsequent period. Further, the present results showed that an appearance of 14 Hz sleep spindle facilitated slow wave activities at the centro‐parietal areas, while an appearance of 12 Hz sleep spindle facilitated slow wave activities at the fronto‐central areas. These results suggest that sleep spindles provide cortical de‐arousal, and serve to maintain sleep.
Activation of visual cortex in REM sleep measured by 24‐channel NIRS imaging
Authors: Igawa Mariko , Atsumi Yoshikata , Takahashi Kazumi , Shiotsuka Shinichi , Hirasawa Hideto , Yamamoto Ryusei , Maki Atsushi , Yamashita Yuichi , Koizumi Hideaki
Published: March 2003

To visualize dreaming brain functions we studied hemodynamic changes in the visual cortex during the transition from non‐rapid eye movement (NREM) to rapid eye movement (REM) sleep, using a 24‐channel Near‐Infrared Spectroscopy (NIRS) imaging method. Results were compared to the activation in visual cortex by visual stimulation during wakefulness. Subjects were four healthy males between 25 and 49 years of age. Five all‐night polysomnographic and NIRS recordings were made. Increases in the oxygenated hemoglobin concentration in visual cortex were observed from nine of 14 REM periods. The activated areas were broader during REM sleep than during visual stimulation. These findings suggest that activation of visual cortex in REM sleep might represent dream‐related brain activity.
The manual zero potential shifting method in dipole analysis: Comparison with neuroimagings in a patient with epilepsy
Authors: Tanaka Kei‐Ichi , Wada Yuji , Nanbu Yuko , Nakagawa Tsutomu
Published: March 2003

Abstract We previously introduced the manual zero potential shifting (MZPS) method into dipole analysis to reduce the influence by error potential at the analytical stage. The source localizations of epileptic spikes as an equivalent current dipole (ECD) were estimated in a patient with symptomatic epilepsy and contrasted with findings obtained by magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT). When spikes were analyzed by the MZPS method, ECDs had high values of dipolarity, an indicator of ECD reliability. Moreover, their locations corresponded with lesions shown by MRI and SPECT. When the same spikes were analyzed by the conventional method, dipolarity values were declined and the locations did not correspond with lesions. These results provide further evidence that the MZPS method is of clinical utility in evaluating the electric source generator of epileptic spikes.
A case of brief psychosis associated with an arachnoid cyst
Authors: Bahk Won‐Myong , Pae Chi‐Un , Chae Jeong‐Ho , Jun Tae‐Youn , Kim Kwang‐Soo
Published: March 2003

Abstract Little is known about the arachnoid cyst and there have been few reports of it accompanying psychiatric disturbances. A 57‐year‐old patient was admitted due to sudden headache, auditory hallucination, and delusion of persecution. An arachnoid cyst was found in the anteromedial aspect of middle cranial fossa on his magnetic resonance image. This was his first psychotic episode and he was also negative to other clinical evaluations including endocrine system. His psychotic symtoms were suspected to be induced by the arachnoid cyst and it was well controlled by low‐dose risperidone administration. He left hospital free from psychotic symptoms on 14th hospital day.
Rapid eye movement‐localized apnea in a female patient with chronic insomnia
Authors: KAYUKAWA YUHEI , OKADA TAMOTSU , HAYAKAWA TOSHIJI , IMAI MAKOTO , TOMITA SATOE , TERASHIMA MASAYOSHI , LAN LI , OHTA TATSURO
Published: March 2003

A middle‐aged female patient with chronic insomnia showed rapid eye movement (REM)‐ localized obstructive sleep apnea. She visited the Sleep Disorders Clinic and complained of insomnia with loud snoring. Once, in the past, her sleep complaints had disappeared after weight reduction but, 6 months later, she complained of excessive daytime sleepiness. Overnight polysomnography revealed REM‐localized apnea. Careful follow up is strongly recommended for a female patient with chronic insomnia who shows REM‐localized apnea.
Firing properties of neurones in the laterodorsal hypothalamic area during sleep and wakefulness
Authors: KOYAMA YOSHIMASA , KODAMA TORU , TAKAHASHI KAZUMI , OKAI KEN , KAYAMA YUKIHIKO
Published: March 2003

Abstract In undrugged, head‐restrained rats, neuronal activity was recorded in and around

the laterodorsal hypothalamic area where orexin neurones are distributed. Among 22

neurones observed across whole sleep–waking states, half (n = 11) were

most active during paradoxical sleep and least active during waking. Others were

equally more active during paradoxical sleep and waking than during slow‐wave sleep

(n = 6), or were most active during waking and least active during paradoxical

sleep (n = 3). The majority of neurones started to increase firing activity prior to the transition of sleep–waking states. These results suggest that the area of the hypothalamus containing orexin neurones plays a role in sleep–waking regulation.
Primary hepatic carcinoid and neuroendocrine carcinoma: Clinicopathological and immunohistochemical study of five cases
Authors: Pilichowska Monika , Kimura Noriko , Ouchi Akio , Lin Hitoshi , Mizuno Yutaka , Nagura Hiroshi
Published: March 2003

Primary hepatic carcinoid and neuroendocrine carcinoma (NEC) are rare tumors. We experienced three carcinoids and two NEC originating in the liver during the past 25 years and attempted to elucidate the clinicopathological and immunohistochemical features of these tumors. The patients had no endocrine symptoms despite two of them having elevated plasma serotonin. Three of the five patients died of the tumor after operation with an average survival time of 20.6 months. All tumors were large (up to 26 cm in diameter), four of them solitary and one multinodular, and were not associated with liver cirrhosis. The carcinoid tumors showed insular, trabecular or glandular arrangement of argyrophilic cells, whereas in the NEC this histological pattern was distorted. Immunohistochemically the tumors showed expression of chromogranin A (all cases), chromogranin B (three cases), pancreastatin and chromostatin (four cases, respectively), prohormone convertase PC3 (three cases), carcinoembryonic antigen (CEA) and CA19‐9 (two cases), cytokeratin 56 kDa (three cases), 160 kDa neurofilament (two cases) and neuron‐specific enolase (two cases). Serotonin and glucagon were sporadically detected in two tumors. The most useful marker to confirm the diagnosis was chromogranin A, which was cleaved to pancreastatin and chromostatin in the tumor tissue, and was more reliable than other markers of neuroendocrine differentiation.
Thymidine phosphorylase expression in human colorectal mucosa, adenoma and carcinoma: Role of p53 expression
Authors: Shomori Kohei , Sakatani Takashi , Goto Akira , Matsuura Takahiko , Kiyonari Hiroshi , Ito Hisao
Published: March 2003

The enzyme, thymidine phosphorylase (dThdPase) is identical to platelet‐derived endothelial cell growth factor (PD‐ECGF), which acts as a potent angiogenic factor. The present study immunohistochemically examined the expression of dThdPase in human colorectal mucosa, adenomas and carcinomas, as well as six cultured colorectal carcinoma cell lines, in terms of intratumoral microvessel density (IMVD) and P53 expression. Thymidine phosphorylase was observed in lymphocytes, fibroblasts and macrophages, as well as smooth muscle cells and Schwann cells in the peripheral nerve fibers. The dThdPase‐positive stromal cells apparently outnumbered the normal epithelial cells, adenoma and carcinoma cells with dThdPase. Weak but obvious cytoplasmic immunoreactivity was noted in a few normal colonic epithelia, predominantly the upper surface area, while a few adenoma cells showed weak nuclear immunostaining for dThdPase in six (24%) of the 25 colonic adenomas. Expression of dThdPase was noted in 33 (73.3%) of the 45 Dukes A and B, 14 (51.9%) of the 27 Dukes C and 14 (56.0%) of the 25 Dukes D carcinomas. The mean IMVD was 84.0 ± 26.2 in the 36 dThdPase‐negative carcinomas and 97.9 ± 31.6 in the 61 dThdPase‐positive carcinomas, the value being significantly higher in the latter group (P< 0.05). The frequency of dThdPase expression was significantly lower in the P53‐negative carcinomas than in the positive carcinomas (P< 0.05). Western blot analysis showed the highest expression of dThdPase in LoVo carrying the wild‐type p53 gene, followed by Colo201, Colo320, DLD‐11 and WiDr carrying the mutated gene. These results indicate that: (i) the main source of dThdPase is stromal cells, including lymphocytes and macrophages in both colorectal normal and carcinoma tissues; (ii) dThdPase may take part in the induction of intratumoral microvessels, regardless of tumor stage; and (iii) expression might be modulated by not only P53 but also other molecules.
An immunohistochemical study of bizarre neoplastic cells in pleomorphic adenoma: Its cytological nature and proliferative activity
Authors: Takeda Yasunori
Published: March 2003

The cytological nature and proliferative activity of bizarre neoplastic cells, widely scattered in pleomorphic adenomas of salivary gland origin were studied. Pleomorphic adenomas containing numerous bizarre neoplastic cells were found in four cases, and were equal to 2.9% of all pleomorphic adenomas examined. All four cases presented as well‐circumscribed, firm masses measuring less than 1.5 cm in size, located in the palate, and were of 7 months to 4 years duration. Histopathologically, these pleomorphic adenomas were cell rich type, and were well demarcated from surrounding tissues, although their fibrous capsules were partially defective. In addition to characteristic histopathological findings of pleomorphic adenoma, numerous neoplastic cells with bizarre appearance were scattered throughout the lesion, excepting for tubuloductal structures. These bizarre neoplastic cells had irregular‐shaped and large nuclei with or without hyperchromatism, although their nucleoli were small and mitotic figures were few. Furthermore, there were many multinucleated giant cells, some of which showed multilobulated nuclei. Neither necrosis nor infarct was seen in the tumors. Immunohistochemically, bizarre neoplastic cells scattered in solid‐proliferating areas and myxoid areas were neoplastic myoepithelial cells in nature. There was no statistical significance of MIB‐1 labeling indices between pleomorphic adenomas with bizarre neoplastic cells and usual pleomorphic adenomas. The p53 labeling indices were quite low. Although the benign nature of pleomorphic adenomas with numerous bizarre neoplastic cells and hypercellularity, distinguishing such pleomorphic adenomas from various stages of malignant transformation in pleomorphic adenomas and other carcinomas should be made by histological section of submitted biopsy specimen or aspirated content for cytological diagnosis. The present paper suggests that the term ‘bizarre cell pleomorphic adenoma’ is an appropriate name for this neoplasm, in that it is distinguished from the usual benign pleomorphic adenoma which is easily diagnosed by routinely prepared histological or cytological stainings.
Epithelial splenic cysts in an intrapancreatic accessory spleen and spleen
Authors: Sasou Shunichi , Nakamura Shin‐ichi , Inomata Masaaki
Published: March 2003

A rare case of cysts simultaneously occurring in the intrapancreatic accessory spleen and spleen in a 49‐year‐old female is reported. The patient underwent distal pancreatomy for a cystic tumor of the pancreas, and a splenectomy. A multilocular cyst (4.3 × 2.6 cm) in an accessory spleen at the pancreas tail, and a solitary cyst (1.2 × 0.9 cm) of the spleen were found. The cyst in the intrapancreatic accessory spleen was lined by non‐keratinizing stratified squamous epithelium, and the spleen cyst by a single layer of flat epithelium; these lining cells were positive for Alcian blue stain and periodic acid‐Schiff reaction, and were immunohistochemically positive for cytokeratin, HBME‐1 and Sialyl‐Tn. Epithelial membrane antigen, carcinoembryonic antigen and CA19‐9 were positive in the accessory spleen cyst but were negative in the spleen cyst. An electron microscopic examination of the flat epithelium of the spleen cyst revealed numerous microvilli on the surface, cytoplasmic microfilaments, and a number of tight junctions between adjacent cells. These features suggested that the two cysts differ in nature, and origin; the accessory spleen cyst may be an embryonic inclusion of the pancreas duct while the spleen cyst may be an inclusion cyst of the mesothelium.
Placental pathology in systemic lupus erythematosus with antiphospholipid antibodies
Authors: Ogishima Daiki , Matsumoto Toshiharu , Nakamura Yasushi , Yoshida Koyo , Kuwabara Yoshinori
Published: March 2003

Systemic lupus erythematosus (SLE) is associated with a poor pregnancy outcome. Antiphospholipid antibodies (APL), which include lupus anticoagulant (LAC) and anticardiolipin antibodies (aCL), are frequently found in patients with SLE, and their presence has been associated with fetal loss. To examine placental pathologic features of SLE patients with APL, we performed a pathologic study on 47 placental tissue samples from 47 pregnant SLE patients with APL (15 patients; four LAC single‐positive patients, seven aCL single‐positive patients, four LAC and aCL double‐positive patients) and without APL (32 LAC and aCL double‐negative patients). The incidence of extensive infarction, decidual vasculopathy, decidual thrombosis and perivillous fibrinoid change, which have been thought to be characteristic lesions of APL placenta, was significantly higher in the LAC and aCL double‐positive patients than in the patients without APL. Conversely, the above‐mentioned lesions between the LAC or aCL single‐positive patients and the APL negative patients did not differ significantly. Among the 15 patients with APL, two of the three patients with both decidual vasculopathy and thrombosis had extensive infarction associated with fetal death. Moreover, the patients having fetal death showed LAC and aCL double‐positivity. In conclusion, this study indicated that the LAC and aCL double‐positivity is an important factor for extensive infarction resulting from decidual vasculopathy and decidual thrombosis in the SLE placenta. Moreover, it was indicated that LAC and aCL double‐positivity is an important risk factor for fetal death in the SLE patient.
Sarcomatoid carcinoma of the renal pelvis: A case report
Authors: Sekido Yasutomo , Satoh Fumiko , Usui Yukio , Tsutsumi Yutaka
Published: March 2003

A case of sarcomatoid carcinoma of the renal pelvis is reported. A 72‐year‐old male was admitted with a chief complaint of right flank pain. Clinical imaging studies revealed marked dilation of the right renal pelvis caused by a tumor at the pyeloureteric region. Right nephrectomy was performed in June 1999. The 8.4 × 6.5 cm tumor was grossly polypoid in appearance and protruded into the renal pelvis. Histologically, sarcomatoid spindle cells predominated over the carcinomatous component (mainly transitional cell carcinoma, partly associated with squamous cell and adenocarcinoma components). Osteoclast‐like CD68‐positive multinucleated giant cells were scattered. The sarcomatoid component was immunoreactive for both cytokeratin and vimentin. Sarcomatoid cells negative for cytokeratin were also noted. In both the sarcomatoid and carcinomatous components, nuclear overexpression of p53 oncoprotein was confirmed. The histogenesis of sarcomatoid carcinoma of the renal pelvis is discussed.
Primary small cell (oat cell) carcinoma of the breast: Report of a case and review of the literature
Authors: Yamasaki Tamio , Shimazaki Hideyuki , Aida Shinsuke , Tamai Seiichi , Tamaki Kuniyoshi , Hiraide Hoshio , Mochizuki Hidetaka , Matsubara Osamu
Published: March 2003

A case of primary small cell (oat cell) carcinoma of the breast in a 41‐year‐old woman is presented. The patient was alive and well without disease 16 months after modified radical mastectomy and subsequent chemotherapy. The tumor cells revealed morphologic similarity to oat cell carcinoma of the lung and immunohistochemical expression of neuroendocrine markers. In ultrastructural examination, the tumor cells had neurosecretory granules. Review of nine previously reported cases and this case of primary small cell carcinoma of the breast has revealed that this type of tumor shows prominent vascular invasion, frequent lymph node metastasis, infrequent expression of estrogen receptor, and also very poor prognosis. Immunohistochemical study for the c‐kit proto‐oncogene product, which has been reported to be a specific marker for pulmonary small cell carcinoma, demonstrated positive reactivity in approximately 80% of the tumor cells of this case, which is the first report according to our knowledge. The expression of c‐kit might be some aid to the diagnosis of primary small cell carcinoma of the breast.
S‐100‐positive nerve fibers in hepatocellular carcinoma and intrahepatic cholangiocarcinoma: An immunohistochemical study
Authors: Terada Tadashi , Matsunaga Yoshiko
Published: March 2003

The aim of the present study was to determine whether or not liver carcinomas are innervated, since there have been no previous reports on the distribution of nerve fibers in human hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). We investigated nerve fibers by immunohistochemical and morphometric methods in 63 cases of HCC and 28 cases of ICC. An antibody to S‐100 protein was used to visualize nerve fibers. In HCC, S‐100‐positive nerve fibers were absent in the tumoral region, including the sinusoids, and tumoral fibrous septa, while in the capsule of HCC some S100‐positive nerve fibers (density: 0.08 ± 0.03/mm2) were present in contact with vasculatures. In ICC, a few nerve fibers were noted in the tumoral stroma (density: 0.02 ± 0.01/mm2). No nerve fibers were seen in the neovasculized vessels (tumor vessels) in both HCC and ICC. In invasive regions of HCC and ICC, there were S‐100‐positive nerve fibers in pre‐existing residual portal tracts (density: HCC, 0.11 ± 0.03/mm2; ICC, 0.13 ± 0.04/mm2). In non‐tumor regions of HCC and ICC, there were many S100‐positive nerve fibers (density: 0.41 ± 0.13/mm2) in portal tracts and, to a much lesser degree, in the sinusoids. These results suggest that tumor cells and vasculatures in HCC and ICC are rarely influenced by nerve fibers.
Multiple minute carcinoids in type A gastritis: Attempt at 3‐D reconstruction
Authors: Nojiri Takuya , Ikegami Masahiro
Published: March 2003

In type A gastritis, the numbers of endocrine cell micronests (ECM) and carcinoids increase through the trophic action of gastrin. This study examined the characteristics and growth of carcinoids in type A gastritis. A total of 395 lesions in five surgically removed stomachs with type A gastritis were investigated, in terms of number, size, distribution and histological appearance, to clarify the tumorigenesis and progression of carcinoids. 3‐D reconstruction using serial paraffin sections was used to study carcinoid progression. Our findings suggest that in type A gastritis, carcinoids arise in areas where minute carcinoids are present at a high density. They also suggest that early stage carcinoids not only become large expansively, but also develop in a very complex manner, by maintaining contact with surrounding minute carcinoids.
Apoptosis as an independent prognostic indicator in squamous cell carcinoma of the esophagus
Authors: Shibata Hiroshi , Matsubara Osamu
Published: March 2003

Apoptosis plays a crucial role in determining net cell proliferation and cell turnover in various tumors. The rate of apoptosis in tumor cells has been reported to be a useful prognostic indicator in colorectal carcinoma. We examined apoptosis in 72 specimens of esophageal squamous cell carcinoma, by the terminal deoxynucleotidyl transferase (TdT)‐mediated deoxyuridine triphosphate (dUTP) digoxigenin–nick end labeling (TUNEL) method. We examined correlation of apoptosis with outcome, clinicopathological features, and expression of the apoptosis‐related proteins p53 and Bcl‐2. The percentage of apoptotic cells, or apoptotic index (AI), ranged from 0.8 to 9.4 (mean: 3.47; SD: 2.02). Overall, 5‐year survival of patients with high AI (AI ≥ 5.0; n= 18) tumors was significantly higher than that of patients with low AI tumors (AI < 5.0; n= 58; 76.9% versus 44.9%; P= 0.042). AI did not correlate significantly with the clinicopathological features of patient age and sex, depth of tumor and histological differentiation, lymph node metastasis, lymphatic invasion, or venous invasion. In p53‐negative tumors, the AI was significantly higher than in p53‐positive tumors. We concluded that AI may be a useful prognostic indicator in esophageal squamous cell carcinoma following curative surgery, and that apoptosis in this tumor is related to relative underexpression of p53 protein.
Carcinoma of the urinary bladder with a lymphomatous appearance
Authors: Kimura Masatomo , Kashiwagi Hideo , Furuta Tomoko , Otsuka Kayo , Satou Takao , Hashimoto Shigeo , Matsuzaki Osamu
Published: March 2003

We present the first report of bladder carcinoma that demonstrates a mixture of two distinct histological patterns resembling malignant lymphoma. The patient was a 79‐year‐old man. One of the histological patterns was a diffuse growth of monomorphic carcinoma cells, and the other was a dense lymphoplasmacytic infiltrate, obscuring the carcinoma. The tumor cells showing both patterns expressed cytokeratin and epithelial membrane antigen, but not lymphoid markers. Careful immunohistochemical evaluation should be done when diagnosing urinary bladder carcinomas resembling lymphomas (other than primary lymphomas).
Specificity of the histopathological triad for the diagnosis of toxoplasmic lymphadenitis: Polymerase chain reaction study*
Authors: Lin Mei‐Hui , Kuo Tseng‐tong
Published: March 2003

Toxoplasmosis is a common cause of lymphadenopathy, but toxoplasmic cysts are not usually found in histological sections used for establishing diagnosis, except on extremely rare occasions. The histopathological triad of florid reactive follicular hyperplasia, clusters of epithelioid histiocytes, and focal sinusoidal distention by monocytoid B cells has been considered to be diagnostic of toxoplasmic lymphadenitis, but the validity of the histopathological triad is based indirectly on serological correlation only. The demonstration of Toxoplasma gondii DNA in lymph nodes displaying the histopathological triad will indicate the validity of the histopathological triad as the criterion for the histopathological diagnosis of toxoplasmic lymphadenitis. We used frozen tissues of 12 lymph nodes with the histopathological triad and tissues of 27 lymph nodes from patients with various other conditions (including 13 cases of follicular lymphoid hyperplasia, FLH; three cases of dermatopathic lymphadenopathy, DPL; two cases of plasmacytosis; two cases of Castleman's disease; two cases of metastatic adenocarcinoma; and five cases of lymphoma) to detect T. gondii DNA by polymerase chain reaction. Ten out of 12 lymph nodes with the triad and six out of 27 lymph nodes without the triad were positive for T. gondii DNA. Thus, the sensitivity of the triad was 62.5% (10/16) and the specificity was 91.3% (21/23). The predictive value of positive tests was 83.3% (10/12) and the predictive value of negative tests was 77.7% (21/27). The six cases positive for T. gondii DNA without the triad were four cases of FLH, one case of DPL, and one case of plasmacytosis. None of the neoplastic diseases was positive. The false positive and negative cases could be due to sampling problems or past T. gondii infection. The results confirm that the histopathological triad is highly specific for the diagnosis of toxoplasmic lymphadenitis and can be used confidently.
Absence of mutations in the β‐catenin and adenomatous polyposis coli genes in papillary and follicular thyroid carcinomas
Authors: Miyake Noriko , Maeta Hiroyuki , Horie Satoshi , Kitamura Yukisato , Nanba Eiji , Kobayashi Kaoru , Terada Tadashi
Published: March 2003

β‐Catenin has multiple functions both in intercellular adhesion and in signal transduction. As a signaling molecule, mutations in exon 3 of the β‐catenin gene stabilize this protein in the cytoplasm. Subsequently, accumulated β‐catenin protein translocates to nuclei with T‐cell factor‐4, and upregulates transcriptional activity of the target genes involved in carcinogenesis. Mutations in exon 3 of the β‐catenin gene have been detected in various carcinomas. We examined immunolocalization of β‐catenin protein and mutations in the β‐catenin and adenomatous polyposis coli (APC) genes in papillary carcinoma (25 cases), follicular carcinoma (two cases), and benign thyroid tumor (29 cases). We detected no mutation in exon 3 of the β‐catenin gene in both malignant and benign thyroid tumors by polymerase chain reaction (PCR) and direct sequencing. No mutations in the mutation cluster region of APC were found in any tumor samples analyzed. Immunohistochemically, β‐catenin showed membranous localization in most specimens. These results suggest that mutations of the β‐catenin and APC genes are rare and that activation of the Wnt signaling pathway may not contribute to pathogenesis in human papillary and follicular thyroid carcinomas.
Increased expression of cyclooxygenase‐2 in human salivary gland tumors
Authors: Sakurai Kazunari , Urade Masahiro , Noguchi Kazuma , Kishimoto Hiromitsu , Ishibashi Miki , Yasoshima Hitoshi , Yamamoto Tadashi , Kubota Akira
Published: March 2003

We examined the immunohistochemical localization of cyclooxygenase (COX)‐2 in human salivary gland tumors. Thirty salivary gland adenomas (SGA), 40 salivary gland carcinomas (SGC) and 15 normal salivary glands (NSG) were studied. NSG showed restricted COX‐2 staining only in the epithelial cells of salivary ducts. In contrast, COX‐2 protein was detected in 27 cases of SGA (90%), except for three myoepitheliomas, and in all cases of SGC (100%) at various intensities and in various fashions. Thirteen SGA (43%) and 36 SGC (90%) cases showed strong COX‐2 staining predominantly in tumor cells containing ductal components, as did serous and mucous acinic components of acinic cell carcinomas, mucoepidermoid carcinomas and mucinous carcinomas. These findings may suggest that COX‐2 in salivary gland tumors is expressed in tumor cells derived from pluripotential ductal epithelium that can histologically develop into either serous or mucinous acinar cells.
CD34‐positive stromal cells and alpha‐smooth muscle actin‐positive stromal cells in the tumor capsule of skin sweat gland neoplasms
Authors: Nakayama Hirofumi , Enzan Hideaki , Miyazaki Eriko , Moriki Toshiaki , Toi Makoto , Zhang Yanhu
Published: March 2003

To elucidate the roles of CD34‐positive stromal cells and alpha‐smooth muscle actin‐positive stromal cells at the tumor border of skin sweat gland neoplasms, we examined expression of stromal cell markers in the tumor capsule of 19 skin sweat gland neoplasms (16 mixed tumors of the skin and three nodular hidradenomas) using monoclonal antibodies to CD34, CD31, cytokeratin 14 (CK14), alpha‐smooth muscle actin (ASMA) and high molecular weight caldesmon (HCD). We regarded CD34‐positive, CD31‐, CK14‐, ASMA‐ and HCD‐negative stromal cells to be CD34‐positive stromal cells, and ASMA‐positive, HCD‐, CK14‐, CD34‐ and CD31‐negative stromal cells to be ASMA‐positive stromal cells. CD34‐positive stromal cells were detected in the tumor capsule of all 19 of the tumors examined. In nine of the 16 mixed tumors (56%) and all of the three nodular hidradenomas, ASMA‐positive stromal cells were detected at the immediate inner side of the CD34‐positive stromal cell layers. These results indicate that cellular components in the tumor capsules of mixed tumors of the skin and nodular hidradenomas are CD34‐positive stromal cells and ASMA‐positive stromal cells, and suggest that stromal cells of these two cell types are associated with tumor capsule formation of skin sweat gland neoplasms.
Uterine tumors resembling ovarian sex‐cord tumors producing parathyroid hormone‐related protein of the uterine cervix
Authors: Suzuki Chikako , Matsumoto Toshiharu , Fukunaga Masaharu , Itoga Tomoko , Furugen Yoshiaki , Kurosaki Yoshihisa , Suda Koichi , Kinoshita Katsuyuki
Published: March 2003

A case of uterine tumors resembling ovarian sex‐cord tumors (UTROSCT) producing parathyroid hormone‐related protein (PTH‐rP) of the uterine cervix is reported. A 66‐year‐old woman underwent total hysterectomy with bilateral salpingo ‐oophorectomy due to the possibility of a malignant uterine tumor. A fairly well‐circumscribed tumor, measuring 8 × 5 × 7 cm, was present in the myometrium of the cervix and extended into the endocervical mucosa. Histologically, the tumor showed predominantly sex‐cord‐like differentiation and the features of conventional endometrial low‐grade stromal sarcoma were observed in part. Immunohistochemically, the tumor cells were negative for CD10. From these findings, we diagnosed the present case as Clement and Scully’s group II UTROSCT arising from the uterine cervix. To our knowledge, this is the first report of the cervical occurrence of UTROSCT. Furthermore, in this tumor, production of PTH‐rP was demonstrated by normalization of serum PTH‐rP after the tumorectomy and immunoreactivity for PTH‐rP in the tumor cells.
Bcl‐2, iNOS, p53 and PCNA expression in normal, disordered proliferative, hyperplastic and malignant endometrium
Authors: Cinel Leyla , Polat Ayşe , Aydin Özlem , Düşmez Duygu , Eğilmez Reyhan
Published: March 2003

We attempted to determine Bcl‐2, inducible nitric oxide synthase (iNOS), p53 and proliferating cell nuclear antigen (PCNA) expression, and the relationships between them, in endometrioid adenocarcinomas and precursor lesions. Expression of Bcl‐2, iNOS, p53 and PCNA were investigated immunohistochemically in 91 samples from benign (proliferative (pEM), secretory (sEM), disordered proliferative (dEM), inactive/atrophic (aEM), hyperplastic endometrium) and malignant endometrial tissue. Staining scores for Bcl‐2 in the dEM, endometrial hyperplasia (EMH) and endometrioid cancer (ECA) groups were higher than in the pEM group (P = 0.004; P = 0.036 and P = 0.020, respectively). A significant difference in proliferating cell nuclear antigen staining was found between simple and complex EMH samples (P = 0.000). An inverse relationship was found between iNOS and p53 in the hyperplasia group (r = −0.533, P = 0.019). While a significant difference was found in p53 staining in ECA between the pEM, dEM and EMH groups, no such difference was found in iNOS staining. In addition, there was no direct relationship between iNOS and p53 in the ECA group. It was concluded that the interaction between iNOS, p53 and Bcl‐2 in proliferative processes in the development of type 1 endometrioid adenocarcinomas is different from that in tumors originating in other organs.
Mucosal high apoptotic activity and low p21WAF1/CIP1 expression and submucosal low proliferative activity in superficially spreading early gastric cancers: Comparison with the penetrating growth type
Authors: Ichinoe Masaaki , Mitomi Hiroyuki , Kikuchi Shiro , Tanabe Satoshi , Akino Fumiyuki , Okayasu Isao
Published: March 2003

In order to investigate cell kinetics and cell cycle regulator protein expression with reference to the growth pattern of early gastric carcinomas (EGCs), we evaluated a total of 240 EGCs with submucosal invasion clinicopathologically and 106 submucosal invasive lesions immunohistochemically. The incidence of lymph node metastasis was relatively high (36.4%) in the superficially spreading growth (SUP) type tumors whereas the penetrating growth (PEN) type had a low incidence (5.7%, P < 0.001) and correlated with submucosal tumor size. Ki67 labeling was lower in submucosal areas of the SUP‐type tumors (median, 37.3%) than the PEN‐type tumors (51.0%, P < 0.001). ssDNA labeling in the lamina propria, indicative of apoptotic activity, was higher in the SUP‐type tumors (0.55%) than in PEN‐type (0.30%, P < 0.01) lesions. The expression of cell cycle regulator p21WAF1/CIP1 was lower in the SUP‐type tumors (lamina propria 15.6%, submucosa 2.6%) than in PEN‐type tumors (lamina propria 26.5%, submucosa 4.4%, P < 0.05–0.001). In conclusion, differences in cell kinetics and p21WAF1/CIP1 expression might influence the growth pattern of EGCs. The SUP‐type EGC, characterized by high apoptotic in the lamina propria and low proliferative activities in the submucosa, is associated with frequent lymph node metastasis, suggesting a strong correlation between tumor size in the submucosa and metastatic potential.