Search

Objectives This study was carried out to detect vulnerable coronary plaques by color fluorescent angioscopy. Background Collagen fibers (CFs) mainly provide mechanical support to coronary plaques. Oxidized low-density lipoprotein (Ox-LDL) induces macrophage proliferation, which in turn destroy CFs while accumulating lipids. As such, demonstration of the absence of CFs, deposition of lipids, and the Ox-LDL may suggest plaque instability. Methods Fluorescence of the major components of the atherosclerotic plaques was examined by fluorescent microscopy using a 345-nm band-pass filter and 420-nm band-absorption filter (A-imaging). Fluorescence of Ox-LDL was examined using a 470-nm band-pass filter and 515-nm band-absorption filter (B-imaging) and Evans blue dye as an indicator. Fluorescence in 57 excised human coronary plaques was examined by A-imaging color fluorescent angioscopy. Oxidized LDL in 31 excised coronary plaques and in 12 plaques of 7 patients was investigated by B-imaging color fluorescent angioscopy. Results Collagen I, collagen IV, and calcium exhibited blue, light blue, and white autofluorescence, respectively. In the presence of beta-carotene which coexists with lipids in the vascular wall, collagen I and IV exhibited green, collagen III and V white, cholesterol yellow, cholesteryl esters orange fluorescence. Oxidized LDL exhibited reddish brown fluorescence in the presence of Evans blue dye. Therefore, coronary plaques exhibited blue, green, white-to-light blue, or yellow-to-orange fluorescence based on plaque composition. Histological examination revealed abundant CFs without lipids in blue plaques; CFs and lipids in green plaques; meager CFs and abundant lipids in white-to-light blue plaques; and the absence of CFs and deposition of lipids, calcium, and macrophage foam cells in the thin fibrous cap in yellow-to-orange plaques, indicating that the yellow-to-orange plaques were most vulnerable. Reddish brown fluorescence characteristic of Ox-LDL was observed in excised coronary plaques, as also in patients. Conclusions Color fluorescent angioscopy provides objective information related to coronary plaque composition and may help identify unstable plaques.

Background: If oxidized low-density lipoprotein (oxLDL), LDL, lysophosphatidylcholine (LPC) and apolipoprotein B (apoB) can be visualized simultaneously, their roles in the initiation, progression and destabilization of atherosclerotic plaques can be objectively evaluated. Methods and Results: (1) The fluorescence characteristic of each atherogenic substance was investigated by microscopy using a band-pass filter (470 nm) and a band-absorption filter (520 nm) with homidium bromide (Ho) and trypan blue (TB) as indicators. (2) 50 excised human coronary plaques were classified by their autofluorescence into green, greenish-yellow and yellow, and the localization of oxLDL, LDL, LPC and apoB were investigated by color fluorescence angioscopy (CFA). The plaque colors were white, yellow and glistening yellow by conventional angioscopy. (1) OxLDL and LDL exhibited golden fluorescence, whereas LPC and apoB exhibited red fluorescence. (2) By CFA, 16 of 19 greenish-yellow and 1 of 8 yellow plaques exhibited red and golden fluorescence in a mosaic pattern, indicating co-deposition of oxLDL/LDL and LPC/apoB; 3 greenish-yellow and 7 yellow plaques exhibited red fluorescence, indicating solitary deposition of apoB; 23 green plaques infrequently exhibited these fluorescence colors. Conclusions: OxLDL/LDL and LPC/apoB were successfully visualized as co-deposited in greenish-yellow autofluorescence plaques, but only LPC/apoB in yellow autofluorescence plaques. (Circ J 2010; 74: 2181-2186)

Four new antibiotics, TMC-171A (2), B (3), C (4) and TMC-154 (5) have been isolated from the fermentation of fungal strains Gliocladium sp. TC 1304 and TC 1282, respectively. Spectroscopic and degradation studies have shown that TMC-171s and TMC-154 were new members of the TMC-151 class of antibiotics, unique polyketides modified with a D-mannose and a D-mannitol or a D-arabitol. These compounds showed moderate cytotoxicity to various tumor cell lines.

膣原発の明細胞腺癌を経験したので報告する.症例は不正性器出血, 排尿障害を主訴とした40歳の女性.膣前壁に易出血性の腫瘍が認められ, 病理学的検索が行われた.細胞診では, 腫瘍細胞はシート状あるいは乳頭状の集団として認められた.細胞質はライトグリーン淡染性で広く, 核には大小不同が目立ち, 微細穎粒状のクロマチン, 1個ないし数個の明瞭な核小体を有していた.裸核状の大型細胞の混在もみられた.明細胞腺癌が疑われたが, hobnail cellは明らかでなかった.組織学的には腫瘍細胞は淡明で比較的豊富な胞体と核小体の目立つ核をもち, 主として乳頭状, 部分的には管腔形成性あるいは充実性に増殖していた.乳頭状部分にはhobnail cellも見出された.胞体にはグリコーゲンと考えられるPAS染色陽性細穎粒が認められた.鼠径部リンパ節生検にて転移が確認されたが, 種々の画像検査, 膀胱鏡, 子宮および尿細胞診にて転移性腫瘍が否定され, 膣原発明細胞腺癌と診断された.

We report a case of dilated cardiomyopathy with hyperthyroidism. A 28-year-old man was admitted because of congestive heart failure and atrial fibrillation, and was newly diagnosed as having hyperthyroidism. Despite administration of antithyroid medication, he developed recurrent congestive heart failure. An echocardiogram revealed a moderately dilated left ventricle with diffuse hypokinesis. Though his thyroid function normalized, the patient's cardiac dysfunction did not improve. Beta-blocker therapy was begun with subsequent improvement in clinical symptoms. This suggests that beta-blocker treatment may be effective in patients with atrial fibrillation associated with cardiomyopathy and hyperthyroidism.

Lysophosphatidylcholine (LPC) is a proinflammatory and proatherogenic substance, and it plays an important role in the initiation, progression, and destabilization of atherosclerotic plaques. If LPC in the vascular wall is visualized in vivo, the mechanisms of atherosclerosis and the effects of medical and interventional therapies on atherosclerosis can be objectively evaluated. Therefore, this study was carried out to visualize LPC in human coronary plaques using a color fluorescence angioscopy (CFA) system. (1) The fluorescence characteristics of LPC were investigated by color fluorescence microscopy (CFM) using Trypan blue dye (TB) as an indicator. For fluorescence imaging, a combination of a band-pass filter (345 nm) and a band-absorption filter of 420 nm (A imaging), or a combination of a band-pass filter (470 nm) and a band-absorption filter of 520 nm (B imaging) was employed. (2) The fluorescence of LPC in the excised human coronary plaques was investigated by CFA and CFM scanning using the same filters as those in CFM. In the presence of TB, LPC exhibited a red fluorescence in both A and B imaging. This red fluorescence color in both A and B imaging was not observed for the other known major substances that constitute the atherosclerotic plaques. This red fluorescence color in both A and B imaging was detected by CFA in both white and yellow plaques that were classified by conventional angioscopy. This fluorescence color was found to be distributed in a web-like or diffuse configuration by CFM scanning. LPC in the human coronary plaques was successfully visualized by CFA using TB as an indicator.

The case is a 60-year-old woman who had complained of right coxalgia. At the first time, there was no fracture on roentgenograms of the hip. Significantly elevated erythrocyte sedimentation rate (ESR) level was found. After a month, the pathological fracture of the right femoral neck was fonud. The case was diagnosed as the multiple myeloma by open biopsy. And then the operation of endoprosthesis was performed. It is difficult to diagonose multiple myeloma without apparent fracture, but it is useful to examine bone scintgraphy and blood test.

最近我々の経験した肺原発悪性線維性組織球腫 (MFH) 4例について臨床病理学的検討を行った. 全例男性で高喫煙歴があった. 全例赤沈が亢進し, 血清鉄が低値を示した. 腫瘍マーカーでは, フェリチン, 免疫抑制酸性蛋白 (IAP) が高値を示した. 放射線治療を行った症例ではフェリチン, IAPが治療効果と関連して変動を示した. 2症例で白血球増多がみられ, サイトカインとの関連が示唆された. 術前の生検診断に際しては免疫組織化学染色が有用であり3例中2例でMFHと診断し得た. 予後は極めて不良で外科療法, 化学療法, 放射線療法にもかかわらず全例診断後1年以内に死亡した. 剖検では, 全例局所再発もしくは遠隔転移を認めた. 今後の集学的治療の確立が課題であろう.

Spontaneous CSF otorrhea is a rare condition, and about forty cases have been described in the literature to date. Here a case of spontaneous CSF otorrhea is reported.A 37-year-old man had suffered from recurrent bacterial meningitis and CSF otorrhea. Left mastoidectomy was carried out on May, 1989, by an otologist in the other hospital, but the origin of CSF leakage coudn't be identified. The patient was admitted to our hospital on January, 1990, to treat CSF otorrhea. Left temporal craniotomy was carried out. A dural defect was found in the left middle cranial fossa connecting to a bony defect at the left tegmen tympani. The defect was repaired by packing the tegmen tympani with fascia and fatty tissues. CSF otorrhea completely disappeared postoperatively.Spontaneous CSF otorrhea should be considered as a cause of recurrent bacterial meningitis. High resolution CT scan and MRI will be very useful in the diagnosis of this rare problem.

A case of mucoepidermoid carcinoma of the larynx is reported. The patient was a 63-year-old man who had suffered from sore throat for nine months. By physical examination, swelling in the right epiglottis and arytenoid was noted. Histopathological findings of the specimen showed a mucoepidermoid carcinoma (low grade malignancy). The patient had chemotherapy and radiotherapy. Among malignant tumors of the larynx, mucoepidermoid carcinoma seemed to be extremely rare. Only seven cases of the laryngeal mucoepidermoid carcinoma including this case have been reported in our country. A pertinent literature was reviewed in this paper.

Generally, it is considered that visceral fat brings insulin resistance and hyper-insulinemia, in the mechanisms of metabolic syndromes. However, whether hyperinsulinemia brings about accumulation of visceral fat is not clear. We followed a case of insulinoma that caused primary hyperinsulinemia, and measured the change in visceral fat and insulin resistance before and after surgical resection of the insulinoma. A 58-year-old woman was admitted to investigate the cause of spontaneous hypoglycemia. An oral glucose tolerance test (OGTT) showed hyperinsulinemia with a high basal level and a glucagon infusion test showed an abnormally high insulin level. Abdominal computed tomography (CT) scan showed an accumulation of visceral fat. Selective celiac angiography showed a pancreatic tumor shadow. Under a diagnosis of insulinoma, the pancreatic body and tail were removed. At 3 months after the operation, the visceral fat area had decreased from 132.6 to 64.2 cm(2). The fasting serum total cholesterol and triglyceride were also reduced. In addition, high-density lipoprotein cholesterol and preheparin serum lipoprotein lipase mass had increased. The midband on the polyacrylamide gel disc electrophoresis of lipoproteins, which appeared before operation, had disappeared completely. An OGTT showed a non-diabetic pattern after the operation. These results suggest that hyperinsulinemia might be one of the factors that enhance visceral adiposity and insulin resistance.

An 82 years old man with four large tumors on his left forearm visited our hospital in July 1991. At first these tumors were suspected to be malignant. Xray, bone-scintigram and angiogram of the forearm suggested malignant tumors. There was no evidence of tuberculosis on the chest Xray when first taken. Six months later the tumor developed, producing a fistula and the patient decided to be admitted for surgery. A diagnosis of tuberculosis was made and administration of INH RFP EB was effective. It is important to be aware that tuberculosis sometimes closely resembles malignant tumors. Therefore, if a malignant tumor is suspected biopsy is necessary to make a diagnosis, keeping tuberculosis in mind.

Background Leiomyosarcoma occurring as a primary cardiac tumor has been known as an extremely rare condition. Previous studies of leiomyosarcoma with rhabdomyoblastic differentiation have conducted to those arisen from another site, and they indicated a poorer prognosis of this tumor. Case presentation A 69-year-old woman was referred to our hospital for an operation concerning umbilical hernia. Subsequent imaging examinations before an operation indicated the presence of primary cardiac malignant tumor due to its atypical shape. And then, it was surgically removed. Histopathologically, tumor cells consisted of two different types: spindle and polyhedral cells. Immunohistochemically, it is interesting to note that 2.1% of spindle cells and 23.1% of polyhedral cells showed positive reactivity for myogenin. Furthermore, we performed double-immunostaining for alpha-smooth muscle actin (SMA) and myogenin. The rates of alpha-SMA and myogenin double negative, alpha-SMA single positive, myogenin single positive, and alpha-SMA and myogenin double positive in spindle cells were estimated as 69.1%, 28.8%, 1.1% and 1.0%, respectively. In contrast, the rates in polyhedral cells were estimated as 76.9%, 0.0%, 23.1%, and 0.0%, respectively. Conclusion Our immunohistochemical evaluation suggested that rhabdomyoblastic differentiation in leiomyosarcoma might be generated not only by de novo generation from mesenchymal cells. To the best of our knowledge, this is the first case of primary cardiac leiomyosarcoma with partial rhabdomyoblastic differentiation.

A case of bilateral renal cell carcinoma with multilocular cysts is described. A 42-year-old female was admitted to our hospital for the purpose of further examination or right renal cystic mass discovered incidentally by ultrasonography. After she was examined by CT-scan and angiography, right nephrectomy was performed under the diagnosis of right renal cancer. Histological diagnosis was multilocular cystic renal cell carcinoma. One year later a small cystic legion was found in the left kidney. Under the diagnosis of left renal cancer, left partial nephrectomy was performed. Histological diagnosis was multilocular cystic renal cell carcinoma same as the right kidney. Multilocular renal cyst is classified into several classes by its style of development. This case of bilateral renal cell carcinoma which grew to be multilocular cysts is the first case in Japan as far as we can search.

乳腺原発骨肉腫の発生頻度は比較的低く, 全乳腺悪性腫瘍の0.5～3.0%とされており, 本邦における既報告例も十数例を数えるに過ぎない.本症例は49歳・女性の左乳房下にみられた小腫瘤で, 化骨性筋炎に類し, 異型類骨組織, 異型軟骨組織および線維肉腫様組織が層状配列 (Zoning) を示していた.細胞診では偏心性の不正円形核, 陥入や切れ込みを有し, 粗穎粒状の分散クロマチンと核縁の肥厚が目立ち, 胞体限界の不整な異型骨芽細胞ど類円形核をもち, 核縁が菲薄で, 核質の明るい異型軟骨芽細胞を類別し得た. さらに, 長楕円形核を有する線維芽細胞様細胞および多核の異型巨細胞を認めた. これらの細胞は, 光顕および電顕的観察より得られた細胞学的特異性をおおむねよく反映しており, 塗抹標本における背景への配慮も診断上きわめて重要なことを示唆していた.