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Background: Thin nodular melanoma (NM) often lacks conspicuous melanoma-specific dermatoscopic criteria and escapes clinical detection until it progresses to a thicker and more advanced tumour. Objective: To investigate the dermatoscopic morphology of thin (≤2 mm Breslow thickness) vs. thick (>2 mm) NM and to identify dermatoscopic predictors of its differential diagnosis from other nodular tumours. Methods: Retrospective, morphological case–control study, conducted on behalf of the International Dermoscopy Society. Dermatoscopic images of NM and other nodular tumours from 19 skin cancer centres worldwide were collected and analysed. Results: Overall, 254 tumours were collected (69 NM of Breslow thickness ≤2 mm, 96 NM >2 mm and 89 non-melanoma nodular lesions). Light brown coloration (50.7%) and irregular brown dots/globules (42.0%) were most frequently observed in ≤2 mm NMs. Multivariate analysis revealed that dotted vessels (3.4-fold), white shiny streaks (2.9-fold) and irregular blue structureless area (2.4-fold) were predictors for thinner NM compared to non-melanoma nodular tumours. Overall, irregular blue structureless area (3.4-fold), dotted vessels (4.6-fold) and serpentine vessels (1.9-fold) were predictors of all NM compared to non-melanoma nodular lesions. Limitations: Absence of a centralized, consensus pathology review and cases selected form tertiary centres maybe not reflecting the broader community. Conclusions: Our study sheds light into the dermatoscopic morphology of thin NM in comparison to thicker NM and could provide useful clues for its differential diagnosis from other non-melanoma nodular tumours. © 2020 European Academy of Dermatology and Venereology

Nippon Steel Yawata Works operates with only one blast furnace in service. BF No. 1 (inner volume : 4407 m3 ) was blown off on January 31, 1998 after operating for thirteen years. The third campaign of BF No. 4 (inner volume : 4250 m3 ) was started the following day and productivity reached 2.0 t/d.m3 IV after fifteen days of operation. This paper describes the characteristics of the relining of No. 4 furnace. Also presented is the background of the speedy switchover of large blast furnace operation and the rapid increase in productivity without any reduction in output.

Using a polyclonal antibody raised against a liver stellate cell (LSC) line derived from a rat CCl4-cirrhotic liver, we isolated 14 clones from a complementary DNA library prepared with total RNA extracted from the same cell line, with nucleotide sequences homologous to that of the type I procollagen C-proteinase enhancer protein (PCPE) gene. The longest PCPE insert of 1,530 base pairs contained an open reading frame coding for 468 amino acids. PCPE cDNA recognized by Northern blot a 1.7-kilobase messenger RNA (mRNA) in total RNA extracted from freshly isolated and early passaged LSC, LSC lines derived from normal (NFSC) and cirrhotic (CFSC) rat livers, and various LSC clones derived from CFSC. The expression of PCPE mRNA was increased threefold in CFSC compared with NFSC. PCPE mRNA was not detected in total rat liver, freshly isolated hepatocytes, or endothelial or Kupffer cells. However, the expression of PCPE mRNA was induced in fibrotic livers of rats treated with CCl4. PCPE mRNA expression in LSC was up-regulated by transforming growth factor beta1 (TGF-beta1) and down-regulated by tumor necrosis factor alpha (TNF-alpha), similar to the changes in alpha1 (1) procollagen mRNA induced by these cytokines. PCPE was not detectable in liver biomatrix proteins obtained from normal liver. However, PCPE was increased in liver biomatrix proteins from cirrhotic livers and was proportional to the amount of collagen. These data suggest that PCPE may play an important role in the processing of type I collagen during liver fibrogenesis, and that TGF-beta1 and TNF-alpha regulate its expression. (Hepatology 1997 Sep;26(3):611-7)

Highly sensitive and selective detection of morphine (MO) was realized by coupling an immunoreaction of an anti-MO monoclonal antibody and a surface-plasmon-resonance (SPR) phenomena. A normorphine-bovine serum albumin (NM-BSA) conjugate prepared as an antigen was immobilized on the Au thin film of sensor chip by physical adsorption. The incident angle of the SPR system using the NM-BSA immobilized chip increased almost linearly with increasing concentration of antibody up to ca. 5 /spl mu/g/ml (ppm). The addition of MO into the antibody solution (5 ppm) was found to reduce the incident angle shift sharply because of the inhibition effect of MO. Based on this inhibiting principle, the present sensor could detect MO very sensitively in the concentration range of 0.1-10 ng/ml (ppb).

The initial and follow-up CT and MRI images of ten patients with hepatic metastases from ovarian tumors were retrospectively analyzed to establish their features and sequential changes in appearance.Ten patients with hepatic metastasis from ovarian tumors received initial and follow-up CT and MRI examinations. Six patients were followed up every two to three weeks before surgical tumor resection. Both CT and MR images were analyzed by two radiologists.A total of fourteen lesions were detected by CT and MRI in 10 patients. All 14 lesions were demonstrated as areas of marked hyperintensity on T2-weighted MRI. Eleven cyst-like tumors were demonstrated as round or oval low density lesions on CT and as areas of hypointensity on T1-weighted imaging. Three lesions were shown as solid masses with slightly low attenuation at the initial CT examination and slightly low or iso-intensity areas on T1-weighted imaging, and these lesions showed early peripheral globular enhancement and delayed enhancement on contrast-enhanced CT and MR imaging. Cystic formation was observed two to three weeks later after initial study in all the 3 solid lesions. Rapid subcapsular effusion, which showed obvious enhancement on delayed Gd-DTPA enhanced MR imaging, was observed in two patients.The hepatic metastatic tumor from cystic ovarian carcinoma may manifest as a well-defined cystic lesion or as a solid mass, and the solid mass shows delayed enhancement on contrast-enhanced CT and MR imaging. Furthermore, rapid cystic formation and rapid subcapsular extension is frequently seen.

To evaluate the efficacy of endoscopic variceal ligation (EVL) in prophylactic therapy for oesophageal varices, we performed a randomized prospective trial to compare the recurrence of oesophageal varices treated by EVL with those treated by endoscopic injection sclerotherapy.Fifty patients with liver cirrhosis were divided into two groups at random, after informed consents were obtained, to receive prophylactic therapy for bleeding of oesophageal varices. Group 1 patients underwent sessions of sclerotherapy with 5% ethanolamine oleate used as the sclerosant. Group 2 patients underwent EVL followed by one or two sessions of sclerotherapy.During the 18 month follow-up period, both the recurrence rate in group 2 (56%) and the incidence of bleeding (20%) were significantly higher compared with group 1 (recurrence rate 16%, bleeding 0%).This result indicates that EVL is not effective for prophylactic therapy for oesophageal varices in liver cirrhosis.

The binding constants between disulfide-intact or various disulfide-reduced bovine alpha-lactalbumins and an Escherichia coli chaperonin, GroEL, were determined by using the equilibrium dialysis method. The disulfide-intact and one-disulfide (Cys6-Cys120)-reduced alpha-lactalbumins were shown not to bind with GroEL both in the presence and absence of Ca2+. The two-disulfide (Cys6-Cys120 and Cys28-Cys111)-reduced alpha-lactalbumin, which has the native-like tertiary structure in its beta-domain region and an unfolded alpha-domain in the presence of Ca2+, showed considerable binding with GroEL. The binding free energy of the two-disulfide-reduced alpha-lactalbumin in the presence of Ca2+ is close to that of the molten globule state of disulfide-intact alpha-lactalbumin. This result suggests that GroEL binds to the unfolded alpha-domain of alpha-lactalbumin regardless of the conformation of the beta-domain. The fully disulfide-reduced and two-disulfide-reduced alpha-lactalbumins were found to bind more strongly with GroEL in the absence of Ca2+ than the two-disulfide-reduced alpha-lactalbumin in the presence of Ca2+, thus indicating that the unfolding of the beta-domain of alpha-lactalbumin leads to stronger interaction with GroEL.

Sensitive and reliable laboratory parameters are necessary to evaluate the degree of liver regeneration serially in patients after partial hepatectomy for liver cancer. We evaluated the serum levels of transforming growth factor-alpha (TGF-alpha) and hepatocyte growth factor (HGF), both of which are potent mitogens for hepatocytes, in 22 hepatectomized patients with liver cancer: 10 patients with hepatocellular carcinoma and 12 patients with metastatic liver tumors. Ten patients who underwent laparotomy for nonhepatic surgery were also studied as surgical controls. The serum TGF-alpha and HGF levels were measured by sandwich enzyme-linked immunosorbent assay techniques. Both the serum TGF-alpha and HGF levels increased after partial hepatectomy. However, there was no correlation between the levels of TGF-alpha and HGF. The maximal level of TGF-alpha achieved in each case correlated significantly with the resected liver volume and the increased volume of the remaining liver. Hepatocyte growth factor showed no such correlations. After nonhepatic surgery, the HGF level also increased significantly, while the TGF-alpha level did not. These results suggest that the serum TGF-alpha level varies depending on the regenerative stimulus to the liver, and that its increase corresponds with the degree of liver regeneration that occurs in patients after partial hepatectomy for liver cancer. In contrast, it is unlikely that the serum HGF level reflects liver regeneration. In conclusion, the serum TGF-alpha level can be used as a parameter for evaluating liver regeneration in patients who have undergone partial hepatectomy.

A case is presented of unruptured aneurysm of the non coronary sinus of Valsalva, causing involvement of A-V node and right coronary artery compression. The patient was a 68 year-old woman with a complaint of general fatigue. Electrocardiogram showed complete A-V block. Computed tomography showed an aneurysm of the non coronary sinus of Valsalva. A temporary pacemaker was implanted, but the patient developed respiratory failure and heart failure and died. At autopsy, macroscopically disseminated tuberculosis was noted in both lungs and kidneys. Microscopically a tuberculous inflammatory lesion extending into the A-V node was found. We report this rare case with some consideration of the literature.

The radiographic appearances of three cases of Castleman's disease of hyaline vascular type are reported. CT demonstrated homogeneous masses with marked contrast enhancement. Calcification was seen in one, and associated lymphadenopathy was seen in two. All tumors were hypervascular with prominent tumor blush on angiography. Sonography showed the masses to be hypoechoic with hyperechoic spots. On MR imaging, all tumors had homogeneous architecture with hypointensity on T1-weighted images and hyperintensity on T2-weighted images. In tumors with above characteristics in areas where lymphoid tissue is normally found, Castleman's disease should be added to the list of differential diagnosis.

Fat-storing cells (FSC, lipocytes, or Ito cells) of liver store vitamin A and are the main producers of extracellular matrix in normal and cirrhotic liver. During liver injury, FSC undergo an activation process characterized by a decrease in vitamin A storage and an increase in cell proliferation and extracellular matrix deposition. This activation process also occurs upon culturing FSC from normal liver. In contrast to most cells of nonmuscle origin, activated FSC express two cytoskeletal proteins normally found in muscle, desmin, and smooth muscle alpha-actin. Based on their strategic perisinusoidal location, it has been hypothesized that FSC play a role in regulating blood flow. However, the nature of the contractile elements involved in this process remains to be determined. In this communication we demonstrate the presence of a sarcomeric myosin in proteins solubilized from liver biomatrix. In addition we demonstrate the expression of sarcomeric myosin heavy chain (MHC) mRNA and protein in two FSC clones derived from a CCl4-cirrhotic rat liver (CFSC). Through cloning the cDNA corresponding to the MHC gene expressed in these cells we demonstrate that it encodes fast IId skeletal MHC and thus represents a marker normally seen in adult muscle. The unexpected expression of an adult stage skeletal muscle molecular motor in FSC from cirrhotic liver is consistent with the proposed specialized contractile capacity of these cells.

A 40-year-old woman was admitted because of increasing exertional dyspnea. Right heart failure was suggested by the presence of hepatomegaly, pretibial edema and also echocardiographic findings. Physical examination and echocardiography showed no evidence of valvular disease or congenital heart disease except for right ventricular dilatation and tricuspid regurgitation. The ventricular septum deviated toward the left ventricle throughout the cardiac cycle, but left ventricular function was preserved. Severe pulmonary hypertension averaging 44 mmHg was revealed by cardiac catheterization. Digital subtraction angiography and pulmonary blood flow scintigraphy showed no evidence of pulmonary artery embolism, and no interstitial pulmonary lesions that might have caused pulmonary hypertension were recognized. Hypergammaglobulinemia suggested an autoimmune disorder, and signs of systemic lupus erythematosus (SLE), such as pleural effusion, proteinuria, lymphocytopenia, LE cell phenomenon and antinuclear antibodies were present. Several autoimmune diseases are known to be causative factors of pulmonary hypertension. However, only ten cases of SLE complicated by pulmonary hypertension have been reported the present one. These cases were characterized by a high incidence of Raynaud's phenomenon and positivity for anti-RNP antibody. In our present case, SLE activity was suppressed using prednisolone, but pulmonary hypertension persisted and the patient eventually died due to right cardiac failure. Judging from the clinical course of the ten reported cases of SLE-pulmonary hypertension, there seems to be no hope of improving the pulmonary hypertension once it has become established. Therefore it is important to detect and cure pulmonary hypertension as early as possible.

Because hepatocellular carcinoma treated by transcatheter arterial embolization often regains its size, routine follow-up is necessary. The usefulness of pulsed Doppler ultrasound for detection of this type of recurrence was compared with ultrasonography and computed tomography in 21 such hepatocellular carcinomas. Of 15 hepatocellular carcinomas diagnosed by angiography as showing recurrence, four were detected with ultrasonography and five were detected with computed tomography. Doppler signals were obtained in the peripheral portions corresponding to tumor vessels or stains on angiograms in 14 of these 15 hepatocellular carcinomas, but they were undetectable in six hepatocellular carcinomas with no recurrence. All signals disappeared after transcatheter arterial embolization. One false-negative hepatocellular carcinoma with pulsed Doppler ultrasound showed faint tumor stains on angiograms; these were also negative on ultrasonography and computed tomography. Pulsed Doppler ultrasound may be superior to ultrasonography and computed tomography as a routine procedure to detect the recurrence of hepatocellular carcinoma treated by transcatheter arterial embolization.

In 21 patients with chronic liver disease, the ratio of liver to muscle signal intensity on T1-weighted images was negatively correlated with the progression of hepatic fibrosis defined according to findings by laparoscopy and liver biopsy, and differentiated six patients with early chronic hepatitis from eight with liver cirrhosis. On T2-weighted images, the number of low intensity nodules comparable in size to regenerating nodules surrounded by connective tissues showed a positive correlation with stage. When hepatic fibrosis with no necrosis or fat infiltration was induced in rats, T2 values were positively correlated with hepatic hydroxyproline content, though there was no such correlation for T1 values. These results suggest that MR imaging may be useful for determining the progression of hepatic fibrosis in chronic liver disease. T2 values may directly reflect hepatic fibrosis.

To evaluate the influence of diabetes mellitus on coronary artery disease and the results of coronary bypass surgery, a review was made of 63 consecutive patients undergoing isolated saphenous vein aortocoronary bypass, of whom 38 patients (G-1) were nondiabetic, 9 patients (G-2) had impaired glucose tolerance, and 16 patients (G-3) were diabetic. The severity of coronary artery disease was assessed using an angiographic grading system. Among three patient groups, there was no difference in total coronary score per patient reflecting total extent of disease (G-1; 15.7 +/- 5.5, G-2; 14.1 +/- 5.9, G-3; 17.1 +/- 6.3, mean +/- S.D.) and the incidence of diffusely diseased vessels. The mean number of diseased vessels (greater than 50% stenosis) per patient was 2.5 +/- 0.6 in G-1, 2.6 +/- 0.7 in G-2, and 2.5 +/- 0.7 in G-3, and the mean number of bypass grafts per patient was 2.3 +/- 0.9, 2.2 +/- 0.9, and 2.1 +/- 0.7, respectively. Coronary luminal diameters and the severity of atherosclerotic changes of coronary arteries at the site of graft anastomosis, studied intraoperatively, were similar in all groups. Vein graft blood flows and early graft patency in diabetics (112 +/- 55 ml/min, 96.9%, respectively) were also similarly good as those in the other groups (98 +/- 49 ml/min, 91.4% in G-1, and 92 +/- 39 ml/min, 94.1% in G-2). Overall hospital mortality was 1.6% (one of 63). The only death from meningoencephalitis occurred in the diabetic group.(ABSTRACT TRUNCATED AT 250 WORDS)

P-1894B an inhibitor of collagen prolyl hydroxylase was applied topically to cotton pellet-induced granuloma and to skin lesions in rats. The total hydroxyproline content of the granulomata was significantly reduced by this agent. It also reduced the hydroxyproline content in the tissues surrounding skin lesions during the healing process, with delayed diminution in lesion size. These results suggest that collagen prolyl hydroxylase inhibitor P-1894B may be a suitable agent for topical treatment of hypertrophic scar tissue or keloid.

Insulin and glucagon have been reported to be hepatotrophic since they are effective in potentiating liver regeneration and protecting the liver from atrophy 1–7. These results were obtained under experimental conditions with a deficiency of endogenous insulin and glucagon induced by portal deprivation1,2,4, evisceration5,6, or alloxan diabetes3,7. Thus, it is possible that the effect was only supplementary to the restoration from retardation. Both hormones have been applied to the treatment of acute hepatic failure8–11. The action, however, seems to be complicated. The favourable effect of glucagon and insulin on the survival of mice with fulminant viral hepatitis reported by Farivar et al.8 might be the result of hepatoprotection, since 24 h after viral infection they observed morphologically an attenuation of hepatocellular necrosis with the therapy. The promotion of liver functions besides the stimulation of liver regeneration could explain the rapid improvement of prothrombin time and total bilirubin levels after hormone infusion in alcoholic hepatitis patients reported by Baker et al.9.

The potential utility of spectroscopic imaging by dephasing amplitude changing (SIDAC) was evaluated in fatty infiltration in rats induced by cholesterol and ethanol. There was an excellent correlation between the in vivo fat-to-water ratio obtained from SIDAC and that in liver specimens from in vitro measurement (r = 0.97). SIDAC is a promising method for semiquantitative analysis of fatty infiltration of the liver.

Double-radionuclide autoradiography proved to be feasible using combinations of Tc-99m and I-125, or Tc-99m and C-14. Because of the short half-life of Tc-99m (6 hr), we first registered Tc-99m on x-ray film. Given an adequate Tc-99m:I-125 activity ratio of 20:1, the exposure duration for Tc-99m was still too short for I-125 to blacken the x-ray film. The pure emission from C-14 is completely absorbed by a thin aluminum sheet--hence no problem there. After the decay of Tc-99m, therefore, it was entirely feasible to continue autoradiography with I-125 (T1/2 = 60.2 days) or C-14 (T1/2 = 5730 yr). Based on these conditions, we applied (a) tracer microspheres labeled with I-125 and Tc-99m to define the respective perfusion areas of the left anterior descending, septal, and left circumflex coronary arteries of the beating heart, and (b) Tc-99m pyrophosphate and C-14 antipyrine to demarcate respectively the localization of the infarct-avid substance and the regional blood flow. We verified the first procedure with postmortem angiography and the second with histochemistry.

End-systolic pressure-volume relationship (ESPVR) of the in situ heart in the dog was measured during changes in contractile state and was compared with end-systolic pressure-length (ESPLR) or stress-strain relationship (ESSSR). Circumferential segmental length and wall thickness at the equator and external long and short axis diameters of the left ventricle (LV) were determined sonomicrometrically, and LV volume was calculated by an ellipsoidal model. Circumferential wall stress at the equator was calculated by a very thin shell model. Contractile state was enhanced by an intravenous infusion of dobutamine and was suppressed by propranolol. ESPVR, ESPLR, and ESSSR were determined during a reduction of arterial pressure by occluding temporarily the inferior caval vein (IVC). ESPVR, ESPLR, and ESSSR during changes in end-systolic pressure from 108 +/- 3 to 71 +/- 2 mmHg were linear, irrespective of inotropic states (r greater than 0.92). Slopes of these relationships increased similarly in case of dobutamine and were reduced after propranolol, yet the extrapolated X-axis intercept of ESPVR, ESPLR, and ESSSR remained unchanged. Thus the slope of ESPVR is unique to the inotropic state, and both ESPLR and ESSSR are useful as a substitute for ESPVR when there is no regional wall motion abnormality.

End-systolic pressure-length relationship (ESPLR) was examined in the heterogenously contracting heart in open-chest dogs. Regional length was measured sonomicrometrically in the areas of both the left circumflex coronary artery (LCX) and left anterior descending coronary artery (LAD). ESPLR was linear during a transient reduction in arterial pressure following occlusion of the inferior caval vein (IVC). In group 1 (12 dogs), saline as a control condition (Cont) and isoproterenol (Iso, 0.05 microgram/min) to enhance the regional contractile state were infused into the LCX. Percent shortening in the LCX area increased from 13 to 16% (P less than 0.01) in Iso. The slope (Ees) of ESPLR increased from 57 to 71 mmHg/mm (P less than 0.01) in Iso. The extrapolated X-axis intercept (Lo) of ESPLR was unchanged. In the LAD area, Ees and Lo remained constant. In group 2 (13 dogs), lidocaine (1 mg/min, Lid 1; 5 mg/min, Lid 5) was infused into the LCX to induce mild and severe hypokinesis, respectively. Percent shortening in the LCX area was reduced from 14 to 8% (P less than 0.01 vs. Cont) in Lid 1 and 5% (P less than 0.01 vs. Cont, P less than 0.05 vs. Lid 1) in Lid 5. Ees tended to decrease in Lid 1 but to increase in Lid 5 (statistically not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Right and left ventricular function was evaluated in 28 patients with dilated cardiomyopathy to determine whether both ventricular functions were equally impaired in each patient. The ejection fractions of both ventricles were measured using equilibrium radionuclide ventriculography. In 13 patients the left ventricular ejection fraction (LVEF) was lower than the right ventricular ejection fraction (RVEF) by 6% or more, their mean values being 24 +/- 8% (mean +/- SD) and 37 +/- 7%, respectively (group 1). The difference between the LVEF and RVEF was less than 6% in nine patients; LVEF 29 +/- 8% and RVEF 30 +/- 7% (group 2). In six patients the RVEF was lower than the LVEF by 6% or more, and their mean values were 21 +/- 6% and 37 +/- 10%, respectively (group 3). The frequency of ventricular tachycardia, which was determined by the Holter ECG, was significantly higher in group 3 (100%, 6/6) than in the others (group 1 + 2; 41%, 9/22), p less than 0.05. The NYHA functional class correlated well with the LVEF, but not with the RVEF. It was concluded that the left and right ventricular functions are not necessarily equally impaired in patients with dilated cardiomyopathy, and that the difference may correlate with their clinical features.

A retrospective investigation of 21 cases of hepatocellular carcinoma with liver cirrhosis presumably of viral origin revealed a significant fall in the value of the zinc turbidity test from 15.5 +/- 6.9 (mean +/- SD) at 1 year to 11.2 +/- 2.5 units at 6 months before the discovery of the carcinoma (p less than 0.05), and a return to 16.8 +/- 7.2 units one month after the diagnosis (p less than 0.05). The values at 6, 2 and 1 month before the diagnosis were significantly lower than that for 120 control cirrhotics without hepatocellular carcinoma at 16.3 +/- 7.2 units (p less than 0.05). The fall in value occurred before or concurrently with a rise in the alpha-fetoprotein level in three patients, in whom it has been determined serially. Based on the results obtained, the decrease in the zinc turbidity test value may be used as an indicator for impending hepatocellular carcinoma in patients with liver cirrhosis.

S ynovial fluid mirrors the pathology of joint diseases in much the same manner as the urine reflects processes taking place in the kidney. Its careful examination adds much to the accuracy of diagnosis and, at times, affords the only means of establishing it correctly. Much information can be obtained from volumes of fluid as little as 0.1 to 0.2 ml.; amounts that are obtainable from the temporomandibular joint.