Search

We evaluated the conditions of fixation for ultrastructurally demonstrating the endogenous peroxidase (PO) activity of macrophages in biopsied human liver. The application of microwaving and immersion fixation with tannic acid and aldehydes allowed excellent visualization of PO activity in the nuclear envelope (NE), rough endoplasmic reticulum (rER), and cytoplasmic granules (CG), with good preservation of cellular ultrastructures. The macrophages with PO activity showed one of the following five patterns of PO localization: positive in both the NE and rER but negative in the CG (type 1); negative in both the NE and rER but positive in the CG (type 2); negative in the NE but positive in both the rER and CG (type 3); positive in all three (type 4); PO negative (type 5). The type 1 cells resembled typical Kupffer cells, type 2 cells monocytes, and type 3 and 4 cells the exudate-resident macrophages considered to be a transitional form between exudate and resident macrophages. Type 5 cells may also be a transitional form between the exudate and resident macrophage, or an end-stage macrophage derived from exudate macrophages which have lost their PO activity. Tannic-acid-aldehyde immersion fixation with microwaving may be a useful method in the study of the PO activities of macrophages in biopsied human liver specimens.

We treated a married couple who developed Mycoplasma pneumonia at the same time, and whose clinical courses and serum soluble interleukin-2 receptor (sIL-2R) levels were markedly different. The 30-year-old wife developed acute respiratory failure and her sIL-2R levels were extremely increased. After pulse therapy, her clinical state was improved, with a marked decrease in sIL-2R. In contrast, the 36-year-old husband, also suffered from the pneumonia with a moderate increase of sIL-2R, and recovered without any complications. The difference in their clinical states may be reflected in their serum sIL-2R levels, a marker of T cell activation in vivo.

Objective: To clarify the effect of ammonia produced by Helicobacter pylori, which has strong urease activity, on the blood ammonia level. Design: (1) The quantification of ammonia production by live H. pylori in vitro. (2) The measurement of venous and portal ammonia levels following the instillation of H. pylori into the stomachs of normal or cirrhotic rats. Methods: (1) The urease reaction was carried out at 37°C with bacteria suspended in phosphate-buffered saline and 400 mmol/l urea solution in acetate buffer, pH 5.0. (2) Bacterial suspensions with or without urea solution were instilled into the stomachs of male normal Wistar rats or into rats in which cirrhosis had been induced by injection of carbon tetrachloride; venous and portal ammonia levels were then measured

Experimental studies have suggested that the continuous administration of 0.02% NH, solution, induced by Helicobacter pylori (H, Pylori), leads to a glandular atrophy of the gastric mucosa, and adversely affects healing of acetic acid ulcers in rats, because of the suppression of cell kinetics of the regenerative epithelial cells and connective tissues at ulcer margins. To visualize the distribution of H. pylori in human gastric mucosa, a phenol red dye spraying endoscopy was performed in 45 patients with gastric ulcers, and 43 patients with duodenal ulcers, who were medicated with a full dose of H2-blocker until ulcer healing, and with half doses thereafter. In the H. pylori negative cases, 8 (88.9%) of 9 gastric ulcers healed within 3 months after medication, with no relapse discernible up to 6 months after healing of the preceding ulcer. The relapse rate was 25% up to 12 months after ulcer healing. In contrast, only 22 (66.1%) of 36 gastric ulcers healed within 3 months after medication in the H. pylori positive cases. The relapse rate was 12.5% up to 3 months, 30.4% UP to 6 months and 63.6% up to 12 months after ulcer healing. In addition, all 6 duodenal ulcers healed within 2 months after medication in the H. pylori negative cases, with no relapse discernible up to 12 months after healing of the preceding ulcer. In contrast, in the H. pylon positive cases, 20 (53.1%) of 37 duodenal ulcers healed within 2 months, and the relapse rate was 14.3%, 33.3%, and 66.7% up to 3, 6 and 12 months respectively after healing of the preceding ulcer. These data suggest that H. pylori is likely to interfer with ulcer healing, and promotes peptic ulcer relapse.

A case of non-functioning neuroblastoma of the adrenal in a 28-year-old woman is reported. She was admitted complaining of left upper abdominal pain and high fever. Physiological examination revealed an elastic, well delimtted mass with smooth surface at the left hypochondrium. The findings from aortogram and abdominal CT suggested that the tumor originated in the left adrenal gland. However, this tumor was diagnosed clinically as a non-functioning adrenal tumor, because any abnormality was not detected in biochemical examinations, for example, urinary excretion of VMA, HVA, adrenalin, noradrenalin and dopamine, serum value of cortisol and aldosteron, etc. At the operation, the elastic hard tumor which had a well vasculized capsule, was found in the left retroperitoneal space. The tumor adhered to the left kidney so tightly that combined removal of the tumor and the left kidney was performed. Moreover, neither swelling of lymphnodes nor liver metastasis was not observed. Surgical specimen measured 14×11×8cm in size and the cut surface was gray with hemorrhage in part. The histopathological diagnosis was rossete-forming neuroblastoma. There has been no evidence of recurrence for more than one year postoperatively.

比較的大量のIFNをB型慢性肝炎15例(CAH 14例, CIH 1例)に投与し,投与終了後1.5年から3.3年間経過観察し,主としてHBV関連マーカーの推移を検討した. HBe抗原は全例で陽性であり,DNAPは14例で陽性,1例で陰性であった. HBV DNAは全例で陽性であった.使用したIFNはα型,β型,組み換え型ヒト白血球αA, HLBIである.2例でIFNが2回投与された.IFNの総投与量は1×108IUから4.77×108IUで,投与期間は原則として4週間である.HBe抗原の消失率は投与終了時33.3%, 1.5年後40%で,それ以降に変化は認めなかった.SC率は終了時13.3%, 1年後20%で,それ以降に変化はなかった, DNAPの陰性化率は終了時42.8%, 1年以降は約40%であった.しかし,HBV DNAはHBe抗原消失例においても,1年以降持続的に陰性化した例はなかった.2例でIFN治療後HBe抗体へSCし,抗体価が高値で持続しているにもかかわらず,HBVの増殖と関連してSGPTの異常がみられた.IFNが有効と考えられた例では治療前のSGPTが150KU以上の変動を示すCAHであった.

51歳女性にみられたPBCとルポイド肝炎のoverlapした症例を報告した.Raynaud症状,口腔および眼球の乾燥感や全身倦怠感を訴え入院,入院後99mTc-Sn-Colloid, 99mTc-PIシンチグラフィーやERCPにて胆嚢,および胆管の閉塞所見を認めず.Schirmer testおよび唾液腺造影所見よりSjogren症候群と診断される.第1回入院前より黄疸,皮膚掻痒感や黄色腫を認めなかった.GOP, GPT, ALPの軽度上昇を認めるも,血清コレステロール値は正常であった.抗ミトコンドリア抗体(AMA)は陽性.抗平滑筋抗体,抗核抗体,抗DNA抗体,LE cell testはすべて陽性であった.外科的楔状肝生検にてchronic non-suppurative destructive cholangitisの所見と著明なpiecemeal necrosisやbridging necrosisを認め,PBCとCAHのoverlapした所見であった.その後,血清トランスアミナーゼの著高を来し第2回入院となる.ステロイド投与により自覚症状および肝機能検査成績の著明な改善が認められた.AMAの亜型ではanti-M2は陽性であったが,anti-M4は陰性であった.

3年以上経過観察されているHBe抗体持続陽性のB型慢性肝疾患21例(SGPTが100 Karmen units以上の異常を認める9例とSGPTが持続的に正常な12例)で経時的に血中HBV DNAとDNA-Pを測定し,SGPTの上昇がHBVのreactivationと関係しているか否かを検討した.SGPTの異常が認められた9例の組織診断はCAH 5例, CAH cLC 2例, LC2例であった.これらの例ではSGPTの上昇はHBVのreactivationと関係していたが,HBe抗原の再出現やHBe抗体の消失する例はみられなかった.一方,SGPTが正常な12例では血中HBV DNAやDNA-Pは持続的に陰性であった.従って,HBe抗体陽性のB型慢性肝炎でも血清トランスアミナーゼの上昇を認める例ではHBVのreactivationが関与している可能性を考慮し,抗ウイルス剤の適応を検討する必要があると思われた.