[Conference: lessons in clinical training. Attitude of nursing personnel in understanding the patient - an interaction with an aged patient without family].
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Biomedical subjects
Publications and source records attributed to H Sakuma.
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Histiocytic cells with S100 protein compose a cell lineage independent of the monocyte-macrophage system. Langerhans cells and indeterminate cells in the skin and oral mucosa, interdigitating cells in the T-zone of the lymph node, and other lymphoid tissues belong to this cell lineage. In addition to these cells, small S100+ cells showed morphological transition to large histiocytes. In human fetuses, a large number of S100+ lysozyme- NCA- cells first appeared in the thymic medulla by the end of the third month of gestation, and rapidly disseminated to the various lymphoid organs in accordance with the spread of T-lymphocytes during the fourth month of gestation. S100+ small cells were more frequent than large cells and showed more rapid dissemination in the early stage. S100- lysozyme+ NCA+ immature macrophages appeared in the liver, spleen, lymph node anlage, and other tissues at the second month of gestation, and their distribution was completely different from S100+ histiocytes. Fetal development of T-zone histiocytes with S100 protein supported the hypothesis that there are two histiocytic cell lines; one is the monocyte-macrophage system, another is the S100+ T-zone histiocyte system.
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A 33 year-old woman was admitted with chief complaint of abdominal pain and high fever. A barium-enema showed serration and a tumor was seen in the proximal ascending colon. At laparotomy, a localized tumor about 5 cm in diameter was located in the proximal portion of the ascending colon. The operation was made according to the ileoceal resection. On the macroscopic examination of the resected specimen, a small hole penetrating into the subserosa of the ascending colon was noticed and a tumor measuring approximately 3 x 1.2 x 1 cm was located under the hole. A female worm, Trichuris trichiura, was found to be harbored in the adjacent site of the lesion. Histopathologic examination revealed granulomatous tissue reaction due to penetrating of Trichuris trichiura. The patient is in good health now 20 months after operation.
A 57-year-old male with polymyositis developed jaundice which was induced by intrahepatic cholestasis. During his course before and after discontinuation of the administration of an anabolic steroid hormone which was suspected as the possible agent, serum gamma-glutamyl transpeptidase (gamma-GTP) levels were consistently within normal level, although serum levels of bilirubin, A1-P and LAP were elevated. Difference in the levels among biliary tract enzymes was discussed with regard to the mechanism of elevation of serum biliary tract enzyme levels, and a possible significance of the examination of bile juice was suggested.
In an attempt to clarify the cytological characteristics of the RES cells in the lymph nodes and their embryological correlations, lymph nodes and lymph node anlages of germ-free rats, nude mice, and human fetuses were light and electron microscopically examined. On the basis of differences of intracellular organelles, their behaviors for reticulum fibers and of endogeneous peroxidatic activity, histiocytes should be reasonably distinguished from the cells conventionally called reticulum cells. Reticulum cells and histiocytes respectively are destined to differentiate in different directions from the early stage of development of the lymph node anlage. Sinus endothelial cells are ontogenetically originated and differentiated from the endothelial lining cells of lymphatic vessels. Primitive reticular cells are differentiated into mature reticulum cells in the lymph nodes, they transform into the lympho-reticular cells, further into lymphoblasts, and finally develop into medium-sized lymphocytes.
The present authors have studied the cellular composition of the primary follicle (PF) in the germ-free rat lymph nodes and the development of PF in the human lymph node anlages by using the light- and the electron microscopy. According to the ultrastructural study, the cellular composition of PF in the germ-free rat lymph nodes and classified into five cell types, 1) lymphocytic cells (small and medium-sized lymphocytes), 2) large lymphocytes (= large germinal center cells), 3) reticulum cells with desmosomes (RED), 4) desmodendric cells (DDC), and 5) histiocytes. The interstitial cells with desmosome are classified into DDC and RED based on the relationship to collagenous fibers and the morphological differences. There are amorphous electron-dense intercellular materials among the cytoplasmic processes of DDC, which are distinguished from histiocytes based on the morphological differences. PF emerges as a spherical aggregation of young DDC straight underneath the marginal sinus in the outer cortex of the human embryonal lymph node anlages on the 16th fetal week.
A 61-year-old woman was found to have a right flank mass. Radiologically, the mass was thought to be of renal origin. Surgically, however, the tumorous lesion adhered tightly not only to the cortical surface but extended to the retroperitoneum and psoas muscle. Pathological examination confirmed the lesion to be malacoplakia which was characterized by the presence of von Hansemann cells and Michaelis-Gutmann bodies. Despite the effort made to focus on the initiating site of the tumor, it was considerably difficult to decide whether it originated from either an extremely superficial part of the renal cortex or renal capsule or retroperitoneum itself. Histochemical and electron microscopical investigations on the von Hansemann cells and Michaelis-Gutmann bodies were made. The pathogenesis of malacoplakia was briefly discussed with particular emphasis on its possible occurrence in the patients under various therapeutic regimes.
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In order to evaluate cardiac sympathetic nerve activity, plasma norepinephrine levels in the coronary sinus (NECS) and in the artery (NEA) were determined in 24 subjects with cardiovascular diseases and in six with functional murmur. The resting NECS was greater than NEA in 14 subjects with normal left ventricular end-diastolic pressure (LVEDP) (p < 0.001) and/or in 22 with normal cardiac index (p < 0.04), whereas NECS was not significantly different from NEA in the remaining patients with elevated LVEDP and/or with reduced cardiac index. Isometric handgrip exercise increased both NECS and NEA (p < 0.001). When subjects were divided into two groups according to the slope of the ventricular function curve (delta stroke work index/delta LVEDP), NECS during exercise was greater then NEA in the group having slopes of 1.0 or more (p < 0.01), but neither values significantly differed in the group with slopes of less than 1.0. In the latter group, cardiac NE overflow rat calculated from the difference between NECS and NEA multiplied by coronary sinus plasma flow, was significantly less than that of the former group before and during handgrip (p < 0.05 and p < 0.01, respectively). These results suggest that cardiac norepinephrine release into the coronary sinus is reduced in patients with impaired cardiac function.
Cell morphology of histiocytes and fibroblasts was observed light- and electron microscopically in the subcutaneous connective tissue of unstimulated adult rats. Striking ultrastructural differences between them were noted in the cell surface characters, extent and development of endoplasmic reticula, especially of rough-surfaced ones, and volumes of lysosomal components. Rosetting assays revealed that histiocytes were positive for EA- and EAC-rosette formation and capable of engaging in immunophagocytosis. However, fibroblasts were negative for both rosettings. In the experiments of vital staining with lithium carmine, Fesin phagocytosis, carrageenin granuloma formation, in vivo culture by intraperitoneal implantation of diffusion chambers, and subculture, cytological changes of histiocytes or macrophages and fibroblasts, as well as their transformation, were investigated. Although fibroblasts often simulated histiocytes under certain stimulated conditions, no transformation of fibroblasts into histiocytes was confirmed. Ontogenetically, histiocytes already existed in the subepidermal mesenchyme of rat fetuses before differentiation of undifferentiated mesenchymal cells into fibroblasts and showed no relationship to the fibroblasts. Ultrastructural cell morphology and cultural characteristics of the fetal histiocytes were presented and their possible origin was discussed briefly.
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A preoperative patient with pheochromocytoma was satisfactorily treated with oral labetalol, while a conspicuous increase in urinary output of catecholamines (CA) and of vanillylmandelic acid (VMA) was observed after labetalol therapy. Exaggerated increases in urinary CA and in VMA were also confirmed in normal volunteers immediately after oral labetalol. These effects of labetalol on urinary CA and VMA, however, were proved to be largely due to the interference with the usual photometries rather than due to its stimulation of CA release. Therefore, it should be emphasized that clinical evaluations of CA and its metabolites must be performed before labetalol therapy to avoid an erroneous diagnosis of pheochromocytoma.