Sebaceous carcinoma--with special reference to histopathologic differential diagnosis.
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Biomedical subjects
Publications and source records attributed to K Nishihara.
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Sixty renal allograft tissues obtained from 29 patients were stained with hematoxylin and eosin. These tissues were histologically classified into 4 patterns according to the distribution pattern of the infiltrating cells: normal, focal, focal-diffuse, and diffuse types. Clinical signs of acute rejection were observed in 88% of the patients with the diffuse type infiltration, and 83% of those with the focal-diffuse type infiltration but in only 13% of those with the focal type infiltration. Twenty-four renal allografts were analyzed by the ABC and the IGSS methods using monoclonal antibodies. The number of T cells (Leu 1) accounted for about 80% of the total number of infiltrating cells; 2-8% of the cells were B cells (Leu 12); about 10% were NK/K cells (Leu 7); and 4-6% were monocytes/macrophages (Leu M3). As to helper/inducer T cell (Leu3a) and killer/suppressor T cell (Leu2a), which are T lymphocyte subsets, there were more Leu3a- than Leu2a-positive cells in focal type tissue, but there were more Leu2a- than Leu3a-positive cells in focal-diffuse and diffuse type tissue. In most cases that developed clinical signs of acute rejection, there were more Leu2a- than Leu3a-positive cells. The Leu3a/Leu2a ratio in most of the AZA-administered cases dropped immediately after the transplantation and maintained a low value, but in the CSA-administered cases it decreased gradually post-transplant.
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The etiology of hemifacial spasm had long been obscure until 1962 when Gardner proved that this hyperdysfunction of the facial nerve was caused by mechanical compression of the facial nerve by vascular structures in the posterior cranial fossa. In 1977, Jannetta proposed a specific location at the root entry zone of the facial nerve; this area has consequently been considered to be especially vulnerable to minor trauma such as vascular compression. In patients with hemifacial spasm, the posterior cranial fossa cavity is commonly found to be small or shallow on plain craniogram; this anatomical change in the skull is regarded as pathognomonic for the facial nerve hyperdysfunction. To make a quantitative analysis of the posterior cranial fossa volume in these patients, the following method was used. In the preliminary study, a dry human skull with an artificial "tentorium" made of thick paper was prepared to decide the fundamental plane for volume measurement by CT scan. This plane included attachments of posterior clinoid ligaments, superior petrosal veins and lateral sinuses. When this fundamental plane was projected to the lateral view on CT scan, it appeared to be almost identical to the line connecting the tip of posterior clinoid process to the internal occipital protuberance (the fundamental line). A horizontal CT scan for an intracranial volume measurement was performed in a parallel fashion to this fundamental line, with a 5 mm slice for the infratentorial and a 10 mm slice for the supratentorial area. The intracranial area of each horizontal slice was calculated by computed planimeter.(ABSTRACT TRUNCATED AT 250 WORDS)
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A new double immunohistochemical technique for the simultaneous detection of B-cells and T-cells was investigated, using tissue preparations obtained from human axillary lymph nodes and rejected renal allografts. The specimens were immunostained first for the demonstration of B-cells, by the immunogold-silver staining (IGSS) method using Leu-12 monoclonal antibody, and then for T-cells by the avidin-biotin-peroxidase complex (ABC) method using Leu-1 monoclonal antibody. With the present methods, both B-cells and T-cells were clearly detected and distinctively identified without cross-linking of antibodies or double reaction of enzymes.
A unique case of hepatolithiasis associated with cholangiocarcinoma is described. The intrahepatic calculi consisted mainly of cholesterol rather than calcium bilirubinate. A bacteriological study of the intrahepatic and gallbladder bile was negative, though bacterial infection of the bile duct has been considered a main factor responsible for formation of intrahepatic calculi.
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Recently microvascular decompression surgery has been performed for trigeminal neuralgia or glossopharyngeal neuralgia with remarkable success. In differential diagnosis of such neuralgia, a lot of atypical facial pain must be taken into consideration, one of which is so-called Eagle's syndrome. This syndrome is characterized by elongated styloid process or calcified stylohyoid ligament compressing the Vth and/or IXth cranial nerve. In the present paper we report three cases of Eagle's syndrome and discuss the mechanism, differential diagnosis and surgical treatment of the facial pain in this syndrome. The first case was a 40-year-old man. He complained of continuous dull pain on the right face. Sometimes he also suffered from radiating pain into the orbit and maxillary region. A-P and lateral projection of plain skull film showed elongated styloid process measuring about 4.5 cm in length. This process curved medially and was palpable in the tonsillar fossa. Above mentioned radiating pain was released by the injection of local anesthesic agent into the tonsillar fossa. From these findings, diagnosis of Eagle's syndrome was made. He was performed partial styloidectomy by transoral approach with complete relief of the facial pain. The second case was a 49-year-old woman. She complained of continuous or periodic pain that radiating from the right subauricular area to the right neck. Lateral view of plain skull film showed elongation of her right styloid process measuring about 4 cm in length. In the right tonsillar fossa, the elongated styloid process was palpable, compression of which induced radiating pain. By injection of anesthesic material into the right tonsillar fossa the pain disappeared temporarilly.(ABSTRACT TRUNCATED AT 250 WORDS)
An intraoperative recording of a direct compound action potential of the 8th cranial nerve with pre, intra and postoperative monitorings of auditory brainstem evoked response (ABR) was carried out for the purpose of clarifying mechanism and prevention of postoperative hearing dysfunction following microvascular decompression surgery as a treatment for hyperdysfunction syndrome of cranial nerves. In 221 patients with hemifacial spasm and tic douloureux out of 510 patients operated on by microvascular decompression surgery, ABR was monitored before, during and after surgery and furthermore, in the recent 94 patients among them, an intraoperative direct recording of a compound action potential of the acoustic nerve was performed simultaneously. Among these 94 patients, postoperative mild hearing dysfunction was encountered in 11 patients and severe reduction of hearing acuity in 2. As a result of our studies of monitoring action potential of the 8th cranial nerve and ABR, the following conclusions were drawn. When a latency of component V of ABR was delayed by more than 1.5-2.0 msec during surgery, and delay of latency of main negative peak (N1) of an action potential of the acoustic nerve exceeded by more than 1.0 msec, the occurrence rate of postoperative hearing dysfunction became positively high. There were two different types of changes in both ABR and action potentials; one type was a delay of an action potential in combination with that of ABR latencies and the other one was merely a delay in ABR components without following a remarkable change in action potentials. The former change might due to be an insult of whole neural pathways of the 8th cranial nerve including a cochlear nucleus and the latter change may due to be functional changes of the structures proximal to the cochlear nucleus. The delay of latencies in ABR and action potentials could be imposed either by a traction of the 8th cranial nerve or by a compression of the region of cochlear nucleus by a blain spatula as well as a vascular insufficiency of the tiny vessels which supplied these neural structures. To avoid the surgical insult to the acoustic nerve itself and more proximal neural pathways, the traction of any neural structures by a brain spatula should be lasted less than 5 minutes with more than 2 minutes intervals when judged from the results of our monitoring studies and the pressure of the compression on the cerebellar cortex is much preferable to be less than 20 mmHg for the safety throughout whole surgical procedures.
In case of the advanced extension into the thoracic cavity, it has been difficult to remove a large thoracic spinal hourglass tumor by conventional laminectomy, even adding costotransversectomy, due to high risk of injuring diverse important vessels and other organs by blind manipulation. A case of a large thoracic spinal hourglass neurinoma with advanced extension into the mediastinum is presented. A 49-year-old female was admitted for the further examination of the left mediastinal tumor, incidentally detected on routine chest roentgenogram, which was suspected as the part of spinal hourglass tumor. Her neurological examination was normal except hyperreflexia of bilateral lower extremities. Plain chest roentgenogram showed a left mediastinal mass behind the aortic arch and the descending aorta, which slightly enlarged in size, compared with its previous size in the chest film taken 3 years ago. Thoracic spine tomogram showed the destruction of the left pedicle of T4, the absorption of posterior aspect of the T4 vertebral body and the dilatation of the left intervertebral foramen between T4-T5. Myelogram showed the complete block of dye column at T4. Metrizamide CT scan revealed the large extradural hourglass tumor, which compressed the dural theca anterolaterally and extended through the dilated left T4-T5 intervertebral foramen into the left mediastinum and attached to the descending aorta. Two stage operation, the first for the removal of the left mediastinal tumor by transthoracic approach and the second for intraspinal canal tumor by posterior approach, was performed with success for this large thoracic spinal hourglass tumor.(ABSTRACT TRUNCATED AT 250 WORDS)