Biomedical subjects
Publications and source records attributed to T Inagaki.
A case of pineal epidermoid cyst with interesting findings of magnetic resonance imaging (MRI) is reported referring to the literature. In our case, homogeneous high density area is seen on CT and high signal intensity is recognized on T1-weighted MRI and low signal intensity on T2-weighted MRI.
Using modified Bielschowsky method, we studied neuropathologically 159 aged subjects autopsied during the period from 1976 to 1988, of which we found 19 cases (average age at death: 82.6 ys) with numerous diffuse plaques in the frontal and temporal neocortex and no severe senile changes in H1-H3 of Ammon's horn (dp group). Amyloid angiopathy had been excluded and one case was excluded because of considerable cerebrovascular lesions. The dp group was divided into 8 demented (average age at death: 86.0 ys) and 10 nondemented patients (average age at death: 79.7 ys). We compared the number, type, and ratio of types of senile plaques in the frontal cortex, temporal cortex, and putamen of the demented and nondemented groups, and obtained the following results: (1) Eight (14%) of the 59 nondemented and 8 (40%) of the 20 demented cases in which no severe senile changes in the neocortex and hippocampus had been detected by Bodian stain showed numerous diffuse plaques in the neocortex when the modified Bielschowsky method was used. (2) The ratio of classic and primitive plaques to diffuse plaques in the frontal cortex was the same in both groups, but the nondemented group had exclusively diffuse plaques in the temporal cortex. (3) In the putamen 2 nondemented cases (20%) and 6 demented cases (75%) had exclusively diffuse plaques. We considered that classic and primitive plaques are more closely related to dementia than are diffuse plaques in the temporal lobe in cases without severe senile changes in the hippocampus.
A case of Binswanger disease with numerous diffuse plaques in the neocortex was reported. This male patient had a previous history of hypertension and myocardial infarction. From the age of 60, he developed dysarthria, bradykinesia, marche à petit pas and falling down. Neurological examination at his first admission disclosed muscular rigidity and increased jaw and deep tendon reflexes, but dementia was not found. Brain CT showed moderate brain atrophy and EEG consisted of slow wave dysrhythmia. He was diagnosed of Parkinsonism and treatment started without effects. During his second admission for the treatment of myocardial infarction, at the age of 64, delirium developed. Progressive dementia began and finally he was confined to bed. From the age of 69, spontaneous speech became almost lost. Contracture of the extremities, increased deep tendon reflexes and force grasping were noted. Brain CT showed symmetrical low attenuation in the frontal and parietal white matter with moderate dilatation of the lateral ventricles. At the age of 70, he died of general prostration about ten years after the initial symptoms. Neuropathological findings: Macroscopic findings: The brain weighed 1300 g. Atherosclerotic changes of the large arteries at the base of the brain were moderate. Coronal sections of the brain showed moderate enlargement of the lateral ventricles with multiple small lacunes in the basal ganglia. Microscopic findings: Bilateral diffuse demyelination of the white matter with sparing of the U-fibers was noted. Holzer stain revealed fibrillary gliosis in the left parietal and occipital white matter. Marked adventitial fibrosis of the deep white matter arteries and terminal stages of hyalinosis of the perforating arteries were found. Basal ganglia showed status lacunaris. Bilateral pyramidal tracts were atrophic secondly.(ABSTRACT TRUNCATED AT 250 WORDS)
Two cases of vinyl-chloride-induced angiosarcoma of the liver were investigated with special reference to the invasive character of malignant endothelial cells. Histological findings of the liver were similar in both cases. The liver angiosarcoma was multicentric and consisted of three portions: a peripheral parenchymal area, an intermediate mottled area, and a central cavernous area. Microscopically the intermediate area showed a mixture of fibrosis and cell infiltration of various patterns. At the periphery, yellowish brown parenchymal tissues remained and were always associated with sinusoidal changes, from non-cellular dilatation to trabecular growth of the small round cells. Under electron microscope, the small round cells showed direct contact with red blood cells and hepatocytes. Thus, the sinusoidal small cell infiltration is thought to be an initial lesion of angiosarcomatous transformation. Because none of the liver is free from these sinusoidal changes, partial hepatectomy would not be indicated even in a patient with few cavernous lesions.
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A series of investigations was conducted to trace serum superoxide dismutase (SOD) activities by ELISA and localizations of hepatic tissue SOD by the indirect method using peroxidase conjugated antibody, and the diagnostic and physiological significance of SOD in 19 alcoholics was studied. The values increased significantly both in serum Cu, Zn-SOD to 136 +/- 18 ng/ml (normally 33 +/- 9 ng/ml) and in serum Mn-SOD to 859 +/- 686 ng/ml(normally 84 +/- 30 ng/ml) respectively when polyclonal antibody was used (P less than 0.001). The increase in serum Mn-SOD was higher than that in serum Cu, Zn-SOD, fluctuations of these values showed similar tendencies. Meanwhile, serum Cu, Zn-SOD (94 +/- 50 ng/ml) identified by monoclonal antibody, also, showed higher values than that of normal subjects (37 +/- 7 ng/ml) (P less than 0.001). On the other hand, localization of hepatic tissue Cu, Zn-SOD in alcoholics varied, being 63.2% in the cytoplasmic diffuse type, 42.0% in the nuclear diffuse type, 42.1% in the vacuolated membrane type, and 15.8% in the small granular type respectively. Participation of Cu, Zn-SOD in ethanol oxidation, protective roles played by cell membrane, lysosome membrane and nucleic acid of Cu, Zn-SOD to harmful free radicals was presumed. In addition, localization of hepatic tissue Mn-SOD was mostly of the cytoplasmic diffuse type (52.7%) and was extremely variable. From such results, relative or absolute reductions of hepatic tissue SOD in alcoholics was suggested to act on the development of tissue injuries acceleratingly.
The identification and clinical significance of light microscopic giant mitochondria (GM) were investigated in liver biopsy specimens of 60 alcoholics. By light microscopic examinations using the same section and neighboring sections, we suggest that light microscopic GM correspond to the crystalloid bodies (CB) detected on ultrastructural observation. The reasons are as follows: (1) difference in stainability between eosinophilic light microscopic GM and acidbasophilic mitochondria; (2) similarity in morphological features and density of the round- and cigar-shaped types at the light microscopic level to those of CB at the electron microscopic level; (3) similarity of the area occupied in the hepatic cytoplasm at both light and electron microscopic levels; (4) the crystalline structure of CB in compatible with the subtype of Mallory body (MB); (5) a description of CB has been made at the electron microscopic level, although not yet at the light microscopic level. Moreover, we clinically observed that light microscopic GM seldom appeared either in early fatty liver of cases aged 35 or less or the late macronodular liver cirrhosis stage of alcoholic liver injuries while they were frequently recognized during the acute aggravation phase of the chronic stage (GPT: p less than 0.05). Furthermore, if one was to assume that MB is a change accompanying necrosis of the liver cells, the light microscopic GM might be a change accompanying degeneration of the cytoplasmic organelles.
Clinical and neuropathological studies of a case of pallido-nigro-luysian atrophy with thalamic degeneration and ossification of the posterior longitudinal ligament (OPLL) is reported. The patient was a 72-year-old man, suffering from gait disturbance caused by OPLL for about 3 years. The clinical features were characterized by gradual development of disorientation in place, time and person, memory disturbance, vertical gaze palsy and rigidity of extremities. Dysarthria, dysphagia, bradykinesia, masked face and neck dystonia appeared at the advanced stage of his illness. There was no tremor or other involuntary movements. A clinical diagnosis of parkinsonism was suspected. The main neuropathological findings were neuronal loss and gliosis in globus pallidus, substantia nigra, subthalamic nucleus and thalamus. In addition, neuronal loss of the anterior horn of the cervical spinal cord due to compression by OPLL (C4-C7) was recognized. The neuropathological findings of the present case were consistent with systemic degenerative disorder of the nervous system affecting the pallido-nigro-luysian tract. This rare disorder should be considered in the differential diagnosis of parkinsonism in old people.
The number of the nerve cells, appearance of Alzheimer's neurofibrillary tangles and of senile plaques in the hippocampus of 100 female autopsy cases aged 56-101 were compared in relation to age and grade of dementia. The number of nerve cells of granular and pyramidal layers decreased significantly with age, however, the decrease in number did not necessarily correlate with the grade of dementia. Appearance of Alzheimer's neurofibrillary tangles was increased in grade with age and with grade of dementia of all types. Appearance of senile plaques increased in grade only in cases with dementia of Alzheimer's type, but not in case with cerebrovascular type of dementia.
The amount of autofluorescent granules of nerve cells of the hippocampus and cerebellum in 92 female autopsy cases aged 56-101 was micrometrically compared with regard to their age and grade of dementia. Highly significant differences were found in the amount of pigment between the nerve cells of the granular and pyramidal layers of the hippocampus and between Purkinje cells and dental nuclear cells of cerebellum. No significant difference, however, was observed according to age or to grade of dementia.
Histopathological examination of two autopsy cases of myotonic dystrophy (MyD), a 65-year-old man (case 1) and a 61-year-old woman (case 2), revealed Alzheimer's neurofibrillary tangle (NFT) in the limbic system without concomitant presence of senile plaque as well as cavum septi pellucidi and thalamic inclusion body. The NFT were particularly abundant in the mesolimbic cortex. In addition to these, small traumatic scars were observed in the frontal lobe of case 1, who had clinically shown severe dementia. From these findings, it might be assumed that both premature aging and head trauma played an important role in the pathogenesis of NFT in these patients with MyD. The dementia of case 1 could be correlated well with abundance of NFT in the mesolimbic cortex.
A case of adenomatoid mesothelioma of the pleura was presented. The patient was a 69-year-old woman with diabetes mellitus. She was admitted to our hospital because of a chest roentgenographic abnormality, which was pointed out during her clinical course. Chest X-ray-film on admission revealed a semicircular lesion located in the left lower lung field. The physical examination and laboratory data showed no abnormalities. Left lower lobectomy was performed. The tumor was approximately, 3.0 x 3.0 x 3.0 cm, elastic soft, encapsulated, and originated from the pulmonary pleura. The histological findings of the tumor showed benign epithelial localized pleural mesothelioma. However histologically, the tumor tissue was not like the usual epithelial type. That is, most cells which had intracellular vacuoles, were similar to signet ring cell. The tumor was diagnosed as adenomatoid mesothelioma of the pleura.
A 37-year-old male was admitted to hospital because of a right hypochondrial pain and icterus. His physical examination showed hepatosplenomegaly, and the laboratory findings demonstrated abnormal hepatic and pancreatic functions. A CT examination revealed a large mass of a low density in the pancreas head and tail. Further, an immunological study revealed that the patients serum Ca 19-9 level was elevated, but that the CEA and AFP levels were normal. Both the pathological and cytological examinations, however, did not indicate a malignancy of the pancreas. The patient subsequently developed uremia, a hemorrhagic tendency, and then died. An autopsy confirmed a pancreatic tumor which occupied the head of pancreas. Histologically, the tumor contained round cells with scanty cytoplasms and showed a sarcomatous pattern. An immunohistochemical study showed that the LCA, MB-1, and the LN-1 for B cell markers were positive, while the MT-1 for T cells was negative. The case illustrates a malignant lymphoma of the pancreas which demonstrated a serum Ca 19-9 elevation.
We reported a case with bilateral necrosis of the basal ganglia after hypotensive shocks. The patient was a 69-year-old woman, who fell into a hypotensive shock (B.P. below 40 mmHg) of unknown origin during examination of her bladder cancer and was admitted into CCU. After admission, hypotensive shocks were repeated four times (B.P. below 50 mmHg each time). Neurological examination revealed a left spastic hemiplegia. Brain CT on 10th day showed bilaterally low density areas around the basal ganglia and a diagnosis of brain infarction was made. She gradually presented quadriplegia and symptomatic changes from pyramidal to extrapyramidal signs. Brain CT on 24th day showed bilateral hemorrhagic infarction of the basal ganglia with enhanced effect. On 79th day, she again fell into shock and died. Neuropathological examination of the brain was as follows. 1) laminar necrosis of the deep layers of the cerebral cortex, 2) bilateral necrosis of the hippocampal Sommer sector, 3) bilateral necrosis of the caudate nucleus, putamen and pallidum with neuronal loss and infiltration of fat granule cells, 4) sparing of the internal capsules, 5) bilateral necrosis of the reticular zone of the substantia nigra, 6) foci of fresh necrosis and loss of Purkinje cells in the cerebellum. These lesions are consistent with those of selective vulnerability in hypoxia as described by Scholz et al. An extensive distribution of cerebral as well as basal ganglia necrosis in this case was caused by repeated shocks.(ABSTRACT TRUNCATED AT 250 WORDS)
Two cDNA clones for the alpha-subunit of rat liver electron transfer flavoprotein were isolated and their nucleotide sequences were determined. The longer cDNA contained a protein-coding region of 900 nucleotides and 3'-noncoding region of 335 nucleotides. The identity of the clone was confirmed by matching the amino acid sequence predicted from the cDNA with the sequence of one of the lysyl endopeptidase-digested peptides from the purified alpha-subunit. The molecular weight of the protein calculated from the protein-coding nucleotides was approx. 3,000 daltons smaller than that of the precursor, suggesting that the cDNA was not of full length. The derived amino acid composition fairly agreed with the chemically determined amino acid composition of the purified alpha-subunit, indicating that the protein-coding region contains most of the mature alpha-subunit.
A 68-year-old Japanese woman presented with complaints of appetite and weight loss. Early pancreatic duct adenocarcinoma was diagnosed by endoscopic retrograde cholangiopancreatography (ERCP), which revealed partial obstruction of the main pancreatic duct. Pancreatoduodenectomy with lymph node dissection was performed. Macroscopically, no pancreatic tumor was detected. Histologically, the pancreatic lesion showed continuous changes consisting of duct epithelial cell hyperplasia, carcinoma in situ, and invasive carcinoma. Immunohistochemical stains for carcinoembryonic antigen and CA19-9 were positive in cancer cells.
A case of periodic depression treated prophylactically with carbamazepine for over 10 years is reported. Recurrence of depressive episode was completely inhibited during the carbamazepine treatment and depressive relapses occurred 2 to 4 months after the discontinuation of carbamazepine treatment. No notable side effect was found during the treatment.