Effects of reclining posture on velopharyngeal closing pressure during swallowing and phonation.

Velopharyngeal closure plays an important role in preventing air pressure leakage during swallowing and phonation from oropharynx to nasopharynx. Levator veli palatini muscle activity is influenced by oral and nasal air pressure, volume of the swallow bolus and postural changes. However, it is unclear how velopharyngeal closing pressure is affected by reclining posture. The purpose of this study was to investigate the effects of reclining posture on velopharyngeal closing pressure during swallowing and phonation. Nine healthy male volunteers (age range, 27-34 years) participated in this study. Velopharyngeal closing pressure during a dry swallow, a 5-mL liquid swallow, a 5-mL honey-thick liquid swallow and phonations of /P∧/ and /K∧/ were evaluated in an upright posture and at reclining postures of 60° and 30°. A manometer catheter was inserted transnasally onto the soft palate, and each trial was repeated three times. A solid-state manometer catheter with an intra-luminal transducer was used to evaluate the amplitude and duration of each trial, and data were statistically analysed. Average amplitudes during dry and liquid swallows were significantly lower in reclining postures compared with the upright posture, but the amplitude was not significantly different during the thick liquid swallow. Average durations were not affected by postural changes. The amplitudes during phonations were lower in reclining postures, but the differences were not significant. Velopharyngeal closure is significantly affected by reclining posture. This suggests that velopharyngeal closing pressure may be adjusted according to afferent inputs, such as reclining posture and bolus viscosity.

Phenotypic characterization of human B-lymphocyte subpopulations, particularly human CD5+ B-lymphocyte subpopulation within the mantle zones of secondary follicles.

We have investigated the precise distribution of human B-lymphocyte subpopulations (CD5+ B lymphocyte, Leu-8+ lymphocyte, immunoglobulin D (IgD)+ lymphocyte, alkaline phosphatase (ALPase)+ B lymphocyte and bcl-2 protein+ B lymphocyte) within the mantle zones (MZs) and phenotypic characterization of human CD5+ B lymphocytes using immunohistochemical techniques and flow cytometric analysis. IgD+ lymphocytes and ALPase B lymphocytes were confined to the inner layer and outer layer of the MZs of secondary follicles, respectively. CD5+ B lymphocytes and Leu-8+ B lymphocytes were mostly located in the inner layer of the MZs. Bcl-2 protein+ B lymphocytes were seen throughout the MZs. The precise distribution pattern of human B-lymphocyte subpopulations may help further understanding of the histogenesis and features of B-cell lymphomas, particularly mantle cell-derived lymphomas as well as the B-cell differentiation pathway. A minor population of CD5+ B lymphocytes expressed IgD. Almost all the CD5+ lymphocytes did not express ALPase. The data support the fact that CD5+ B lymphocytes are located more in the inner layer than in the outer layer of the MZs. Leu-8 and bcl-2 protein were detected in a large population of CD5+ B lymphocytes. In addition, Ki-67 antigen was not expressed on the CD5+ B lymphocytes. The data suggest that human CD5+ B lymphocytes may be long-living and resting (G0 and G1a stage) cells possessing the capability of continuously recirculating between blood and lymph nodes to participate in some immune responses. Moreover, Leu-8 and CD44 were detected in the majority of CD5+ B lymphocytes but intercellular adhesion molecule-1 (ICAM-1) and very late antigen-4 (VLA-4) were detected in the minority. The data may account for a high percentage of Leu-8 and CD44 expression and a low percentage of ICAM-1 and VLA-4 expression on B-chronic lymphocytic leukemia (B-CLL), which is considered to be a neoplastic counterpart of normal CD5+ B lymphocyte.

Pseudosarcomatous myofibroblastic tumor of the urinary bladder in children: a study of 11 cases with review of the literature. An Intergroup Rhabdomyosarcoma Study.

Pseudosarcomatous myofibroblastic tumor (PMT) is the result of reactive proliferation of myofibroblasts. In children, PMT of the urinary bladder can be mistaken for embryonal rhabdomyosarcoma clinically, radiologically, and by light microscopy. We are reporting the clinical, histological, and immunohistological features of 11 patients with childhood PMT of urinary bladder that were diagnosed initially as a sarcoma, usually rhabdomyosarcoma. The morphologic spectrum of PMT is broad, with mixtures of myxoid, leiomyomatous, and sclerosing matrix patterns, the myxoid type being the most common. The proliferating cells consist of three forms of myofibroblastic cells: long spindle cells (type I), intermediate spindle cells (type II), and ganglion-like cells (type III), together with various types of inflammatory cells. The immunohistologic profile of the proliferating cells was characterized by positive reactions to vimentin, muscle-specific actin, alpha-smooth-muscle actin, polyclonal desmin, and keratin. Ultrastructural studies showed myofibroblastic differentiation of the tumor cells. No patients have had metastases or local recurrence. Histologic, immunohistochemical, and clinical data from 71 cases of PMT, including the 11 cases in this report, confirm the benign behavior of these lesions. The etiology of these lesions is unclear, including the absence of surgical or other trauma in all of the children.

Gaucher's disease, type I (adult type), with massive involvement of the kidneys and lungs.

A 33-year-old Japanese male, first diagnosed as having Gaucher's disease at the age of 3 years, died of renal and pulmonary failure. Autopsy findings disclosed the proliferation of Gaucher's cells in the liver, bone marrow, lymph nodes, kidneys and lungs. Electron-microscopical findings suggested that the Gaucher's cells observed in the renal glomeruli might be derived from circulating macrophages.

An intrapulmonary teratoma associated with bronchiectasia containing various kinds of primordium: a case report and review of the literature.

An intrapulmonary teratoma (IPT), multiloculated and bronchiectatic, with two polyps inside a 23-year-old man is reported. The IPT, a very rare benign cystic lesion, was communicating with segmental bronchus and was removed by a segmental resection from the upper lobe of the left lung. The teratoma contained various kinds of primordial derivatives, such as mesoderm, ectoderm, and endoderm. Though 65 cases of IPT have been reported in the literature (1839-1996), in the present case there were over 15 germ derivatives, the largest number reported to date. The tumor contained thymic tissue, apart from mediastinum, which may be significant in relation to the pathogenesis of IPT. Clinical manifestations, age, and gender distributions and the kind of germ cell derivatives are discussed.

Geographical aspects of bcl-2 gene involvement in Japanese patients with non-Hodgkin's B-cell lymphomas.

Using three separate bcl-2 probes, we examined involvement of the bcl-2 gene in Japanese patients with non-Hodgkin's B-cell lymphomas. Of 52 patients with follicular lymphoma (FL), 24 had rearrangements. In a group of 50 patients with diffuse lymphoma, three of 32 patients with diffuse large cell lymphoma had rearrangements. The frequency of rearrangements in each of these groups, as detected by both major and minor breakpoint cluster region probes, was compatible with that found in other Far Eastern studies. However, the difference in frequency between the groups studied in the Far East and the West was significant, and these two geographically distinct populations also displayed a difference in the breakpoint distribution. In the immunophenotype study of 33 patients with FL, the expression of CD10 antigen correlated with bcl-2 involvement, whereas none of the other B markers emerged as parameters to distinguish between the two lymphoma groups; those with, and without, the rearrangements.

Detection of c-ras gene mutation and expression of p21 protein in dysplasias and carcinomas complicating ulcerative colitis.

Point mutations of c-ras genes and the expression of p21 protein were analyzed in 13 patients with colorectal carcinoma complicating ulcerative colitis; in 12 of the 13, there were dysplastic lesions close to the carcinomas. Point mutations of c-ras genes were studied by polymerase chain reaction and dot blot hybridization with 32p-labeled oligonucleotide probes. Findings indicated mutations of c-Ki-ras at condons 12, 13, and 61 and c-Ha-ras and c-N-ras at condons 12 and 61. The expression of p21 protein was analyzed by immunohistochemical staining using a monoclonal antibody. Only 1 of the 13 patients with carcinoma showed a point mutation, this being from G to A transition at the second position of codon 12 of c-Ki-ras. No point mutations of c-Ki-ras, c-Ha-ras, or c-N-ras were found in other carcinomatous lesions and dysplasias. In the dysplastic or carcinomatous lesions of 11 patients, the increased expression of p21 protein was observed. These results suggest that point mutations of c-ras genes are rare in dysplasias and carcinomas complicating ulcerative colitis and that the increased expression of p21 protein is not always correlated with point mutations of c-ras genes.

Histological classification of the neoplastic changes arising in ulcerative colitis: a new proposal in Japan.

Patients with total ulcerative colitis with a longstanding course of the disease have a high risk of developing colorectal carcinoma. Colonoscopic surveillance to detect precancerous tissue and/or cancer in these patients has been carried out in countries with a high incidence of ulcerative colitis. Riddell's classification has been widely used for the interpretation of biopsy specimens obtained from the colonoscopic surveillance. In Japan, however, there are problems in accepting Riddell's classification, mainly because the intramucosal carcinomas diagnosed by Japanese histopathologists are included in the category of high-grade dysplasia in Riddell's classification. Based on the results of a meticulous slide review carried out by seven histopathologists in this study, a new classification is proposed: UC-I, inflammatory change; UC-II, indefinite; UC-IIa, probably inflammatory; UC-IIb, probably neoplastic; UC-III, neoplastic but not carcinomatous; and UC-IV, carcinoma. Intramucosal carcinomas is included in the category UC-IV. We consider that the diagnosis of intramucosal carcinoma is to be made when there is a high grade of cytological and structural atypia consistent with carcinoma. Interobserver and intraobserver variability with this classification was acceptable. We believe this new classification will be widely use in cancer surveillance in ulcerative colitis in Japan.

Simultaneous expression of activated lymphoid cell-associated and granulocytic cell-associated antigens on Hodgkin's and Reed-Sternberg cells in Hodgkin's disease.

The surface antigens of Hodgkin cells and Reed-Sternberg cells (H- and R-S cells), including lacunar cells, were analyzed with a large panel of monoclonal and polyclonal antibodies by an immunohistochemical method and an immunoelectron microscopic technique. H- and R-S cells in each histologic subtype of nodular sclerosis, mixed cellularity and lymphocyte depletion were stained similarly with anti-Leu-M1, anti-Leu-11b, TG8, anti-HLA-DR, anti IL-2R, RSC-1 (Ki-1) and anti-alpha-1-antitrypsin, but not with other antibodies examined. These findings suggest the following: (1) H- and R-S cells of nodular sclerosis, mixed cellularity and lymphocyte depletion are not heterogeneous, at least in terms of surface antigen expression, and (2) H- and R-S cells may be lymphoid cells which simultaneously express activated lymphoid cell-associated antigens (e.g., HLA-DR, RSC-1 and IL-2R) and granulocytic cell-associated antigens (e.g., Leu-M1 and TG8).

Immunohistologic detection of the primary follicle (PF) in human fetal and newborn lymph node anlages.

The primary follicle (PF) emerges as a globular nest of follicular dendritic cells (FDC) and lymphocytes in the lymph node anlage in the 16th gestational week. It increases in size with age but no germinal center is found until several months later, after birth. Using a panel of monoclonal antibodies, the authors have defined phenotypes of component cells of the PF. The PF contains a B-cell population including IgM+, CD20+, CD21+, and CD24+ cells, together with a T-cell population including CD3+, CD4+, CD5+, and CD8+ but no IgG+ cells. It also contains many CD5+ B cells and several IgD+ and alkaline phosphatase-positive cells but few CD15+, CD25+, CD30+, CD38+, and Ki-67+ cells. CD24+ and dendritic reticulum (DRC)-1+ cells show an irregular meshwork pattern in the PF. CD5+ B cells appear even before the formation of the PF and increase after formation of the PF. The lymphocytic phenotype of the PF is similar to that of the mantle zone of the secondary follicle. The phenotypic characteristics indicate that the PF appears as an aggregation of CD5+ B cells and plays an important role as the ancestor of the secondary follicle as well as helper T cells and FDC.

A single clonal origin of neoplastic B cells in a patient with CD5+B-intermediate lymphocytic lymphoma terminating in plasmacytoid differentiation.

To investigate the clonal origin of a case of CD5+B-intermediate lymphocytic lymphoma terminating in plasmacytoid differentiation, we analyzed the immunophenotype and immunoglobulin gene rearrangements in the first and second lymph nodes from which biopsy specimens were taken. Immunohistochemical study revealed that both neoplasms have the same immunoglobulin light chain type (kappa-light chain). Immunoglobulin gene analysis using the Southern blot method revealed the identical immunoglobulin heavy chain and kappa-light chain gene rearrangements in both neoplasms. These findings suggest that both neoplasms are derived from a single clonal B cell. The present case may help a further understanding of CD5+B-lymphocyte differentiation pathway.

Retroperitioneal lymphangiomyomatosis with lymphedema of the legs.

Retropertioneal tumor is demonstrated by lymphangiography in a 28 year old woman with lymphedema of both legs. Retroperitioneal tumor was subtotally extirpated, with subsequent subsidence of the swelling of both legs. According to the pathologic examination of the extirpated specimens, lymphangiomyomatosis was confirmed. This is the fisrt case reported in the literature of lymphangiomatosis presenting with lymphedema of the leg in the absence of pulmonary involvement, pleural or abdominal effusion.

Four cases of metastatic lymphoma into the temporal bone.

A histopathological study on 17 temporal bones obtained from 9 patients who died of malignant lymphoma revealed metastasis of malignant lymphoma in 7 temporal bones from 4 of them. There were no differences in stages at the initial diagnosis between the cases with metastasis and those without metastasis. However, the higher was the frequency of metastasis, the longer became the period from the first medical examination to death. In addition, malignant lymphoma was considered to metastasize into the temporal bone by the following two routes, 1) direct infiltration or invasion from the cerebrospinal fluid and 2) hematogenous metastasis or invasion.

Immunohistochemical evaluation with Ki-67: an application to salivary gland tumours.

Using Ki-67, a monoclonal antibody, the proliferating capacity of 15 salivary gland tumours, including nine pleomorphic adenomas, four adenoid cystic carcinomas, one mucoepidermoid carcinoma and one acinic cell carcinoma was determined immunohistochemically, using normal salivary gland tissue as a control. The frequency of Ki-67 positive cells was 4.7 percent in the normal salivary gland and one percent in pleomorphic adenomas, whereas the average frequency in malignant tumours was 18.3 percent. Among adenoid cystic carcinomas, the frequency was related to the morphological type; the solid sub-type had the highest frequency of Ki-67-positive cells. As this sub-type is recognized as the most aggressive of these tumours, this technique has the potential of providing an early indication of the clinical behaviour of a tumour.

Histogenesis and pathogenesis of follicular small cleaved cell lymphoma (FSCCL), diffuse small cleaved cell lymphoma (DSCCL) and intermediate lymphocytic lymphoma/lymphocytic lymphoma of intermediate differentiation (ILL/IDL).

We have investigated the cellular origin and/or pathogenesis of follicular small cleaved cell lymphoma (FSCCL), diffuse small cleaved cell lymphoma (DSCCL) and intermediate lymphocytic lymphoma/lymphocytic lymphoma of intermediate differentiation (ILL/IDL) based on a series of immunologic and molecular genetic (bcl-1, bcl-2 and bcl-3 genes) studies. These studies have led to the conclusion that the cellular origin or pathogenesis of ILL/IDL and DSCCL is distinctly different from that of FSCCL: (1) FSCCL is a neoplastic counterpart of follicular center cells (FCC) of secondary follicles because of the presence of CD10 and bcl-2 gene rearrangement and the absence of CD5 and bcl-1 gene rearrangement; (2) DSCCL and ILL/IDL are a neoplastic counterpart of mantle zone (MZ) B lymphocytes because of the presence of CD5 and bcl-1 gene rearrangement and absence of CD10 and bcl-2 gene rearrangement; and (3) FSCCL scarcely develops into DSCCL, and the previously proposed concept that DSCCL represents a diffuse counterpart of FSCCL does not hold good. These results indicate that DSCCL and ILL/IDL are identical, derived from primary follicular cells or MZB cells of secondary follicles, and should be unified under MZB lymphocyte-derived lymphomas. They are distinguished from FCC-derived lymphomas in morphologic, immunologic, cytogenetic and molecular genetic features. Bcl-1 and bcl-2 genes may be associated with the pathogenesis of FCC-derived lymphoma and MZB lymphocyte-derived lymphoma, respectively.

A case of fibrous hamartoma of infancy: an immunohistochemical study.

To clarify the histogenesis and immunohistochemical nature of fibrous hamartoma of infancy, we have studied a typical case of this disease using an immunohistochemical technique with a large panel of antibodies. It was found that immature-appearing stellate and spindle-shaped cells were mesenchymal in nature, but it was not ascertained whether those cells were differentiated into various specialized connective tissues corresponding with embryonic stages of connective tissue differentiation. These results reveal the immunohistochemical nature of tissue components of fibrous hamartoma but poorly support the previously described concept that fibrous hamartoma of infancy is a hamartomatous disease.

[Middle cerebral artery occlusion with Moyamoya phenomenon.--2nd report: report of an autopsy case].

About the middle cerebral artery occlusion with moyamoya phenomenon, we have reported the clinical and angiographical study of 10 cases. Now we present an autopsy case. A 53-year-old female was admitted to our hospital on May, 22, 1978, two hours after an apparent subarachnoid hemorrhage. Neurological examination revealed drowsiness, nuchal rigidity right hemiparesis and motor aphasia. Left carotid angiogram showed an occlusion of the left middle cerebral artery at its origin with moyamoya phenomenon, but did not demonstrate an occlusion and/or stenosis of the intracranial internal carotid artery. Furthermore right carotid and bilateral vertebral angiograms were normal. The hospital course was progressively uphill, and she did not have any focal neurological deficits at discharge. But she committed suicide with a poison (Paraquat) on August, 19, 1978. Histopathologic examination of the left middle cerebral artery revealed a stenosis, with a maximum diameter of 900 microns. In this portion the lumen was not be occluded, and arteriosclerotic and inframatric exchanges were not present. The elastica interna was reduplicated, frayed and at times discontinuous. The tunica media was very thin or disappeared. On the other hand, moyamoya vessels were found between distal and peripheral portion of the stenotic middle cerebral artery as a collateral circulation. These findings suggested that the stenotic arterial wall of the left middle cerebral artery might be a congenital hypoplasia.

Production and usefulness of monoclonal antibodies against B cells.

We have described new monoclonal antibodies (FUN-1, -2, FK61, FB1, FB21) which recognize B cells in the peripheral blood and lymphoid tissues. In preliminary reports FB1 and FUN-1 were described previously as anti-CD20 and -CD86 antibodies, respectively. FB1 and FB21 recognize an intracytoplasmic epitope (35, 38 kD) and a sialic acid-dependent carbohydrate epitope, respectively. FB1 reacts with pan B cells and FB21 with a subpopulation of B cells. In addition, FB21 shows relatively specific reaction with papillary or follicular carcinoma of the thyroid gland, but not with normal thyroid follicules and most benign thyroid gland tumors. Since FB1 and FB21 can be used with formalin-fixed paraffin-embedded tissue sections, they are useful for diagnosis of B cell lymphoma or thyroid carcinoma. FUN-1 recognizes surface antigen (CD86) on activated B cells, monocytes in peripheral blood and germinal center B cells in lymphoid tissues. CD86 has an important role in T cell activation and the antigen-specific T-cell dependent immune response.

Hodgkin's disease with CD 20 (B1) positive Reed-Sternberg cells--an immunohistochemical and immunoelectron microscopic study.

20 cases of Hodgkin's disease, [five nodular sclerosis (NS), 12 mixed cellularity (MC), and three lymphocytic depletion (LD)] were studied immunohistochemically and immunoelectron-microscopically to clarify the origin of Reed-Sternberg (RS) cells. The majority of RS cells expressed activated lymphoid cell-associated antigens (CD 30, CD 25, HLA-DR) and granulocyte-associated antigen (CD 15). RS cells in seven cases (one NS, five MC and one LD) reacted with CD 20 (B1). Three of these cases (all three MC) were also positive with CD 19 (B4). These findings suggest that some RS cells may be of B cell lineage.

[Spontaneous thrombosis of an azygos anterior cerebral artery aneurysm--report of a case (author's transl)].

A case of spontaneous thrombosis of azygos anterior cerebral artery aneurysm was reported. A 39-year-old man was admitted to our hospital on April 23, 1979, 5 days following an apparent attack of subarachnoid hemorrhage. On admission, he complained a headache and left hemiparesthesia. Neurologic examination revealed a very slight nuchal rigidity, left hemihypesthesia and hypalgesia. Routine laboratory studies were noncontributory. Left and right carotid angiograms showed an azygos anterior cerebral artery aneurysm. Twelve days after the attack, a left carotid angiogram demonstrated a segmental narrowing and widening of an azygos anterior cerebral artery, and then the aneurysm was filled incompletely. Nineteen days after the attack, the aneurysm was not visualized on right carotid angiogram. Neck clipping and resection of the aneurysm was performed on May 8, 1979. Cross section of the aneurysm exposed a thrombus. He showed postoperatively a slight hypesthesia in the left lower limb. Complete thrombosis of intracranial aneurysm occurring spontaneously is rare. We collected 42 such cases including the present case from the literature and discussed some factors facilitating intraluminal thrombosis. Although the shortest previous period of thrombosis is noted to be over a course of 5 days, the thrombosis in our case in 19 days after subarachnoid hemorrhage was certainly a relative rapid event.