Large colorectal adenomas. An approach to pathologic evaluation.

Adenomatous polyps are common neoplastic lesions of the large intestine. The risk of carcinoma increases with polyp size. Small polyps are typically totally embedded for histologic examination, but no standard method for sampling large, grossly benign polyps has been established. We reviewed grossly noninvasive adenomas 2.5 cm or larger to determine the percentage that contained high-grade dysplasia (HGD) and invasive cancer (IC). Based on these findings, we suggest an approach to evaluating large adenomas. Forty-three colon resections met the inclusion criteria (no previous diagnosis of cancer, no gross evidence of invasion, and totally embedded polyp). Twelve (28%) had HGD with 3% (1 of 33 slides) to 100% (4 of 4 slides) containing HGD. Five (12%) had IC with 4% (3 of 72 slides) to 42% (5 of 12 slides) containing IC. All cases with IC had HGD in other slides. Probability studies showed that in the majority of cases, polyps would need to be entirely embedded to have an estimated probability of 95% or more of detecting either HGD or IC. Therefore, grossly noninvasive adenomas should be routinely entirely embedded.

Immediate prediction of recovery of consciousness after cardiac arrest.

OBJECTIVE: Short-latency somatosensory evoked potential (SSEP) monitoring has been reported to be useful in predicting neurological outcome in patients with cardiac arrest and hypoxic-ischemic encephalopathy. To obtain the immediate data of SSEP and evaluate the relationship between the presence of cortical activity and the recovery of consciousness, SSEP was recorded immediately after return of spontaneous circulation. DESIGN AND SETTING: Prospective observational study in an intensive care unit of a university general hospital. PATIENTS: The study included 30 patients resuscitated from out-of-hospital cardiac arrest. INTERVENTIONS: Basic and advanced cardiac life support, and intensive care. MEASUREMENTS AND RESULTS: SSEP were recorded between 40 and 170 min (median 65) after spontaneous circulation returned. In the initial study all 30 patients showed the Erb's point potential and the N11-13 component, while only 12 (40%) showed cortical activity. Patients were assessed neurologically for recovery of consciousness until 1 month after cardiac arrest. Of 12 these patients 8 recovered consciousness within 10 days, while all patients without cortical activity died without opening their eyes. CONCLUSION: Even immediately following resuscitation, absence of cortical activity in SSEP indicates unlikelihood of recovering consciousness, while the preservation of such activity suggests that consciousness is improved. The result promises further accumulation of patients to validate the predictive ability of SSEP in managing postresuscitated patients.

Production of monoclonal antibody against Aeromonas hydrophila haemolysin.

Two hybridoma cell lines that produce monoclonal antibodies against Aeromonas hydrophila haemolysin were established by fusion of myeloma and spleen cells obtained from a mouse immunised with haemolysin detoxified with tetranitromethane. Enzyme-linked immunosorbent assay (ELISA) showed that the two purified monoclonal antibodies, B7 and B11, recognised the same epitope on the haemolysin molecule. Antibody B7 neutralised the haemolytic and enterotoxic activities of the haemolysin. It is concluded that the same site on the haemolysin molecule is responsible for both haemolytic and enterotoxic activities.

Cytologic study of the tissue repair cells of the uterine cervix. With special reference to their origin.

In order to characterize tissue repair cells (TR) of the uterine cervix and clarify their origin, exfoliated cells obtained after laser conization for early cervical lesions were examined. One specimen was first examined by Papanicolaou staining and then examined for epithelial membrane antigen (EMA) and vimentin by immunocytochemical staining, using a restaining method. The other specimen was observed by phosphotungstic acid-hematoxylin (PTAH) staining. Morphologic findings on TR were investigated together with the histologic findings on the wound healing process. TR were classified morphologically into three groups: stromal (STR), epithelial (ETR) and of unknown origin (UTR). Validity of this classification was confirmed by the findings of immunocytochemical staining with EMA and vimentin. These cells appeared one to eight weeks after laser conization. TR with relatively large nuclei, or atypical TR (ATR), appeared when each type of TR was most plentiful, at two to five weeks. Regarding the origins of each TR, cytologic and histologic findings could be considered to offer evidence that ETR originated with hyperplasia of immature cells of the squamous epithelium or reserve cells below the columnar epithelium. The presence of myofibrils in cytoplasm, demonstrated by PTAH staining for STR and some UTR, strongly suggested the possibility that these cells were myofibroblasts in granulation tissue.

Transcatheter arterial embolization for postpartum massive hemorrhage: a case report.

A 29-year-old woman suffered uncontrollable massive hemorrhage from a deep vaginal laceration following spontaneous vaginal delivery. Pelvic angiography revealed extravasation from a branch of the right pudendal artery. Transcatheter arterial embolization was successfully performed and quickly achieved hemostasis. When postpartum hemorrhage cannot be controlled with conservative treatment, transcatheter arterial embolization should be considered in order to avoid major surgery in an unstable patient and to maintain reproductive potential.

Strangulation of small bowel due to Meckel diverticulum: CT findings.

We report an unusual case of small bowel strangulation due to long Meckel diverticulum. CT demonstration of the bundle-like segment contiguous with the distended fluid-filled loops of bowel contributed to the prompt preoperative diagnosis.

[A case of occult testicular tumor].

A 43-year-old male presented with a left supraclavicular mass as well as an upper abdominal mass. Biopsy of the supraclavicular mass revealed seminoma with components of both embryonal carcinoma and choriocarcinoma. Right orchiectomy was performed because physical examination showed that the left testis was normal but the right testis was slightly atrophic. The primary tumor which was approximately 1 cm in diameter was found in the right testis and histological examination revealed seminoma. When germ cell tumor is found in a region other than the gonads, either primary extragonadal germ cell tumor or occult testicular tumor is considered. To differentiate between the two, it is imperative to make careful histological exploration of the testes.

[Effects of bronchial artery infusion (B-AI) with single use of MMC after intravenous peplomycin (PEP) administration in lung cancer].

Effects of BAI therapy on 86 cases of lung cancer were evaluated in three groups: single-use of MMC group after intravenous PEP administration (PEP (iv).MMC group), PEP and MMC combination use group (PEP + MMC group) and single use of MMC group. Tumor regression rate determined by chest X-ray film 2 or 3 weeks after BAI was highest in the PEP (iv).MMC group followed by the PEP + MMC and MMC group. Cavity formation was more typical in the group treated with PEP + MMC. Histopathological effects were best for the PEP + MMC group followed by those of the PEP (iv).MMC and MMC group. As for side effects, pulmonary fibrosis and necrotizing bronchitis were noted in 8% of the PEP + MMC group, but side effects in the other two groups were mild. In conclusion single use of MMC after intravenous PEP administration was found to be the best way to give BAI in these three groups.

[Effects of the bronchial artery infusion of peplomycin (PEP) and mitomycin C (MMC) in lung cancer--comparison with single administration of PEP or MMC].

Effects of BAI with PEP 30 mg+MMC 10 mg on 26 patients with lung cancer were evaluated in comparison with 34 cases treated with single PEP or MMC. Histopathological findings of the cases treated with PEP+MMC and PEP alone showed more effective results than that of MMC alone. The tumor decreased rate on the chest X-ray film of the cases treated with PEP+MMC was highest and the cavity formation was also typical in the cases with PEP+MMC and PEP alone. The side effects of the cases with PEP+MMC were able to reduce markedly to about 50% compared with single administration of PEP or MMC; however pulmonary fibrosis and necrotizing bronchitis were noted in 8%.

[Effects of pepleomycin (PEP) infused through bronchial artery for lung cancer: in comparison with the cases of mitomycin (MMC) or carboquon (CQ)].

(1) Therapeutic effects of bronchial artery infusion (BAI) of peplomycin (PEP), a derivative of bleomycin, were examined in the 13 patients with lung cancer. The effectiveness of PEP was compared with that of 59 patients treated with mitomycin (MMC) or carboquon (CQ). (2) In all cases treated with PEP, histopathological effects revealed to be more than grade IIa of Shimosato's criteria, which were more effective than that with MMC or CQ. (3) Histopathological changes of the metastatic lymph nodes were similar to that of the main tumor. (4) In the cases treated with PEP, tumor decreased rates shown in the chest X-ray films 2 weeks after BAI were lower than that with MMC or CQ. Cavity formation in the tumor was recognized in 62% of the cases treated with PEP. (5) Low fever lasting several days after administration of BAI and GI symptoms such as nausea and vomiting were main side effects, which were mild and not so serious.

[A clinical study on 164 patients with extensive burn--with special reference to improved survival factors].

One hundred and sixty four patients with extensive burn were treated over 6 years, 1976 through 1981. Clinical data were analyzed, dividing into successive period; Grod: Group I (83 patients, 1976-1978) and Group II (81 patients, 1979-1981). The mean age was 28.9 years, the mean burn area was 52.6% body surface area (% BSA) and Burn Index was 38.7 in group I, whereas in Group II 33.7 years, 56.0% BSA, 41.8, respectively. There are no statistical difference between the two groups. The mortality of the 164 patients was 50.6%. That of Group I was 55.4% and 45.7% in Group II. Excluding patients with almost fatal burns over 70% BSA or over 60 years of age, the former mortality is 33.3% and the latter is 21.3%. When a mortality rate was analyzed in patients with 50-70% BSA and aged less than 60 years in Group I, it was 65.0% and in Group II 36.8%. The main difference in the treatment between the two periods are as follows. Air fluidized beds were used in the latter period. As topical agents, silver sulfadiazine cream was administered in the former period, and silver sulfadiazine cream nitrate was administered in the latter period. Concerning debridement and skin graft, surgery was carried out 2-3 weeks after burn in the former period, while it started within one week in the latter period. In the latter period, active nutritional support and new generation of Cephem were used. These facts reveal that progress in various aspects of the treatments in the latter period have resulted in improvement of the mortality rate.

Polychromator for the edge Thomson scattering system in ITER.

A new type polychromator has been designed for the edge Thomson scattering system in ITER. Signal light is parallelly dispersed into two parts at the first interference filter. Spectral transmissivities for some spectral channels may enhance better than the conventional type polychromator. In the new type polychromator, the misalignment due to the machine accuracy is expected to be within the margin of APD area. In order to calibrate the spectral transmissivity using the dual-laser injection method during the plasma discharge, it is preferred that the spectral channels are separated at the geometric mean of the injected two wavelengths.