Enzymatic hydrolysis of heated whey: iron-binding ability of peptides and antigenic protein fractions.

This study evaluated the influence of various enzymes on the hydrolysis of whey protein concentrate (WPC) to reduce its antigenic fractions and to quantify the peptides having iron-binding ability in its hydrolysates. Heated (for 10 min at 100 degrees C) WPC (2% protein solution) was incubated with 2% each of Alcalase, Flavourzyme, papain, and trypsin for 30, 60, 90, 120, 150, 180, and 240 min at 50 degrees C. The highest hydrolysis of WPC was observed after 240 min of incubation with Alcalase (12.4%), followed by Flavourzyme (12.0%), trypsin (10.4%), and papain (8.53%). The nonprotein nitrogen contents of WPC hydrolysate followed the hydrolytic pattern of whey. The major antigenic fractions (beta-lactoglobulin) in WPC were degraded within 60 min of its incubation with Alcalase, Flavourzyme, or papain. Chromatograms of enzymatic hydrolysates of heated WPC also indicated complete degradation of beta-lactoglobulin, alpha-lactalbumin, and BSA. The highest iron solubility was noticed in hydrolysates derived with Alcalase (95%), followed by those produced with trypsin (90%), papain (87%), and Flavourzyme (81%). Eluted fraction 1 (F-1) and fraction 2 (F-2) were the respective peaks for the 0.25 and 0.5 M NaCl chromatographic step gradient for analysis of hydrolysates. Iron-binding ability was noticeably higher in F-1 than in F-2 of all hydrolysates of WPC. The highest iron contents in F-1 were observed in WPC hydrolysates derived with Alcalase (0.2 mg/kg), followed by hydrolysates derived with Flavourzyme (0.14 mg/kg), trypsin (0.14 mg/kg), and papain (0.08 mg/kg). Iron concentrations in the F-2 fraction of all enzymatic hydrolysates of WPC were low and ranged from 0.03 to 0.05 mg/kg. Fraction 1 may describe a new class of iron chelates based on the reaction of FeSO4 x 7 H2O with a mixture of peptides obtained by the enzymatic hydrolysis of WPC. The chromatogram of Alcalase F-1 indicated numerous small peaks of shorter wavelengths, which probably indicated a variety of new peptides with greater ability to bind with iron. Alcalase F-1 had higher Ala (18.38%), Lys (17.97%), and Phe (16.58%) concentrations, whereas the presence of Pro, Gly, and Tyr was not detected. Alcalase was more effective than other enzymes at producing a hydrolysate for the separation of iron-binding peptides derived from WPC.

Status analysis and strategic framework for sanitation management in Asia and Africa.

Following rapid population increase and industrial development, the ever increasing environmental pollution and the associated sanitation-related problem are no longer regional or local but have become an issue requiring global-dimensional concern and the provision of problem-solving alternatives. Especially, since most problems result from inappropriate sewerage and the lack of sewage treatment system are in a serious state occurring in economically underdeveloped regions, and as such, their significance is enormous. The United Nations Environment Programme (UNEP) has been making efforts to establish the technology selection methodology applicable in developing countries, through the accurate status, investigation and analysis of the wastewater management state in Asian and African regions, and the sanitation management guideline utilisable by political leaders or decision-makers. As part of this effort, the Korea Institute of Water Environment (KIWE), together with the UNEP, selected China and Vietnam (in Asia) and Kenya and Ethiopia (in Africa) as subject countries to investigate and perform on-site sanitation management investigations and analysis in this research. Results obtained from the on-site investigation were analysed, and in order to be helpful in establishing a strategy for sanitation management in underdeveloped countries, the strategic framework (SF) has been made based on characterised results.

Minimal deviation melanoma with epidermotropic metastases arising in a congenital nevus.

A congenital nevus removed from a 20-year-old woman was found to contain a minimum deviation melanoma. Subsequently, there were multiple nodular recurrences in the region of the excision as well as in the grafted skin. Microscopically the recurrent lesions closely resembled the original nevus, including the junctional activity and even the grafted skin. Lymph node metastasis occurred 5 1/2 years after excision of the nevus. This is the first report of a minimal deviation melanoma arising in a congenital nevus with epidermotropic metastases.

Metastasizing atrial myxoma.

Tumors that were identical in morphology to a previously excised atrial myxoma were found in the choroid plexus and the scapula of a 46-year-old woman 8 and 10.5 years, respectively, after cardiac surgery. Ultrastructurally the scapular lesion resembled previously reported atrial myxomas. This case demonstrates that atrial myxoma is a true neoplasm capable of metastatic spread despite its slow growth and innocuous histologic appearance.

Composite pleomorphic xanthoastrocytoma and ganglioglioma: report of four cases and review of the literature.

Composite pleomorphic xanthoastrocytoma (PXA)-ganglioglioma (GG) is a rare recently described entity. Only three examples have been documented, one of which showed evidence of malignant transformation. We report an additional four cases and update the literature. With the exception of an 82-year-old man, all patients have been under 30 years of age. The temporal lobe was involved in three cases and cerebellum in another three. Radiologic features were those common to PXA and GG. Histologically, all were "collision tumors" composed of abutting, although spatially distinct, PXA and GG components. In two cases, the second element was only recognized at reexcision or recurrence. Histologic anaplasia, always in the PXA component, was evident as brisk mitotic activity and/or necrosis in five cases. Of the seven patients, one died of disease 17 years after the onset of seizures and after multiple recurrences, the last of which largely resembled glioblastoma. We conclude that the composite PXA-GG is a rare neoplasm that shares many features of its individual components. In addition to its temporal lobe predilection, the cerebellum is frequently affected. As when it occurs in isolation, the PXA component of composite PXA-GG possesses the potential for malignant transformation.

Myelodysplastic syndrome: diagnostic implications of cytochemical and immunocytochemical studies.

Cytochemical and immunocytochemical studies were performed on bone marrow aspirates from 96 cases of primary myelodysplastic syndrome (MDS), 11 cases of secondary MDS, 22 cases of non-MDS hematologic disorders, and 10 cases of nondiagnostic, apparently normal marrow specimens to determine the practicality and utility of these stains for diagnosing MDS. Cytochemical studies included iron stain, periodic acid-Schiff (PAS), peroxidase, butyrate esterase, chloroacetate esterase, and double esterase stains. Immunocytochemical staining was done with monoclonal antibody HP1-1D, which recognizes the glycoprotein IIb/IIIa complex in megakaryocytes. The iron stain remained most helpful in identifying abnormal ringed sideroblasts, a feature of dyserythropoiesis, and thus in supporting the diagnosis of MDS. The PAS stain was helpful, if positive, in identifying patients with MDS; however, when it was negative, this stain did not help distinguish MDS from non-MDS hematologic disorders. The immunocytochemical stain with HP1-1D monoclonal antibody was also helpful in identifying atypical micromegakaryocytes, indicative of dysmegakaryopoiesis. Other cytochemical abnormalities were infrequently observed and were less specific for the diagnosis of MDS. The combination of two stains--for example, PAS and iron stain or PAS and double esterase--was helpful, however, in excluding MDS, inasmuch as neither the miscellaneous nor the control group stained positively with these combinations.

Sarcomatoid salivary duct carcinoma of the parotid gland.

Salivary duct carcinoma (SDC) is a high-grade neoplasm known to histologically resemble high-grade ductal carcinoma in situ of the breast. We describe 3 cases of sarcomatoid salivary duct carcinoma, a heretofore unreported variant of SDC. Each case was a composite of SDC and sarcomatoid carcinoma and histologically similar to reported cases arising in the breast. The clinicopathologic features, including immunohistochemistry, of 3 cases were investigated. In the 3 men, ages 56, 68, and 70 years, the resected parotid tumors measured 1.5, 3.5, and 1.5 cm, respectively. Only the 3.5-cm tumor extended beyond the parotid gland into soft tissue. This patient died at 3 years with pulmonary metastases. The other patients were free of disease at 6 and 12 months. Histologically, each case was a composite of usual-type SDC and sarcomatoid carcinoma. SDC showed typical cribriform architecture, whereas anaplastic, spindled cells constituted the sarcomatoid areas. Immunohistochemically, epithelial elements stained as follows: cytokeratin (AE1/AE3 & CAM 5.2) positive in 3 of 3 cases, EMA positive in 3 of 3 cases, vimentin negative in 3 of 3 cases, desmin negative in 3 of 3 cases, c-erbB-2 positive in 1 of 2 cases. Sarcomatoid elements stained as follows: AE1/AE3 negative in 3 of 3 cases, CAM 5.2 rare positive cell in 1 of 3 cases, EMA focally positive in 3 of 3 cases, vimentin positive in 3 of 3 cases, desmin negative in 3 of 3 cases, c-erbB-2 negative in 2 of 2 cases. Electron microscopy, performed in one case, showed scattered junctional complexes congruent with epithelial differentiation. Immunohistochemical results, EMA and CAM 5.2 positivity, and ultrastructural findings supported our belief that these unique biphasic tumors represented SDC with sarcomatoid carcinoma. We conclude an element of sarcomatoid carcinoma rarely may arise in association with SDC, and it is erroneous to diagnose such tumors as "carcinosarcoma."

Extrarenal Wilms' tumor with cerebellar metastasis in a four-year-old girl with spina bifida.

This report documents the occurrence of an extrarenal nephroblastoma from which a cerebellar metastasis developed in a four-year-old girl with spina bifida. The second tumor became symptomatic two years after the resection of the primary, suggesting a treatment effect as a factor for the delay in the growing of the metastatic neoplasm. Histologic and ultrastructural features of the metastasis were similar to those described in Wilms' tumors of the kidney. The pathogenesis of this exceptional association, including malformation, malignancy, and unusual site of metastasis, is discussed.

Signet-ring cell carcinoma of the breast: a clinicopathologic study of 24 cases.

Twenty-four cases of signet-ring cell carcinoma of the breast are presented. These represented 4.5% of 535 cases of surgically treated breast cancer at Indiana University Medical Center. Twelve cases were associated with ductal carcinoma, nine with lobular carcinoma, one with colloid carcinoma, and four were pure signet-ring cell carcinoma. The mortality rate, incidence of axillary lymph nodal metastases, and number of involved lymph nodes were greater in cases of signet-ring cell carcinoma than with other forms of mammary carcinomas without signet-ring cells. It is proposed that signet-ring cell carcinoma can manifest as a pure lesion or as a variant of ductal, lobular, or colloid carcinoma, and that it is an aggressive histologic variant of mammary carcinoma.

Flow cytometric immunophenotypic characterization of pediatric and adult minimally differentiated acute myeloid leukemia (AML-M0).

We reviewed the clinicopathologic and immunophenotypic profiles of 7 pediatric and 11 adult minimally differentiated acute myelogenous leukemias (AML-M0). We also compared and evaluated myeloperoxidase in leukemic blasts using standard cytochemical and polyclonal antibody immunohistochemical stains. No distinctive clinical findings were noted in either patient group; however, thrombocytopenia typically was more prominent in adults. Adult AML-M0 also was associated with an immature myeloid profile (CD34+, terminal deoxynucleotidyl transferase positive, CD13+, and CD33+), in contrast with pediatric AML-M0, which usually lacked terminal deoxynucleotidyl transferase or CD34 but expressed bright CD33 with weak or negative CD13. Coexpression of the T-cell-associated antigen CD7 was observed in both groups. Antibody immunohistochemical stains were more sensitive than cytochemical stains for detection of myeloperoxidase activity and a useful adjunct for establishing a diagnosis of myeloid leukemia in paraffin-embedded marrow tissues.

Hypercalcaemia due to hyperparathyroidism in a patient with chronic renal failure and renal carcinoma.

A 65-year-old woman with a history of a left heminephrectomy for renal carcinoma developed hypercalcaemia 11 years after the operation. The same kidney was found to contain a recurrent renal carcinoma. After the radical nephrectomy of the left kidney, hypercalcaemia remitted but reappeared 11 months later. The right kidney was small but functioned at a level of creatinine clearance of 10--15 ml/min. Metastatic work-up was negative, and secondary causes of hypercalcaemia were excluded. A neck exploration revealed a parathyroid adenoma. With parathyroid resection the serum calcium declined to normal, and the risk of hypercalcaemic nephropathy in the remaining kidney was precluded.

Radionuclide venography: imaging monitor in deep-vein thrombosis of the pelvis and lower extremities.

Seventy-four adults with documented deep-vein thrombosis of the pelvis and/or lower extremities had baseline and follow-up radionuclide venography (RNV), giving a total of 171 studies. Fifty-nine of the patients had unilateral venous thrombosis, of which 36 (61.0%) involved the left side and 23 (39.0%) the right. The higher incidence in the left side was attributed to the longer and more horizontal course of the left common iliac vein, as well as to compression by the right iliac artery and inguinal ligament. In 13 patients bilateral involvement was noted. "Normalisation" of the venous circulatory pattern was characterised by recanalisation and partial or significant disappearance of abnormal collaterals. This occurred in 43/74 patients. In 24 cases, no change was recorded during the interval, while seven patients deteriorated.

Scintigraphic features of superior vena cava obstruction due to substernal non-toxic goitre.

Four men with clinical features of superior vena caval syndrome due to large substernal non-toxic multinodular goitre have undergone radionuclide superior vena caval studies. In all cases the dynamic scintigraphs showed a characteristic thyroidal configuration attributed to the definition of stretched thyroidal veins and their tributaries. Radiocontrast studies of two patients demonstrated the characteristic thyroid configuration. A radionuclide superior venacavogram taken post-thyroid lobectomy in one case showed the features had reverted to normal.

Hyposplenic blood picture in systemic amyloidosis. Its absence is not a predictable sign for absence of splenic involvement.

We studied a total of 61 cases of systemic and senile amyloidosis to evaluate the significance of a "hyposplenic blood picture" (the presence of numerous Howell-Jolly bodies) in these patients and to correlate its presence with the pattern and severity of the splenic involvement. To ascertain whether this peripheral blood picture is prevalent with a certain type of amyloidosis, we classified all cases by immunostaining with a panel of antibodies against AL amyloid (kappa and lambda light chains), serum amyloid-associated protein, prealbumin, beta-2 microglobulin, and amyloid p component. Based on immunostaining results, all cases were classified as AL (31 cases), AA (8 cases), or senile (prealbumin-positive, 22 cases) amyloidosis. Howell-Jolly bodies were identified in six patients with amyloid L amyloidosis; of these, four cases had diffuse splenic cord involvement, one had a follicular pattern, and one had a vascular pattern. Only one of these patients had a typical hyposplenic blood picture. This patient had far-advanced diffuse splenic involvement. The remaining five patients had rare to few Howell-Jolly bodies. In addition, 12 other patients had diffuse splenic involvement with no Howell-Jolly bodies present. This study concludes that even when there is advanced diffuse replacement of splenic cords with amyloid on light microscopy, the "pitting" function of the spleen appears to be preserved in most cases. The absence of a hyposplenic blood picture cannot be equated with normal splenic cord histology in patients with systemic amyloidosis.

Bronchial carcinoid appearing as a breast mass.

Carcinoid tumors of the breast are extremely rare. We studied what is to our knowledge the second case of an extramammary carcinoid presenting initially as a breast mass. Varying degrees of ribbon, trabecular, acinar, and insular patterns were present in the primary bronchial tumor and in several secondary deposits, including the initial breast lesion. The cells were argyrophilic and contained round and membrane-bound electron-dense granules. Estrogen and progesterone receptors were present in a cerebral metastasis. Polypeptide hormones and 5-hydroxytryptamine were not detected by immunocytochemistry.

Juvenile xanthogranuloma. Ultrastructural and immunocytochemical studies.

Morphologic features of three cases of juvenile xanthogranuloma (JXG) were consistent with the current concept of a benign process, although the lesion in one case grew steadily to an extensively infiltrating large mass, which clinically suggested a malignant growth. Ultrastructurally, the lesion consisted of morphologically different developmental stages of histiocytes, probably reflecting different functional levels. An interesting finding was the presence of occasional subplasmalemmal linear densities between these cells. These densities were at times symmetrically opposed, forming desmosomelike junctional complexes. Immunohistochemical study for the presence of lysozyme, alpha 1-antitrypsin, and S100 protein by the avidin-biotin-peroxidase complex was performed in all three cases. All immunostains were negative except the positive lysozyme stain in two cases. The ultrastructural and cytochemical characteristics of histiocytes in JXG were similar to epithelioid cells in the lymph node, suggesting that JXG is a reactive lesion.

Changes in external ear resonance after 3 types of surgery in the patients with chronic otitis media.

OBJECTIVE: This study was designed to identify the external ear resonance characteristics of patients with tympanic membrane perforation and to investigate subsequent changes in external ear resonance, depending on the length of the postoperative period and which of 3 different types of operation was performed: tympanoplasty with canal wall-up mastoidectomy, epitympanoplasty, and canal wall-down mastoidectomy. STUDY DESIGN AND SETTING: A total of 227 ears of 188 patients and 96 control ears comprised the study. We measured the gain and frequency of the first peak of external ear resonance with a real ear analyzer. RESULTS: Gain and frequency of the first peak recorded in the preoperative group did not differ from those of the control group. However, negative peaks appeared around 1 to 1.5 kHz in half of these ears. The gain increased markedly in all 3 postoperative groups. The canal wall-down mastoidectomy and epitympanoplasty groups showed significantly lower frequencies compared with the tympanoplasty with canal wall-up mastoidectomy and control groups, but there was no difference between them. The increased gain diminished over time, but the peak gain did not equalize with that of the controls, even after 15 months. CONCLUSIONS: Additional gain should be considered of around 1 to 1.5 kHz for hearing aid users with tympanic membrane perforation. Postoperative changes in external ear resonance should be expected in patients with chronic otitis media, suggesting that fine readjustments of the hearing aid may be necessary.

Clear cell carcinoma of the larynx A variant of mucoepidermoid carcinoma.

A case of clear cell carcinoma of the larynx is presented. By light microscopy the lesion was composed mainly of sheets of clear cells containing intracytoplasmic mucin and glycogen. Glandular lumina, tonofilaments, and desmosome-tonofilament complexes were observed on electron microscopy. The presence of these features established that this unusual neoplasm was a clear cell variant of mucoepidermoid carcinoma.

The evolutional stage changes in sarcoidosis on gallium-67 scintigraphy.

UNLABELLED: Gallium-67 scintigraphy has been proven as the imaging modality of choice in monitoring the presence of active disease in sarcoidosis. The purpose of this study is to analyze the patterns of evolutional stage changes of sarcoidosis while on steroid therapy by Ga-67 scintigraphy. METHODS: Eighty-six consecutive patients with biopsy-proved sarcoidosis are evaluated by Ga-67 scintigraphy. Thirty-six of 86 patients have had a baseline and one to eight follow-up Ga-67 scintigraphs (total 136 studies). The initial follow-up scintigraphs are obtained on average about 4-12 months after the baseline study. RESULTS: Seventeen of 36 patients (47.2%) are in stage IV at the time of the baseline study. Following their first course of corticosteroid therapy, 13 patients remained in the same stage and activity distribution pattern while 13 patients have shown reversion to other stages, eight patients showed complete remission while two patients became active from inactive stage. CONCLUSION: Evolutional stage changes are seen in 23 patients (63.9%), including eight patients (22.2%) who showed complete scintigraphic remission. The evolutionary stage changes remain quite variable and unpredictable. This, however, should not detract from the usefulness of Ga-67 scintigraphy in the diagnosis and prognostic evaluation of sarcoidosis, particularly when extrapulmonary involvement (Stage IV disease) is present.

Fine-needle aspiration cytology of cystic hypersecretory ductal carcinoma in situ of the breast: a case report.

Cystic hypersecretory intraductal carcinoma is an unusual, cystic form of intraductal breast carcinoma affecting middle-aged women. Cytopathologists have rarely encountered this lesion, with only 2 other cases having been previously reported (Colandrea et al., Arch Pathol Lab Med 1988:112:560-563; Kim et al., Acta Cytol 1997;41:892-896). In our cases, the cytologic findings of both air-dried, Diff-Quick-stained and ethanol-fixed, Papanicolaou-stained smears are presented. The cytologic hallmarks of this entity include the presence of a few scattered epithelial cells with bland nuclear morphology in a background of extensive, amorphous, pink-staining material. Cytomorphologically, the differential diagnosis includes other entities containing pink-staining material such as colloid carcinoma, mucocele-like lesion of the breast, and benign fibrocystic change.