Establishment of a human megakaryoblastic cell line (T-33) from chronic myelogenous leukemia in megakaryoblastic crisis.

A megakaryoblastic cell line, termed T-33, was established from the peripheral blood of a patient with Philadelphia chromosome-positive chronic myelogenous leukemia in megakaryoblastic crisis. T-33 cells have been maintained in RPMI 1640 medium containing 10% fetal calf serum in a single cell suspension with a doubling time of 24-36 h for over 2 years. Giemsa-banded karyotypes were female hyperdiploid with a modal chromosomal number of 51, all cells including Philadelphia chromosome. The cells showed strong positivity for periodic acid-Schiff and alpha-naphthyl acetate esterase, and weak for alpha-naphthyl butyrate esterase, but were negative for myeloperoxidase. Flow cytometric analysis of cell surface markers showed the existence of HLA-DR, MY-7, MY-9, and a platelet antigen (Yukb), and no markers for T- or B-lymphocytes. Most of the cells fixed with acetone were positive for Factor VIII, platelet glycoprotein IIb-IIIa, IIIa (Yukb), and Ib, but negative for glycophorin A and hemoglobin. Ultrastructural platelet peroxidase was demonstrated in 2-3% of cells and the percentage of positive cells increased up to 20% after the treatment with 12-O-tetradecanoylphorbol-13-acetate. The cells contained small dense granules negative for platelet peroxidase, their number increasing threefold after 12-O-tetradecanoylphorbol-13-acetate treatment. Such treated cells frequently showed a complex of the demarcation membrane in the cytoplasm. T-33 responded thrombin to exhibit calcium influx. This cell line may be useful for the study of the early stage of megakaryocytic differentiation in human megakaryopoiesis.

Late cardiac strangulation due to an iatrogenic pericardial defect.

A 14-year-old boy developed broad posterolateral myocardial infarction. During cardiac surgery at age five, a small pericardial window had been made. Autopsy revealed an extensive left-sided pericardial defect and necrosis of the left ventricular free wall, which had herniated and strangulated through the enlarged pericardial defect.

Arteriosclerosis of the gastroepiploic and internal thoracic arteries.

Arteriosclerosis of the right gastroepiploic artery (GEA) and the internal thoracic artery (ITA) were compared by pathological observation. Specimens were obtained from 35 patients who underwent coronary artery bypass grafting with simultaneous use of these two kinds of arterial grafts. Degree of arteriosclerosis was classified in five categories: 0, normal; 1, luminal narrowing less than 25%; 2, luminal narrowing between 25% and 50%; 3, luminal narrowing greater than 50%; and 4, overt atherosclerosis with ulceration or calcification. The number of arteries with degree 0, 1, 2, 3, and 4 was 16 (46%), 15 (43%), 3 (9%), 0, and 1 (3%) in GEA and 27 (77%), 8 (23%), 0, 0, and 0 in ITA, respectively. Incidence of degree 0 was higher in ITA, but differences were not significant. The mean wall thickness was 0.30 +/- 0.13 mm in GEA and 0.21 +/- 0.07 mm in ITA (p less than 0.05). In 23 patients who underwent postoperative angiography, all 46 arterial grafts were patent without focal stenosis. We conclude that GEA has slightly more intimal thickening than ITA, but significant luminal narrowing caused by arteriosclerosis is rare. Gastroepiploic artery can be expected to be a suitable conduit for coronary artery bypass grafting.

Comparative study between the gastroepiploic and the internal thoracic artery as a coronary bypass graft. Size, flow, patency, histology.

Ninety-two gastroepiploic artery (GEA) and 322 internal thoracic artery (ITA) grafts which underwent postoperative angiography (0.5-24 postoperative months, mean 2.0 months) were compared. The sites of GEA anastomosis were 5 left anterior descending, 3 diagonal, 16 circumflex and 68 right coronary arteries and for ITA grafts, 241 left anterior descending, 40 diagonal, 36 circumflex and 5 right coronary arteries. Patency rates were 96% (88/92) of GEA and 98% (314/322) of ITA, respectively. No focal stenosis in the graft trunk was found in both GEA and ITA except occasional spasm in GEA. Six (6%) GEAs were opacified via the superior mesenteric artery. Mean diameter of grafts just proximal to the anastomosis measured by angiogram was 2.3 mm in GEA and 1.9 mm in ITA (P less than 0.01). Free flow after intraluminal papaverine injection was 90.6 ml/min (50-300 ml/min) in 48 GEAs and 81.3 ml/min (50-150 ml/min) in 98 ITAs. Histology showed normal to mild intimal sclerotic changes in 58 of 63 (92%) GEAs and in 94 of 95 (99%) ITAs. From these results, we concluded that GEA is a suitable conduit and good long term patency similar to ITA grafting can be expected in coronary artery bypass grafting.

A case of malignant fibrous histiocytoma after breast conserving therapy for breast cancer.

A 45-year-old woman with malignant fibrous histiocytoma (MFH) of the breast following breast conserving therapy (BCT) is described. She noticed a lump in her left breast 52 months after BCT for breast cancer. The lump was excised and nodular fasciitis was initially diagnosed. However, the tumor recurred locally 4 times in the next 18 months. MFH was finally diagnosed. This case is considered to be radiation-induced sarcoma. The risk of radiation-induced sarcoma after BCT seems to be very low, however careful follow-up is necessary.

Clinical significance of cerebral aneurysm in renovascular hypertension due to fibromuscular dysplasia: two cases in siblings.

Two cases, in siblings, of renovascular hypertension caused by fibromuscular dysplasia (FMD) of the renal artery associated with cerebral aneurysms are reported. Both of the cases were found to have cerebral aneurysm, as well as multiple stenotic or occluded lesions in arteries such as renal, mesenteric, celiac, and internal carotid arteries. One case died of subarachnoid hemorrhage and the other case was successfully operated on for the aneurysm. This report suggests that FMD should be considered to be a systemic angiopathy including the cerebral artery, as well as the renal artery. Thus, cerebral angiography is recommended to detect the association with cerebral aneurysm, at least, in cases with multiple lesions of FMD. Occurrence of FMD in siblings also indicates that a genetic factor might be involved in the pathogenesis of FMD.

Ischemic cardiomyopathy without significant coronary stenosis. A case report.

The authors present a rare case of myocardial infarction in a fifty-eight-year-old man without significant coronary artery stenosis apparent on the emergency coronary angiogram. However, a second angiogram two days later revealed a total occlusion of the left anterior descending artery. Intracoronary thrombolytic therapy was performed with a successful outcome. The patient was subsequently readmitted with an acute myocardial infarction, and the coronary angiogram again failed to demonstrate significant stenosis. Thereafter, the patient's left ventricular function deteriorated progressively, with the occurrence of another myocardial infarction and frequent bouts of symptoms related to congestive heart failure. He died of ischemic cardiomyopathy about seven years later. Findings including an autopsy report showed that myocardial ischemia was involved in the pathogenesis of what initially appeared to be primary dilated cardiomyopathy, based on emergency angiograms.

[Decreased growth hormone secreting cells of the hypophysis in senile cachexia].

Basic morphometry of the pituitary gland in aged patients with cachexia was performed. In 10 control specimens, growth hormone(GH) cells accounted for 42.9 +/- 3.4% of the total, compared with 33.8 +/- 7.0%(p < or = 0.01) in patients with severe cachexia senilis. ACTH cells accounted for 16.0 +/- 7.4% in the control group and 14.1 +/- 9.0% in the senile cachexia group(p > or = 0.1). The mean pituitary weight was 0.60 g in control cases and 0.46 g in cases of extreme cachexia(p < or = 0.01). In the hypophyses of patients with senile cachexia, atrophy of GH cells and increase of the fibrous stroma were also prominent. The ratio of the summarized value for total GH cells in cachexia senilis patients and controls was 1:2.2. The difference was regarded as sufficiently large to be a causative factor in the establishment of cachexia senilis.

[Flow cytometric analysis of the DNA content of sclerosing hemangioma of the lung].

DNA ploidy and DNA content of two surgically resected sclerosing hemangioma of the lungs were examined by flow cytometry. Cell kinetics were analyzed by using DNA index and the proliferation index. Both cases were diploid, and their proliferation indices were 22.91 and 25.53, respectively, suggesting that they are benign tumors.

[Histological grading of alveolar type renal cell carcinoma based on architectural variation].

Ninety-two of a total 107 renal cell carcinomas excluding papillary, sarcomatoid and other uncommon histological types were classified into 3 groups based on architectural variations. Statistically analyses were carried out for prognostic significance. Histological criteria of 3 groups were defined as follows. Group I consists predominantly of tubular formations with characteristic cystic change. Group III shows solid proliferation without tubular formations, and Group II shows small alveolar or trabecular structures with inconspicuous tubular formations. According to the survival curves (Kaplan-Meier method), the prognosis of Group I was significantly better than II and III. Ten year survival rate of each group was 88 +/- 7.8% in Group I, 39 +/- 8.8% in Group II, and 0% in Group III. The distribution of T and V stages in the 3 groups were not significantly different. Nuclear grading of Group I and II was not so different, though high grade cases predominated in Group III. Therefore, the present grading of alveolar type renal cell carcinoma based on architectural atypia was considered to be a useful prognostic parameter.

[A model of orthotopic transplantation in mice using MBT-2].

We attempted to produce a malignant urinary bladder carcinoma in mice by transplanting MBT-2 cells. MBT-2 carcinoma about 3.0 x 10(3) cells/0.02 ml were successfully transplanted into the bladder wall with an incidence of 80% (20/25) after three experimental weeks. Inoculated tumor cells grew expansively into the bladder cavity from the bladder submucosa, and invaded the muscle layer. We observed that tumors caused gross hematuria and bilateral hydronephrosis. This malignant tumor model in which a tumor is implanted into its original organs seems to be useful for predicting clinical effectiveness in experimental cancer therapy.

[Antitumor effect of combined use of purified human natural tumor necrosis factor (N-TNF) and cis-diamminedichoroplatinum (II) (cisplatin) on the implanted bladder carcinoma (MBT-2) in mice].

The antitumor effect of tumor necrosis factor (TNF) in combination with Cis-diammine-dichloroplatinum (II) (Cisplatin) upon implanted bladder carcinoma (MBT-2) in mice was analysed together with the toxicity. Mice were implanted into the bladder wall with about 10(4) cells MBT-2 viable cells. TNF was the purified human natural tumor necrosis factor. The antitumor effects were evaluated by the volume of the tumor thus implanted and the drug-toxicity by the body weight of mice and microscopic as well as macroscopic findings of the main organs. As a result, 1) The toxicity of TNF to mice was not enhanced in a dose-dependent fashion when combined with Cisplatin. 2) The antitumor effect by combination of TNF and Cisplatin was significantly increased compared to control group. 3) The effects of TNF was enhanced in a dose-dependent fashion when combined with Cisplatin. 4) The antitumor effects was confirmed by pathological findings. These results suggest that the combined use of n-TNF and Cisplatin is promising as a clinically effective treatment against bladder cancer in human.