Gapped Collective Charge Excitations and Interlayer Hopping in Cuprate Superconductors.

We use resonant inelastic x-ray scattering to probe the propagation of plasmons in the electron-doped cuprate superconductor Sr_{0.9}La_{0.1}CuO_{2}. We detect a plasmon gap of ∼120 meV at the two-dimensional Brillouin zone center, indicating that low-energy plasmons in Sr_{0.9}La_{0.1}CuO_{2} are not strictly acoustic. The plasmon dispersion, including the gap, is accurately captured by layered t-J-V model calculations. A similar analysis performed on recent resonant inelastic x-ray scattering data from other cuprates suggests that the plasmon gap is generic and its size is related to the magnitude of the interlayer hopping t_{z}. Our work signifies the three dimensionality of the charge dynamics in layered cuprates and provides a new method to determine t_{z}.

Turning a first order quantum phase transition continuous by fluctuations: general flow equations and application to d-wave Pomeranchuk instability.

We derive renormalization group equations which allow us to treat order parameter fluctuations near quantum phase transitions in cases where an expansion in powers of the order parameter is not possible. As a prototypical application, we analyze the nematic transition driven by a d-wave Pomeranchuk instability in a two-dimensional electron system. We find that order parameter fluctuations suppress the first order character of the nematic transition obtained at low temperatures in mean-field theory, so that a continuous transition leading to quantum criticality can emerge.

[Evaluation of imaging before lung volume reduction surgery for pulmonary emphysema; fused image of multi-detector row computed tomography and scintigram].

Lung volume reduction surgery (LVRS) is performed as surgical therapy for severe pulmonary emphysema. In assessing diagnostic imaging indications, emphysematous change is the strongest in the thoracic computed tomography (CT), while the accumulation decrease is most remarkable in ventilation scintigram and lung perfusion scintigram. Preoperative evaluation of imaging using multidetector-row CT (MDCT) and scintigram were performed, and the multiplanar reconstruction (MPR) image of the MD CT and the single photon emission CT (SPECT) image of the scintigram were fused by the workstation. It was possible to evaluate the excision and the range of LVRS easily by looking at the fused image, and it was useful in deciding on the surgical approach. It is believed that accurate, comprehensible imaging information contributed to an improvement in the surgical outcome of LVRS.

[Imaging aid for thoracoscopic thymectomy; thymic vein visualization].

The spread and progress of thoracoscopic surgery has been remarkable. There are many important organs and blood vessels in the mediastinal space, thus, as inadvertent injury invites serious consequences, it is necessary to understand the anatomical position of existing structures. When enucleating the thymoma under a thoracoscope, one of the blood vessels to be careful about is the thymic vein. Therefore, we examined whether the thymic vein could be confirmed using a multidetector-row computed tomography (MD CT). We believed we could understand the anatomical position of the thymic vein by analyzing the high resolution slice data provided in MD CT using a work station. The diameter of the thymic is from a little less than 1 mm to 3 mm, and there were individual variations in position and the number of the vein. The thymic vein flowed into the left brachiocephalic vein in many cases. In some cases, the thymic vein flowed into the right internal thoracic vein or superior vena cava. It appears that visualization of the thymic vein could provide useful data when performing thoracoscopic thymectomy.

[Selection of the bronchial tube for one-lung anesthesia by multidetector-row computed tomography (MD CT) evaluation].

One-lung anesthesia is a method of anesthesia performed by inserting the tip of a bronchial tube into either the right main bronchus or the left main bronchus. The right bronchial tube is a special structure. Since the distance of the carina to the right upper lobe bronchus is short, a side hole is made to prevent blockading of the right upper lobe bronchus, and the cuff is attached aslant to it. When inserting a bronchial tube into the right main bronchus, care is required to prevent the occurrence of atelectasis though a gap in the bronchial tube. We evaluated the structure of a trachea and a bronchus using the multidetector-row computed tomography (MD CT), and tried to select the right bronchial tube most suitable for each structure. There are individual differences in the structure of a trachea and a bronchus. By creating a 3-dimensional image of a trachea and a bronchus, the structure could be easily grasped, and therefore selection of the most appropriate bronchial tube according to the structure was possible.

An unusual presentation of McCune-Albright syndrome confirmed by an activating mutation of the Gs alpha-subunit from a bone lesion.

The McCune-Albright syndrome (MAS) is characterized clinically by polyostotic fibrous dysplasia, café-au-lait skin lesions, sexual precocity, and various other endocrinopathies. Recent investigations suggest an etiological role for embryonic somatic missense mutations that predict the substitution of a His or Cys for Arg at amino acid 201 of the Gs alpha-subunit (Gs alpha). Identification of these mutations in affected tissues is a sensitive assay that may help define a more complete clinical spectrum of the MAS. We investigated a woman who developed fibrous dysplasia 24 yr after premature menstruation. To determine if this was an unusual MAS variant, DNA and RNA were analyzed from affected and unaffected tissues. From samples of affected rib and normal rib DNA was extracted, amplified by polymerase chain reaction, subcloned, and sequenced. RNA was extracted from affected bone, reverse transcribed, amplified by polymerase chain reaction, subcloned, and sequenced. DNA sequence predicting a His for Arg substitution at Gs alpha amino acid 201 was found in 47% of the recombinant plasmids from DNA of affected bone and 17% of the plasmids from DNA of unaffected bone; a significant (P < 0.05) difference in frequency. The His201 substitution was found in 42% of the recombinant plasmids from RNA of affected bone. We conclude that this clinical variant is qualitatively indistinguishable from presentations of the complete MAS.

Radioiodide uptake and turnover in a pseudo-medullary thyroid carcinoma.

A mass in a woman's neck, with no sequestration by Tc-99m imaging, was accompanied by an elevated serum calcitonin on one occasion. Light microscopy of a biopsy was consistent with medullary thyroid carcinoma. Electron microscopy showed secretory granules similar to those found in normal C-cells and in medullary carcinoma of the thyroid. The neck mass (and pulmonary and hepatic metastases likely from the principal mass) concentrated radioiodide (I-131). Subsequent immunoperoxidase examination of the tissues showed them to contain thyroglobulin but not calcitonin. The tumor was thus likely of follicular-cell origin. Reports of radioiodide uptake in medullary thyroid carcinoma may be correct, but each case will have to be re-examined with attention to tissue markers such as thyroglobulin and calcitonin. These markers might more correctly classify the origin of the tumor. The possibilities of cell interconversion and of dual origin are also discussed. Whole-body turnover of radioiodide was quantified as well as that in the pulmonary lesions. Rapid removal of radioactivity was present, suggesting that agents reducing iodide turnover might have therapeutic value in these cases. At five days after radioiodide administration, a biopsy specimen showed that the tumor-to-blood ratio (per gram) was greater than 1.

Shunt nephritis from Propionibacterium acnes in a solitary kidney.

Since its initial description in 1965, immune complex glomerulonephritis associated with ventriculoatrial shunts (VAS) has been reported widely in the literature. The most common incriminating organism is Staphylococcus epidermidis, but less often, an organism generally regarded as nonpathogenic, such as Propionibacterium acnes, has been noted as the cause. Shunt infection usually occurs within a few months after placement or manipulation of the shunt, and shunt nephritis (SN) develops gradually over months to years after. Treatment involves mandatory removal of the shunt and antibiotics; prognosis is variable. We report a case of SN with P acnes that is unusual because of its occurrence in a solitary kidney 6 years after shunt placement, persistently negative blood cultures, and normal complement levels. Percutaneous biopsy of a solitary kidney should be considered if it is expected that the result may guide therapy of progressive renal failure.

Autologous peripheral blood progenitor cell transplantation for non-Hodgkin's lymphoma with extensive bone marrow necrosis.

A patient with malignant lymphoma, large cell type and extensive bone marrow necrosis at presentation is reported. Bone marrow necrosis persisted even after a complete remission was induced with standard chemotherapy. Because of this adverse prognostic factor, circulating stem cells were collected and reinfused following a myeloablative regimen consisting of busulfan, etoposide and cyclophosphamide. The patient engrafted rapidly and a subsequent bone marrow examination was free of both lymphoma and necrosis. To the best of our knowledge, this is the first reported patient with extensive bone marrow necrosis in whom circulating progenitor cells were harvested and utilized successfully.

Embolic tubular epithelial cells in percutaneous renal biopsies.

Four percutaneous renal biopsies with intravascular embolic tubular epithelial cells are presented. This unusual finding is presumably the result of the needle biopsy procedure and can be a puzzling and misleading artifact. It is postulated that dislodged tubular epithelial cells are pushed forward into or pulled back into punctured intrarenal arteries and subsequently transported to distant glomeruli.

A simplified method of preparing permanent tissue sections for the erythrocyte adherence test.

A method of preparing permanent sections of tissue for the erythrocyte adherence test using glutaraldehyde fixation and polylysine as the bonding agent is described. This method enables rapid staining with hematoxylin and eosin without loss of indicator erythrocytes.

Multiple oncocytic papillary cystadenomas of the larynx: a case report.

A patient had multiple oncocytic cysts of the larynx and, concurrently, epidermoid carcinoma of the larynx. Total laryngectomy for the epidermoid carcinoma made it possible to carefully examine and histologically document the multifocal and oncocytic nature of the lesions. The authors interpret the findings to represent both hyperplastic and metaplastic processes.

Immunohistochemical demonstration of human chorionic gonadotropin in tumors of the urinary bladder.

All transitional cell carcinomas of the bladder diagnosed in male patients within a five year period were studied for human chorionic gonadotropin (hCG) production. Biotin-avidin immunoperoxidase analysis for hCG was performed on all paraffin blocks containing carcinoma-in-situ, grade I, grade II, and grade III transitional cell carcinoma. Of a total of 29 patients, one case of carcinoma-in-situ (1/5), and five cases of grade III transitional cell carcinoma (5/15) were found to have hCG-positive tumor cells. The findings indicate that transitional cell carcinoma should be added to the list of malignant tumors capable of producing hCG.

Diagnostic pitfalls in the diagnosis of soft tissue bladder tumors in pediatric patients.

This is a case report of a low-grade leiomyosarcoma of the bladder in a four-year-old girl. The pitfalls in diagnosing a soft tissue tumor of the bladder in pediatric patients are discussed. This case is particularly instructive because the differential diagnosis was broad, difficult, and of serious consequence. This report discusses the process by which histologic, immunohistologic and ultrastructural data were used to sidestep the pitfalls in diagnosing this unusual tumor. Clinical follow-up data bearing out our conclusion are also presented.

Immunological techniques to differentiate lymphoma from other malignancies.

Seven patients, who had lymph nodes or masses examined by both immunoperoxidase staining and flow cytometry, are presented to illustrate the value of each technique including a critical analysis of the current application of these techniques in the pathology laboratory. All seven patients had diagnoses established by immunoperoxidase staining using antibodies directed against: Leukocyte Common Antigen (LCA), Epithelial Membrane Antigen (EMA), Neuron Specific Enolase (NSE), Leu M1, B4 or chromagrafin and synaptosin. Flow cytometry, which could be more rapidly performed, when sufficient cells could be separated from the node or mass, was diagnostic in two of the seven cases. Flow cytometry failed to show abnormalities in Hodgkin's disease or solid tumors, but it was useful in rapid diagnosis of lymphoma, provided that the sample contained mostly involved tissue. Nodes in which there was a minor infiltration with lymphoma cells could only be detected by immunoperoxidase technique.

The role of flow cytometry in the diagnosis of lymphoma: a critical analysis.

Flow cytometry, now used routinely to aid in the classification of leukemias, is increasingly being evaluated as a rapid technique for determination of surface antigens on the cells teased from lymph nodes and other masses with suspected lymphoma. The present study reviews biopsy specimens from patients examined during a two year period which were sent for flow cytometry with a diagnosis of suspected lymphoma. Sixteen of 25 samples (64 percent) produced cell suspensions of sufficient quantity and quality to be diagnostically helpful. Results showed that in 9/16 (56 percent) the diagnosis of lymphoma or cancer could be suspected by flow cytometry alone, while 4/16 were consistent with the final tissue diagnosis of normal or reactive hyperplasia. Three samples that came from patients who had morphologic evidence of malignant disease on biopsy (two Hodgkin's disease and one large cell lymphoma) had flow cytometry results that were interpreted as normal. Flow cytometry is rapid and appears to be virtually diagnostic of non-Hodgkin's lymphoma when a majority of cells are B cells with an abnormal kappa/lambda ratio (> 4.0 or < 0.25). Nonhematologic malignancy can be suspected if less than 75 percent of the cells show CD45 (common leukocyte antigen). Hodgkin's disease cannot be detected by flow cytometry as it is currently used, and as many as 15 percent (1/6 in this study) of lymphomas may show normal results. It is extremely helpful when the biopsy sample actually contains the cells of interest in large proportion. Loss of architectural relationships in the course of processing specimens for flow cytometry is a major disadvantage when small foci of lymphoma or tumor cells exist together with large amounts of stroma or normal lymphocytes.

Immunoperoxidase staining of tumors by an antibody to Xenopus pNiXa.

pNiXa, a serpin from oocytes and embryos of Xenopus laevis, was tested as a tumor marker in human and rodent tissues. A peptide corresponding to the histidine-rich domain of pNiXa was conjugated and administered to rabbits to produce a polyclonal antibody, which was purified by antigen-affinity and used for immunoperoxidase staining of formalin-fixed, paraffin-embedded tissue sections. Staining with pNiXa-antibody was positive in 23/187 human tumors (12 percent) and negative in 119 specimens of normal human tissues. Positive reactions were more frequent in liver (38 percent) and colon (34 percent) tumors than breast (18 percent), prostate (9 percent), mesothelioma (20 percent) or lung (0 percent) tumors. Staining was negative in human tumors from other sites. Rodent tumors and preneoplastic foci induced by chemical carcinogens were surveyed for staining with pNiXa-antibody. Staining was positive in 10/10 hepatic lesions (hepatocellular foci, adenomas, carcinomas) induced in hybrid D2B6F1 mice by diethylnitrosamine and phenobarbital, whereas murine mammary tumors and thyroid, pituitary, renal, and colon tumors of F-344/CNr rats were negative. Thus, immunostaining with pNiXa-antibody identifies a subset of human and murine tumors; further studies are needed to determine if reactivity of pNiXa-antibody has diagnostic or prognostic significance.

Adoptive transfer of activated human autologous macrophages results in regression of transplanted human melanoma cells in SCID mice.

The potential anti-tumor activity of human macrophages, grown in macrophage colony stimulating factor (M-CSF), was examined in mice homozygous for the mutation severe combined immune deficiency (scid) bearing xenografts of autologous human melanoma. Injection of scid mice, bearing subcutaneous melanoma xenografts, with the cultured macrophages or with the macrophage culture supernatant, once or repeatedly, resulted in partial to complete regression of tumors. Since a large number of such macrophages (greater than 1 x 10(9)) could be grown in vitro for repeated injection, the scid-human chimera can serve as an in vivo model to examine the role of human macrophages in tumor immunity and to explore the potential of the in vitro cultured macrophages in the therapy of cancer.

Granulocyte colony stimulating factor-producing diffuse malignant mesothelioma of pleura.

We report the rare case of a 61-year-old man with a diffuse malignant mesothelioma of mixed subtype which produced granulocyte colony-stimulating factor (G-CSF). The white blood cell (WBC) was elevated to 85,100/mm3 without any evidence of infection, and the G-CSF level in the pleural effusion was also increased at 13,200 pg/ml. The lobes of the lung were encased in a tumor. Histopathologically, the tumor cells were of a polymorphous morphology with an epithelial and sarcomatoid mixed pattern. Immunohistochemistry showed that the tumor cells were positive for vimentin, cytokeratin, epithelial membrane antigen, thrombomodulin, and G-CSF, and negative for carcinoembryonic antigen (CEA), CD34, and surfactant apoprotein-A.

[The efficacy of a comprehensive smoking cessation class, combined with nicotine patch and gum replacement therapy].

A six-month comprehensive smoking cessation class was conducted in our hospital, and the results were evaluated after one year. To increase the rate of smoking cessation, a smoking cessation support team composed of a medical doctor, a pharmacist, nurses, a registered dietitian, and a physical therapist was formed. The team provided specialized lectures and comprehensive group counseling programs every two weeks for the first two months and every month for the next four months. Each participant's expired carbon monoxide concentration and body weight were measured at every attendance. The participant continued with beneficial behavioral treatment for smoking cessation for six months, with nicotine replacement therapy (NRT) for the first eight weeks. The protocol of our NRT consisted of both the routine use of nicotine patches (Nicotinell TTS) and the rescue use of nicotine gum (Nicorette). We first ascertained each participant's degree of nicotine dependence, using the Fagerström Tolerance Questionnaire score, and daily nicotine intake was estimated by a detailed questionnaire. We then divided the participants into two NRT groups according to their nicotine dependence. The higher nicotine dependence group consisted of those whose Fagerström Tolerance Questionnaire score was more than 5 points or whose estimated nicotine intake was more than 10 mg/day. This group they used Nicotinell TTS 30 (TTS 30) for the first four weeks, TTS 20 for the next two weeks, and TTS 10 for the last two. In the lower dependence group. TTS 20 and TTS 10 were each given for four weeks. Nicotine gum use was restricted to 4 pieces a day for the first week and reduced by one per day each subsequent week. As a result, there was an 81.3% smoking cessation rate after eight weeks, 70.3% after six months, and 58.2% after one year. In conclusion, two courses of routine nicotine patch use, with the addition of restricted rescue use of nicotine gum, can produce better longterm abstinence results than previously reported NRTs, suggesting that this may be one of the best ways to cease smoking. We also emphasize that intensive group counseling programs and lectures supported by doctors and medical teams, as well as a continuing behavioral treatment component, may be indispensable for enhancing longterm sustained abstinence rates.