Development of heat hyperalgesia and changes of TRPV1 and NGF expression in rat dorsal root ganglion following joint immobilization.

The aim of this study was to examine whether threshold to heat stimuli, and expression of transient receptor potential vanilloid1 (TRPV1) and nerve growth factor (NGF) in dorsal root ganglion (DRG) altered under conditions of long-term limb immobilization. A plastic cast was wrapped around the right limb from the forearm to the forepaw to keep wrist joint at 90° of flexion for 5 weeks. Heat hyperalgesia was tested using the plantar test at 6 h after removing cast. The rats were perfused transcardially with 4 % paraformaldehyde and DRGs were excised at 24 h after removing cast. For size distributions of the TRPV1-IR and NGF-IR neuronal profile, the DRG area measurements over 1000 DRG neurons per animal were measured in each side, on both the immobilized (ipsilateral) and contralateral sides. Ipsilateral withdrawal latency was significantly shorter than contralateral sides. Ipsilateral percentage of immunoreactive neurons in the total DRG neurons was significantly higher than contralateral sides in TRPV1-IR and NGF-IR. Long-term casting induced heat hyperalgesia, and up-regulation and phenotypic change of TRPV1-IR and NGF-IR in DRGs on the immobilized side. These DRG alterations may involve heat hyperalgesia after long-term limb immobilization.

Inverted papilloma with osteogenesis in the anterior ethmoid and frontal sinuses.

OBJECTIVE: We report a rare case of new bone formation (osteogenesis) within an inverted papilloma, occurring in the ethmoid and frontal sinuses. METHOD: The histopathological and radiological findings, differential diagnosis, and treatment of tumour-induced osteogenesis are discussed. RESULTS: A 68-year-old man complained of headache and left-sided, purulent rhinorrhoea of five years' duration. On nasal endoscopy, lesions similar to inflammatory nasal polyps were seen. Pre-operative radiological images demonstrated opacification of the left nasal cavity and anterior ethmoid and frontal sinuses, plus a bone-density lesion. The mass with bony lesion was completely removed endoscopically. The mass was histopathologically diagnosed as an inverted papilloma surrounding bony tissue. Furthermore, the histopathological findings (including immature bony tissue rimmed by osteoblasts) indicated an extremely rare case of inverted papilloma induced osteogenesis. Six months after surgery, no recurrence was detected. CONCLUSION: This case highlights the importance of clinical awareness of tumour-induced osteogenesis.

Accumulation of mitochondrial DNA mutation with colorectal carcinogenesis in ulcerative colitis.

We recently reported that oxidative stress elicited by chronic inflammation increases the mutation of mitochondrial DNA (mtDNA) and possibly correlates with precancerous status. Since severe oxidative stress is elicited in the colorectal mucosa of individuals with ulcerative colitis (UC), the possible occurrence of an mtDNA mutation in the inflammatory colorectal mucosa and colitic cancer was investigated. Colorectal mucosal specimens were obtained from individuals with UC with and without colitic cancer and from control subjects. The frequency of mtDNA mutations was higher in colorectal mucosal specimens from patients with UC than that from control subjects. The levels of 8-hydroxy-2'-deoxyguanosine, a DNA adduct by reactive oxygen species, were significantly higher in UC than in control. Specimens from patients with colitic cancer contained a significantly higher number of mtDNA mutations. The present observations suggest that the injury followed by the regeneration of colorectal mucosal cells associated with chronic inflammation causes accumulation of mtDNA mutations. The increased instability of genes, including those on the mtDNA, is consistent with the high and multicentric incidence of colorectal cancer in individuals with UC. Thus, analysis of mtDNA could provide a new criterion for the therapeutic evaluation, and may be useful for the prediction of risk of carcinogenesis.

Intestinal goblet cell autoantibody associated enteropathy.

This report describes a case of refractory enteropathy with circulating intestinal goblet cell autoantibodies (IGA). A 19 year old man with hyperthyroidism had suffered from protracted diarrhoea for nearly 10 years. Histological examination showed evidence of collagenous enterocolitis. The diarrhoea did not improve despite fasting under total parenteral nutrition. An immunofluorescence assay demonstrated IGA without anti-enterocyte autoantibodies, the hallmark of autoimmune enteropathy, although other criteria were fulfilled. None of 109 controls, including 55 cases of inflammatory bowel disease and one of lymphocytic colitis, had IGA. This case is considered to be a variant of autoimmune enteropathy, and might be a distinct entity.

Validity of simple mucosal biopsy criteria combined with endoscopy predicting patients with ulcerative colitis ultimately requiring surgery: a multicenter study.

BACKGROUND: Recent mucosal biopsy criteria combined with endoscopy effectively differentiate patients with ulcerative colitis ultimately requiring surgery (UC-S) from those receiving medication alone (UC-M). However, the criteria were inconvenient in practical use because of the need for complicated calculations, and the validity has not been verified in other institutes where the indications for surgery may differ. The aims of this multicenter study were to propose simple criteria in which calculation can be performed by mental arithmetic and to measure their validity. METHODS: Based on the above original criteria, we constructed simple criteria in which coefficients and constant were simplified to integral numbers. The criteria consisted of the diagnostic categories, highest-risk, high-risk, unpredictable, low-risk, and lowest-risk of surgery. The validity of these proposed criteria was evaluated in 121 patients with UC-S and 186 with UC-M from 11 institutes. RESULTS: The categories of high-risk and low-risk had sensitivities exceeding 86.0% and specificities exceeding 95.2%, and the validities were maintained at high levels in most individual institutes. There was little difference in validity between the proposed and original criteria when testing using the same patients. CONCLUSIONS: Despite simplified coefficients and constant, the proposed criteria reliably predicted the eventual clinical outcome of patients with ulcerative colitis and would be helpful in determining the necessity of surgery.

Spontaneous regression of hepatic adenoma in a patient with glycogen storage disease type I after hemodialysis: ultrasonographic and CT findings.

A 23-year-old woman was admitted to our hospital with recurrent gouty arthritis. Laboratory findings showed hypoglycemia, lactic acidosis, hyperlipidemia, and hyperuricemia, with normal values of serum alfa-fetoprotein (AFP) and protein induced by vitamin K absence (PIVKA-II). A diagnosis of glycogen storage disease type I (GSD-type I) was made on the basis of the laboratory data, liver biopsy findings, and partially deficient thrombocyte glucose-6-phosphatase (G-6-Pase) activity. Ultrasonography and computed tomography revealed multiple focal hepatic masses. Biopsied specimens of the lesion demonstrated a hepatic adenoma, which changed in appearance in the relatively short period between echography and computed tomography. This interesting phenomenon may highlight the importance for careful follow-up of hepatic adenomas, because of the potential of rupture, hemorrhage, or malignant transformation. During follow-up, the present patient received hemodialysis due to renal failure, and the adenoma regressed spontaneously after 8 years. Included are diagnostic images, demonstrating the association of hepatic adenoma and GSD-type I.

[The history of Helicobacter pylori].

Histological and ultrastructural studies of gastric mucosa with spiral bacteria had been published at the Royal Perth Hospital of Western Australia in 1979. The pathologist Warren correlated them with inflammation. In 1981, Marshall was training in internal medicine. Warren, Marshall and Goodwin started culture of bacteria, but spiral bacteria were not cultured. The 35th culture was left during the Easter holiday, and after 5 days 1-mm transparent colonies were seen on the plate. Since discovery Helicobacter pylori(H. pylori) have continued to fascinate and challenge doctors and scientists for 18 years to come. In 2000, triple therapy with PPI, Amoxicillin and clarithromycin was approved for treatment of peptic ulcer disease in Japan.

Helicobacter pylori infection increases mucosal permeability of the stomach and intestine.

It is important to study the effect of Helicobacter pylori infection on the permeability of the intestine. Permeability was evaluated by oral sucrose tolerance test using sucrose 25 g in 200 ml of water. Existence of H. pylori itself was associated with increased permeability of sucrose. Also, the permeability of sucrose increased as polymorphonuclear and lymphocyte infiltration increased. The increase of mucosal permeability suggests that antigens like protein penetrate into the body and result in systemic reactions. Thus, it is important to study the implication of increased permeability in relation not only to gastric diseases but also certain systemic diseases.

A case of malignant fibrous histiocytoma on the knee joint in a patient with rheumatoid arthritis.

Abstract An elderly woman with rheumatoid arthritis and receiving nonsteroidal anti-inflammatory drugs (NSAIDs) treatment was diagnosed with a malignant fibrous histiocytoma in her left knee joint. However, no metastatic lesion caused by the malignant fibrous histiocytoma was found, probably owing to the NSAIDs therapy. Her general condition worsened, and eventually led to renal failure and death from progressive respiratory failure caused by pulmonary effusion. This is the first known report of a malignant fibrous histiocytoma originating in the left knee joint that was complicated by rheumatoid arthritis.

Self-augmentation effect of male-specific products on sexually differentiated progesterone metabolism in adult male rat liver microsomes.

It is well known that several 3-keto-4-ene steroids such as progesterone and testosterone are metabolized in a gender-specific or -predominant manner by adult rat liver microsomes. In the male, these steroids are primarily metabolized into two oxidized (16alpha-hydroxyl and 6beta-hydroxyl) products mainly by the respective, male-specific cytochrome P450 subforms, CYP2C11 and CYP3A2, while they are primarily metabolized into the 5alpha-reduced products by female-predominant 5alpha-reductase in the female. These sexually differentiated enzyme activities are largely regulated at the transcription level under endocrine control. In the present study, we show that unlabeled 16alpha-hydroxyprogesterone and 6beta-hydroxyprogesterone inhibited the 5alpha-reductive [(3)H]progesterone metabolism by adult male rat liver microsomes without significantly inhibiting the CYP2C11 and CYP3A2 activities producing themselves, whereas 3alpha-hydroxy-5alpha-pregnan-20-one and 5alpha-pregnane-3,20-dione not only stimulated the 5alpha-reductive metabolism producing themselves but also inhibited the male-specific oxidative metabolism. This finding compels us to propose a novel hypothesis that adult male rat liver microsomes may possess a self-augmentation system regulated by the male-specific products on sexually differentiated steroid metabolism, besides regulation by gene expressions of the related enzymes.

[Diagnosis of ulcerative colitis and the biopsy method].

The biopsy specimen should be oriented flat on a ground glass slide or on a piece of filter paper so that the submucosa is on the slide and the mucosa uppermost to allow proper histopathological interpretation. It is important to perform the biopsy based on a full knowledge of features of inflammatory diseases of the large intestine. Biopsies should be taken from apparently normal and abnormal mucosa. It is necessary to observe the mucosa of the colon carefully for any mass lesions to find dysplasia or cancer complicating the ulcerative colitis. Any suspicious areas should be liberally biopsied. Biopsies should also be performed at random, because of possible existence of dysplasia or cancer which is not visible at endoscopy. This occurs especially in the rectum; biopsies can also be performed after inversion of the endoscope.

Comparison of pathologic changes in Helicobacter pylori-infected Mongolian gerbils and humans.

Helicobacter pylori has been recognized as a pathogen causing gastroduodenal disease, with adequate evidence to prove this relation in clinical research. Available animal models, however, were inadequate until 1995, when a new animal model of H. pylori infection was established using Mongolian gerbils. In this study we compared pathological changes in seven H. pylori-infected Mongolian gerbils with ulcers to five patients with gastric ulcer who underwent operation. All of the animals showed positive reactions for both H. pylori culture and serum anti-H. pylori antibody titer. All human subjects had H. pylori on the mucosal surface. Thus, inflammatory cell infiltration in the pyloric gland area was observed throughout almost all layers in the animals. In contrast, inflammation was observed in the surface layer of the mucosa in the pyloric gland area in the human subjects. Lymph follicle formation was observed more often in humans than in the animals. Inflammation of the fundic gland area in both groups was weaker than of the pyloric gland area and was observed within the mucosa. Histological changes observed in both groups were chronic active gastritis, lymph follicles, and intestinal metaplasia in the stomach. H. pylori-associated gastritis in humans is characterized by erosion, inflammation with neutrophil infiltration, lymph follicles, intestinal metaplasia, and atrophy. These findings are similar to those in this animal model. Thus, H. pylori infection might participate in the pathogenesis of gastroduodenal mucosal damage. In conclusion, the Mongolian gerbil is a good animal model for H. pylori-associated gastric diseases, and it might be useful for investigating the pathogenesis of H. pylori infection.

Pathological changes in glandular stomach of Helicobacter pylori-infected Mongolian gerbil model.

We have established a Helicobacter pylori-infected Mongolian gerbil model, following Hirayama's method, to clarify gastric diseases associated with H. pylori infection. We administered the culture broth of H. pylori ATCC 43504 orally to 8-week-old male Mongolian gerbils. After H. pylori inoculation, the gerbils were fed in a vinyl isolator. Subsequently, over the course of 48 weeks, they were killed for histopathological examination, H. pylori culture, and serum antibody measurement. H. pylori colonization in the glandular stomach was seen in all the infected gerbils, but only a few H. pylori were detected histologically. The serum antibody titer in the H. pylori-inoculated group increased gradually in comparison with controls. Acute inflammation, immature epithelium, and erosion were observed 2 weeks after H. pylori infection. Chronic inflammation was noted from 4 weeks after H. pylori infection. We also found intestinal metaplasia and gastric ulcers from 12 and 24 weeks after inoculation, respectively. Some histological findings were similar to those in humans, but the chronic inflammation in the gerbils was present mainly in the deep mucosa and submucosa. This appears to be a good animal model for H. pylori-associated gastric diseases and it may be useful for investigating the pathogenesis of H. pylori infection.

The relationship between stapling doughnuts: characteristics and functional results after total gastrectomy.

BACKGROUND/AIMS: The objective of this study was to determine whether the thickness of the esophageal doughnut is related to postoperative results in total gastrectomy. METHODOLOGY: Thirty-eight total gastrectomy patients were studied, including 18 who underwent jejunal pouch reconstruction and 20 who did not have pouch reconstruction. We used the Proximate-ILS circular stapler, with purse-string suturing at the cut end of the esophagus performing only the mucosal layer manually in all cases. We divided the esophageal doughnuts after stapling into two groups: Group A: doughnut involving muscle tissue of 0-25% of the esophageal circumference; Group B: doughnut involved muscle tissue of 25-100% of the esophageal circumference. Reflux scores and the scintigraphic reflux index were determined. RESULTS: No significant difference was found between the two groups in reflux score or scintigraphic reflux index. CONCLUSIONS: These findings indicate that the degree of postoperative reflux esophagitis was not affected by the amount of the muscular layer included in the esophageal doughnut. Continuity, and not variability of the degree of involved muscle in the esophageal doughnut, is an important factor at the time of stapling.

Pathologic changes in the glandular stomach and duodenum in an H. pylori-infected Mongolian gerbil model.

We have established a Helicobacter pylori-infected Mongolian gerbil model following Hirayama's method to investigate gastric diseases associated with H. pylori infection. We orally administered the culture broth of H. pylori ATCC 43504 to 8-week-old male Mongolian gerbils. After this, the gerbils were fed in a vinyl isolator. Subsequently, over the course of 48 weeks some of them were sacrificed for histopathologic examination and H. pylori culture. H. pylori colonization in the glandular stomach was seen in all the infected gerbils but only a few H. pylori were detected histologically. Acute inflammation, immature epithelium, and erosion were observed 2 weeks after H. pylori infection. Chronic inflammation was noted from 4 weeks after H. pylori infection. In addition, we found intestinal metaplasia and gastric ulcers from 12 and 24 weeks, respectively. There was mild to moderate inflammation in the duodenum but no ulcerative lesions or gastric metaplasia were observed. Some histologic findings were similar to those in humans, but inflammation occurred mainly in the deep mucosa and submucosa. This is a good animal model for H. pylori-associated gastric diseases but not for duodenal ulcers or gastric metaplasia. It might be useful for investigating the pathogenesis of H. pylori infection in the stomach.

Importance of pretreatment viral load and monitoring of serum hepatitis C virus RNA in predicting responses to interferon-alpha2a treatment of chronic hepatitis C. Hanshin Chronic Hepatitis C Study Group.

The aim of this study was to determine what factors correlate with a favorable response to interferon-alpha2a (IFN-alpha2a) treatment in chronic hepatitis C. Fifty patients with chronic hepatitis C who received a 26-week treatment with IFN-alpha2a (474 million units in total) were assessed for pretreatment parameters and biochemical and virologic events during the treatment. According to biochemical and virologic responses to the treatment, 16 patients (32%) were categorized as sustained complete responders (SR), 13 (26%) as initial complete responders (IR), and 21 (42%) as nonresponders (NR). By multivariate analysis, a low viremia level was the only independent predictor of SR among pretreatment parameters (p = 0.0088). The percentage of patients showing hepatitis C virus RNA negativity at 2 and 12 weeks of treatment was significantly higher in SR (94% and 100%, respectively) or IR (69% and 92%, respectively) than in NR (14% and 33%, respectively) (p = 0.001). In contrast, the normalization of serum alanine aminotransferase levels at both time points failed to differentiate among SR, IR, and NR. These results indicate that monitoring of serum hepatitis C virus RNA at an appropriate time during treatment in addition to determination of pretreatment viral load is important in predicting responses to IFN-alpha2a treatment.