Association of cytosine-adenine repeat polymorphism of the estrogen receptor-beta gene with rheumatoid arthritis symptoms.

The influence of the polymorphism of the estrogen receptor-beta gene, cytosine-adenine (CA) dinucleotide repeat in intron 6, in the occurrence of rheumatoid arthritis (RA) was investigated. Forty-seven RA patients and 36 control subjects with osteoarthritis (OA) were recruited. CA repeat polymorphism was examined using denaturing high-performance liquid chromatography (WAVE DNA Fragment Analysis System). The mean number of CA repeats was significantly higher in RA than in OA patients. Two groups were established: or=22 repeats (long L); and 3 kinds of genotypes (SS, SL, LL) were found. In RA patients, the L allele frequency was higher (OR = 2.03; P

Comparative effects of plasmapheresis and intravenous cyclophosphamide on urinary podocyte excretion in patients with proliferative Lupus nephritis.

Intravenous cyclophosphamide (IVC) in combination with steroids is standard therapy for Lupus nephritis. Reduction of autoantibodies and circulating immune complexes can be used in the treatment of autoimmune diseases. The aim of the present study was to compare the effects of IVC pulse therapy and double-filtration plasmapheresis (DFPP) on proteinuria and urinary excretion of podocytes in adult patients with diffuse proliferative Lupus nephritis (DPLN). Twenty patients were randomly assigned to two groups. Group A (n = 10) was treated with IVC (0.75 - 1.0 g/m2 body surface area) pulse therapy, given as boluses once a month for 6 consecutive months, combined with oral corticosteroid (up to 1 mg/kg/day) administration. Group B (n = 10) was treated with a combination of DFPP (performed 1-2 times weekly) and corticosteroid (up to I mg/kg/ day). The total average number of treatments was 8.4 and the therapeutic efficacies were evaluated after 6 months. Twenty healthy individuals participated as a control group. Urinary podocytes were examined by immunofluorescence with monoclonal antibodies against podocalyxin. Both Group A and Group B reduced proteinuria (p < 0.001) as well as the number of urinary podocytes (p < 0.001). Differences between the 2 treatment outcomes were not statistically significant. Cyclophosphamide pulse therapy and DFPP may be similarly effective in the treatment of podocyte injury in patients with DPLN.

Renal adenomatosis associated with carcinoma of the lower urinary tract: a case report with immunohistochemical study.

A case of renal adenomatosis of the left kidney associated with a carcinoma of the ipsilateral ureter in a 49-year-old man is examined. One hundred and eight adenomas, which were smaller than 15 mm in diameter, and a single microcarcinoma, which measured 1 mm in diameter, were found in the kidney. Further, there were more than 800 hyperplastic lesions which could be classified into three groups: (i) 792 of distal origin; (ii) 24 of proximal origin; and 10 of collecting duct origin. The serial sections obtained from 19 paraffin blocks were stained using Leu M1 as the proximal marker and epithelial membrane antigen (EMA) as the distal/collecting marker to assist in determining the origins. Ten of the small adenomas (15 lesions), which did not exceed 3 mm in diameter, were predominantly positive for EMA and five were predominantly positive for Leu M1. Further, hyperplastic lesions of distal and collecting duct origins were diffusely positive for EMA and sporadically positive for Leu M1. The lesions of proximal origin were predominantly positive for Leu M1 and sporadically positive for EMA. These findings suggest that a progression from hyperplasia and a direct transition from a single tubule to adenoma occurred multifocally in different segments of the nephrons throughout the left kidney.

A case of low-grade fibromyxoid sarcoma of the thigh.

A case of low-grade fibromyxoid sarcoma in the thigh of a 21 year old female is described. The patient had a fist-sized well-defined mass in her left thigh that enlarged over a 6 month period. Histologically, the neoplasm showed contrasting fibrous and myxoid areas with a swirling growth pattern. Cellularity was low to moderate, and the stromal cells were benign looking without mitoses or nuclear pleomorphism. The tissue was not noticeably vascular. Some stromal cells were aggregated around the blood vessels. The stromal cells were immunoreactive to vimentin, but were negative to keratin, desmin, alpha-smooth muscle actin, actin HHF35, S-100 protein, neuron-specific enolase, and epithelial membrane antigen. Ultrastructural examinations of the stromal cells revealed well-developed rough endoplasmic reticulum, mitochondria, pinocytotic vesicles, and numerous intermediate-sized filaments in the cytoplasm. These findings seem to indicate that the stromal cells were fibroblastic in origin. The occurrence of the tumor in a young adult, its location and its large, well defined borders together with the characteristics revealed through histological investigation, indicated that it was in fact what has been termed by Evans as a low-grade fibromyxoid sarcoma.

[Expression of the p53 protein in human osteosarcoma].

The expression of the p53 tumor suppressor gene protein was analyzed in 35 resected osteosarcomas, 5 resected osteochondromas, and in 2 human osteosarcoma cell lines by immunohistochemistry and flow cytometry. An abnormality in the expression of the p53 protein was found in 10(29%) of the 35 osteosarcomas. An overexpression of the p53 protein showed no correlation with the clinicopathological features, but the p53 protein staining pattern showed a tendency to be correlated with aggressive growth and the metastatic potential. Diffusely-stained tumors had a worse prognosis than those focally-stained. The relationship between the expression of p53 protein and the cell cycle was examined by flow cytometry. The maximum overexpression of p53 protein was detected in the cells at the S phase. These results indicated that the nuclear accumulation of the p53 protein, especially the staining pattern, was a potentially useful prognostic factor for osteosarcoma. However our study did not show any clear correlation between either the growth pattern or the morphological type of osteosarcoma and the immunohistochemical results for the p53 protein.

Magnetic resonance imaging of pigmented villonodular synovitis in subtalar joint. Report of a case.

Pigmented villonodular synovitis (PVNS) is rare in the foot; however, it developed in the subtalar joint extending around the ankle of a 24-year-old man. The diagnosis was made by a combination of clinical findings, most notably the aspiration of the synovial fluid. Magnetic resonance imaging was most useful in showing the extent of the soft-tissue mass before surgery. Low-signal intensity of the mass, featured on both T1- and T2-weighted images, was suggestive of PVNS.

A case of epidural granulocytic sarcoma preceding acute leukemia.

A 20-year-old male developed both coccygeal and leg pain and followed by rectocystic disturbance. Disc herniation between L5 and S was suspected and laminectomy was performed. At surgery, an easily curretable tumor occupied the epidural space from L5 to the end of the sacrum. In part, the tumor spread out of the vertebral canal and invaded the surrounding muscle tissue. This muscle tissue and part of the lamina were checked histologically. Initial blood analysis revealed 5% blast-like cells, but failed to confirm them as leukemic cells. Histologically, the tumor cells had round or oval nuclei with large nucleoli and scanty cytoplasm without granulocytic differentiation. Malignant lymphoma or Ewing's sarcoma was initially suspected, but the definite diagnosis was uncertain. Immunohistochemical staining with the PAP method and enzyme histochemistry revealed that the tumor cells were positive for lysozyme and naphthol ASD chloracetate esterase. Thus, granulocytic sarcoma was finally diagnosed. Electron microscopic findings supported this diagnosis. Subsequent karyotyping of bone marrow cells revealed 8; 21 translocation, thus the final diagnosis of this patient was myelodysplastic syndrome, refractory anemia with excess blast cells in transformation or acute myelogenous leukemia, M2, by the FAB classification.

Interaction of macrophages with rheumatoid articular cartilage.

These experiments investigated the in vitro interaction of macrophages and rheumatoid articular cartilage. When rheumatoid articular cartilage samples were incubated with normal peripheral blood mononuclear cells (PBM) for 1 hour or 12 hours in vitro, there were large numbers of PBM attached to the articular surface, and some PBM invaded the cartilage during the 12 hour incubation period. Conversely, in cartilage from osteoarthritic and normal subjects in the control, only a few PBM were attached to the articular surface after incubation with PBM. Under electron microscopic observation, macrophages were tightly attached to the surface and within the eroded cartilage. Light and electron microscopic observation with immuno-peroxidase staining of the rheumatoid cartilage surfaces showed the deposition of immunoglublins adjacent to the attached macrophages, suggesting the presence of immune-complexes as chemoattractants. These results suggest that macrophages in a rheumatoid joint may play an important role in the formation of pannus, resulting in the destruction of cartilage to interact with immune-complexes trapped in the superficial region of the rheumatoid articular cartilage.

Lipid microspherules in synovial fluid of patients with pigmented villonodular synovitis.

We describe 2 patients with pigmented villonodular synovitis. In both patients, synovial fluids (SF) were characterized by the presence of abundant, strongly birefringent lipid microspherules, which appeared as Maltese crosses and were found both inside foam cells and free in the SF. Histologically, the synovial membranes showed pigmented villonodular synovitis, with aggregation of foam cells containing abundant lipid microspherules in their cytoplasm. Observation of numerous birefringent lipid microspherules and foam cells in SF may be a clue to the diagnosis of pigmented villonodular synovitis.

A clinicopathologic study of bony spurs on the pes anserinus.

Nineteen cases of exostoses located on part of the pes anserinus were studied clinically and histologically. All lesions were resected during surgery between 1965 and 1985. In these 19 cases, 14 had involvement of the tibia only at the insertion of the pes anserinus. Five had multiple exostoses with pes anserinus involvement. All exostoses occurring only in pes anserinus showed an icicle appearance in roentgenography and had no detectable cartilage cap. On the other hand, exostoses in patients with multiple exostoses (osteochondromas) showed varying appearances in roentgenography and had cartilage caps on their surfaces. Exostoses occurring only in the pes anserinus may or may not be osteochondromata and could be classified as pes anserinus bony spurs.

Interaction of polymorphonuclear leukocytes with immune complexes trapped in rheumatoid articular cartilage.

When rheumatoid articular cartilage samples were incubated with normal polymorphonuclear leukocytes (PMN) in vitro, large numbers of PMN were seen attached to the articular surface. As observed by electron microscopy, significant numbers of these cells invaded the cartilage tissue and phagocytosed amorphous material which presumably contained immune complexes. In control cartilage from osteoarthritic, pyogenic, and normal subjects, only a few PMN were attached to the articular surface after incubation with PMN. These results demonstrate that immune complexes trapped in the superficial region of the rheumatoid articular cartilage may play an important role in the destruction of cartilage by the release of lysosomal enzymes from PMN.

[A comparative study of long-term results of surgical and medical treatment for ischemic heart disease].

Left ventricular performance, survival rate and subjective symptoms were analyzed in 243 cases of angina pectoris (147 cases of A-C bypass and 96 cases of medical treatment) and 58 cases of left ventricular aneurysm (21 cases of surgical treatment and 37 cases of medical treatment). Left ventricular performance of angina pectoris were improved in surgical group 6 months after A-C bypass with the significance of p less than 0.02-0.05. However, in the medical group, it showed unchanged or aggravated tendency during average 18 months. Similar results were obtained in the patients with left ventricular aneurysm and furthermore, aggravation of EF and Max dp/dt/p in some medically treated cases was observed. Operative death by A-C bypass was seen in 4 cases (2.7%) and 5 years cumulative survival rate was 92.6% including late death cases died during average 30.1 months in the medical group and its 5 years survival rate was 77.3%. For left ventricular aneurysm, no operative death was recognized and the 5 years cumulative survival rate was 95%. Whereas during average 32.7 months in the medical group, 8 cases died and 5 years cumulative survival rate was 78.6%. Improvement of subjective symptoms after treatment for both ischemic heart diseases was also conspicuous in the surgical group.

[T gamma lymphocytes in rheumatoid synovial membrane].

The proportion of T lymphocytes with receptors for the Fc portion of IgG (T gamma cells), revealed by mixed rosette assay, was determined in the synovial membrane and peripheral blood of 11 patients with rheumatoid arthritis. The percentage of T gamma cells in the lymphocytic infiltration of rheumatoid synovium was significantly lower than that found in peripheral blood (p less than 0.005). There was no significant difference between the percentage of T lymphocytes in the synovial tissue and that in peripheral blood. Depressed supressor activity of T lymphocytes in rheumatoid synovial membrane might lead B-lymphocytes to blastic transformation to the plasma cell series with consequent production of large amounts of immunoglobulins in the joint.

Activation of T and B lymphocytes in NZB mice.

Since NZB mice manifest evidence of intense B cell activation, the state of activation of their T cells was explored. Electron microscopic examination and automated laser light scatter analysis demonstrated the presence of many blast lymphocytes in the spleens of aging NZB mice but not in controls. Only 45% of these large cells were B cells by the criterion of stainable surface IgM. NZB T and B cells were separated using the fluorescence-activated cell sorter; cytographic analysis revealed that both T and B cell populations contained substantial numbers of blast cells. The data thus indicated that T cells, as well as B cells, undergo activation as autoimmunity develops in NZB mice.