Morphogenesis of Aortico-pulmonary Septation Anomaly Induced by Bis-diamine Treatment Special reference to vimentin, desmin and fibronectin immunoreactivities

In order to clarify the morphogenesis of the A-P septum, the conotruncal septum, the myocardial sheath and the smooth muscle cells of the great arteries in the normal hearts and bis-diamine induced cardiovascular anomalies, an immunohistochemical technique using the antibodies for vimentin, desmin and fibronectin was applied. Morphological and immunohistochemical changes in the treated hearts were as follows : (1) the A-P septum which was hypoplastic appeared later than in the normal hearts ; (2) retraction of the myocardial sheath was delayed compared with the normal hearts ; (3) switching from vimentin to desmin in the muscles of the atria and ventricles caused a delay of one day behind that of the normal hearts ; (4) vimentin immuno-reactivity in the smooth muscle cells of the pulmonary trunk was weaker than that of the aorta, and (5) weak reactivity of fibronectin occurred concomitant with weak vimentin reactivity. It is concluded that bisdiamine may induce the morphological anomalies of the A-P septation by inhibiting the production or perturbing the migration of neural crest cells which have been a precursor of the mesenchyme in the anlage of the A-P septum, subsequently by either inhibiting production or changing the nature of extracellular matrix, or by affecting the coordination of intermediate filaments

Progressive Retrograde Acute Coronary Occlusion after Gianturco-Roubin Stenting

We report a case of progressive retrograde acute coronary occlusion after Gianturco-Roubin (GR) stenting in a patient with two vessel diseases. A GR stent was implanted in the proximal part of the left anterior descending artery (LAD) because of suboptimal results of percutaneous transluminal coronary angioplasty (PTCA). More than 90% stenosis occurred in the non-stented region just distal to the edge of the GR stent. Another stenosis ensued mid-stent after PTCA was performed for that lesion. Acute occlusion from the mid- LAD to the main trunk progressed immediately after PTCA for the LAD. The patient died of cardiogenic shock despite repeated bail-out PTCA procedures for both the main trunk and the proximal LAD. Acute retrograde occlusion might be caused by in-stent thrombosis, or acute recoil of GR stent associated with insufficient stent dilatation and acute coronary arterial elastic recoil

An Autopsy Case of Biliary Cystadenocarcinoma of the Liver

Summary : An autopsy case of a 58-year-old female with biliary cystadenocarcinoma is presented. A large cyst occupied the entire left lobe of the liver associating with multilocular daughter cysts and solid lesion. Histologically, tumor showed papillary, back-to-back glandular, cribriform pattern in the inner surface of the cysts with stromal invasion. Polygonal atypical cells were arranged in cords and adenoid cystic pattern in the solid lesion. Immunohistochemically, EMA was stained in the tumor cells as well as normal hepatocytes. CEA was diffusely stained in the cytoplasm and luminar surfaces of the tumor cells, while CEA was stained only in the luminar surfaces of benign-appearing eptithelial cells of the cysts. Keratin and α-fetoprotein were not stained in the tumor cells. The origin of this tumor remains unknown, although transformation from congenital solitary cyst, biliary cystadenoma and reminiscence of cystadenoma of the pancreas or originally occurrence of cystadenocarcinoma in the liver are considered the basic histogenesis of cytadenocarcinoma of this case

Adamantinoma of the Tibia. - Report of a Case with Findings of Ultrastructural and Immunohistochemical Studies,

A case of tibial adamantinoma in a one-year and ten-month old girl is reported. She had gait disturbance and her roentogenogram showed a well circumscribed radiolucent area in the tibia. Light microscopic examination showed the epithelial component of nests and pseudoglandular arrays in the loose fibrous connective tissue. We finally diagnsed the tumor as adamantinoma of the tibia based on roentogenographical and histological findings. Moreover, the nature of the neoplastic cells was studied by the immunohistochemical and electron microscopic methods. The adamantinoma is regarded as a unique neoplasm capable of differen - tiating into epithelial elements as well as mesenchymal ones . Detection of epithelial component is important to differentiate from similar disorders. The fibrous dysplasia- like lesion in stroma is interpreted as a part of the spectrum of mesenchymal differentiation

A Case of Anomalous Origin of the Right Coronary Artery from the Left Sinus of Valsalva - Special Reference to PTCA Procedures and Aspirin Effect to Failed PTCA of the Anomalous Coronary Artery -

An unusual case of a 53-year-old male with a right coronary artery originating from the left sinus of Valsalva is presented. Despite acute myocardial infarction due to occlusion of the aberrant right coronary artery (RCA), PTCA was not immediately performed. After 81 mg/day of aspirin had been administered for 1 month, PTCA to the subtotal stenosis of the RCA resulted in failure due to poor deployment of the guiding catheters complicated by withdrawal and uncrossing of a guiding wire. However, complete recanalization occurred after giving the patient 162 mg/day of aspirin for 8 months. Low dose aspirin was effective in recanalizing the subtotal stenosis after failed PTCA

Three Cases of Renal Infarction : Special Reference to Etiology, CT findings and Therapy

Three cases of renal infarction are presented. Case 1 presented left renal infarction associated with mild mitral stenosis, moderate degree of mitral regurgitation (MR) and tricuspid regurgitation (TR). A small thrombus was detected in the posterior wall of the left atrium and left auricle. Case 2 presented right renal infarction complicated with hypertrophic cardiomyopathy (HCM) associated with severe TR and mild MR. Case 3 presented multiple infarction of the left kidney without any complication. Renal infarction in two cases was possibly induced by small clots in the atrium or blood stream, which might had been driven from atrial fibrillation

An Autopsy Case of Carcinosarcoma of the Esophagus

A case of carcinosarcoma, a rare polypoid tumor of the esophagus is presented. The characteristic gross and microscopic features as well as a discussion of the histogenesis of the sarcomatous elements are presented by microscopic, immunohistochemical and electron micronscopic examinations. Immunohistochemically, keratin and EMA (epithelial membrane antigen) were demonstrated in the islands of squamous cell carcinoma within the sarcomatous elements and in the carcinoma in situ at the border of normal mucosa. Vimentin, desmin, actin, myoglobin, factor VIII, S-100 protein, NSE, neuraminidase were not demonstrated in both the carcinomatous and the sarcomatous elements except for a positive reactivity to a-1-antichymotrypsin in the sarcomatous elements at part. It is suggested that the sarcomatous elements are of epithelial origin based on the facts as follows : 1 transition from overlying epithelium or carcinomatous islands to sarcomatous elements existent ; 2 some small tubules were formed within the sarcomatous elements, which showed transition into the sarcomatous elements ; and 3 a part of the sarcomatous elements revealed either positive or weak reactivity to keratin and EMA. Further, weak reactivity to keratin and EMA in the more anaplastic lesion may reflect the lack of tonofilaments and desmosomes in the ultrastructural findings

Successful Resuscitation from Ventricular Fibrillation during Jogging in a Young Patient with Hypertrophic Cardiomyopathy

A 15-year-old girl, who was previously in good health, suddenly collapsed while jogging. Immediate cardiopulmonary resuscitation (CPR) was initiated, and she arrived at our hospital 13 minutes later. The ventricular fibrillation (VF) on admission was reverted to sinus rhythm 18 minutes after collapse by the second cardioversion. The echocardiogram revealed hypertrophic nonobstructed cardiomyopathy (HNOCM), although the 24hr ambulatory electrocardiographic, electrophysiologic and exercise stress tests could not define the exact cause of VF. Exercise-induced ischemia with sustained mild hypokalemia was suspected to be the cause of VF. The patient recovered consciousness three days after admission, and followed an uneventful course of treatment with oral atenolol not associating with disabling neurological deficit. Immediate basic life support and delivery of automatic external defibrillator on the spot is needed to rescue patients with out-of-hospital cardiac arrest