Koshi Yamashita

PULMONARY MUCORMYCOSIS WITH FATAL MASSIVE HEMOPTYSIS

A case of pulmonary mucormycosis in a 57 year old woman with acute promyelocytic leukemia (APL) who died of massive hemoptysis is reported. Chest radiography revealed changes that began with a small focal infiltration and progressed to a large round nodule with cavity formation. Postmortem examination showed the nodule to be composed mainly of infarcted lung tissue with saprophytic growth of Mucor. An adjacent proximal branch of the left pulmonary artery was thrombosed with mucoraceous hyphae, and it had ruptured into the cavitary space around the necrotic tissue and then into a conducting bronchus. In general, both fatal massive hemoptysis and cavity formation are rare in pulmonary mucormycosis. In our present case, the histological findings suggested that both phenomena were closely related to the pulmonary infarction caused by Mucor invasion of the pulmonary artery.

Experimental and clinical studies on differential diagnosis of bone diseases with nucleomedical procedures.

This report is a study of the differential diagnosis of bone diseases using nucleomedical procedures. Experimental and clinical studies on the accumulation of 201Tl and 67Ga in bone inflammation and bone tumors were performed. Also, the degree of deposition of 99mTc-phosphorous compounds represented as a color difference was evaluated for a differentiation between malignant and benign diseases of the spine and shoulder. Uptake of 201Tl in inflammation of the spine and in tumor of the pelvis of rabbits was very low, while that of 67Ga was high. Uptake of 67Ga decreased gradually with lapse of time after the onset of inflammation. These experimental results agreed with clinical studies. The detectability of malignant tumors with 201Tl was inferior to that with 99mTc-label and 67Ga, although osteolytic lesions were occasionally 201Tl-positive. In terms of color range, the difference was 2 or less in spines of normal subjects and 3 or more in the metastatic bone disease and compression fracture. This difference was not statistically significant. Since 67Ga scan was occasionally negative in compression fracture, a differentiation was considered to be possible in such a case. A combined study of bone imaging with 99mTc-phosphorous compound including color difference, 67Ga imaging, bone-marrow imaging and radiography are considered to be helpful for the differentiation.

CONGENITAL ENDOCARDIAL FIBROELASTOSIS OF THE HEART: POST‐MORTEM REPORT OF A CASE

The patient aged 7 years old boy. The parents were unrelated and in normal health. However, 3 brothers (including the patient) out of 7 siblings had keratosis of both palmas and plantas and died with unclear heart failure at 8 years of age. Four sisters are all living and well. The Wassermann reaction was negative. One week before admission he was pyrexic and complained of cough. On physical examination, he appeared dyspnoeic lying on the back and showed facial edema. The heart was enlarged and sometimes systolic murmurs were auscultated. A roentgenogram of the chest revealed a large and globular cardiac shadow which suggested a congenital lesion. Findings of E.C.G. revealed suspicious findings of incomplete left bundle branch block. The hemoglobin content was 14.4 g/dl, hematcrit 43.3%. serum protein 6.1 g/tll, blood sugar 74 mg/dl, alb./glob. ratio 1.44, icteric index 4, CCFT 0, albumin 3.6 g/dl, globulin 2.5 g/dl, cholinesterase 0.75 A ~ H . alk. phosphatase 2.4 p, cholesterol 127 mg/dl, phenol turb. t. 7 p, NPN 35 mg/dl, urea N 17.5mg/dl, and examination of serum electrolyte was normal value. The W.B.C. 18,900 per c.mrn. (neutrophilia) . Antistreptolysis reaction (A.S.L.O.) showed a value of 250p. Sedimentation rate of blood was 13mm. The child’s condition grew worse, and he died on the early morning of the 28th day in the hospital. The final diagnoses were congenital heart failure and keratosis palmaris et plantaris. The liver was palpable 4 finger’s breadth and the spleen was not palpable.

Fluorescence Microscopical Studies on Various Exudate Cells in the Inflammatory Focus.

Cytological studies have been actively carried out by many anthorities since about 1900, and many notewarthy results have been obtained. But, especially, it may be noteworty that the works of the school of SABIN and KIYONO on living observation of the cells, constitute the foundation of the actual cytology. Recently, the electron-microscope has been used t o study the supermicroscopical structure of various cells, and these may give a clue in meaning the truth of the function of the cells. On the other hand, the application of Isotope has contributed in clearing the phase of cytochemical function moment by moment, namely, the Isotope may be indispensable for medical and biological studying method of cytology with a great future. And yet, their research will be too numerous to be mentioned. As mentioned above the research of cytology has been making remarkable progress, and recent new methods are contrived to inquire into the unknown truth one after another. Results have already been found in Germany in about 1930. HELMHOLZ (1896), GOLDSTEIN (1911), and others observed on the fluorescence of animal tissue before completion of the fluorescentmicroscope. STUBEL (191 1) found that the animal tissue has the one with ultraviolet illumination using LEHMAN’S apparatus (1910). Furthermore, in the field of physics, chemistry, botany, and bacteriology, great progress has been made. ( l ) ( l e )

On the Relation Between the Function and Morphology of Each Liver Disease Based on Autopsy Studies

The relation of morphology and function of the liver is clear with the needlebiopsy and numerous studies have been reported along this line. However, that this procedure may represent focal disease in liver well, may be misleading to judge the degree of the hepato-pathological change with so small a sample. Furthermore, if many samples are obtained from each part of the liver, the histological picture and function may be investigated in detail, but its procedure is actually very difficult. The authors attempted to investigate the correlation between the function and the histological picture by necropsy. The materials of 25 cases whose hepatic function had been examined, were used in this investigation. The following 8 groups were classified by autopsy: (1) Primary hepatic cancer ; 3 cases, (2) metastatic cancer ; 8 cases, (3) primary hepatic disease except group (1) ; 4 cases, (5) tumors without metastasis in liver ; 4 cases, (6) disease except tumor without relation to liver ; 2 cases, (7) leukemia in group (2) ; 2 cases (8) cancer cases treated with anticarcinomatics ; 5 cases. Specimens were obtained from 5 constant areas in the liver, and were examined with Hematoxylin and Eosin stain and other special stains in all cases. (Table I1 and Fig. 2) The histological features considered, under a constant standard, were summarized as following ; (1) liver cell damage, (2) round cell infiltration, (3) focal necrosis, (4) portal space cellularity, (5) peripheral inflammation, (6) fibroblast proliferation, (7) Kupffer’s cell mobilization, (8) increase of connective tissue in portal sapce, (9) angiogenesis, (10) pseudobile duct proliferation, (11) bile duct proliferation, (12) altered reconstruction, (13) biliary stasis, (14) fatty metamorphosis. The biochemical examination of blood was as follows : Hemoglobin (Hb), hematocrit (Ht), serum protein (SP), blood sugar (BS), albumin to globulin ratio (A/G), icteric index (Ii), total bilirubin (Tb), albumin (Al), globulin (Gl), (Table I)