Toshiaki Tsuto

OK-432 therapy for lymphangioma in children: why and how does it work?

Intralesional injection of OK-432 (lyophilized incubation mixture of group A Streptococcus pyogenes of human origin) is safe and effective therapy for lymphangioma. The authors evaluated the mechanism of this therapy in 6 patients who had cystic lymphangioma. The intracystic fluid of the cystic lymphangioma was aspirated before and after (on days 1 and 4) the OK-432 therapy. Changes in cell populations and cytokine productions in each aspirated fluid were analyzed. White blood cells in the intracystic fluid increased markedly in number. Before OK-432 therapy, 96% of the intracystic white blood cells were lymphocytes, and the remaining were neutrophils and macrophages. On day 1, the percentages of neutrophils and macrophages increased to 72% and 21%, respectively. On day 4, the percentage of lymphocytes increased to 72%. Flow cytometry analysis using monoclonal antibodies showed that the number of natural killer cells (CD56+) and T cells (CD3+) had increased. The activity of cytotoxic tumor necrosis factor (TNF) and interleukin-6 increased immediately after OK-432 injection and remained high in titer until day 4. These findings suggest that the white blood cells induced and activated by OK-432, and the cytokines (including TNF) produced by these cells increased the endothelial permeability, and thus the accelerated lymph drainage and increased lymph flow let to shrinkage of the cystic spaces.

OK-432 therapy for unresectable lymphangiomas in children

To avoid surgery-related complications, intralesional OK-432 therapy was used in 23 patients with unresectable lymphangiomas (1986 through 1989). Total or near total shrinkage of the lesions, without serious complication, was noted in 10, marked shrinkage in 8, slight shrinkage in 3, and no response was noted in the remaining 2. Recurrence of the lesions has not been observed during follow-up (4 to 35 months). The side effects of OK-432 therapy were a fever for 2 to 3 days and a local inflammatory reaction lasting 3 to 5 days. The local inflammation did not cause any damage to the overlying skin and did not lead to scar formation. The results suggest that intralesional OK-432 therapy is effective for most unresectable lymphangiomas.

Coexistence of dopamine and neurotensin in hypothalamic arcuate and periventricular neurons

The coexistence of dopamine and neurotensin in the same neuronal perikarya in the arcuate nucleus of the rat hypothalamus was examined by combined fluorescence histochemistry and immunohistochemistry on the same tissue sections and we obtained the evidence of the coexistence of two substances. The functional significance of those two substances for the prolactin release from the anterior pituitary was also briefly discussed.

Immunohistochemical investigations of gut hormones in the colon of patients with Hirschsprung's disease*

The distributions of gut hormones in the colon of Hirschsprungs disease were investigated by the peroxidase-antiperoxidase (PAP) immunohistochemical method. Three colonic segments (ganglionic, oligoganglionic, and aganglionic) were stained by the unlabeled antibody enzyme method. The immunoreactivity of vasoactive intestinal polypeptide (VIP) was found to be reduced in the oligoganglionic and aganglionic segments. Antisera to substance P and met-enkephalin demonstrated immunoreactive cells and fibers in the ganglionic segment, whereas these cells and fibers were almost completely absent in the oligoganglionic and aganglionic segments. A similar distribution was seen for the mucosal endocrine cells with somatostatin immunoreactivity. Antisera to neurotensin, motilin, bombesin, and cholecystokinin revealed no immunoreactivity in the normal colon or the three segments. The differences in these peptides between normal and impaired colonal segments may be one of the causes of colon constriction in Hirschsprungs disease.

Distribution of the VIP-like immunoreactive neurons in the cat central nervous system ☆

Immunohistochemical topographic localization of the vasoactive intestinal polypeptide (VIP)-like immunoreactive neurons in the cat brain was investigated using a peroxidase anti-peroxidase technique. VIP-like immunoreactive neurons were mainly localized in the cerebral cortex, limbic cortex, hypothalamic nuclei; suprachiasmatic nucleus, supraoptic nucleus, paraventricular nucleus, periventricular nucleus and arcuate nucleus, and in the midbrain; such as the central grey and the raphe nucleus. It was demonstrated that VIP-like immunoreactive neurons were widely distributed in the cat brain, particularly in the hypothalamus, compared with those of the rat and mouse; though whether these differences were species-related or due to differences in the physiological conditions remains to be determined. This is the first report of VIP neuronal perikarya in the arcuate nucleus of mammalian species, although these cells are present in the arcuate nucleus of birds.

An immunohistochemical investigation of vasoactive intestinal polypeptide in the colon of patients with Hirschsprung's disease.

The distribution of vasoactive intestinal polypeptide (VIP) in the colon of patients with Hirschsprungs disease was investigated by the peroxidase-antiperoxidase (PAP) immunohistochemical method. Three colonic segments, ganglionic, oligoganglionic and aganglionic, were stained by the unlabeled antibody enzyme method. VIP immunoreactive nerve cell bodies, nerve fibers and nerve endings were distributed throughout the ganglionic and oligoganglionic segments. In contrast, the aganglionic segment contained no VIP nerve endings and the number of fibers was reduced. These differences are thought to be a cause of constriction of the colon in Hirschsprungs disease and VIP neurons are therefore believed to participate in the relaxation of smooth muscle.

Morphological survey of neurotensin-like immunoreactive neurons in the hypothalamus ☆

Neurotensin-like immunoreactive neuronal perikarya, fibers and terminals in in the rat hypothalamus were investigated by light and electron microscopic immunocytochemistry. Distributional density and pattern of these elements were clarified. Fine structure of immunoreactive neuronal perikarya with respect to development of cell organellae and immunoreactive dense granules was also elucidated. Features of immunoreactive processes, dendrites and preterminal axons were examined electron microscopically. In addition to the above findings by light and electron microscopic immunocytochemistry, we examined the coexistence of dopamine and neurotensin-like immunoreactive substances in these same neurons in the arcuate and periventricular nuclei. This was proved by the application of fluorescence histochemistry and immunocytochemistry on the same sections. Moreover, we speculated that the ascending noradrenergic neurons influence the neurotensin immunoreactive neurons in the paraventricular nucleus since a marked decrease in the number of neurotensin-like immunoreactive neuronal perikarya was observed after transection of ascending noradrenergic pathway.

Biliary manometry in choledochal cyst with abnormal choledochopancreatico ductal junction

Intraoperative manometry of the biliary tract and measurement of amylase levels in choledochal cysts were performed in seven patients, aged 14 months to 5 years, with choledochal cysts, in an investigation of the pathophysiology of the biliary tract. An abnormal choledochopancreatico ductal junction was observed in these seven patients by preoperative endoscopic retrograde cholangiopancreaticography (ERCP) or intraoperative cholangiograms. All six patients examined showed a high amylase level in the choledochal cyst (5,450 to 46,500 Somogyi Units). The intraoperative manometry of the biliary tract showed that a remarkable high pressure zone as was found in the area of sphincter of Oddi was not found in the area of abnormal choledochopancreatico ductal junction. The pressure recordings also demonstrated that the sphincter of Oddi pressure in the patient with choledochal cyst was increased by gastrin stimulation. On the contrary, no pressure reaction to gastrin or secretin was found in the area of abnormal choledochopancreatic ductal junction. From these results it seems that free reflux of pancreatic juice into the biliary system occurs, and the reflux stream depends upon the pressure gradient between pancreatic ductal pressure and common bile duct pressure because of the lack of a sphincter function at the choledochopancreatico ductal junction.

The fine structures of the VIP-Like immunoreactive neurons in the cat hypothalamus

The fine structures of the VIP-like immunoreactive neurons in the suprachiasmatic nucleus (SCN) and the arcuate nucleus ( ARN ) of the cat hypothalamus were investigated by electron microscopic immunocytochemistry. The VIP-like immunoreactive soma and fibers could be successfully visualized by a modified PAP method. VIP-like immunoreactive neurons in both nuclei contained immunoreactive rER, Golgi complexes and many immunoreactive granules, as well as well developed mitochondria. VIP-like immunoreactive synaptic endings with synaptic membrane specialization of Grays type I and II were found in the SCN. Moreover VIP-like immunoreactive preterminal elements that made synaptic contact with VIP-like immunoreactive neuronal soma were also detected. On the other hand, it was difficult to detect typical preterminal endings with immunoreactivity in the ARN ; however, VIP-like immunoreactive processes in contact with the basement membrane of the capillaries were observed. These observations indicate that VIP-like immunoreactive neurons in the SCN act as intrinsic neurons and are involved in neuroendocrine function in ARN .

Objective assessment of anorectal function after sphincter reconstruction using the gluteus maximus muscle: Report of a case

Sphincter reconstruction using the gluteus maximus muscle was attempted in a 9-year-old boy who had been incontinent following surgery for the high type of anorectal malformation. Anorectal function following this procedure was assessed by anorectal manometry, defecogram, and electromyography. Postoperative function improved from Kelly 1 (poor) to Kelly 3 (fair). Adequate anorectal pressure difference and good voluntary contraction were documented one year after surgery. A defecogram one month postoperatively showed the presence of an empty segment which had not been noted before. Tonic activity at rest, which had not been present before, was found both one month and one year after surgery. These results indicate that the gluteus maximus muscle maintains some function as a newly created anorectal sphincter. In the present study, the patient was examined periodically for one year after surgery. Further follow-up studies are necessary.