The immunoglobulin heavy chain (IgH) gene of B-cells dramatically alters twice in their differentiation to memory or plasma cells; VDJ recombination at B-cell precursor and somatic hypermutation, class switch recombination and receptor revision at germinal center (GC) B-cells. Among them, somatic hypermutation of the IgH gene variable region (VH gene) is a powerful tool for detection of B-cell differentiation. B-cells and B-cell neoplasms have been divided into following ; 1) pre-GC B-cells and neoplasms with a germline VH gene and 2) GC and post-GC B-cells and neoplasms with a somatically mutated VH gene. In this article, we review normal B-cell differentiation and histogenesis of various types of B-cell neoplasms on the aspect of somatic mutation of the rearranged VH gene. In particular, differences between CD5+ and CD5− B-cell neoplasms, using our own data of over 100 cases with B-cell neoplasms, are discussed. Although CD5+ B-cells are included in pre-GC B-cells for the reason of germline VH gene in most of CD5+ Bcells, an about 5% of CD5+ B-cells show somatically mutated VH gene. The rearranged VH gene of CD5+ B-cell neoplasms shows heterogeneity, whereas CD5− B-cell neoplasms possess somatically mutated VH gene with a mean of 8∼12%. Both CD5+ B-cell chronic lymphocytic leukemia and CD5+ diffuse large B-cell lymphoma display that about half of cases show a germline or low frequency of somatic mutation and the others possess somatically mutated VH gene. CD5+ mantle cell lymphoma constitutes most cases with germline and a small number of cases with mutated VH gene. Therefore, CD5− B-cells & CD5− B-cell neoplasms are distinct from CD5+ B-cells and CD5+ B-cell neoplasms in somatic mutation of VH gene. It suggests that each of CD5− and CD5+ B-cells independently has its own differentiation.
Pre-eclampsia is still one of the leading causes of maternal and fetal morbidity and mortality. Despite active research for many decades, the etiology of this disorder exclusive to human pregnancy is an enigma. Recent evidence suggests there may be several underlying causes or predispositions leading to endothelial dysfunction and causing the signs of hypertension, proteinuria, and edema— findings that allow us to make the diagnosis of the “syndrome” of pre-eclampsia. It is obvious that a single mechanism responsible for the syndrome pre-eclampsia does not exist. Instead, several mechanisms can act together and even multiply each other. The search for the underlying cause of this disorder and for a clinical marker to predict which women will develop pre-eclampsia is ongoing, with its prevention being the ultimate goal.
Objective: We evaluated preoperative pulmonary function as a predictor of respiratory complications and mortality in patients undergoing lung cancer resection to confirm the guideline of the British Thoracic Society : lung cancer surgery in patients with predictive postoperative FEV1.0 (%FEV1.0ppo)>40% and predictive postoperative diffusion capacity for carbon monoxide (%DLCOppo)>40% can be carried out with average risk. Methods: We retrospectively studied 356 consecutive patients who underwent pulmonary resection at our Department from January 1992 to December 2001. Preoperative pulmonary function tests included vital capacity (VC), %VC, forced expiratory volume in one second (FEV1.0), FEV1.0%, diffusion capacity for carbon monoxide (DLCO), predictive postoperative FEV1.0 (FEV1.0 ppo), postoperative respiratory function expressed as a percentage of the predicted normal value (%FEV1.0ppo, %DLCOppo). Postoperative complications were divided into 2 groups: respiratory complications (pneumonia, atelectasis, etc) and other complications (bronchopleural fistu la, prolonged air leak, arrhythmia, etc). Results: Postoperative deaths occurred in 14 (3.9%) patients. Postoperative respiratory complications developed in 27 (7.6%) patients. Pneumonectomy (p<0.001), preoperative chemotherapy (p<0.01) and advanced stage (p<0.05) were identified as risk factors of postoperative deaths. Patients undergoing lobectomy with FEV1.0≥1,500 ml did not die of respiratory complications. Patients undergoing pneumonectomy with FEV1.0ppo≥800 ml/m2 did not die of respiratory complications. Patients undergoing pneumonectomy with %FEV1.0ppo<40% and %DLCOppo<40% did not survive. Five of the 7 patients who died of respiratory complications were treated with preoperative chemotherapy. The values of their %DLCOppo were all less than 40%. By multivariate analysis, %FEV1.0ppo was significant independent factor associated postoperative death. Conclusions: We conclude that the guideline is useful for the selection for surgery of lung cancer patients. If preoperative chemotherapy is performed, the measurement of %DLCO is recommended before surgery.
Biological monitoring of toluene exposure by urinary hippuric acid determination and a subjective symptom survey by self-administered questionnaire were performed in 20 workers at low toluene exposure in factories to evaluate the health hazard including dysfunction of nervous system. Environmental monitoring was carried out using toluene gas detection tubes. Urine samples were collected three times a day in order to measure hippuric acid: first before the commencement of work, then at the end of forenoon work, and lastly at the end of afternoon work. Toluene vapor concentrations of throughout the workday ranged from 15.3 to 31.4 ppm. The urinary hippuric acid concentrations correlated with the toluene concentrations of ambient air (r=0.58, p=0.01). The subjective symptoms increased in close association with the exposure to toluene; the prevalence rate of subjective symptoms “during work” in the exposed group was 15 times higher than the rate of the non-exposed group (p<0.0001). The prevalence rate of subjective symptoms “ off-work” in the exposed group was 2.4 times higher than the rate of the nonexposed group (p<0.0001), and also the prevalence rate of “nineteen symptoms offwork which are apparently related to central nervous system (CNS) and autonomic nervous system (ANS)” in the exposed group was 1.8 times higher than the rate of the non-exposed group (p<0.05). From these results, these subjective symptoms, which have been believed to be complained in high organic solvent exposure should be reassessed and reconsidered in evaluating the nervous system dysfunction and local irritation in relatively low toluene exposed workers.
A 58-year-old man with a 15-year history of idiopathic pulmonary fibrosis was hospitalized for rapid progression of muscle weakness to bilateral foot drop. Although laboratory data revealed high titers of myeloperoxidase anti-neutrophil cytoplasmic antibody (489 EU), the patient was diagnosed as polyarteritis nodosa limited to the lower portions of the legs. Despite of the treatment with large doses of corticosteroids and cyclosporin A, his symptoms barely improved during the following two months.