Pancreatic diabetes in a follow-up survey of chronic pancreatitis in Japan

Background We aimed to determine the cumulative rate of diabetes mellitus (DM) and the risk factors for DM in patients with chronic pancreatitis (CP) in Japan. Methods We conducted a follow-up survey of CP in 2002 in patients registered as having CP in 1994, and confirmed 656 patients to be checked in regard to the survey items concerning diabetes. We analyzed the cumulative rate of DM and the risk factors for DM over an 8-year follow up period. Results In 1994, 35.1% of 656 CP patients had DM, and the incidence of diabetes had increased to 50.4% in 2002. Of 418 patients without diabetes in 1994, 28.9% (121/418) were newly diagnosed with DM in 2002. Alcoholic CP was the most common type of CP in patients with newly developed diabetes, accounting for 67.8%. The incidence of DM was highest in those with alcoholic CP (34.3%) followed by idiopathic CP (23.0%). The risk of diabetes increased 1.32-fold after the onset of pancreatic calcification. Of 121 patients with newly diagnosed DM in 2002, 37 (30.6%) had pancreatic stones in 1994 and 49 (40.5%) had a stone in 2002. The highest incidence of newly diagnosed DM was observed in patients with continuous alcoholic intake (40.9%). Patients treated with camostat mesilate developed DM less frequently than those without camostat mesilate. Conclusions The present study showed that the incidence of DM in patients with CP increased with time. Of 418 CP patients without DM in 1994, 28.9% developed DM over a period of 8 years. Continuous alcoholic intake aggravated CP and increased the risk of DM in those with CP.     

Primary mesenteric liposarcoma successfully diagnosed by preoperative imaging studies

Liposarcoma is one of the most common primary neoplasms in the retroperitoneum, whereas primary mesenteric liposarcomas are rare. We encountered a case of liposarcoma which arose from the mesentery of the jejunum that was diagnosed by imaging studies before surgical operation.     

Ictal electroencephalographic correlates of posttreatment neuropsychological changes in electroconvulsive therapy: a hypothesis-generation study

OBJECTIVES: Electroconvulsive therapy (ECT) has been associated with memory and neuropsychological changes, but which features of ECT are associated with those changes have not been well investigated. The aim of this hypothesis-generation study was to examine correlations between ictal electroencephalographic (EEG) characteristics and cognitive side effects after ECT. METHODS: Eight patients with major depressive disorder were examined with the Wechsler Memory Scale-Revised (WMS-R), the Stroop test, the Trail Making Test, and verbal fluency before and after ECT treatment. Seven ictal EEG measurements (eg, slow-wave phase amplitude, postictal suppression) were manually rated by 3 independent psychiatrists. The correlations between ictal EEG measurements, changes in WMS-R subset scores, and non-memory-related neuropsychological assessments were examined with Spearman rank correlation. RESULTS: Verbal memory, general memory, attention/concentration, delayed memory of WMS-R subset scores, and the Stroop test scores improved significantly after ECT treatment. Postictal suppression and slow-wave amplitude correlated positively with delayed memory and visual/verbal discrepancy score. Slow-wave amplitude correlated negatively with letter fluency. The longer the polyspike wave duration, the higher the attention/concentration test results. CONCLUSIONS: Certain ictal EEG measurements were associated with changes in several neuropsychological test results that had improved 2 weeks after the final ECT treatment. A hypothesis-testing study with a larger sample is needed to verify the relationships between EEG measurements and neuropsychological test performance.     

Pancreatoduodenectomy for locally advanced ascending colon cancer after neoadjuvant chemotherapy (mFOLFOX6)

A 69-year-old man was referred to our hospital with the chief complaint of a palpable abdominal mass. Computed tomography and colonofiberscopy revealed that a large type 2 ascending colon cancer had invaded the duodenum and pancreas. To down-size the tumor, chemotherapy was planned and a FOLFOX regimen was effective; we therefore decided to perform a radical operation. The patient is still alive and disease-free 1 year and 8 months after the surgery.     

Mouse model of paraquat-poisoned lungs and its gene expression profile

Paraquat (PQ)-induced pulmonary toxicity is characterized by initial development of pulmonary edema, infiltration of inflammatory cells, and damage to the alveolar epithelium, which may progress to severe fibrosis. However, the exact role of PQ in the progression of the pathogenesis has not been clearly established. To understand the mechanism of PQ in pulmonary toxicity, we developed an animal model of PQ-induced lung injury by intranasal instillation of PQ solution using C57Black/6J mice. Twenty microliters of PQ solution (0.01, 0.01, and 0.04 mg/mouse) was applied through the nares, and the same amount of vehicle was applied in control mice. The pathological progression of lung pathology in our mouse model was very similar to that of patients suffering from PQ poisoning. The lungs of some animals exposed to PQ showed acute fulmination, resulting in death from 5 days post-exposure, but others showed a more protracted injury, resulting in typical pulmonary fibrosis at 3 weeks. Using this PQ-poisoned mouse model, we examined the gene expression at the initial destructive phase (within 5 days) that fibrosis has not completely developed. We prepared RNAs after 6h, 24h, and 5 days and examined the changes of the expression levels for 45 selected genes. The genes showing >2-fold increase at 6h or a time-dependent decrease during this experimental period may be the early markers for the destructive phase. These genes are Mt1, Mt2, Hmox1, Gcl, GR, IL-6, IL-13, Txn1, Fas, FasL, Lpin2, Mmp1a, Mmp12, Sfp-B, Sfp-D, CAT, EC-SOD, GST, and Pltp. On the other hand, the genes involved in the development of fibrosis, such as procollagen, Fn1, Eln, SMA, and Mmp9, Timp1 were significantly increased on day 5, not at 6h nor at 24h, after PQ treatment (the late marker). The genes showing a significant increase (Mmp3 and Mmp8) or decrease (VEGFA) at 24h and 5 days and not at 6h may be also the late markers. These changes in gene expression, which are equalled to functional activities of proteins, will be the targets for future studies focused on the development on PQ-induced pulmonary damage.