A case of siblings with Meckel's diverticulum diagnosed before operation

The authors encountered a sibling case of Meckel's diverticulum in 9 and 11 year old Japanese boys. They were diagnosed using contrast examination and ^99mTc-pertechnetate scintigraphy before operation. The familial tendency is one in every 2500 families. Only 15 cases of familial occurence have been reported by five authors.     

Endobronchial Malignant Lymphoma: Unusual Manifestations -- A Report of Two Cases --

Two unusual manifestations associated with endobronchial malignantlymphoma are reported. A 58-year-old white female was firstseen with massive hemoptysis requiring blood transfusion andpneumonectomy for histiocytic lymphoma (large cell type). Thesecond case was that of a 47-year-old black male treated previouslyfor poorly differentiated lymphocytic lymphoma (medium-sizedcell type) who had a relapse in the lungs. Increasingly copioussputum production led to respiratory distress which requiredextensive radiation therapy and chemotherapy for its control.     

Latitude and Pancreatic Cancer

With regard to the geographical distribution of pancreatic cancermortality, the relationship of the latitude and of the averagetemperature to pancreatic cancer mortality was examined. Bothinternationally and within Japan, a strong positive associationbetween latitude and pancreatic cancer mortality and a strongnegative association with the average temperature were observed.The simple correlation coefficient between pancreatic cancermortality and the latitude was 0.724 for males and 0.725 forfemales, and that between pancreatic cancer mortality and theaverage temperature was –0.773 for males and –0.729for females in 26 countries. In the 47 prefectures in Japan,the coefficient was 0.612, 0.615, –0.589, and –0.630respectively. Most of these relationships remained statisticallysignificant after controlling for per capita consumption offood which was also related to the pancreatic cancer mortalityinternationally, such as sugar, eggs, milk and dairy products,oils and fats, pulse, coffee, and fat. Within Japan, an urban-ruraleffect on the pancreatic cancer mortality was not observed inspite of a higher intake of fat in large cities. There remainsthe possibility that factors related to latitude or averagetemperature other than diet may be involved in the occurrenceof pancreatic cancer.     

Gastric vascular ectasia treated by endoscopic mucosal resection

An 80‐year‐old woman consulted our hospital complaining of general weakness. She had iron deficiency anemia, and upper gastrointestinal endoscopy revealed a small lesion accompanying a small amount of fresh bleeding in the stomach. Close observation of the lesion revealed that it was composed of a local assembly of dilated microvessels. The diagnosis of this patient was gastric vascular ectasia causing anemia. Endoscopic ultrasonography demonstrated that the lesion involved the mucosal and submucosal layers of the stomach, and that there were no large vessels inflowing to or outflowing from the lesion. In the present case, we attempted endoscopic mucosal resection (EMR). The lesion was completely resected by only one procedure of EMR without complications such as bleeding. After the endoscopic treatment, iron deficiency anemia improved. Follow‐up endoscopy performed 1 year later revealed that there was no residual or recurrent lesion. Although there have not been any published reports describing the use of EMR for gastric vascular ectasia, EMR may be a useful endoscopic treatment for this condition.     

The relationship of DSM-III-R personality disorder to clinical variables in patients with major depression: Possible difference between personality disorder clusters

Abstract The relationship of DSM-III-R personality disorder (PD) to demographic and clinical variables was investigated based on 96 consecutive outpatients with major depression. No significant difference in the variables was found between those with and those without PD. Those with PD from each cluster were compared with those without PD in terms of the variables. In these comparisons many relationships of PD to the variables were found, and these relationships were different between the three PD clusters detailed in DSM-III-R. Patients with cluster B PD demonstrated a prominent uniqueness in his/her relationship to the variables. This uniqueness was similar to what had been reported previously with regard to patients with PD. There was no significant difference in the variables between those with cluster C PD and those without PD. Those with cluster A PD may have a negative family history of affective disorders.     

Ascites with Peritoneal Myeloid Metaplasia in a Patient with Advanced Non-Hodgkin's Lymphoma

Peritoneal myeloid metaplasia associated with ascites containingnumerous hemopoietic cells in a patient with non-Hodgkin's lymphomais described. It is suggested that massive infiltration of lymphomacells into the bone marrow caused marrow failure and compensatorymechanisms supervened leading to myeloid metaplastic implantsin the peritoneum associated with ascites as well as in theliver, spleen and lymph nodes. There was also a significantleukoerythroblastic reaction in the peripheral blood.     

Antibodies to P450IID6, SLA, PDH-E2 and BCKD-E2 in Japanese patients with chronic hepatitis

Auto-antibodies specific to various antigens in chronic hepatitis (CH) have been detected but their specificities and implications were uncertain. The aims of the present study were to investigate the frequency and the significance of seropositivity of antibodies to P450IID6 or liver/kidney microsome 1 (LKM1), soluble liver antigen (SLA), pyruvate dehydrogenase (PDH) and branched-chain keto acid dehydrogenase (BCKD) in 188 Japanese patients with different forms of CH by western blot or enzyme immunoassay (EIA). Anti-LKM1 was also measured by indirect immunofluorescent test. Anti-P450IID6 was found in 6/188 (3.2%) CH patients including 5/104 (4.8%) with hepatitis C virus (C) infection and 1/12 (8.3%) CH-C patients with antibodies to nuclear and smooth muscle antigens and hypergammaglobulinaemia (> 2.5 g/dL). This patient was the only one diagnosed with autoimmune hepatitis (AIH). All CH patients with hepatitis B (B), hepatitis non-B non-C (NBNC) and AIH were seronegative for anti-LKM1. Antibodies to soluble liver antigen were found in two of 188 (1%) patients, one with AIH and one with CH-B. Anti-BCKD-E2 but not anti-PDH-E2 was found in four patients (2.5%), one with AIH, two with CH-C, and one with NBNC. There was no obvious difference in age, sex ratio and laboratory findings in patients with or without anti-SLA and anti-BCKD-E2. Antibodies to P450IID6, SLA, PDH-E2 and BCKD-E2 are uncommon in adult CH-C, CH-B, CH-NBNC and AIH patients in Japan. Some of these patients positive for auto-antibodies appear to have autoimmune features and might require a careful follow up. The heterogeneity of these antibodies in CH preclude further justification for subtyping of AIH by the presence of the distinct auto-antibodies.     

OKT3 therapy for transfusion-associated graft-versus-host disease in a neonate

Transfusion-associated graft-versus-host disease (TA-GVHD) is a fatal side effect of blood transfusion. The present study describes a case of TA-GVHD in a neonate treated with anti-CD3 monoclonal antibody (OKT3). The patient died of systemic bacterial infection. However, it is suggested that OKT3 suppressed the graft-versus-host reaction due to the improvement in the clinical signs and a change in the human leucocyte antigen (HLA) type on the surface of circulating lymphocytes. A relatively large dose of OKT3 together with steroid pulse therapy and cyclosporin A may be required for the control of TA-GVHD in neonates.     

Dipyridamole-provoked chest pain implies severe coronary artery disease in children

The diagnostic significance of dipyridamole-provoked chest pain was studied in 17 children with severe coronary arterial stenotic lesions (CAL) complicated with Kawasaki disease. Although dipyridamole induced chest pain in seven patients (symptomatic group), 10 reported no pain (asymptomatic group). In the asymptomatic group, seven children had one vessel disease (1VD) of right coronary artery (RCA) and the other three had two vessel disease (2VD) involving the RCA and left anterior descending artery (LAD). Four multivessel disease patients, one three vessel disease (3VD) and three 2VD of LAD and RCA, and three 1VD of LAD, were symptomatic. In the thallium scans, all patients, except two of the asymptomatic group, showed perfusion abnormalities. In addition, the extent score of the symptomatic group was significantly worse than that of the asymptomatic group (P = 0.01). While only one in six of the asymptomatic group showed abnormal ST depression on treadmill exercise electrocardiography, all patients in the symptomatic group (P = 0.02) showed ischemic ST depression. These findings suggest that the occurrence of chest pain after medication with dipyridamole closely correlates with the severity of CAL in children.