Intestinal bleeding during the treatment of chronic myeloid leukemia with imatinib mesylate

A 35-year-old woman attended our hospital with chronic myeloid leukemia and was prescribed imatinib mesylate. She was admitted with lower abdominal pain, stomatitis, and hyposthenia after an increase in her dose of imatinib mesylate. When the treatment was changed to interferon-alpha and Ara-C, the lower abdominal pain, stomatitis, and hyposthenia improved, but bone marrow aspiration showed 36.4% blasts. After the treatment was changed back to an increased dose of imatinib mesylate (800 mg), the stomatitis deteriorated and intestinal bleeding reoccurred. Endoscopy demonstrated the presence of multiple ulcers in the ascending colon and 99mTc RBC scintigraphy demonstrated lesions of the large and small intestine. The patient declined any treatment except for transfusion and died suddenly after ten days. The present case suggests that we should carefully consider the possibility of intestinal bleeding when prescribing imatinib mesylate.     

Hidroacanthoma simplex: a case report and analysis of 70 Japanese cases

Imatinib is a specific and potent inhibitor of the BCR-ABL tyrosine kinase. Several clinical trials have demonstrated the efficacy of imatinib in chronic myeloid leukemia. Adverse cutaneous reactions induced by imatinib are frequent and may be dose related. We report a case of an unusual pustular eruption in a patient with chronic myeloid leukemia, who received high doses imatinib for blast crisis and later voriconazole for invasive pulmonary aspergillosis. At the time of his skin eruption, elevated plasma levels of imatinib were recorded. Imatinib is primarily metabolized by the cytochrome CYP3A4. Voriconazole is a cytochrome CYP3A4 inhibitor and can lead to high plasma levels of imatinib. This case suggests that severe drug reactions to imatinib may be related not only to imatinib doses, but also to elevated plasma drug levels resulting from pharmacokinetic interactions. The monitoring of imatinib plasma levels may be of help for identifying patients at risk for severe toxicity.     

Neural precursor cells division and migration in neonatal rat brain after ischemic/hypoxic injury

Ischemia/hypoxia (I/H) causes severe perinatal brain disorders such as cerebral palsy. The neonatal brain possesses much plasticity, and to enhance new cell production would be an innovative means of therapy for such disorders. In order to elucidate the dynamic changes of neural progenitor cells in the neonatal brain after ischemia, we investigated new cells production in the subventricular zone and subsequent migration of these cells to the injured area. Newly produced cells were confirmed by incorporation of bromodeoxyuridine (BrdU), and attempt for differentiation was investigated by immunohistochemistry for molecular markers of each cellular lineage. In the sham-control brain, there were many BrdU-labeled cells which gradually decreased as the animal becomes older. Many of these cells were oligodendroglial progenitor or microglial cells. Although there were only few neuronal cells labeled for BrdU in the sham-control, they dramatically increased after I/H. They were located at just beneath the subventricular zone where the progenitor cells reside and to the injured area, indicating that newly produced cells migrated to the infarct region and differentiated into neuronal precursor cells in order to compensate the lost neural cells. We found that BrdU-labeled astroglial, oligodendroglial progenitor, and microglial cells were also increased after I/H, suggesting that they also play active roles in recovery. Progenitor cells may have potential for treating perinatal brain disorders.     

Durability of tungsten carbide burs for the fabrication of titanium crowns using dental CAD/CAM

The purpose of this study was to evaluate the durability of tungsten carbide burs for the fabrication of titanium crowns using two dental CAD/CAM systems (DECSY, Digital Process, Japan and Cadim, Advance, Japan). A tungsten carbide bur in each system was examined and used without fracture to fabricate 51 titanium crowns. For both systems tiny chips were found on the bur blade at the 11th machining. These chips gradually enlarged as the number of machining times increased. At the first machining no significant difference in the average surface roughness was found on the crown between the two systems (1.6 microm for DECSY and 1.2 microm for Cadim). The cutting grooves became dull and the average surface roughness increased as the number of machining times increased. It is concluded that the tungsten carbide burs for both systems can be used to fabricate up to 51 titanium crowns.     

A case of schwannoma in the tongue diagnosed with enhanced magnetic resonance image

We encountered a case of schwannoma of the tongue in a 74-year-old man, who complained chiefly of contact pain in an ulcer in the left sublingual region. Although by computed tomography we could not differentiate the lesion as a cyst or tumor, with magnetic resonance (MR) imaging we diagnosed a benign tumor on the basis of lesion enhancement. Axial and coronal MR imaging revealed the three-dimensional location of the lesion. This case showed that enhanced MR imaging is useful for the differential diagnosis of a benign tumor in the oral cavity.     

NO-release ability and DNA-damage activity of aromatic N-nitroso compounds

To develop a new nitric oxide-donor (NO-donor) that is useful for chemical and biochemical research, we synthesized several aromatic N-nitroso compounds including 1-[N-nitroso-N-(4-tolyl)carbamoyl] piperidine-4-carboxylic acid (1f) and phenyl(2-pyridyl)-N-nitrosamines, which spontaneously generate NO at ambient temperature. Thermal decomposition of these compounds was run under mild conditions. Gaseous NO released from them was quantified by means of the Griess reaction using a specially designed apparatus in which NO2- is generated from NO. The structure of products arose from the radical cleavage of N-NO bond was clarified by chemical and spectral studies. Generation of NO from the N-nitroso compounds was also confirmed by ESR spectroscopy. The action of these NO-releasing compounds against DNA was examined. When the pBR 322 DNA was treated with 1f at 37 degrees C for 3 h, the DNA single-strand breaks was 31% for 1 mM of 1f. The denitrosated compound and sodium nitrite did not show any effective DNA-cleaving activity. On the other hand, aromatic N-nitrosamines induced weak DNA-cleaving activity under the same condition.     

Tethered cord syndrome: overview of diagnosis and treatment

This article covers the basis of tethered cord syndrome as a stretch-induced spinal cord disorder, including pathophysiology, signs and symptoms, imaging diagnosis, indication for surgical treatment, and surgical procedures. Anomalies that cause mechanical spinal cord tethering are listed, and the surgical untethering technique for each anomaly is described.     

Fetal hemorrhage associated with congenital intestinal atresia

We encountered two cases of severe intrauterine hemorrhage associated with congenital intestinal atresia. In both cases, the first sign that necessitated immediate clinical management was the abnormal fetal heart rate patterns, represented by prolonged bradycardias and late decelerations. This occurred immediately after the onset of labor. An emergency cesarean section was performed on both patients and, despite being born with severe anemia, the condition of the infants was excellent. We found that continuous fetal heart rate monitoring should be performed if polyhydramniosis suspected, when the fetus is diagnosed with congenital intestinal atresia and when changes in intrauterine pressure are clinically expected, such as at the onset of labor or after amniocentesis.