Nonfunctioning pancreatic endocrine tumor with extension into the main pancreatic duct: report of a case

Pancreatic endocrine tumors (PETs) rarely involve the main pancreatic duct. We report a case of malignant nonfunctioning pancreatic endocrine tumor (NFPET) with prevalent intraductal growth. A 47-year-old woman was referred to us after ultrasonography at a routine health check showed diffuse swelling of the pancreas. Preoperative imaging showed a solid mass in the tail of the pancreas and a bulging intraductal mass in the main pancreatic duct. We performed total pancreatectomy because the tumor occupied almost the entire lumen of the main pancreatic duct. Histological examination confirmed well-differentiated endocrine carcinoma. We review reported cases of the intraductal growth of NFPETs and discuss the pathogenesis of these unusual tumors.     

New dopamine agonist pramipexole improves parkinsonism and depression in Parkinson's disease

Previous studies have shown that pramipexole might have the potential to improve depressive symptoms in patients with Parkinson's disease. To provide more evidence, in five Japanese patients at Hoehn & Yahr stage 1-3 we evaluated the Unified Parkinson's Disease Rating Scale (UPDRS), Hamilton Depression Rating Scale (HAMD) and Montgomery Asberg Depression Rating Scale (MADRS) at our hospital. After the pramipexole treatment, each total score of UPDRS, HAMD and MADRS significantly decreased compared with that before the treatment. Our data indicate that pramipexole improves depressive symptoms in patients with Parkinson's disease.     

Short-term and long-term efficacy of topiramate in refractory generalized epilepsy of children

Topiramate (TPM) was administered to 25 children with intractable generalized epilepsy. A > or =50% decrease in seizure frequency was observed in 56% and 45% of children at two months and one year after initiation of TPM therapy, respectively. However, efficacy of TPM for Lennox-Gastaut syndrome was low. TPM therapy was discontinued in five of 25 children at 3-5.5 months due to lack of efficacy or aggravation of seizures. No serious adverse effects were observed during TPM therapy. The present study revealed that TPM has clinical efficacy in the treatment of children with intractable generalized epilepsy.     

Transposition osteotomy of the acetabulum for advanced-stage osteoarthritis of the hips

Background  Transposition osteotomy of the acetabulum (TOA) was the first periacetabular osteotomy in which the acetabulum was transposed with articular cartilage. TOA improves coverage of the femoral head and joint congruity. The purpose of this study was to investigate whether TOA is an appropriate option for treating osteoarthritis of the hips at the advanced stage by comparing it with matched control hips at the early stage. Methods  Between 1998 and 2001, TOA was performed in 104 hips of 98 patients. Altogether, 16 of 17 hips (94%) with osteoarthritis at the advanced stage were examined and compared with 37 matched control hips at the early stage. The mean age at the operation was 48 years (38–56 years), and the mean follow-up period was 88 months (65–107 months). Results  TOA corrected the acetabular dysplasia and significantly improved containment of the femoral head. Clinical scores were also significantly improved in both groups. In the advanced osteoarthritis cases, there was a tendency for abduction congruity before transposition osteotomy of the acetabulum to reflect the clinical outcome. Conclusions  TOA is a promising treatment option for advanced osteoarthritis of the hips as well as for patients at an early stage when preoperative radiographs show good congruity or containment of the joint.     

An epidemiological study of children with status epilepticus in Okayama, Japan

BACKGROUND: The incidence of status epilepticus (SE) in Asian children, including Japanese, has not been reported. METHODS: In 2003, we performed an epidemiological study of SE on Japanese children (31 days or older to <15 years of age) in Okayama City by ascertaining all lifetime first episodes of SE. RESULTS: Thirty-seven patients (22 males and 15 females) were identified. The annual incidence of SE was 38.8 per 100,000 population (95% CI: 24.5-49.5). Febrile SE in the absence of CNS infection accounted for 17. Acute symptomatic etiologies other than febrile SE were observed in eight patients, including three cases of influenza encephalitis/encephalopathy. Five were classified as remote symptomatic and the remaining seven as cryptogenic. The highest incidence (155.1/100,000) was seen in the age range of 31 days or older to <1 year, followed by 101.5/100,000 in the age range of one year, and the incidence decreased after eight years. In 26 of the 37 patients, SE was their first seizure. As for seizure types, 32 had convulsive SE, including tonic status in one. Five others showed nonconvulsive SE, including complex partial SE in four and absence status in one. No one died of SE. Two patients who brought on SE because of influenza encephalitis/encephalopathy suffered from motor disturbance with or without mental disturbance after SE. CONCLUSIONS: The incidence of SE tended to be higher in Japanese children than reported in Caucasians. The Japanese had an age-specific incidence pattern similar to that of Caucasians.     

Effects of low-dosage simvastatin on rheumatoid arthritis through reduction of Th1/Th2 and CD4/CD8 ratios

The objective of this study was to assess both the anti-inflammatory and immunomodulatory effects of low-dosage simvastatin on rheumatoid arthritis (RA). In each patient, simvastatin at 10 mg/day was administered for 12 weeks. The other treatments were unchanged at least 3 months before simvastatin administration to the end of the study. Patients were assessed for the improvement in clinical, laboratory, and immunological parameters of RA and for adverse events. Twenty-four patients with RA were enrolled. Clinical symptoms, including patient's assessment of pain and disease activity on visual analog scale (VAS), the swollen joint and tender joint counts, and handgrip strength significantly improved. Physician's assessment of disease activity on VAS, a period of morning stiffness and modified health assessment questionnaire showed a tendency of improving after administration of low-dosage of simvastatin. Of special interest was that the median levels of erythrocytes sedimentation rate, C-reactive protein, and rheumatoid factor were significantly decreased from 54.0 mm/h to 45.5 mm/h, from 1.50 mg/dl to 0.85 mg/dl, and from 57.0 IU/ml to 28.0 IU/ml, respectively, after administration of simvastatin. ACR20 and ACR50 responses were achieved in 62% and 38%, respectively, of simvastatin-treated patients for 12 weeks. Immunological assessment in peripheral blood revealed that the Th1/Th2 and CD4/CD8 ratios were significantly reduced by simvastatin. No adverse events were reported during simvastatin treatment. Immunomodulation through the alteration of Th1/Th2 and CD4/CD8 ratios may be a pharmacological mechanism in the anti-rheumatic effect of low-dosage simvastatin. Although it is necessary to evaluate the long-term effects of statins, low-dosage statins appear to be good as additional therapeutic agents.