Recent advances in biochemical diagnosis and assessment of severity in acute pancreatitis

Serum amylase is most commonly used as a biochemical marker of acute pancreatitis (AP). But it lacks specificity. The serum lipase level is more accurate and a better marker. Serum elastase -1 level is specific and remains elevated longer, but its radioimmunoassay is not routinely used. Recently, it can be rapidly measured by latex turbidometric immunoassay with automatic analyzer. Biochemically, only CRP test is available and useful to assess severity, but its sensitivity is unacceptably low in the early course of the disease. Urinary trypsinogen activation peptide (TAP) or trypsinogen-2 is an earlier marker. Increasing knowledge of the inflammatory process in AP has led to possibly useful biochemical indicators of severity, such as cytokines, nonpancreatic synovial type group II PLA2 or granulocyte elastase.     

Three-dimensional sonographic features of a fetus with Wolf-Hirschhorn syndrome

We present a case of fetal Wolf-Hirschhorn syndrome diagnosed by conventional two-dimensional and three-dimensional ultrasonography. Conventional two-dimensional ultrasonography revealed a diaphragmatic hernia, nuchal edema, and suspected hypospadias. Three-dimensional ultrasonography clearly showed a flattening of the face, a high forehead, a broad nasal bridge continuing to the forehead, exophthalmos, and micrognathia (resembling the appearance of a Greek warrior helmet), but conventional two-dimensional ultrasonography did not depict these findings. Prenatal chromosomal analysis confirmed the diagnosis of Wolf-Hirschhorn syndrome [46XY, del(4)(p15.2)]. Here we demonstrate how three-dimensional ultrasonography provided a novel visual depiction of the facial dysmorphism, which helped substantially in prenatal counseling.     

Left-sided hepatic hydrothorax diagnosed by contrast-enhanced ultrasonography with intraperitoneal injection of Levovist

A 62-year-old Japanese woman was admitted to our hospital with dyspnea. Chest X-ray revealed massive pleural effusion on the left side. Contrast-enhanced ultrasonography using Levovist was performed to confirm the transdiaphragmatic passage of ascitic fluid into the pleural cavity. After injection of Levovist into the peritoneal cavity, an enhanced pulsative flow into the pleural cavity was detected. This is the first report of hepatic hydrothorax diagnosed by contrast-enhanced ultrasonography. This method is safe and useful for the diagnosis of hepatic hydrothorax, and it allows observation of the real-time movement of ascitic fluid from the peritoneal cavity to the pleural space and detection of the site of the peritoneopleural communication.     

Phagocytic Entry of Legionella pneumophila into Macrophages through Phosphatidylinositol 3,4,5-Trisphosphate-Independent Pathway

Legionella pneumophila, a causative agent of Legionnaire's disease, is an intracellular pathogen. It intervenes in the signal transduction of macrophages by secreting effector molecules through the Icm/Dot type IV secretion system (T4SS). There is a connection between signaling cascades that regulate phagocytosis and the production of reactive oxygen species (ROS). Class I phosphatidylinositol 3-kinase (PI3-K) and its product phosphatidylinositol 3,4,5-trisphosphate (PI(3,4,5)P(3)) play key roles in the reorganization of cytoskeleton (phagocytosis) and activation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (ROS production). We investigated the production of PI(3,4,5)P(3) and recruitment of class I PI3-K and Rac1 during phagocytosis of L. pneumophila by macrophages. Transient recruitment of class I PI3-K as well as PI(3,4,5)P(3) production was observed around a phagocytosed T4SS mutant LELA3118 or avirulent mutant 25D in an early stage of infection. In contrast, class I PI3-K was recruited while accumulation of PI(3,4,5)P(3) was not observed around wild type JR32. Immunoglobulin G (IgG)-opsonized live JR32, which would activate class I PI3-K through the Fcγ receptor pathway, did not induce PI(3,4,5)P(3) production. Regardless of whether wild type or mutants were used, transient Rac1 accumulation was observed around bacteria. These results indicate that the phagocytosis of wild type L. pneumophila occurs via a special mechanism in which PI(3,4,5)P(3) production is absent. This suggests that L. pneumophila may inhibit the production of PI(3,4,5)P(3), but not the recruitment of class I PI3-K and Rac1, in a T4SS-dependent manner. L. pneumophila may start the modulation of host signaling cascade immediately after contact with host cells to evade the ROS-dependent bactericidal system while completing entry into macrophages.     

A Japanese version of the Rosenberg Self-Esteem Scale: translation and equivalence assessment

OBJECTIVE: A Japanese version of the Rosenberg Self-Esteem Scale (RSES) was developed through the forward-backward translation procedure. METHODS: Married couples consisting of a native English speaker and a native Japanese speaker acted as translators to enhance the representativeness of language in the target population. Multiple translations were produced, and a panel of reviewers identified problems in conceptual and semantic equivalence between the original scale and the translated version. The Japanese version was altered accordingly with reference to alternate Japanese forms from the original English to Japanese translations. The altered translation was again retranslated into English, and problematic differences were checked. This forward-backward process was repeated until satisfactory agreement had been attained. The RSES was administered to 222 native English speakers, and the developed Japanese version (RSES-J) was administered to 1320 native Japanese speakers. RESULTS: Factor analysis revealed nearly identical factor structure and structural coefficients of the items between two sets of data. Target rotation confirmed the factorial agreement of the two scales in different cultural groups. High Cronbach's alpha coefficients supported the reliability of test scores on both versions. CONCLUSION: The equivalence between the RSES and the RSES-J was supported in this study. It is suggested that the RSES and the RSES-J are potential tools for comparative cross-cultural studies.     

Serum pepsinogen and gastric cancer screening

Since the 1990's, the test for serum pepsinogen as a marker for chronic atrophic gastritis has been incorporated into gastric cancer screening programs, on a trial basis, to identify people at high risk for gastric cancer. The addition of the serum test to the cancer screening program has been shown to improve the detection rate of cancer and pepsinogen testing is useful in detecting early-stage gastric cancers arising from atrophic gastric mucosa, which macroscopically tend to be elevated and histologically differentiated. Furthermore, the cost for the detection of a single cancer case is much less than that for conventional screening. Thus, with the introduction of pepsinogen testing, complimenting barium X-ray, a more efficient screening system is available.     

Phlegmonous gastritis developed during chemotherapy for acute lymphocytic leukemia: A case report

BACKGROUNDPhlegmonous gastritis (PG) is a rare bacterial infectious disease characterized by neutrophil-based purulent inflammation of the gastric wall. The most representative causative bacterium is Streptococcus pyogenes, followed by Staphylococcus, Pneumococcus and Enterococcus. Hepatic portal venous gas (HPVG) is considered a potentially fatal condition and is rarely associated with PG.CASE SUMMARYThe white blood cell count of a 70-year-old woman with acute lymphocytic leukemia in complete remission dropped to 100/μL after consolidation chemotherapy. Her vital signs were consistent with septic shock. Venous blood culture revealed the presence of Bacillus cereus. Abdominal computed tomography (CT) and esophagogastroduodenoscopy (EGD) showed marked thickening of the gastric wall. As with the other findings, CT was suggestive of HPVG, and EGD showed pseudomembrane-like tissue covering the superficial mucosa. Histopathological examination of gastric biopsy specimens showed mostly necrotic tissue with lymphocytes rather than neutrophils. Culture of gastric specimens revealed the presence of Bacillus cereus. We finally diagnosed this case as PG with Bacillus cereus-induced sepsis and HPVG. This patient recovered successfully with conservative treatment, chiefly by using carbapenem antibiotics.CONCLUSIONThe histopathological finding of this gastric biopsy specimen should be called "neutropenic necrotizing gastritis".