Gastrointestinal lesions in an adult patient with Henoch-Schönlein purpura

A 28 year-old man was admitted because drug toxication, due to a high dose of antipsychotic drugs, presented purpuric rash on both legs, lower abdominal pain, arthralgia, and fresh-bloody stool. Colonoscopy observed numerous small ring-like petechiae in the rectum and in the sigmoid colon. Upper gastrointestinal endoscopy found a few petechiae in the antrum of the stomach and in the duodenal second portion. He was treated with coagulation factor X III after admission. After 38 days, there was no abnormal mucosa in the colorectum, the duodenal second portion, or the antrum of the stomach. The disappearance of gastrointestinal lesions correlated with the course of the illness. Gastrointestinal tracts should be thoroughly observed in patients with Henoch-Sch?nlein purpura.     

Long-term follow-up after coronary stent implantation in patients with coronary artery disease

Prospective randomized trials of coronary stenting in patients with coronary artery disease have shown a reduced incidence of cardiac events. However, little is known of the late outcome of patients treated with coronary stenting. The purpose of this study was to evaluate the relatively long-term clinical outcomes (3 to 6 years) of patients treated with successful coronary stenting. The long-term clinical outcome was studied in 101 consecutive patients (78 males and 23 females) who had undergone successful coronary stent implantation for coronary artery disease in our hospital from October 1994 to September 1997. During a follow-up period of 48.9+/-9.5 months (range, 6-73 months), cardiac events were documented in 37 patients. The rate of survival free of cardiac events was 67% at 3 years. Multiple logistic regression analysis showed that ACC/AHA lesion type and residual percent diameter stenosis greater than 20% after stenting were the significant explanatory factors of adverse cardiac events. Long-term clinical outcome in patients with coronary artery disease treated with successful coronary stenting was influenced by the ACC/AHA lesion type of stented lesion and residual percent diameter stenosis after stent implantation.     

MT95‐4, a fully humanized antibody raised against aminopeptidase N,reduces tumor progression in a mouse model

Aminopeptidase N (APN/CD13) is involved in tumor cell invasion and tumor angiogenesis and is considered a promising therapeutic target in the treatment of cancer. To develop a novel monoclonal antibody‐based cancer therapy targeting APN/CD13, we established a fully humanized anti‐APN/CD13 monoclonal antibody, MT95‐4. In vitro, MT95‐4 inhibited APN/CD13 enzymatic activity on the tumor cell surface and blocked tumor cell invasion. B16 mouse melanoma cells stably expressing human APN/CD13 were also established and were inoculated s.c. or injected i.v. into nude mice. We found that expression of human APN/CD13 in murine melanoma cells increased the size of subcutaneous tumors, extent of lung metastasis and degree of angiogenesis in the subcutaneous tumors; these tumor‐promoting and angiogenesis‐promoting characteristics were reduced by the i.p. administration of MT95‐4. To further verify the specificity of MT95‐4 for neutralization of APN/CD13 activity, MT95‐4 was administered into NOD/SCID mice inoculated s.c. with H1299 or PC14 cells, which exhibit high expression of APN/CD13, or with A549 cells, which exhibit weak expression of APN/CD13. MT95‐4 reduced tumor growth and angiogenesis in mice bearing H1299‐derived and PC14‐derived tumors, but not in mice bearing A549‐derived tumors. These results suggested that the antitumor and anti‐angiogenic effects of MT95‐4 were dependent on APN/CD13 expression in tumor cells. Given that MT95‐4 is the first fully humanized monoclonal antibody against APN/CD13, MT95‐4 should be recognized as a promising candidate for monoclonal antibody therapy against tumors expressing APN/CD13.     

Striking effect of left ventricular high filling pressure with mitral regurgitation on mitral annular velocity during early diastole. A study using colour M-mode tissue Doppler imaging.

AIMS: To evaluate the effect of considerably high left ventricular filling pressure with mitral regurgitation on mitral annular velocity during early diastole. SUBJECTS: Two hundred and forty-three patients who underwent cardiac catheterization for evaluation of chest pain. METHODS: Mitral annular velocity during early diastole was measured by colour M-mode tissue Doppler imaging. Patients were divided into the following three groups according to the cardiac catheterization data. Group A (n=147): patients having left ventricular relaxation time constant tau<46 ms and left ventricular end-systolic volume index <38 ml m(-2); group B (n=88): patients having tau>or=46 ms and/or end-systolic volume index >or=38 ml m(-2); group C (n=8): patients having mean pulmonary capillary wedge pressure >or=16 mmHg in addition to tau>or=46 ms and end-systolic volume index >or=38 ml m(-2). RESULTS: Mitral annular velocity during early diastole was significantly less in group B (4.8+/-1.4 cm s(-1)) than in group A (7.7+/-1.9 cm s(-1)). However, there was no significant difference between groups A and C (8.3+/-0.8 cm s(-1)). A transmitral E/A >1.0 was observed in 12/147 patients of group A, 10/88 of group B, and 8/8 of group C. The incidence of >or=Sellers' grade II mitral regurgitation was higher in group C than the others. CONCLUSIONS: A paradoxically faster mitral annular velocity during early diastole is found in patients having left ventricular dysfunction with moderate to severe mitral regurgitation and considerably high left ventricular filling pressure. Attention should be paid to an interpretation of mitral annular velocity during early diastole regarding left ventricular early diastolic performance in patients having mitral regurgitation with an E/A >1.0 in their transmitral flow.     

Intracystic hemorrhage of a simple liver cyst mimicking a biliary cystadenocarcinoma

Simple liver cysts are rarely complicated by intracystic hemorrhage. We encountered a case of simple liver cyst that was morphologically similar to biliary cystadenocarcinoma, which was complicated by asymptomatic intracystic hemorrhage and successfully treated by right lobectomy. A large cystic lesion of the liver was detected in a 57-year-old woman during a mass screening health check. Abdominal ultrasonography (US) revealed that the cystic lesion, containing many hyperechoic papillary structures, occupied almost the entire region of the right hepatic lobe. In addition, a round mural nodule, measuring approximately 5 cm in diameter, was detected in the cystic wall. Abdominal computed tomography (CT) revealed that the inner part of the cystic lesion showed homogeneous low density, but CT did not show the round nodule detected by US. On T1-weighted sequence of magnetic resonance imaging (MRI), the lesion showed homogeneous high signals, together with a low-signal tumorous lesion in the cystic wall. T2-weighted sequence of MRI showed unhomogeneous high signals, together with high signals in the tumorous part. These findings did not exclude the possibility of a malignant cystic tumor, such as biliary cystadenocarcinoma. Therefore, right lobectomy was performed. Histological examinations of resected tissue specimens revealed that the lesion was a liver cyst containing a large amount of blood clot, and that the tumorous lesion detected by US and MRI was a large mass of blood clot which was partly liquefied. This case indicates the diagnostic importance of the morphological discordance between CT and US or MRI findings for liver cyst containing a large amount of blood clot. Received: May 7, 2001 / Accepted: December 27, 2001 Reprint requests to: Y. Kitajima     

Evaluation of endoscopic ultrasonography in colorectal villous lesions

BACKGROUND AND AIMS: The choice of therapeutic procedure for colorectal neoplasias depends largely on the depth of tumor invasion. This study examined the value of endoscopic ultrasonography (EUS) in determining whether local resection is applicable for colorectal villous lesions. MATERIALS AND METHODS: We performed EUS on 125 colorectal neoplasias classified into two categories, villous ( n=35) and nonvillous lesions ( n=90), according to their colonoscopic morphological features. We compared the EUS and clinicopathological findings for each lesion. RESULTS: The overall accuracy of EUS-based evaluation of tumor invasion depth was 60% in villous lesions and 91% in nonvillous lesions. In villous lesions 37% were overstaged and 3% understaged, and in of nonvillous lesions 6% were overstaged and 3% understaged. In differentiating mucosal neoplasias (M)/submucosal cancers with slight invasion (SM-s) from non-M/SM-s, the values in villous and nonvillous lesions were, respectively: sensitivity 60% and 86%, specificity 100% and 99%, and accuracy 66% and 96%. Large (>/=20 mm wide, >/=5 mm high) or rectal villous lesions were more likely than nonvillous lesions to be misjudged with regard to the differentiation between M/SM-s and non-M/SM-s. CONCLUSION: It is difficult to determine the depth of invasion in villous lesions, especially large or rectal lesions, using only EUS. EUS-based evaluation alone cannot determine the appropriate treatment for colorectal villous lesions.     

Recurrent hepatocellular carcinoma with rapid growth after cardiac surgery

A 65-year-old man diagnosed with hepatitis C virus-positive hepatitis and severe valvular heart disease was scheduled to undergo cardiac valve replacement. We then found hepatocellular carcinoma in the liver. Because of his severe cardiac dysfunction, we treated him surgically with radiofrequency ablation for the hepatocellular carcinoma only. We continued medical treatment of the heart disease. He hoped to undergo with cardiac surgery one year later for the cardiac dysfunction. There was no evidence of tumor recurrence. We informed him that cardiac surgery requiring extracorporeal circulation might lead to tumor recurrence. He agreed to cardiac valve replacement, and the surgery was successful. Recurrent hepatocellular carcinoma was found in the liver 1 month after the surgery. Over the next month, the tumor progressed rapidly, showing portal vein thrombi. We believe the use of extracorporeal circulation in particular triggered the rapid growth of the recurrent hepatocellular carcinoma. This is the first report of a recurrent hepatocellular carcinoma associated with hepatitis C virus that progressed extensively after cardiac surgery.     

Transforming growth factor-beta gene polymorphism in sarcoidosis and tuberculosis patients.

SETTING: Transforming growth factor-beta (TGF-beta) plays an important role in many diseases, influencing as it does such processes as immune responses, fibrosing processes, and angiogenesis. Recently, polymorphisms have been described for TGF-beta that are associated with the risk of several diseases. In this study, we investigated whether TGF-beta 1 polymorphism has an effect on sarcoidosis and tuberculosis. OBJECTIVE: TGF-beta 1 Codon 10 T869C polymorphism was investigated in 110 healthy control subjects, 104 sarcoidosis patients, and 101 tuberculosis patients. DESIGN: The TGF-beta genotype was determined using polymerase chain reaction restriction fragment length polymorphism. RESULTS: We found no significant differences in TGF-beta genotypes between sarcoidosis patients and healthy controls or tuberculosis patients and controls. The long axis of the tuberculin skin test was larger in the CC type compared with the CT type. However, there was no association between the TGF-beta genotype and the roentgenographic stage, the disappearance of shadows, or organ involvement in sarcoidosis, nor any association between genotype, the extent or type of roentgenographic shadow, or detected volume of tubercle bacilli in tuberculosis. CONCLUSION: From the results, we believe that TGF-beta polymorphisms on the whole do not have a strong influence on disease onset or clinical progression in sarcoidosis and tuberculosis, although this polymorphism might have an effect on the immune response in a tuberculosis host.