A case of cryopyrin-associated periodic fever syndrome during canakinumab administration complicated by inflammatory bowel disease

Clinical Rheumatology - Cryopyrin-associated periodic fever syndrome (CAPS) is a highly debilitating disorder, which is characterized by unregulated interleukin-1β production driven by...     

Endoscopic treatment for appendiceal intussusception due to barium stool impaction that mimics a submucosal tumor

Techniques in Coloproctology -     

C-type natriuretic peptide of rainbow trout (Oncorhynchus mykiss): primary structure and vasorelaxant activities

Natriuretic peptides (NPs) play important roles in osmoregulatory and cardiovascular systems of vertebrates. For functional studies of NPs, rainbow trout (Oncorhynchus mykiss), a euryhaline fish, is an interesting model. The information on homologous NPs of salmonid fish is, however, still incomplete with respect to C-type NP (CNP). In this study, we isolated cDNAs encoding the precursor of CNP from the brain of trout. Predicted mature CNP (CNP-22) sequence was identical to that of killifish Fundulus heteroclitus, and only one amino acid was different from that of the eel Anguilla japonica, demonstrating a greater conservation among different teleost species than is found with atrial NP (ANP) and ventricular NP (VNP). While the preprosegment of trout CNP retained 57% similarity to the eel sequence, similarities were low to those of sharks and tetrapods. The major site of expression identified by RT-PCR was the brain with minor expression in the atrium. The putative mature CNP-22 was synthesized and its biological activity was compared with other trout NPs (ANP and VNP) using trout ventral aorta, efferent branchial and celiacomesenteric arteries and anterior cardinal vein in vitro. Synthetic trout CNP-22 relaxed all pre-contracted vessels with potencies comparable to trout ANP and VNP.     

Correction to: Detection of acute rib fractures on CT images with convolutional neural networks: effect of location and type of fracture and reader’s experience

Emergency Radiology -     

Hemophagocytic syndrome as the primary clinical symptom of Hodgkin's disease

It is now well recognized that hemophagocytic syndrome (HPS) is occasionally associated with malignant lymphomas. However, its association with Hodgkin's disease has been only rarely reported. We present here a 72-year-old woman manifesting with HPS as the primary and solitary clinical symptom of Hodgkin's disease. She had been suffering from high-grade fever and anemia for more than a month. Based on the findings in bone marrow aspirates, she was diagnosed as having HPS. In spite of extensive surveys including various cultures, serological tests for collagen disease, abdominal and cardiac sonography, chest computed tomography (CT), and renal biopsy, the origin of the fever was not determined. She was treated with steroid pulse therapy and then referred. Radiological studies revealed only mild hepatosplenomegaly and small lymph node swellings around celiac and common hepatic arteries. Reevaluation of the bone marrow specimen revealed the infiltration of small numbers of CD30-, CD15-, and EBER-1-positive large-sized lymphocytes with bizarre nucleus. Under the diagnosis of Hodgkin's disease, she was treated with combination chemotherapy containing pirarubicin, cyclophosphamide, vincristine, and prednisolone. However, it was not effective and she died of rapidly progressive hepatic failure on the 5th day of the chemotherapy. Autopsy was performed, which showed proliferation of lymphoma cells in para-aortic lymph nodes. We believe that diagnostic survey to rule out the underlying lymphoma should be vigorously performed for patients with hemophagocytic syndrome of unknown origin.     

The dipsogenic effect of the renin-angiotensin system in elasmobranch fish.

This study investigated the control of drinking in elasmobranch fish through manipulation of the homologous renin-angiotensin system (RAS). The smooth muscle relaxant papaverine was found to increase basal drinking levels in the European lesser-spotted dogfish, Scyliorhinus canicula, almost 20-fold. However, this response was significantly reduced with the coadministration of the angiotensin-converting enzyme inhibitor captopril which had no effect when administered alone. Captopril was also found to block a 7-fold increase in drinking rate following administration of homologous angiotensin I in S. canicula. Finally, administration of homologous angiotensin II produced a dose-dependent response in drinking rate in two species of elasmobranchs, S. canicula and the Japanese dogfish, Triakis scyllia. These results demonstrate a central role of the RAS in the control of drinking in elasmobranch fish.     

Efficacy of preventive treatment for complications in percutaneous endoscopic gastrostomy in elderly

From September 1995 through May 1999, percutaneous endoscopic gastrostomy (PEG) was performed in 47 elderly patients, aged 65 to 93 (average 78.9). Several treatments were additionally performed to prevent serious complications in these cases, and their usefulness and problems were investigated. Gastropexy was performed to prevent peritonitis in cases of self-removal of tubes in the acute stage. Intraoperative fluoroscopy was used prevent perforation of the intestines. However, re-insertion of the endoscopic, which was necessary with the push method, was omitted to reduce the burden on the patients. In patients with tube troubles in the chronic stage such as the buried bumper syndrome or self-removal, the existing fistula was preserved and the gastrostomy was reconstructed using a narrow polyvinyl chloride tube and a flexible guide wire to prevent peritonitis by erroneous insertion of the tube. In terms of results, gastropexy was useful to prevent peritonitis in one patient with early self-removal of the tube. Data to evaluate the usefulness of fluoroscopy in preventing perforation of the intestine were insufficient, so more patients need to be studied in the future. Even when confirmation of the location of the internal bumper by endoscopy was omitted, there was no case of poor traction of the bumper, so this procedure seems unnecessary. Review of tube troubles, in the chronic stage revealed no case of peritonitis caused by erroneous insertion of tubes or erroneous injection of nutrients with our reconstruction methods, and complete reconstruction of the gastrostomy with preservation of the existing fistula appeared to be possible. However, those additional treatments require extension of the operation time and rise in cost with increased use of medical instruments, so the indications should be carefully considered.     

A single and novel natriuretic peptide is expressed in the heart and brain of the most primitive vertebrate,the hagfish (Eptatretus burgeri)

In teleost fish and tetrapods, the natriuretic peptide (NP) family consists of ANP (atrial natriuretic peptide), BNP (brain natriuretic peptide) and VNP (ventricular natriuretic peptide) that are secreted from the heart, and C-type natriuretic peptide (CNP) that is found in the brain. However, CNP is the only NP identified in the heart and brain of elasmobranchs, suggesting that it is the ancestral type of the NP family and that ANP, BNP and VNP appeared later in the vertebrate phylogeny. To delineate more clearly the molecular evolution of this hormone family, we determined the sequence of NP molecule(s) in evolutionarily the oldest vertebrate group, the cyclostomes. We have cloned a novel NP cDNA from the heart and brain of hagfish, Eptatretus burgeri, using the RACE method and degenerate primers that amplify all known types of NP cDNAs. The novel NP, named EbuNP after the scientific name of this hagfish, appears to be the only NP in the heart and brain, as no other NP cDNAs were amplified even after specific removal of the cloned EbuNP mRNA from the mRNA pool, except for a minor alternatively spliced EbuNP cDNA with a truncated 3'-untranslated sequence. The EbuNP was equally similar to known NPs but was not considered to be a CNP because of the presence of a C-terminal tail sequence. The EbuNP gene was abundantly expressed in the cardiac atrium, ventricle, portal heart and brain but scarcely in the intestine; no expression was observed in the gill and kidney. Mass spectrometry of affinity-purified EbuNP in plasma, heart and brain revealed a 68 amino acid peptide circulating in the blood and stored in the heart, which is cleaved at the typical cleavage signal of a processing enzyme, furin, as observed in mammalian BNP. The C-terminal Gly residue was used for amidation as is the case in eel ANP. The immunoreactive EbuNP was not detected in the brain, suggesting the presence of a different processing form in the brain. These results show that the molecular evolution of the NP family in vertebrates is more complex than previously thought.