Diffuse large B‐cell lymphoma initially presenting with peritoneal dissemination

A 62‐year‐old woman with a severely distended abdomen and no palpable superficial lymph nodes visited the hospital. Computed tomography with contrast enhancement revealed multiple fused and homogeneously contrasting masses filling the abdominal cavity. She was diagnosed with diffuse large B‐cell lymphoma by ultrasound‐guided needle biopsy performed on admission.     

Mental stress test is an effective inducer of vasospastic angina pectoris: comparison with cold pressor, hyperventilation and master two-step exercise test.

BACKGROUND: Cold pressor, hyperventilation and exercise stress tests were usually used for inducing an angina attack in patients with vasospastic angina pectoris. We induced vasospastic angina attack using the mental calculation stress test, and compared the results with those using other stress tests. SUBJECTS AND METHODS: Subjects were 29 patients with vasospastic angina pectoris. Their ages were 60.8+/-8.4 years. Coronary vasospasm was induced by an acetylcholine infusion test during coronary angiography. The mental stress test was performed as follows; after memorizing six digits numbers, they repeated these numbers in reverse for 5 min, and performed serial subtraction of 17 from 1000 for 5 min. Blood pressure, heart rate and ECG were recorded every 1-5 min during the mental stress test. The serum concentrations of epinephrine and norepinephrine were measured before and during the mental stress test. We compared these results with those obtained using cold pressor, hyperventilation and the Master two-step exercise stress test. RESULTS: (1) Eight of the 29 patients (28%) showed ischemic ST-T change, which was caused by the mental stress test. (2) The increase in norepinephrine was greater in patients with an ST-T change than without an ST-T change (0.11+/-0.06 vs. 0.04+/-0.04 ng/ml, P<0.01). (3) The incidence of the ST-T change caused by the mental stress test (28%) was similar to the cold pressor test (27%) and greater than that caused by the hyperventilation test (13%). The incidence of ST-T change caused by the Master two-step test was 55%. CONCLUSIONS: The mental stress test is an effective inducer of vasospastic angina attack, and attack may be induced by neurohumoral vasoconstrictive reflex and/or increased left ventricular afterload.     

Psychological Factors and Mortality Risk in a Rural Area of Japan

Background

The purpose of this study is to assess the association between psychological factors and mortality risk from all causes.

Methods

We used follow-up data for 4,181 persons from 40 to 79 years over a period of 17.6 years from one part of the Japan Collaborative Cohort Study (JACC Study). The status of the individuals comprising the data of the study as of the end of December 2006 was determined from their registration cards and death records. We calculated the proportions of selected variables among 5 psychological factors by sex. Cox’s proportional hazards model was used to evaluate the associations between psychological factors and mortality risk from all causes. Data were adjusted for age, medical history, education, job status, marital status, drinking, smoking, physical activity, sleeping duration, body mass index and breakfast.

Results

During the follow-up period, a total of 791 deaths were recorded. Men who reported feelings of being trusted had a decreased risk for mortality risk from all causes compared with the risk of those who reported “maybe”, whereas those without feelings of being trusted had increased risk for mortality risk from all causes.

Conclusion

This study suggests that the absence of feelings of being trusted increases the risk of all causes of mortality among middle-aged and elderly men in a rural area. Our findings suggest that interpersonal relationships comprise an important factor in longevity.     

Immunohistochemical localization of the proteinase inhibitor region of amyloid precursor proteins in the neocortex of Alzheimer's disease and aged controls

Summary The immunohistochemical localization of the proteinase inhibitor region of amyloid protein precursors (APPI) in the postmortem human neocortex was studied using a polyclonal antibody raised against a purified recombinant human APPI derivative produced by COS-1 cells. APPI-like immunoreactivity (APPI-LI) was found diffusely in the human neocortex. APPI-LI appeared as irregularly shaped granular structures. The size of the APPI-LI structures was 1–4 m in diameter. APPI-LI usually formed a cluster of 10- to 20-m diameter in the cortical gray matter and 20- to 40-m diameter in the subcortical white matter. Double staining for APPI and glial fibrillary acidic protein indicated that APPI-LI in the white matter and molecular layer was localized exclusively in the fibrillary astrocytes. In contrast, APPI-LI was found in neurons as well as in the fibrillary astrocytes in layers II through to VI. Under fluorescence microscopy, APPI-LI in both neurons and fibrillary astrocytes were found in close association with lipofuscin. The present observations indicate that APPI is localized in neurons and astrocytes in the human neocortex and that APPI may be associated with lipofuscin or lysosome in the human neocortex.     

Low extracellular Mg2+ concentrations suppress phagocytosis in vitro by alveolar macrophages from rats.

The aim of this study was to assess the effects of extracellular Mg2+ concentrations on phagocytosis in vitro by alveolar macrophages from rats. Phagocytosis was suppressed in the presence of low, but not high, Mg2+ concentrations. Vanadate, a Mg(2+)-ATPase inhibitor, suppressed phagocytosis. In the presence of a low Mg2+ concentration or vanadate, the cytosolic free Ca2+ concentration ([Ca2+]i) increased, but the cytosolic free Mg2+ concentration did not. These results suggest that low extracellular Mg2+ concentrations and vanadate suppress phagocytosis by rat alveolar macrophages by increasing [Ca2+]i.     

Electrocardiographic diagnosis of left ventricular hypertrophy accompanied by complete right bundle branch block]

The new electrocardiographic criteria for diagnosing left ventricular hypertrophy (LVH) were evaluated in patients with complete right bundle branch block (CRBBB) based on the relationships between left ventricular mass and multiple electrocardiographic variables obtained from 12-lead electrocardiograms. The subjects consisted of 88 patients with CRBBB, whose ages ranged from 18 to 86 years. Patients with histories of myocardial infarction, moderate to severe pericardial effusion and an undetermined axis were excluded from the study. LVH was defined as left ventricular mass (LVmass) > or = 215 g calculated from the Penn method using standard M-mode echo measurements. All electrocardiograms were interpreted by one investigator who had no knowledge of the echocardiographic results. Items calculated were the amplitude of Q, R, and S waves and their A/R, R/S, and S/A ratios, the mean frontal QRS axis, ventricular activation time in lead V5, the Morris' index, ST-T segment depression in leads V5,6, and negative U waves in leads V5,6. We selected 22 items for our criteria according to their sensitivity and specificity, and added to the 11 previously reported ones determined. LV wall thickness correlated best with R I (r = 0.57, p < 0.01), LV diastolic dimension with RV5 (r = 0.48, p < 0.01), and LV mass with R I+S III (r = 0.60, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Successful treatment of weekly paclitaxel for a patient with recurrent lung cancer

A 44-year-old man with recurrent lung cancer was readmitted to the hospital for chemotherapy. He was first treated by chemotherapy of CDDP + etoposide, after which the chemotherapy was changed to a regimen of weekly paclitaxel because of his desire to work. He could then be discharged from the hospital and return to his work. No side effects of this frequent schedule on his immune function were noted. He is now doing well and working. The regimen of weekly paclitaxel seemed to be effective in improving QOL because that regimen allowed him to work.