Multicentric infantile myofibromatosis with spontaneous regression

We report a patient with multicentric infantile myofibromatosis who showed remarkable regression of the lesions. This 7-month-old male was admitted for evaluation of generalized subcutaneous tumor nodules. A radiographic bone survey revealed radiolucent lytic areas in the skull, axis, rib, humerus, femur, ilium, and tibia that resembled a primary neoplasm with multiple metastases. An exisional biopsy, however, led to a diagnosis of infantile myofibromatosis. All the subcutaneous nodules regressed spontaneously within 1 year and 9 months. Correspondence to: Y. Yamaguchi     

A case of confluent and reticulated papillomatosis responsive to ketoconazole cream.

We described here a case of a 43-year-old male who developed confluent and reticulated papillomatosis (CRP). The patient was found to be slightly obese and had no family history of such eruption. Numerous small red-brown erythemas were scattered over a wide area of the back and, in many areas, the erythemas coalesced and formed a reticular pattern. The eruptions appeared 10 days prior to the initial visit to our outpatient clinic. The Parker-KOH preparation of scraped scales revealed numerous round and budding non-clustering cells and no mycelial elements. Histological examination showed subtle papillomatosis and sparse perivascular lymphohistiocytic infiltrations. Periodic acid schiff stain showed a few spores in the stratum corneum. Topical application of 2% ketoconazole cream produced complete resolution of the eruption in 7 days. The course and histological findings of our patient suggest the eruptions were developing CRP lesions. Application of topical antifungal agents appears to be a beneficial initial treatment for early CRP lesions.     

The use of chitin as a new absorbable suture material—An experimental study

A comparative study of four absorbable suture materials, namely; poly-N-acetylglucosamine (Chitin), polyglycolic acid (PGA), plain catgut and chromic catgut, in terms of strength, elongation, tensile strength retention and tissue reaction, was undertaken. The straight pull strength of USP 3–0 size Chitin was over 2.6 kg, compared with PGA, which was over 3.4 kg and the catguts, which were over 2.0 kg. Chitin showed the lowest elongation among the four. The tensile strength retention (TSR) of Chitin in muscle was 45 per cent at 14 days and 7 per cent at 25 days, which was similar to that of PGA. The TSR of Chitin was maintained by 35 per cent in gastric juice, 97 per cent in bile and 100 per cent in pancreatic juice after immersion for 30 days. The corresponding values for PGA were 54 per cent, 0 per cent and 0 per cent, respectively, whereas both catguts had dissolved within 30 days. The tissue reaction of Chitin was similar to that of PGA, whereas the catguts caused more intense tissue reaction.     

Phase I study of fixed dose rate infusion of gemcitabine in patients with unresectable pancreatic cancer

OBJECTIVE: The purpose of this study was to determine the feasible dose of gemcitabine when administered as a fixed dose rate infusion (10 mg/m(2)/min) on a weekly schedule to Japanese patients with unresectable advanced pancreatic cancer. METHODS: Patients were required to have histologically or cytologically proven locally advanced or metastatic pancreatic cancer for which they had received no previous chemotherapy. Gemcitabine was administered intravenously weekly for three consecutive weeks every 4 weeks. Patients at three dose levels were scheduled to receive escalating doses of gemcitabine: 1000 mg/m(2) over 100 min (Level 1), 1200 mg/m(2) over 120 min (Level 2) and 1500 mg/m(2) over 150 min (Level 3). RESULTS: A total of 16 patients were enrolled in this study between December 2003 and September 2004. Maximum-tolerated dose was not reached during the first course. Dose-limiting toxicity was Grade 4 neutropenia. Grade 3 or 4 neutropenia was observed at Level 3 in all six patients in the first course, and administration of gemcitabine on Day 8 or 15 was skipped in all six patients. Non-hematologic toxicity was mild and the most common symptoms were anorexia, nausea and vomiting. Partial response was achieved in 1 of the 17 patients (7%). Median overall survival was 7.3 months. CONCLUSIONS: Gemcitabine administered at a rate of 10 mg/m(2)/min was tolerated up to 1500 mg/m(2), but 1200 mg/m(2) represented a more appropriate recommended dose in further studies owing to neutropenia in Japanese patients with advanced pancreatic cancer.     

Crescentic glomerulonephritis associated with renal cell carcinoma after cancer immunotherapy

A 59 year-old woman showed rapidly progressive glomerulonephritis during immunotherapy for metastatic renal cell carcinoma. She received unilateral nephrectomy and cytotoxic T lymphocyte (CTL) therapy for the treatment of retroperitoneal lymph node metastasis of renal cell carcinoma. With CTL therapy, her retroperitoneal lymph node mass decreased in size. One year after the third round of CTL therapy, her serum creatinine was increased and massive proteinuria occurred. Her renal biopsy specimen revealed necrotizing and crescentic glomerulonephritis with immune complex deposition. Her retroperitoneal lymph node mass continued to decrease in size. Consequently, for the purpose of avoiding interfering with the CTL therapy, we performed double filtration plasmapheresis (DFPP) monotherapy for removal of immune complexes without using immunosuppressive drugs or prednisolone. After 24 sessions of DFPP, her serum IgG was reduced from 3,942 mg/dL to 2,400 mg/dL, and proteinuria (from 9.0 g/day to 0.9 g/day) and renal function (serum creatinine; from 5.6 mg/dL to 2.2 mg/dL) also improved. However, 3 months after the final DFPP, she expired due to perforation of the colon. The autopsy sample of the kidney showed that most of the glomeruli were obsolescent, but immunoglobulin depositions were reduced and necrotizing lesions were diminished. In the patients with RPGN associated with renal cell carcinoma, renal functional recovery has not been observed upon immunosuppressive treatment. Consequently, plasmapheresis is considered to be one of the effective and safe methods for patients with this association. We also discuss previous reports of RPGN associated with renal cell carcinoma, or RPGN after cancer immunotherapy.