Autoimmune hepatitis associated with Graves' disease

A 31-year-old woman with Graves' disease with a 12-month-history of propylthiouracil intake and autoantibodies in the sera was admitted to our hospital. The differential diagnosis between autoimmune hepatitis and propylthiouracil-induced hepatitis was intractable. Steroid therapy was started and she showed a complete response to the treatment. Liver biopsy demonstrated acute hepatitis and plasma cell infiltration. A second liver biopsy, which was performed 10 months after starting steroid therapy, showed some inflammatory cells in the portal tracts. These findings suggest that she had been suffering from autoimmune hepatitis.     

A technique for the measurement of visceral fat by ultrasonography: comparison of measurements by ultrasonography and computed tomography

OBJECTIVE: This study aims to create a method of calculating intra-abdominal visceral fat volume by using ultrasound (US). The visceral fat volume measured by US was evaluated by comparison with the volume measured by computed tomography (CT). METHODS: Eighty-seven patients (52 males and 35 females) were enrolled in this study. Both US and CT were performed, and the visceral fat volume was measured. Both the distance and thickness of the parameters in US were measured as follows: 1) the distance between the internal surface of the abdominal muscle and the splenic vein, 2) the distance between the internal surface of the abdominal muscle and the posterior wall of aorta on the umbilicus, and 3) the thickness of the fat layer of the posterior right renal wall. RESULTS: The equation was calculated as follows: [visceral fat volume]=-9.008+1.191x[distance between the internal surface of the abdominal muscle and the splenic vein (mm)]+0.987x[distance between the internal surface of the abdominal muscle and the posterior wall of the aorta on the umbilicus (mm)]+3.644x[thickness of the fat layer of the posterior right renal wall (mm)]. There was a good correlation between the visceral fat volume calculated by the above equation and the volume by CT described (r=0.860, p<0.0001). CONCLUSION: The measurement of the visceral fat volume using US provided results as effectively as CT, and it was proven to be a useful method.     

Spindle cell carcinoma arising at the buccal mucosa: a case report and review of the literature

Aims:

Spindle cell carcinoma (SPCC) is a subtype of squamous cell carcinoma, and it mainly occurs in the upper aerodigestive duct. On the other hand, it rarely arises in the head and neck region. The prognosis of this tumor is usually poor because of its highly malignant behavior, such as its high incidence of recurrence or metastasis to cervical lymph nodes. However, the number of accumulated cases is still too low to provide the full details of SPCC.

Methodology:

The case of SPCC was counted by using database, PubMed. The authors also present a case of SPCC arising at the left buccal mucosa in a 72-year-old Japanese female in the current study.

Results:

Only six cases of SPCC arising at the buccal mucosa have been reported previously. The authors’ patient died from a recurrent tumor 15 months after the first operation.

Conclusion:

The authors have added this case to the previous knowledge of SPCC arising at the buccal mucosa, and discuss the clinical behavior of SPCC to help suggest a standard treatment strategy for the disease.     

A case of bleeding duodenal ulcer with pemphigus vulgaris during steroid therapy

We report a rare case of bleeding duodenal ulceration in the different form of pemphigus vulgaris (PV). A 52-year-old female was diagnosed with acute pharyngitis and administered methylprednisolone. After several days, melena and many blisters were noted on her body. Endoscopy revealed blood oozing from the second part of a duodeneal ulcer around the major duodenal papilla. After initial endoscopic hemostasis, we observed a large regional, shallow duodenal ulcer. The blisters were suspected to represent the Nikolsky’s sign. The histological findings of her skin were characterized by suprabasal acantholysis and mixed inflammatory cell infiltrates, including scattered eosinophils. There were no other significant findings on skin biopsy or by direct immunofluorescence. Enzyme-linked immunosorbent assay showed an elevated titer of anti-desmoglein 3 autoantibodies in her serum, and the patient was finally diagnosed with mucosal-dominant PV. Although we performed multiple biopsies from the esophagus, stomach and duodenum, the samples did not contain significant findings to enable us to distinguish from pemphigus vulgaris. Corticosteroids remain an essential component of PV treatment. When clinicians encounter PV development during steroid therapy, upper gastrointestinal complications should be considered and diagnostic endoscopy conducted.