Identification of oral bacteria by 16S rRNA gene analysis in elderly persons requiring nursing care

After incubation of saliva from 58 semi-bedridden elderly persons, the cultures were identified based on the 16S rRNA gene base sequence to compare the identification by the conventional culture method. As a result, the 16S rRNA gene base sequence of 198 strains identified by the culture method showed 98.5% or more homology in some of the Human Oral Microbiome database, and the identification of bacterial species and genus was possible. When an organism identified by the 16S rRNA gene sequencing method was compared with that by the culture method, the concordance rates were 54.5% at the genus level and 35.9% at the species level. Streptococcus mitis strains most frequently isolated from saliva that were identified by the culture method were identified as the same species by the 16S rRNA gene sequencing method (32/35), and all the 11 Streptococcus salivarius strains identified by the culture method were identified as the same species by the 16S rRNA gene sequencing method. All the strains identified as Streptococcus anginosus group by the culture method and 8 of the 9 strains identified as Prevotella species by the culture method were identified as the same group and genus by the 16S rRNA gene sequencing method. When an oral microbial flora test with saliva samples from elderly persons is performed, the 16S rRNA gene sequence identification enables us to identify major indigenous bacteria and pathogenic bacteria and is considered useful as a means of supplementing the conventional culture method.     

Aggressive digital papillary adenocarcinoma 5 years after surgical resection of adenoma on index finger

We experienced 72-year-old male who was diagnosed aggressive digital papillary adenocarcinoma (ADPAca) on his right index finger. He had a history of surgical excision of the tumor diagnosed aggressive digital papillary adenoma (ADPA) at the same site 5 years before. After the diagnosis of second surgery, we added the third surgery for wide resection. There are no recurrence and metastasis at postoperative 3 years after third surgery. ADPA and ADPAca have been considered to be different disease by the pathological findings. However, there were many opinions that they should be the same disease clinically because rates of metastasis and local recurrence had no difference in two diseases. Our case experience strongly supported the two diseases should be considered as the same disease. We recommend additional excision of the tumor even the pathological diagnosis is benign as ADPA.     

Clear-cell adenocarcinoma of the uterine cervix in a 17-year-old adolescent

This report describes the case of the youngest Japanese person to be diagnosed with endocervical clearcell adenocarcinoma. In September 2005, a 17-year-old female adolescent visited a physician because of vaginal bleeding. A cervical tumor was discovered, and the patient was referred to our outpatient department. Vaginal examination showed a bleeding tumor approximately 1.5 cm in size protruding from the cervical os. The cytological finding of the uterine cervix was positive for malignancy, and the histological diagnosis by punch biopsy was clear-cell adenocarcinoma of the uterine cervix. A radical abdominal hysterectomy and pelvic lymphadenectomy were performed on October 30. Macroscopic findings showed a tumor, 1.5 cm in diameter, growing from the right side of the uterine cervix. The pathological diagnosis was clear-cell adenocarcinoma of the cervix (PT1b1NR0M0). The patient was discharged from our hospital without any adjuvant therapy. No signs of recurrence have been detected in the 2-year follow up.     

Carpal tunnel pressure in patients with carpal tunnel syndrome due to long-term hemodialysis

We studied carpal tunnel pressure and outcome of endoscopic carpal tunnel release in 42 patients (53 hands) with carpal tunnel syndrome (CTS) and receiving long-term hemodialysis. We compared these results with those of 41 patients (49 hands) with idiopathic CTS. Pressure was measured peroperatively: first, before dilation of the carpal tunnel; second, after dilation but before release of the transverse carpal ligament; and third, after completion of the release. In patients receiving long-term hemodialysis, the highest pressures were 76.9, 56.0, and 7.8 mmHg respectively. In patients with idiopathic CTS, pressures were 68.8, 44.1, and 4.0 mmHg respectively. The clinical outcome was inferior in patients receiving long-term hemodialysis.     

Studies on the risk factors for fenofibrate-induced elevation of liver function tests

We evaluated risk factors for elevation of liver function test values after administration of fenofibrate to 45 hyperlipidemic patients. The effects of 23 factors of physical examinations, clinical laboratory test values, and the background of the patients on the elevation of liver function test values were analyzed by the logistic regression method. The increase of the values of liver function tests was found to be correlated with BMI, serum levels of triglycerides, and ALP before therapy, especially sex, serum gamma-GTP level before therapy and reduced serum triglyceride levels. These results suggest that caution must be exercised to avoid liver dysfunction in patients treated with fenofibrate.     

Rhubarb use in patients treated with Kampo medicines--a risk for gastric cancer?

In vitro mutagenic effects have been reported for ingredients contained in rhubarb. Therefore, rhubarb (Rhei Rhizoma) as an anthranoid laxative could be associated with a risk of developing gastric cancer as well as colorectal cancer. We are not aware of any reports that have examined the relationship between the use of rhubarb and the development of gastric cancer. During the period between 1979 and 1999, we treated 14,616 patients using various Kampo medicines, which sometimes contained rhubarb. In the present study, we determined whether patients, diagnosed with gastric cancer during the period between 1979 and 1999, had been administered rhubarb before the development of gastric cancer. Among the 10 enrolled patients, only 2 patients had been administered rhubarb before the development of gastric carcinoma. The other 8 patients had never received rhubarb before the development of gastric carcinoma. Rhubarb use may have little connection with the development of gastric cancer in practice, even if some ingredients in rhubarb have shown carcinogenic activity in experimental studies.