Autoantibodies frequently detected in patients with aplastic anemia

Although accumulating evidence strongly suggests that aplastic anemia (AA) is a T cell-mediated autoimmune disease, no target antigens have yet been described for AA. In autoimmune diseases, target autoantigens frequently induce not only cellular T-cell responses but also humoral B-cell responses. We hypothesized that the presence of antigen-specific autoantibodies could be used as a "surrogate marker" for the identification of target T-cell autoantigens in AA patients. We screened a human fetal liver library for serologic reactivity against hematopoietic stem/progenitor cell antigens and isolated 32 genes. In 7 of 18 AA patients, an immunoglobulin G (IgG) antibody response was detected to one of the genes, kinectin, which is expressed in all hematopoietic cell lineages tested including CD34+ cells. No response to kinectin was detected in healthy volunteers, multiply transfused non-AA patients, or patients with other autoimmune diseases. Epitope mapping of IgG autoantibodies against kinectin revealed that the responses to several of the epitopes were shared by different AA patients. Moreover, CD8+ cytotoxic T cells raised against kinectin-derived peptides suppressed the colony formation of granulocyte macrophage colony-forming units (CFU-GMs) in an HLA class I-restricted fashion. These results suggest that kinectin may be a candidate autoantigen that is involved in the pathophysiology of AA.     

High body mass index correlates with increased risk of venous irritation by vinorelbine infusion

BACKGROUND: Vinorelbine is currently one of the most active chemotherapeutic agents. However, it is also a moderate vesicant that is well known to cause venous irritation and phlebitis. We conducted this study to identify clinical risk factors related to the incidence of venous irritation caused by peripheral vinorelbine infusion. METHODS: Medical records were used to investigate retrospectively a total of 201 cases of non-small cell lung cancer treated with a chemotherapeutic regimen containing vinorelbine. Venous irritation was evaluated in every course and graded according to the National Cancer Institute Common Toxicity Criteria version 2.0. Gender, age, body mass index (BMI), chemotherapeutic regimen, dose of vinorelbine and prior chemotherapy were used as clinical variables. RESULTS: A total of 928 vinorelbine infusions were administered to the 201 patients, among whom venous irritation occurred in 63 (31%). The incidence of venous irritation was 28% in the normal BMI (<25) group and 45% in the high BMI (25 or more) group and the difference between the two groups was statistically significant (P = 0.037). There were no significant correlations between the incidence of venous irritation and the clinical variables except BMI. In the multivariate analysis BMI was also a significant independent variable that correlated with increased risk of venous irritation (P = 0.017). CONCLUSIONS: Care is required when using vinorelbine to treat patients with a high BMI, especially with regard to the development of venous irritation.     

Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens

BACKGROUND: A proper understanding of prostatic and periprostatic anatomy is essential for surgical procedures and pathological diagnosis; however, the detailed features have not been commonly investigated and completely understood. METHODS: Seventy-nine non-nerve-sparing radical prostatectomy specimens were microscopically investigated for Denonvilliers' fascia, lateral pelvic fascia, prostatic capsule, anterior fibromuscular stroma and the neurovascular bundle. RESULTS: At the lateral aspect, the lateral pelvic fascia and the prostatic capsule were separated by adipose tissue in 41 cases (52%), whereas they adhered in 38 cases (48%). In only 41 cases (52%), the neurovascular bundle existed locally at the postero-lateral region with definite 'bundle' formations. Denonvilliers' fascia and the prostatic capsule adhered tightly at the center of the posterior aspect in 77 cases (97%). A smooth transition from the prostatic capsule to the anterior fibromuscular stroma was observed in all cases. In 70 cases (89%), no prostatic capsule was independently recognized at the anterior aspect. In the remaining 9 cases (11%), the capsule was recognizable as distinct from the anterior fibromuscular stroma. In 67 cases (85%), the lateral pelvic fascia connected and fused with the anterior fibromuscular stroma, and covered the outermost regions of the lateral and anterior surfaces. CONCLUSIONS: All the periprostatic structures are closely related and influence each other. The results support the rationale of anatomical radical prostatectomy, and should be taken into consideration for surgical procedures and pathological diagnosis.     

A case of liver metastases of breast cancer successfully treated by combination chemotherapy using hepatic arterial infusion of docetaxel and systemic administration of trastuzumab

A 43-year-old woman underwent breast-conserving therapy for right breast cancer with multiple liver metastases (pT3N3aM1, stage IV, ER (-), PgR (-), HER2 (3+)), in November, 2002. Following surgery, she received combination chemotherapy using hepatic arterial infusion of docetaxel and systemic administration of trastuzumab weekly. During therapy, no serious side effects and only grade 1 nausea were observed; after 3 courses, therapy was safely continued on an outpatient basis. Metastatic liver tumors responded to the treatment, and they completely disappeared on an abdominal CT 5 months later. In addition, all elevated tumor markers in serum decreased to the normal range. No new metastatic or recurrent lesions were found 14 months after surgery. We conclude that this combination chemotherapy is safe and may be very useful for the treatment of breast cancer patients with liver metastasis.     

Successful treatment of multiple pulmonary metastases of adenoid cystic carcinoma of the external auditory meatus with TS-1

The patient, a 67-year old man, was referred to us with refractory otorrhea of the left ear. The diagnosis was adenoid cystic carcinoma of the external auditory meatus, so the primary focus was excised. During the postoperative observation period, multiple metastases to the lung were noted, for which TS-1 (120 mg/day, given for 28 consecutive days, each course followed by a discontinuation of 14 days) was administered. After the completion of 2 courses, reductions in the metastatic pulmonary lesions and the amount of pleural effusion were noted, while adverse effects were limited to mild anorexia. Thus, it was possible to continue medication for 15 months on an ambulatory basis. It was indicated that TS-1 may be effective in the treatment of multiple pulmonary metastases of adenoid cystic carcinoma.     

An advanced case of squamous cell carcinoma in the left buccal mucosa, upper gingiva, and maxillary sinus (T4N0M0) showing a complete response to chemotherapy with TS-1

We report a case of advanced squamous cell carcinoma in the left buccal mucosa, upper gingiva, and maxillary sinus (T4N0M0) showing a complete response to oral chemotherapy with TS-1. The patient was an 89-year-old female with severe dementia. We carried out chemotherapy with TS-1 50 mg/day, without surgical treatment. The tumor disappeared clinically at 4 months after 3 courses of the TS-1 administration. Adverse drug reactions, including vomiting, leukopenia and thrombopenia, forced a stop of the administration of TS-1. Although she finally died of in senescence 2 months from the cease of administration, there was no recurrence of the cancer at the time.     

Plasminogen activator inhibitor-1 is a downstream mediator of the PGP9.5-related oncogenic pathway in esophageal squamous cell carcinoma

BACKGROUND & MATERIALS AND METHODS: Recently, it has been proved that PGP9.5 is an oncogene candidate for squamous cell carcinomas. To examine the PGP9.5-related oncogenic pathway, we tested for global patterns of gene expression in cancer cells following PGP9.5 gene introduction using an oligonucleotide microarray approach. RESULTS: Plasminogen activator inhibitor-1 (PAI-1) was identified as an overexpressed gene in a PGP9.5-expressed esophageal squamous cancer cell line. To confirm the data obtained, we performed Northern analysis using a PGP9.5 or a PAI-1 cDNA probe and found that PAI-1 mRNA was induced by PGP9.5 expression in NUEC1 cells. We further examined endogenous PGP9.5 and PAI-1 expression in 6 esophageal cancer cell lines. One cell line (NUEC2) with PGP9.5 expression exhibited PAI-1 expression, suggesting the possibility that PGP9.5 might induce PAI-1 directly or indirectly. CONCLUSION: These results suggested that PAI-1 might be a novel downstream mediator of PGP9.5 in esophageal squamous cell carcinomas.     

Phthirus pubis infestation of the eyelashes and scalp hairs in a girl

A 4-year-old girl was seen because of foreign bodies on the eyelashes. Parasites and their nits were seen on the patient's eyelashes and scalp. Her parents denied having Phthirus pubis infection of the axillary, pubic, or body hair, despite confirmation of the infestation in their child. The parasites were removed and the lashes with nits were cut off at the base. The parasite was identified as P. pubis. The scalp was washed with phenothrin shampoo. One month later no P. pubis infestation was found. Removal of the parasites, cutting the lashes at the base, and using phenothrin shampoo on the scalp were effective in resolving phthiriasis.     

Creeping eruption caused by a larva of the suborder Spirurina type X

We report a case of creeping eruption caused by a larva of the suborder Spirurina type X, which developed in a 46-year-old Japanese male. The patient ate small raw squids (Watasenia scintillans) 5 days before the onset of symptoms. On examination, an approximately 25-cm-long serpiginous red track with vesicles was observed from the right to the upper left side of the abdomen of the patient. Histological examination revealed the transverse section of a larval worm in the upper to middle dermis.The patient serum was positive only for the antibody against larvae of the suborder Spirurina type X in ELISA, and negative for all other anti-parasite antibodies. Because a considerable number of people are fond of eating raw or nearly-raw fish and shellfish in Japan, opportunities for developing creeping eruption cause by parasites present in raw fish and shellfish are relatively high.