Serial evaluation of high-resolution computed tomography findings in patients with idiopathic pulmonary fibrosis in usual interstitial pneumonia

BACKGROUND: The development of well-matured fibrosis in usual interstitial pneumonia (UIP) is strongly associated with an unfavorable outcome of patients with idiopathic pulmonary fibrosis (IPF). However, differences in the rates of development are likely to result in variable clinical courses in IPF patients. OBJECTIVE: We tried to evaluate the progression of honeycombing and ground-glass opacity on CT using a scoring system, and to examine those serial changes in the clinical course of disease. METHODS: A hospital-based, retrospective cohort study. Twenty-three patients with IPF diagnosed as UIP by surgical lung biopsy were analyzed during the initial examination by scoring the presence of honeycombing (HC: range, 0-24) and ground-glass opacity (GG: range, 0-24) on CT scan. We also compared the serial changes observed in the CT scores (interval: 2-42 months, 2-6 examinations). RESULTS: (1) The serial change in the HC score in treated patients (n = 10) was similar to that in untreated patients (n = 16); (2) the HC score at the time of the initial examination and the rate of HC progression were both higher in the non-surviving patients (HC 12.3 +/- 3.7, mean +/- SD; deltaHC 4.2 +/- 1.3 per year) than in the surviving patients (HC 5.8 +/- 2.7; deltaHC 1.2 +/- 0.7 per year) (p < 0.05); (3) the GG score did not correlate with the HC score at any of the examinations; (4) the HC score was higher in the lower lung field than in the upper and middle lung fields. CONCLUSIONS: Scoring of the honeycombing and its serial changes using the high-resolution computed tomography scoring method was useful for predicting the prognosis in patients with IPF/UIP. Corticosteroid treatment did not prevent the progression of HC.     

Regression of atypical lymphoid hyperplasia after eradication ofHelicobacter pylori

A rare case of endescopic and histological regression of a gastric lymphoid mucosal lesion after eradication ofHelicobacter pylori is reported. A 72-year-old man was suspected of having a low-grade B-cell gastric mucosa-associated lymphoid tissue (MALT) lymphoma by endoscopic and histological findings. Histology of biopsy specimens showed massive infiltration of atypical lymphocytes and lymphoepithelial lesions. Immunohistochemical staining revealed kappa light chain expression in the infiltrated atypical lymphocytes to be twofold that of lambda light chain. The above diagnosis was thus highly suspected but not confirmed. Antibiotic therapy was given on the basis of evidence ofH. pylori infection. Successful eradication ofH. pylori resulted in remarkable improvement of endoscopic and histological findings. Follow-up studies were carried out 8 months after eradication, with no evidence of relapse. The eradication ofH. pylori appears to be an effective alternative therapy for B-cell lymphoproliferative disease, although longer follow-up and further studies are needed before this treatment can be establisted.     

Allograft liver failure awaiting liver transplantation in Japan

Journal of Gastroenterology - Following liver transplantation (LT), allograft liver failure can be developed by various causes and requires re-LT. Hence, this study aimed to clarify the...     

Clinical implications of local impedance measurement using the IntellaNav MiFi OI ablation catheter: an ex vivo study

Journal of Interventional Cardiac Electrophysiology - Clinical implication of local impedance (LI) for radiofrequency (RF) ablation has not been fully established. This study aimed to investigate...     

Anti-myeloma effect of homoharringtonine with concomitant targeting of the myeloma-promoting molecules, Mcl-1, XIAP, and β-catenin

Since a variety of cell intrinsic and extrinsic molecular abnormalities cooperatively promote tumor formation in multiple myeloma (MM), therapeutic approaches that concomitantly target more than one molecule are increasingly attractive. We herein demonstrate the anti-myeloma effect of a cephalotaxus alkaloid, homoharringtonine (HHT), an inhibitor of protein synthesis, through the induction of apoptosis. HHT significantly reduced Mcl-1, a crucial protein involved in myeloma cell survival, in all three myeloma cell lines examined, whereas certain BH3-only proteins, such as Bim, Bik, and Puma, remained unchanged following HHT treatment, and their expression levels depended on the cell type. HHT also reduced the levels of c-FLIP(L/S), activated caspase-8, and induced active truncated-Bid. Thus, HHT-induced apoptosis appears to be mediated via both intrinsic and extrinsic apoptosis pathways, and the resultant imbalance between BH3-only proteins and Mcl-1 may be pivotal for apoptosis by HHT. In addition, HHT treatment resulted in reduced levels of beta-catenin and XIAP proteins, which also contribute to disease progression and resistance to chemotherapy in MM. In combination, HHT enhanced the effects of melphalan, bortezomib, and ABT-737. These results suggest that HHT could constitute an attractive option for MM treatment though its ability to simultaneously target multiple tumor-promoting molecules.     

Islet-cell hyperplasia causing hyperinsulinemic hypoglycemia in an adult

We report a patient, a 23-year-old man, who had clinical and laboratory findings suggestive of insulinoma. Although imaging studies did not reveal any tumors in the pancreas, distal pancreatectomy was performed because the possibility of small insulinoma could not be completely excluded. Grossly, the surgically removed pancreas did not reveal any tumors. Microscopically, the pancreas exhibited islet cell hyperplasia and nesidioblastosis. To our knowledge, this is the first authentic reported case of islet-cell hyperplasia occurring in a Japanese adult. Received Mar. 4, 1997; accepted May 23, 1997