Successful treatment of refractory acute GVHD with mycophenolate mofetil after peripheral blood stem cell transplantation from the patient's one locus-mismatched mother

A 35-year-old male with chronic myeloid leukemia in the accelerated phase received a peripheral blood stem cell transplant from his HLA-DR-mismatched mother. Graft-versus-host disease (GVHD) prophylaxis was with short-term methotrexate and tacrolimus. After transplantation, grade II skin acute GVHD occurred and was unsuccessfully treated with bolus methylprednisolone administration. The acute GVHD progressed to grade III of the skin, gut and liver, and mycophenolate mofetil (MMF) was accordingly administered at a daily dose of 2 g. This treatment resulted in a dramatic improvement in the clinical features of the acute GVHD. The patient suffered from hemorrhagic cystitis and several episodes of cytomegalovirus antigenemia. MMF may be useful for steroid-resistant acute GVHD despite an increasing risk of viral infections.     

Salvage Surgery for Primary Non-Hodgkin's Lymphoma of the Thyroid Gland with Histopathological Complete Response to Radio-Chemotherapy: Report of a Case

A 74-year-old woman was admitted to a local hospital for investigation of a rapidly growing mass in her neck, and exertional dyspnea. An open biopsy confirmed a diagnosis of non-Hodgkin's lymphoma of the thyroid (NHLT), of a diffuse large cell type. The patient was referred to our department for radio-chemotherapy for stage I E NHLT. She was given radiotherapy in the form of 40 Gy radiation directed at her neck and superior mediastinum, with one course of chemotherapy using cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP). After radio-chemotherapy, the tumor was obviously smaller. Because the patient refused further chemotherapy, she underwent salvage surgery, after being sufficiently advised, and with her informed consent. Histological examination of the removed thyroid tissue showed that the radio-chemotherapy had produced a complete response. Thus, we believe that an open biopsy should be performed early to confirm the diagnosis of lymphoma histologically and to determine the degree of malignancy. We also stress the fact that NHLT is presently most effectively treated by radiotherapy combined with several courses of CHOP chemotherapy. The role of surgery in the treatment of NHLT is diminishing. Received: November 19, 2001 / Accepted: May 7, 2002 Reprint requests to: J. Shimizu     

Ascending Colon Cancer with Hepatic Metastasis and Cholecystolithiasis in a Patient with Situs Inversus Totalis Without Any Expression of UVRAG mRNA: Report of a Case

Situs inversus totalis refers to an inverted position of part or all of the viscera, which represents a mirror-image of the normal location, and it is a relatively rare condition that occurs in one in 4000–8000 people in Japan. We herein report a patient demonstrating a combination of situs inversus totalis, colon cancer with hepatic metastasis, and cholecystolithiasis, who was treated surgically. We found no expression of UVRAG mRNA in our case, thus suggesting that the UVRAG gene is partly responsible for this condition.     

Intracochlear injection of pseudorabies virus labels descending auditory and monoaminerg projections to olivocochlear cells in guinea pig

Pseudorabies virus was used to label transneuronally descending auditory projections following intracochlear injections. At different time points after injection, virus-infected cells were detected immunohistochemically in the central nervous system. Initially (25 h), virus was transported retrogradely to olivocochlear cells in the pons. At 32-72 h after injection, labelling occurred in higher order auditory brainstem nuclei as well as in the locus coeruleus and pontine dorsal raphe. At 90-108 h, virus-infected neurons were found bilaterally in the medial geniculate body and in layer V of the auditory cortex. Viral transneuronal labelling in the auditory cortex after intracochlear application confirms the existence of a continuous descending chain of neurons from the auditory cortex to the cochlea, via the medial and lateral olivocochlear systems. The transneuronal labelling of the locus coeruleus and pontine dorsal raphe suggests that noradrenergic and serotonergic inputs may substantially influence the activity of olivocochlear cells, and thus the cochlea.     

The relationship between eating pathology and perceived family functioning in eating disorder patients in a day treatment program

This study examines the perceived levels of family functioning and their relationships with eating pathology across three eating disorder diagnostic groups. Charts of 65 day treatment female patients, ranging in age from 12 to 27 years, were studied by diagnosis and assessed using the FACES-II and EDI-2. Using multiple regression analyses, it was determined that perceived family functioning yielded significant predictions for various EDI-2 subscales within both Anorexia Nervosa and Eating Disorder Not Otherwise Specified diagnoses. Significant correlations were found between FACESII and the EDI-2 for all three diagnostic groups. Using ANOVA analyses and Bonferroni comparisons, significant differences among diagnoses on the EDI-2 subscales were obtained when studying patients within different family types as defined by FACES-II. These data support previous findings that suggest that as family functioning is perceived to be more dysfunctional the severity level of eating pathology increases.     

A perspective on molecular genetic studies of tardive dyskinesia: one clue for individualized antipsychotic drug therapy

Interindividual genetic profile differences related to antipsychotic drug therapy may be determined based on molecular genetic studies of the pathogenesis of schizophrenia and studies of antipsychotic drug responses (therapeutic as well as adverse responses). In the present article, we review molecular genetic studies of tardive dyskinesia (TD), which is a representative adverse response to antipsychotic drugs. Such studies have been performed to explore the gene-associated pharmacokinetic and pharmacodynamic processes of antipsychotic drugs. Positive associations between several genes and TD have been reported. The accumulation of results from such studies will hopefully lead to individualized antipsychotic drug therapies that involve the application of new genomic techniques, including DNA microarrays. Subsequently, antipsychotic drugs may in the future be prescribed for smaller subgroups of patients who have been classified as having a particular genetic profile.     

Review of 26 patients operated on for primary hyperparathyroidism

The traditional surgical approach for primary hyperparathyroidism (PHP) is routine bilateral neck exploration. At Saiseikai Utsunomiya Hospital, however, unilateral exploration, and the direct resection of one gland is performed if single gland enlargement is suspected, based on the findings of several preoperative localization procedures. Here, we reviewed 26 patients who underwent single gland operations for PHP at our institution between 1993 and 2001. The 26 patients (21 women and 5 men) ranged in age from 20 to 79 years (mean, 54.8 years). None of the patients had multiple endocrine neoplasia (MEN), familial hypercalcemia, or malignant tumors. At least three preoperative localization procedures, such as ultrasonography, computed tomography, thallium technetium scanning, 99mTc sestamibi scintigraphy, or magnetic resonance imaging, were performed in each patient. A parathyroidectomy was then performed under general anesthesia. Contralateral exploration was not routinely performed. In addition, an intraoperative biopsy of the other glands was not performed. The following data were retrospectively collected in all patients: serum calcium, and the HS-PTH at one month and 6 months after the parathyroidectomy. All patients were normocalcemic, and the serum HS-PTH concentration significantly decreased in all patients after this operation. Patients were divided into two groups (adenoma group, n = 16; hyperplasia group, n = 6) and the data was analyzed according to the histological and pathological diagnosis. In both pathological groups, all patients were normocalcemic and the serum HS-PTH concentration was significantly lower after surgery. The serum HS-PTH concentration showed no significant difference between the adenoma group and the hyperplasia group at 6 months after surgery. No complications, including recurrent laryngeal nerve palsy or permanent hypocalcemia, were observed after surgery. In conclusion, if a single gland disease is suspected based on the findings of multiple preoperative localization procedures, resection of the enlarged gland alone appears to provide good results for the treatment of either adenoma or hyperplasia resulting in PHP. In addition, this procedure also reduces the occurrence of postoperative hypocalcemia, because the normal glands are not injured by the biopsy procedures.     

The effects of bismuth,iron, zinc and nitrate on free sulfide in batch cultures seeded with fecal flora

BACKGROUND: Hydrogen sulfide (H2S) and methanthiol (CH3SH) have been implicated as bacterially derived toxins which may be damaging to the gut mucosa. The addition of nitrate and metals that bind sulfide could potentially reduce the concentrations of these toxic gases. In this study, the effects of iron, zinc, bismuth and nitrate on free H2S concentrations in fecal batch cultures were investigated. METHODS: Stool samples were collected from six healthy subjects. Ten percent fecal slurries was made up with phosphate buffer. One milliliter of fecal slurry and 1 ml of metal solution were added to 28 ml anaerobic broth in a 30-ml vial giving final metal concentrations of 0.1, 0.5 and 1.0 mmol/l. For a control, the metal iron solution was replaced by 1 ml of water. After 24 h of incubation at 37 degrees C, 1 ml of the supernatant from the broth was distilled by microdistillation and sulfide determined by HPLC using amperometric detection. RESULTS: A significant reduction in H2S (P<0.05) of 57% was seen with 1.0 mmol/l zinc, but not with 0 and 0.5 mmol/l zinc treatments. Iron at 0.1, 0.5 and 1.0 mmol/l significantly reduced H2S concentrations (P<0.05) by 36%, 44% and 58%, respectively. Bismuth, the most effective metal, reduced H2S concentrations by more than 90% for all treatments. Both magnesium citrate and magnesium acetate did not affect sulfide concentrations, while 41% and 68% reductions were seen from the addition of 0.5 and 1.0 mmol/l magnesium nitrate, respectively (P<0.05). CONCLUSIONS: Bismuth, iron, zinc and nitrate are effective at reducing free H2S concentrations in batch cultures. Side effects of these metals may limit their use in vivo. Nitrate is considered toxic because of its contribution to the formation of the carcinogenic nitrite and nitrosamine, though results presented here may indicate a beneficial effect in the large intestine.