Metastatic intradural extramedullary spinal cord tumor from ovarian cancer: A case report with a literature review

Context: Metastatic intradural extramedullary spinal cord tumors are extremely rare.Findings: A 76-year-old woman presented with intractable neck pain. Three years earlier, she had been treated for ovarian cancer with bilateral salpingo-oophorectomy. A year later, she underwent resection of a brain metastasis. Magnetic resonance imaging (MRI) showed an encapsulated intradural extramedullary mass at C4–C5. C4–C5 hemilaminectomy, tumor resection, and biopsy were performed. Histological examination of the resection revealed an adenocarcinoma. After surgery, her intolerable neck-shoulder pain was fully resolved, and she had no difficulties with daily living activities. However, two months later, she underwent gamma knife radiosurgery for the recurrent metastatic brain tumor, and four months later, she died from cachexia.Conclusion: Although cases of metastatic intradural extramedullary spinal tumors from ovarian cancer are extremely rare, their possibility should be considered in the differential diagnosis. A history of brain metastases and enhancement on T1-weighted MRI were helpful for making an accurate diagnosis.     

Japan College of Rheumatology guideline for the use of methotrexate in patients with rheumatoid arthritis

Methotrexate (MTX), the anchor drug in the current treatment strategy for rheumatoid arthritis (RA), was first approved for treatment of RA in Japan in 1999 at the recommended dose of 6–8?mg/week; it was approved as first-line drug with the maximum dose of 16?mg/week in February 2011. However, more than half of Japanese patients with RA are unable to tolerate a dose of 16?mg/week of MTX. Moreover, some serious adverse events during the treatment with MTX, such as pneumocystis pneumonia (PCP) and lymphoproliferative disorders (LPD) have been observed much more frequently in Japan than in other countries. Therefore, this article, an abridged English translation summarizing the 2016 update of the Japan College of Rheumatology (JCR) guideline for the use of MTX in Japanese patients with RA, is not intended to be valid for global use; however, it is helpful for the Japanese community of rheumatology and its understanding might be useful to the global community of rheumatology.     

Dietary instructions focusing on meal-sequence and nutritional balance for prediabetes subjects: An exploratory,cluster-randomized,prospective, open-label,clinical trial

BackgroundAlthough lifestyle modifications are known to be effective in type 2 diabetes (T2D) as well as in prediabetes, adherence to a healthy diet is difficult for some, and interventions of lifestyle modifications need to be revised occasionally. Meal sequence has been gaining attention as a part of a healthy diet among T2D individuals to improve glycemia and body weight. In addition, a dietary instruction program, SMART Washoku®, which can help individuals to consume a more nutritionally balanced diet, has been developed.MethodsThe current exploratory trial was designed to examine the effects of dietary instructions focusing on meal sequence and nutritional balance in individuals with prediabetes in the Japanese national health check-up and guidance program. Participants were cluster-randomized into three groups: Group A, receiving a conventional health guidance program (n = 11); Group B, receiving health guidance with dietary instructions focusing on meal sequence (n = 18); and Group C, receiving health guidance with dietary instructions focusing on nutritional balance (n = 13). Participants received health guidance education and various measurements before and 6 months after the instructions.ResultsBody weight in Group B was significantly reduced compared to that in Group A, with similar adherence, while the effects on glycemia were similar between the two Groups. Body weight reduction was greater in Group C compared to that in Group A, although adherence in Group C was significantly lower than that in Group A.ConclusionThe group receiving health guidance with dietary instructions focusing on meal sequence exhibited similar adherence and greater reduction in body weight than the group receiving conventional health guidance.     

Epstein-Barr Virus-positive Intestinal Diffuse Large B-cell Lymphoma in a Japanese Patient with Celiac Disease: First Reported Case and a Literature Review

A 60-year-old Japanese woman was diagnosed with celiac disease (CeD) and treated with a gluten-free diet. For five years, she had a good clinical course. However, she complained of inappetence and nausea. Colonoscopy revealed ulcerative tumors in the terminal ileum. A histological examination of biopsy specimens from the ulcerative tumor showed diffuse infiltration of large atypical lymphocytes. Immunohistologically, the atypical lymphoid cells were positive for cluster of differentiation (CD)10 and CD20. Many Epstein-Barr virus-encoded small RNA (EBER)-positive atypical lymphocytes were detected by in situ hybridization. This represents the first reported case of Epstein-Barr virus-positive intestinal diffuse large B-cell lymphoma complicated with CeD.     

Predictive factors for lymph node metastasis in esophageal squamous cell carcinomas contacting or penetrating the muscularis mucosae: the utility of droplet infiltration

Background Tissue features to predict the presence or absence of lymph node metastasis (pN) in cases of esophageal squamous cell carcinoma found to contact or penetrate the muscularis mucosae (m3) on endoscopic mucosal resection (EMR) have yet to be clarified in detail. This study was conducted to determine the utility of droplet infiltration (DI) as a candidate. Methods In 27 m3 esophageal squamous cell carcinoma cases who underwent esophagectomy, DI parameters (longitudinal diameter, DIs; number of constituent cells, DIn; distance from the primary focus, DId) for droplet infiltration were examined to allow comparison with vessel permeation (VP) as a predictive factor for lymph node metastasis. Results DIs ≤ 20 μm, DIn ≤ 4, and DId ≥ 200 μm all demonstrated relations with pN (P = 0.001, 0.006, and 0.03, respectively). As predictive factors for lymph node metastasis, DIs ≤ 20 μm and DIn ≤ 4 had sensitivity and likelihood ratios (LR) equal to or higher than VP. Conclusions Tissue features of DI (DIs ≤ 20 μm and DIn ≤ 4) can be applied as predictive factors for lymph node metastasis in m3 esophageal cancers after EMR. This is the English version of a research paper reported in Gastroenterol Endosc 2004;46:2086–94.     

Technical Note: Method for estimating volume of subretinal fluid in cases of localized retinal detachment by OCT ophthalmoscopy

The volume of the subretinal fluid can be used to assess the condition of different types of retinal and macular disorders. The purpose of this report is to introduce a method to measure the volume of the subretinal fluid with the images of the optical coherence tomography (OCT) Ophthalmoscope in three cases of central serous chorioretinopathy and one case of retinal pigment epithelial detachment. We used the topography-mode program of the OCT Ophthalmoscope and measured the average height of the retinal detachment. By multiplying the size of the area of the retinal detachment and the average height of the retinal detachment, the volume of subretinal fluid could be determined. Examples are given to show the results of volume measurement of subretinal fluid in cases of localized retinal detachments.     

Massive hemorrhage in a patient with intestinal Behçet's disease: report of a case

Major gastrointestinal bleeding is a rare manifestation of intestinal Behçet's disease. We report herein the case of a 64-year-old man with intestinal Behçet's disease complicated by myelodysplastic syndrome who suffered massive hemorrhage. Colonoscopy demonstrated ulceration of the entire colon from the cecum to the rectum, characterized by punched-out ulcers. Angiography demonstrated apparent extravasation of contrast material in the terminal ileum, and embolization was not successful. Continued and massive bleeding necessitated surgical resection of the involved segment of ileum; however, massive bleeding recurred. Re-endoscopy showed oozing hemorrhage from the multiple colon ulcerations. Intra-arterial prednisolone injection therapy was given, following which the melena gradually subsided and completely stopped within a few days.     

Primary hepatic leiomyosarcoma in a woman after renal transplantation: report of a case

In contrast to malignant lymphomas or skin cancer, smooth muscle tumors including leiomyosarcoma are rarely associated with transplant recipients. We herein present a 33-year-old woman with end-stage renal disease who received a transplant at 27 years of age. Four years after the transplantation, at age 31, she underwent a mastectomy because of primary right breast cancer, which was found to be a 5-mm-sized mucinous carcinoma with no regional lymph node metastasis. Six years after the transplantation, a liver tumor was unexpectedly discovered. An explorative laparotomy revealed a well-encapsulated tumor occupying the posterior portion of the right lobe of the liver. The patient underwent a posterior segmentectomy. Histologically, the tumor possessed intermingling fascicles of spindle cells with eosinophilic cytoplasm and elongated nuclei. Based on an immunohistochemical examination, the tumor cells were positive for the muscle-associated antibody. In addition, RNA probes for Epstein-Barr virus were negative based on in situ hybridization. The histologic, immunohistochemical findings were considered to be diagnostic for leiomyosarcoma, which is a low-grade malignancy. Two years after surgery, the patient is doing well with no recurrence of liver tumors or breast cancer. Received: April 16, 2001 / Accepted: September 11, 2001     

Environmental gamma-ray dose rate in Aomori Prefecture, Japan

Japan's first commercial nuclear fuel cycling facilities, including a spent nuclear fuel reprocessing plant, are now under construction in Rokkasho, Aomori Prefecture (prefecture--an area of administration similar to a county in the U.S.). The reprocessing plant is due to be completed by 2004. We surveyed indoor and outdoor environmental gamma-ray dose rates throughout Aomori Prefecture from 1992 to 1996 to get background data before operation of the plant. Glass dosimeters were used to measure cumulative gamma-ray dose rate. The outdoor gamma-ray dose rates were measured at 109 locations in the prefecture. The indoor gamma-ray dose rates were measured at 81 locations, which were generally in a dwelling near the location of an outdoor measurement. The contribution of radionuclides in the ground to the outdoor dose rate was estimated by using in-situ gamma-ray spectrometry with a germanium detector. The spectra were measured at 20 locations used for the glass dosimeter measurements. The outdoor gamma-ray dose rate was higher in the Tsugaru area (western part of the prefecture) than in the Nanbu area (eastern part). Means of the dose rate were 28, 31, and 25 nGy h(-1) for the whole prefecture and Tsugaru and Nanbu areas, respectively. The dose rates in winter were lower than those in the other seasons due to the shielding effect of snow on the ground. Mean contributions of uranium series, thorium series and 40K to the dose rates were 7.7, 8.2, and 9.3 nGy h(-1), respectively. The indoor dose rate was generally higher than the outdoor one, and the mean ratio of indoor to outdoor dose rates was 1.42. Means of indoor gamma-ray dose rate were 41, 37, and 43 nGy h(-1) for the whole prefecture and Tsugaru and Nanbu areas, respectively. The average effective dose rate to people in the prefecture was estimated to be 0.24 mSv y(-1).