Erythropoietin-producing renal cell carcinoma in chronic hemodialysis patients: A report of two cases

Erythropoietin (EPO)-producing renal cell carcinomas in two hemodialysis patients are reported. Despite deteriorated kidney function, these patients did not manifest anemia at diagnosis and their elevated serum EPO levels rapidly returned to within the normal range after nephrectomy. Immunohistochemical staining of the resected specimens showed production of erythropoietin in the tumor cells in one case and in the lining cells of the cyst wall in the other case. Renal cell carcinoma could cause an increase of blood hematocrit level in dialysis patients.     

T cells increase with gastric mucosal interleukin (IL)-7, IL-1, and Helicobacter pylori urease specific immunoglobulin levels via CCR2 upregulation in Helicobacter pylori gastritis

Background and Aims: The purpose of this study was to investigate possible factors that could impact on γδ T cell accumulation in the gastric mucosa. Method: Subjects were 22 Helicobacter pylori (H. pylori)‐free and 75 H. pylori‐infected mucosa biopsies classified into grades I～III gastritis as per our previous study. The number of γδ‐ and 45 RO‐positive T cells were determined by immunostaining. Gastric mucosal anti‐H. pylori urease specific antibodies and interleukin (IL)‐1β, IL‐2, 4, 7, 10 and IL‐12 levels were assayed by enzyme‐linked immunosorbent assay (ELISA). CC chemokine receptor 2 (CCR2) expression levels, migration, and cytokine production in γδ T cells stimulated by H. pylori urease were also evaluated. Results: The γδ T cell count was significantly higher in grade III gastritis which exhibits strong immunoglobulin (Ig)A and IgG responses to H. pylori urease with lymphoid follicles than in other groups. γδ T cell count was significantly correlated with IL‐1β and interleukin‐7 (IL‐7) levels in the gastric mucosa. H. pylori urease immunoreactivity was detected in lamina propria of grade III gastritis, along with many γδ T cells. After H. pylori eradication therapy, the γδ T cell count in grade III gastritis significantly decreased. H. pylori urease stimulated significant increases in CCR2 expression levels, although to a lesser degree than those induced by IL‐7 stimulation in both peripheral and mucosal γδ T cells. Interferon (IFN)‐γ and IL‐10 production was also stimulated by H. pylori urease in peripheral γδ T cells. Conclusions: Gastric mucosal increases in IL‐7 and IL‐1β closely corresponded to the accumulation of γδ T cells in gastric mucosa. An association was also seen between γδ T cell accumulation and H. pylori urease‐specific Ig levels.     

Wrist activity rhythm and sleep diary of delayed sleep phase syndrome

Abstract Wrist activity rhythm and sleep diary data in a case of delayed sleep phase syndrome were investigated. The sleep self-estimation was nearly compatible with the activity levels of the actigraph. The actigraphic data were also analyzed. The subject's most fixed period of activity was 24.31 h, and acrophase (time of day) that fixed the data to a 24 h period was 03.25 h. The subject has had reversed night and day sleep patterns for more than 7 years. It was very difficult to advance the sleep phase when the delayed phase has been continuous long-term under the state of poor social cues.     

CLINICOPATHOLOGICAL STUDY OF UNSUSPECTED GALLBLADDER CANCER DIAGNOSED AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Background: Laparoscopic cholecystectomy (LC) has become a common treatment for benign gallbladder diseases. However, this method has not been established for gallbladder cancer. Methods: In the present study, we examined the clinicopathlogical features of gallbladder cancer that was diagnosed after LC. Results: The presence of unsuspected gallbladder cancer was found in five out of 498 patients (1.00%). Preoperative diagnoses were gallstone in two, gallstone with adenomyomatosis in one, adenomyomatosis in one and gallbladder polyp in one. During LC, there was no evidence of cancer, but bile leakage occurred in two patients. Histologically, the carcinoma had invaded into the subserosa in four patients and into the mucosa in one patient. An additional operation was performed in three patients. Histological examination revealed no cancer cells in the resected liver and lymph nodes. During the average follow‐up period of 47.5 months, no recurrences were observed. Although one patient died of liver metastasis 33 months later, the other three patients who underwent an additional radical operation, showed no recurrence. Conclusions: It is important to prevent port site recurrence or dissemination during LC, so a careful maneuver is required to avoid perforation of the gallbladder. At the time of bile leakage, it is best to wash around the liver bed fully to prevent recurrences of unsuspected gallbladder cancers. If gallbladder cancer has invaded the subserosa or deeper level histologically, a radical second operation should be performed as soon as possible.     

EFFECT OF THIOPENTONE ON MOTOR EVOKED POTENTIALS INDUCED BY TRANSCRANIAL MAGNETIC STIMULATION IN HUMANS

We have studied the effect of repeated doses of thiopentoneon motor evoked potentials (MEP) after transcranial magneticstimulation in 13 patients. Thiopentone was administered i.v.in an initial dose of 2 mg kg^–1, followed by repeateddoses (1 mg kg^–1 every 3 min) until the appearance ofburst suppression on the EEG. The total dose administered wasmean 10.7 (So 2.6) mg kg^–1 The magnetic coil was placedover the MEP scalp stimulation region and evoked electromyographicresponses were recorded from the contra lateral abductor pollicisbrevis. After an initial dose of thiopentone, reproducible MEPresponses were recorded in all patients, but amplitudes werereduced to 42.8% of baseline values. Further administrationof repeated doses of thiopentone produced a dose-dependent decreasein success rate of MEP recordings and a significant reductionin MEP amplitude (P<0.01). Latency did not change significantly,although there was a tendency to increase. During burst suppressionon the EEG, MEP was not recorded successfully in all patients.We conclude that MEP recording during the administration ofthiopentone is feasible only at a minimum dose, with a markedreduction in MEP amplitude. (Br. J. Anaesth. 1993; 71: 849–853)     

Serum Level of Soluble Interleukin-2 Receptor in Patients with Seasonal Allergic Rhinitis

The rate of release of the soluble form of interleukin-2 receptor (soluble IL-2R) reflects T cell activation in vivo . Since T lymphocytes play a central role in respiratory allergic disorders, the measurement of serum levels of soluble IL-2R may be useful in analysing the disease state of allergic disorders. The study has aimed at investigating the seasonal changes in serum soluble IL-2R in 81 patients with seasonal allergic rhinitis due to Japanese cedar pollens, with special reference to the effect of anti-allergic pharmacotherapy and immunotherapy. Serum samples were obtained twice from each patient, before and during the pollen season, and all the serum samples were simultaneously used for determination of soluble IL-2R and cedar pollen-specific immunoglobin E (IgE). Seasonal elevation in soluble IL-2R was not associated with the good clinical outcome but was associated with the poor clinical outcome, irrespective of pharmacotherapy or immunotherapy. Additionally, successful immunotherapy suppressed seasonal elevation of serum soluble IL-2R more strongly than successful pharmacotherapy, and seasonal increase rates in soluble IL-2R were inversely correlated with the duration of immunotherapy. Seasonal increase rates in soluble IL-2R were significantly correlated with seasonal increase rates in specific IgE in both the medication group and the immunotherapy patients. These results may suggest that seasonal changes in serum soluble IL-2R may serve as an indicator for clinical outcome of seasonal allergic rhinitis, that the magnitude of T cell activation could affect specific IgE production, and that T cell activation could be gradually modulated as immunotherapy proceeds. In conclusion, seasonal changes in serum soluble IL-2R may serve as an objective indicator for clinical outcome of seasonal allergic rhinitis.