Heterotopic gastric mucosa of the duodenum mimicking a duodenal cancer

Heterotopic gastric mucosa of peculiar shape and located in the duodenum bore a close resemblance to superficial ulcerating cancer. Radiographic survey showed a flexible lesion with a mucosal pattern resembling area gastrica. Endoscopy revealed its color to be indistinguishable from that of the normal duodenal mucosa. These may be characteristic features of this abnormality.     

A case of gastric cancer with peritonitis carcinomatosa which improved upon oral administration of UFT, mitomycin C and lentinan

A 29-year-old male visited our hospital because of lower abdominal pain. Acute appendicitis was suspected, and surgery was performed. However, no abnormality was found in the vermiform appendix. Instead, atrophy of the greater omentum, numerous nodes of varying sizes, and a small amount of ascites were observed. On the basis of histological examination, a diagnosis of metastatic glandular cancer was made. Gastric fluoroscopy performed 2 months earlier in another hospital had revealed irregularity of the stomach wall and a large concave area on the side of the greater curvature. Photogastroscopy and CT demonstrated progressive Borrmann type III cancer at the corresponding site and metastasis to regional lymph nodes. Biopsy findings were similar to the histological findings. After 1 week, treatment with UFT (400 mg/day), MMC (10 mg/month) and LNT (1 mg/week) was initiated. After about 3 months, i.e., following administration of 40 g UFT, 30 mg MMC and 8 mg LNT, gastric fluoroscopy and photogastroscopy revealed complete disappearance of the tumor. No abnormality was found by laboratory studies. The patient has since returned to a normal life.     

Effect of heptaminol AMP amidate, a new nucleotide derivative, on in vitro humoral immunity

Heptaminol AMP amidate (HAA), a newly developed derivative of 5'-AMP, was found to potentiate the in vitro primary humoral immune response against T cell-dependent antigen, sheep red blood cells, when HAA was present in the early phase of spleen cell culture. Such a potentiating effect was not found against T cell-independent antigens such as lipopolysaccharide (LPS), trinitrophenylated (TNP)-LPS and TNP-Ficoll. The pattern of HAA-mediated immunopotentiation was similar to that of dibutyryl cyclic AMP. When HAA was added to the culture simultaneously with theophylline and imidazole, the immunopotentiating effect of HAA was further augmented and suppressed, respectively. The present results suggested that HAA-mediated immunopotentiation might be in some way related to the intracellular level of cyclic nucleotides in the early phase of culture.     

High-energy proton beam radiation therapy for gynecologic malignancies. Potential of proton beam as an alternative to brachytherapy

Fifteen patients with advanced gynecologic malignancies were treated with high-energy proton beam radiation therapy (RT) at the Particle Radiation Medical Science Center (PARMS), Tsukuba University, Japan, from 1983 to 1987. The potential of proton beam RT as an alternative to conventional brachytherapy was evaluated. Except for one local recurrence, 14 of 15 patients were locoregionally controlled for 15 to 57 months. Two-year local control rate and 2-year survival rate were 92.3% and 93.3%, respectively. Two cases of transient, radiation-induced proctitis (neither of which required surgical treatment) were the only complications despite a target dose that exceeded 8000 cGy in most cases. The results suggest that sharply localized, high-dose proton beam RT can produce an antitumor effect equivalent to that of conventional brachytherapy.     

Acute Form of Pyoderma Gangrenosum Induced by Traumatic Injury

A 45-year-old man with the acute form of pyoderma gangrenosum is reported. He developed characteristic ulcers that rapidly followed violaceous erythema at sites of traumatic injury. The skin lesions repeatedly appeared six times within 7 years. Each time, the skin lesions were localized to sites of trauma, and no systemic symptoms nor abnormal laboratory findings were associated. Histological findings were acute superficial inflammation with neutrophilic infiltration into the dermis. Sweet's syndrome-like skin lesions were once associated, indicating that pyoderma gangrenosum and Sweet's syndrome have a close relationship. Nonsteroidal antiinflammatory drugs, potassium iodide, and minocycline were not effective. He was successfully treated with oral administration of corticosteroid. The pathergy of this patient must have been caused not only by the trauma itself but by additional factors such as epidermal components or contaminating micro-organisms, since traumatic injury did not always cause the skin lesions.     

Perioperative management of a patient requiring surgery for pituitary apoplexy and severe angina pectoris

We describe the management of a 71-yr-old man with pituitaryapoplexy and severe angina pectoris who underwent treatmentof an intra-cranial haemorrhage and open-heart surgery requiringanticoagulant therapy within a very short period. Subtotal removalof the pituitary tumour was undertaken under stable cardiovascularconditions. But ventricular fibrillation occurred after theneurosurgery in the intensive care unit. After the patient wasdefibrillated, intra-aortic balloon pumping was necessary toassist coronary artery blood flow. Twenty hours after neurosurgery,oozing from the surgical wound stopped and coronary artery bypassgrafting with full heparinization was performed uneventfully. Br J Anaesth 2000; 85: 800–2 ^* Corresponding author     

Autopsy cases of asbestosis in Japan: a statistical analysis on registered cases

There are 525 (484 male, 38 female, 3 unknown) autopsy cases with asbestosis registered in the Annual of the Pathological Autopsy Cases in Japan, which is issued by the Japanese Society of Pathology for the years 1958-1996. The frequency of asbestosis (number of cases/total autopsy cases) was 0.017% (76/440,334) for the 1958-1979 time period, 0.058% (226/390,124) for 1980-1989, and 0.099% (223/225,801) for 1990-1996. There was a significant increase in asbestosis cases across the three time periods (p < .0001). The number of asbestosis cases increased markedly among individuals who worked with asbestos products, as well as among those employed in asbestos-processing factories. The frequency of malignant tumors associated with asbestosis was 61.0% (320/525), and the frequency also increased across the three time periods, from 43.4% (33/76) to 62.8% (142/226) and 65.0% (145/223), respectively. Among the 525 cases with asbestosis, there were 174 lung cancers (33.1%), 73 malignant mesotheliomas (13.9%), 29 stomach cancers (5.5%), 14 liver cancers (2.7%), 9 prostatic cancers (1.7%), 8 malignant lymphomas (1.5%), 6 laryngeal cancers (1.1%), 4 pancreas cancers (0.8%), 3 rectal cancers (0.6%), and 28 other cancers (5.3%). The frequencies of lung cancer, malignant mesothelioma, and laryngeal cancer were significantly higher in the cases with asbestosis than among the nonasbestosis cases. The number of malignant tumors related to asbestos exposure is expected to increase in the future.     

Asymptomatic constant isolated proteinuria in children

The clinical features, renal biopsy findings, and subsequent course in 53 children with asymptomatic constant isolated proteinuria were studied retrospectively (1) to determine the prevalence of renal pathologic abnormalities among these children, (2) to identify those clinical characteristics that may enable recognition of children with an increased likelihood of having renal pathologic abnormalities, and (3) to assess the clinical course. All biopsy specimens were examined by light, immunofluorescence, and electron microscopy. Twenty-five patients (47%) had significant glomerular changes (15 had focal segmental glomerulosclerosis, 4 IgA nephropathy, 3 diffuse mesangial proliferative glomerulonephritis without IgA deposition, and 3 membranous glomerulonephritis), and 28 had minimal glomerular changes. There were no differences between the patients with significant glomerular changes and those with minimal glomerular changes with regard to clinical and laboratory findings except for a predominance of boys in the former group. At the latest follow-up, seven patients with significant glomerular changes, but none with minimal glomerular changes, had chronic renal impairment. Because of the high incidence of significant glomerular changes and the high rate of progression to chronic renal impairment, we believe that a renal biopsy is indicated for a child with asymptomatic constant isolated proteinuria.     

Psychologic and cosmetic self-assessments of breast conserving therapy compared with mastectomy and immediate breast reconstruction

Cosmetic and psychologic morbidity was evaluated by patients self-assessment in 42 patients who underwent breast conserving therapy (BCT) and 48 patients who underwent mastectomy with immediate breast reconstruction (MIBR). Although sexual adjustment and fear of cancer recurrence were not significantly different between the two groups, body image was rated as significantly better in the BCT group. Additionally, in the MIBR group, nine patients expressed concern about abdominal or back scars and 15 related abdominal or back pain. Eighty-three percent of the BCT group indicated BCT as a future choice of treatment, whereas only 38% of the MIBR group indicated MIBR as a future choice of treatment. Therefore, body image and patients' satisfaction were thought to have been improved by BCT, but psychologic morbidity was the same in both groups. © 1993 Wiley-Liss, Inc.