Thyroid follicular carcinoma metastasized to the lung, skull, and brain 12 years after initial treatment for thyroid gland--case report

A 65-year-old woman presented with multiple metastases from thyroid follicular carcinoma to the lung, skull, and brain. The skull and brain tumors had been successfully treated by surgery, thyroxine supplementation, and radiosurgery until she died of sudden intracerebral hemorrhage which had no connection with tumor treatment. The lung tumor was treated by conventional irradiation and radioactive ablation. Well-differentiated thyroid carcinoma is a slowly progressive tumor. Follicular carcinoma is thought to have the most optimistic prognosis even with metastases to the lymph nodes and lung. Radioactive ablation using iodine-131 is widely used to treat the primary and/or metastatic lesion. However, the prognosis for patients with brain metastases is poor. Intracranial metastasis of this tumor is rare, but has a mean posttreatment survival of around 12 months. Surgical excision of the metastatic intracranial lesion may be the only effective treatment.     

GENERALIZED CYTOMEGALIC INCLUSION DISEASE IN NEONATES AND INFANTS

Cytomegalic inclusion disease (C.M.I.) is caused by the salivary gland virus which is species-specific, and characterized by formation of inclusion-bearing cells in various organs. From the view point of spreading, it is divided into the localized and generalized type. We studied 18 generalized cases of infants in whom inclusion-bearing cells were detected in more than three organs. As to the portal of entry and the time of infection, cytomegalic inclusion disease can be classified into three subgroups in infants; congenital form (2 cases), early acquired form (8 cases) and acquired form with other debilitating diseases (8 cases).     

PULMONARY COMPLICATIONS OF LONG-TERM RESPIRATOR CARE IN INFANTS

Twelve infantile autopsy cases up to 205 days using a long-term respirator care were examined in this study. These cases could be divided into three subgroups. The Arst group included the cases treated with long-term respirator care for hyaline membrane disease. In this subgroup, bronchopulmonary dysplasla was found during the course. The second group included the cases treated with long-term respirator care for other causes and were very premature infants. In this group, some cases showed bronchopulmonary dysplasia-like lesions. The third Group was similar to the second group except for not being very premature. All Qroups had similar histological changes including alveolar cell desquamation, regeneration of alveolar lining cells, fibrosis, and smooth muscle-like tissue formation of alveolar walls. However, the premature lung tissues remained characteristically in some cases of the second group. In this group, the prematurity of lung was thought responsible for the development of bronchopulmonary dysplasia-like lesion. In addition to bronchopulmonary dysplasia or bronchopulmonary dysplasia-like lesion, other changes including pneumonia, persistent ductus arteriosus, cytomegalic inclusion disease and so forth were discussed.     

HYPOXIC-ISCHEMIC BRAIN LESIONS FOUND IN ASPHYXIATING NEONATES

Early hypoxic-ischemic brain lesions were examined regarding 26 autopsy cases which had severe asphyxia at birth and died within the first week. All cases were divided into three groups according to the birth weight: group A of less than 1,000 grams, group B of 1,001–2,500 grams, and group C of more than 2,501 grams. Neocortical and deep gray matter revealed pyknotic and karyorrhectic neuronal changes; however, in group A, these changes tended to be obscure. The hippocampus was the predictive site of the neuronal changes such as pyknotic neurons in Sommer's sector and karyorrhectic neurons in subiculum. In 12 cases, pontosubicular-type necrosis was found. White matter lesions were relatively characteristic and there was an early appearance of pathological astrocytes such as gemistocytic, Alzheimer-type 2 and stellate astrocytes, periventricular leukomalacia with or without hemorrhage. The brain stem and cerebellar lesions were also found occasionally revealing neuronal or glial changes. We applied the immunoperoxidase method using antisera to glial fibrillary acidic protein (GFAP) and S-100 protein for determination of pathological astrocytes. GFAP was a useful marker for pathological astrocytes in the subpial region and in the white matter. S-100 protein was present in Bergmann's glia and satellite glia as well as pathological astrocytes.     

Density Detection in Dependent Left Lung Region Using Transesophageal Echocardiography

Background: Densities in dependent lung regions worsen oxygenation in patients with acute respiratory distress syndrome. Identification of these densities requires examination using computed tomography (CT). In this study, the authors evaluated the use of transesophageal echocardiography (TEE) to estimate densities in the dependent lung.

Methods: Forty consecutive patients with acute lung injury or acute respiratory distress syndrome who underwent CT and TEE examination were included in this study. Densities in the lower left lung area were detected through the descending aorta by TEE. Density areas observed by TEE were compared with those obtained by CT. The effect of positive end-expiratory pressure (PEEP) application on density area was also evaluated.

Results: Density areas in the dependent lung region measured by TEE were 12.0 +/- 6.1 cm2 (mean +/- SD) at mid esophageal position. Density areas evaluated using TEE in the left lung correlated significantly with those estimated with CT in the left and right lungs (P < 0.01 in both lungs). In addition, the authors observed a significant correlation between Pao2/Fio2 and density areas estimated using TEE (P < 0.05). During positive end-expiratory pressure application, the area of density estimated with TEE decreased and Pao2 improved.     

Effects of TJN-598, a new selective phosphodiesterase type IV inhibitor on anti-Thy1 nephritis in rats

Background  

Phosphodiesterase type IV (PDEIV) plays an important role in the immune response and inflammation. However, it is well known that classical PDEIV inhibitors have systemic side effects, so the clinical and chronic use of these agents as therapy for glomerulonephritis is difficult. This study was performed to elucidate the anti-nephritic effects of TJN-598, a new chemical compound derived from herbal components, on experimental mesangial proliferative glomerulonephritis.     

Drug interaction of (S)-warfarin, and not (R)-warfarin, with itraconazole in a hematopoietic stem cell transplant recipient

BackgroundItraconazole is a potent inhibitor of CYP3A4 and P-glycoprotein, but not CYP2C9. Herein, we report a case study in which the plasma concentration of the CYP2C9 substrate (S)-warfarin, and not the CYP3A4 substrate (R)-warfarin, increased with itraconazole coadministration.CaseA 67-y-old man received an allogenic bone marrow transplant for acute lymphoid leukemia. He was taking oral itraconazole (200 mg/day) and was started on a warfarin dose of 2.0 mg/day. The plasma concentrations of (S)- and (R)-warfarin 3 days after starting warfarin administration were 216 and 556 ng/mL, respectively (INR 0.98), and after 10 days, the concentrations were 763 and 545 ng/mL, respectively (INR 2.43). On day 11 after withdrawal of itraconazole, the concentrations of (S)- and (R)-warfarin were 341 and 605 ng/mL, respectively (INR 1.38). The concentration of (R)-warfarin was not affected by itraconazole; however, the final (S)-warfarin concentration had increased 7.3-fold. The (S)-warfarin/(S)-7-hydroxywarfarin ratio decreased to 2.45 from 8.40 after discontinuation of itraconazole. The permeability of warfarin enantiomers across Caco-2 cells was not influenced by itraconazole and showed no difference between enantiomers.ConclusionsCareful INR monitoring is necessary for warfarin co-administration with itraconazole. Further examination is necessary to elucidate mechanisms of the interaction between warfarin and itraconazole.     

Successful treatment of necrotizing fasciitis in an upper extremity caused by Clostridium perfringens after bone marrow transplantation

We report a 47-year-old man with acute leukemia who survived a severe case of necrotizing fasciitis caused by Clostridium perfringens involving his right upper extremity. On day 5 after stem cell transplantation, progressive local tissue necrosis led to septicemia and disseminated intravascular coagulation. Early diagnosis and prompt initiation of appropriate therapy, including surgical debridement and broad-spectrum antibiotics, were crucial. A recombinant thrombomodulin might have not only resolved the coagulation problem but also prevented multiple organ failure associated with the systemic inflammatory response.     

False-positive human immunodeficiency virus antibody test and autoimmune hemolytic anemia in a patient with angioimmunoblastic T-cell lymphoma

A 44-year-old woman was admitted with generalized lymphadenopathy, which was diagnosed as angioimmunoblastic T-cell lymphoma (AITL). The patient showed autoimmune hemolytic anemia (AIHA), polyclonal hypergammaglobulinemia and a high antinuclear antibody titer. Moreover, a human immunodeficiency virus (HIV)-1/2 screening test using the particle agglutination method was reactive. After chemotherapy for AITL, the AIHA was eliminated, and the false-positive HIV results were no longer detected. Autoimmunity associated with AITL is the likely cause of the cross-reaction with HIV and the AIHA. It is important to recognize that the cross-reaction with HIV can be a potential complication in AITL as well as AIHA.