A case of IgA nephropathy associated with silicosis]

A 51-year-old male who had been working as a building wrecker for 20 years, was admitted to our hospital in June 1999 for proteinuria and hematuria examination. He started this work in 1978. Twelve years later, severe coughing and bloody sputum began and he was diagnosed as having silicosis in 1995. Urinalysis on admission showed proteinuria(294 mg/day), microhematuria(20-30/hpf), RBC cast and granular cast. High serum IgA(770 mg/dl) and high serum interleukin-6(IL-6) (3,280 pg/dl) were found. A renal biopsy showed mild mesangial matrix expansion and mesangial cell proliferation with IgA deposition, which was diagnosed as IgA nephropathy. Chest X-rays showed multiple small nodular lesions on both lung fields indicating silicosis. In Nov. 1999, he resigned from his job as a building wrecker because of increasing coughing and bloody sputum associated with body weight loss. Within 3 months after stopping this work, coughing and bloody sputum disappeared and the abnormal urinalysis findings returned to normal. Serum IgA and serum IL-6 data improved to 462 mg/dl and 2.5 pg/dl, respectively. It is suggested that silicon exposure might be related to the pathogenesis of IgA nephropathy in this patient.     

Is Additional Surgery Always Sufficient for Preventing Recurrence After Endoscopic Submucosal Dissection with Curability C-2 for Early Gastric Cancer?

Annals of Surgical Oncology - When a lesion does not meet the curative criteria of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), referred to as non-curative resection or...     

Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection in early gastric cancer? A multi-center retrospective study in Japan

Background

Although radical surgery is routinely performed for patients who do not meet the curative criteria for endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) due to the risk of lymph node metastasis (LNM), this standard therapeutic option may be excessive given the lower number of patients with LNM. Therefore, we aimed to investigate long-term outcomes and validate risk factors predicting recurrence after ESD.

Methods

Of 15,785 patients who underwent ESD for EGC at 19 institutions between 2000 and 2011, 1969 patients not meeting the curative criteria were included in this multi-center study. Based on the treatment strategy after ESD, patients were divided into radical surgery (n = 1064) and follow-up (no additional treatment, n = 905) groups.

Results

Overall survival (OS) and disease-specific survival (DSS) were significantly higher in the radical surgery group than in the follow-up group (p < 0.001 and p = 0.012, respectively). However, the difference in 3-year DSS between the groups (99.4 vs. 98.7 %) was rather small compared with the difference in 3-year OS (96.7 vs. 84.0 %). LNM was found in 89 patients (8.4 %) in the radical surgery group. Lymphatic invasion was found to be an independent risk factor for recurrence in the follow-up group (hazard ratio 5.23; 95 % confidence interval 2.01–13.6; p = 0.001).

Conclusions

This multi-center study, representing the largest cohort to date, revealed a large discrepancy between OS and DSS in the two groups. Since follow-up with no additional treatment after ESD may be an acceptable option for patients at low risk, further risk stratification is needed for appropriate individualized treatment strategies.

     

Surgical laparoscopic therapy of small bowel tumors: review of the literature and report of two cases

The Authors, after a short review of small bowel tumors, point out that recently a laparoscopic approach for these tumors has been suggested and some cases have been reported. The Authors present two cases of patients operated for small bowel tumor using a laparoscopic technique: the first case for a stromal tumor (GIST), the second case for an adenocarcinoma in advanced stage with multilobar lung metastases. The first patient is alive and disease free after one year, the second died after six months for tumor progression. The Authors believe that laparoscopic technique can be employed with satisfying results also in the treatment of small bowel tumors with moderate trauma and invasiveness.     

地龙(蚯蚓)体内磷脂的组成和血小板活化因子的生物合成

首次发现低等动物地龙(Eisenia foetida,亦称蝗蚓)体内含有血小板活化因子(PAF),含量随季节变化,平均达10.7±6.1pmol/g湿重(或1.1±0.5μmol/mol磷脂)。磷脂成分中,PAF前体物质1-O-烷基-2-酰基(长链)-sn-甘油-3-磷酸胆碱占磷脂酰胆碱的比例高达61.4%。并证实地龙体内含有与哺乳类动物相同的两种PAF合成酶蛋白。当针刺、切断等伤害性刺激时,PAF水平显著升高。此结果提示PAF是一种初始的活性介质,在地龙这类低等动物体内也参与机体的病理、生理应急反应。本研究为阐明中药地龙的降血压等药理作用机理提供新线索。     

Protection against cadmium toxicity by zinc: Decrease in the Cd-high molecular weight protein fraction in rat liver and kidney on Zn pretreatment

The amounts of cadmium, associated with high molecular weight proteins, metallothionein and low molecular weight fractions obtained on Sephadex G-75 gel filtration, were determined in the liver and kidneys of rats treated with Cd. When rats were pretreated with zinc 24 h prior to the Cd injection, Cd associated with the high molecular weight proteins was decreased in both the liver and kidneys. Although the Cd concentration in the liver was increased, the liver showed less morphological damage in Zn-pretreated rats. The above results suggest that Cd-toxicity toward the liver and kidneys may be related to the accumulation of Cd in the high molecular weight proteins.     

Rapid generation of 2-arachidonoylglycerol, an endogenous cannabinoid receptor ligand, in rat brain after decapitation

Rat brain, frozen in liquid nitrogen immediately after decapitation, contains a substantial amount of 2-arachidonoylglycerol (0.34 nmol/g tissue), an endogenous cannabinoid receptor ligand. The level of 2-arachidonoylglycerol in the brain was rapidly augmented after decapitation, the peak being noted 30 s after decapitation (1.54 nmol/g tissue). Noticeably, there are two phases during the increase in the levels of 2-arachidonoylglycerol: a rapid transient increase and a subsequent gradual sustained increase, suggesting that at least two separate mechanisms are involved in the generation of 2-arachidonoylglycerol in the decapitated brain. Gradual sustained formation was also observed for other monoacylglycerols, (e.g. 2-palmitoylglycerol plus 2-oleoylglycerol and 2-cis-vaccenoylglycerol). Thus, it is important to minimize post-mortem changes to estimate the exact tissue levels of 2-arachidonoylglycerol as well as other monoacylglycerols in the brain.     

Augmentation by serrapeptase of tissue permeation by cefotiam

Cefotiam (CTM) is a new cephalosporin with a broad spectrum of activity against both Gram-positive and Gram-negative microorganisms. Cephalosporins are widely used for prophylaxis of infections in patients undergoing thoracotomy. Augmentation by serrapeptase on tissue permeation of CTM was examined in 35 thoracotomy patients with lung cancer. The subjects were divided into two groups according to the method of the administration of CTM. Group I consisted of 17 subjects, each of whom received a single dose of 2 g of CTM alone by an instillation for 30 minutes. Group II consisted of 18 subjects, each of whom received a combination of CTM and serrapeptase; serrapeptase was given 2 tablets (10 mg) each time for three times/day until the day before surgery, and then CTM was administered by the same procedure. The following results were obtained: Individual difference was observed for the permeation of CTM into tissues. Pathologic differences also affected the permeation. Nevertheless, the CTM levels in pulmonary tissues reached about a half of those in the blood in both the single dose group and the combination group, hence sufficient concentrations exceeding MIC80 for main microorganisms that caused infections in the lung were obtained. The concentrations of CTM in inflammatory tissues have showed lower levels than those of normal tissues in both CTM single dose and the combination groups. Decrease of blood flow volume may have contributed to the reduction in levels of CTM in the inflammatory tissues. The ratio of the concentration of the drug in pulmonary tissues to that in the blood was 29.1 +/- 2.5% in the single dose group, and 44.2 +/- 6.0% in the combination group, the latter showing quite a significant increase (P less than 0.05). Combined administrations of CTM and serrapeptase deserves more trials in the case when surgical treatments of the lung are performed. An antiinflammatory effect of serrapeptase in the respiratory system is expected, and in addition, the combined use of CTM and serrapeptase should stimulate permeation of the antibiotic into tissues.