Rapid regrowth of an atypical choroid plexus papilloma located in the cerebellopontine angle

Choroid plexus papilloma usually occurs in the lateral or the fourth ventricle. Primary choroid plexus papilloma of the cerebellopontine angle, as described here, is an uncommon lesion. A 42-year-old man presented with a 1-month history of dysphagia and gait unsteadiness. CT scans and MRI showed a large extra-axial tumor in the right cerebellopontine angle. Pathological study revealed that the lesion was choroid plexus papilloma. Repeat imaging conducted 1 year after the operation showed that the tumor had recurred with distinct cystic features. Pathological examination again revealed increased mitotic activity and supported a diagnosis of atypical choroid plexus papilloma.     

Mutant γPKC found in spinocerebellar ataxia type 14 induces aggregate-independent maldevelopment of dendrites in primary cultured Purkinje cells

Missense mutations in protein kinase Cγ (γPKC) gene have been found in spinocerebellar ataxia type 14 (SCA14), an autosomal dominant neurodegenerative disease. We previously demonstrated that mutant γPKC found in SCA14 is susceptible to aggregation and induces apoptosis in cultured cell lines. In the present study, we investigated whether mutant γPKC formed aggregates and how mutant γPKC affects the morphology and survival of cerebellar Purkinje cells (PCs), which are degenerated in SCA14 patients. Adenovirus-transfected primary cultured PCs expressing mutant γPKC-GFP also had aggregates and underwent apoptosis. Long-term time-lapse observation revealed that PCs have a potential to eliminate aggregates of mutant γPKC-GFP. Mutant γPKC-GFP disturbed the development of PC dendrites and reduced synapse formation, regardless of the presence or absence of its aggregates. In PCs without aggregates, mutant γPKC-GFP formed soluble oligomers, resulting in reduced mobility and attenuated translocation of mutant γPKC-GFP upon stimulation. These molecular properties of mutant γPKC might affect the dendritic morphology in PCs, and be involved in the pathogenesis of SCA14.     

A long-term survivor who received S-1-based multidisciplinary therapy for unresectable advanced pancreatic cancer

A 62-year-old woman with a diagnosis of pancreatic cancer with splenic invasion, liver metastasis, and peritoneal dissemination was scheduled to receive chemotherapy. However, emergency surgery was performed because of an exacerbation of ileus. Laparotomy revealed moderate ascites and innumerable nodular lesions on the mesenteric side of the small intestine and colon. Peritoneal dissemination was associated with many sites of stenosis in the small intestine and colon. Surgery was performed to resect cancer of the tail of the pancreas (the primary tumor) and to permit the oral intake of food. The postoperative course was good, with no complications. On the 19th hospital day, gemcitabine was started as first-line chemotherapy. Tumor marker levels promptly decreased and remained within the normal range for 6 months. The patient received 17 courses of chemotherapy. Tumor marker levels increased subsequently, and chemotherapy was switched to S-1 as second-line treatment. Twelve courses were delivered, and tumor marker levels decreased again. Erlotinib was then added to S-1, and treatment was continued. Tumor marker levels decreased after adding erlotinib, even when there was no further response to S-1 alone. At present, the patient is receiving combined therapy with S-1 and irinotecan and has survived for 3 years and 1 month after surgery. Our findings suggest that S-1-based chemotherapy for second-line and subsequent treatment contributed to long-term survival.     

How to make sure a balloon-type gastrostomy replacement was made right by ultrasound

With the spread of gastric fistula, there have been increased reports of catheter aberrant and fistula damage during the time of catheter exchange procedures. Therefore, it has been recommended that a diagnostic imaging or endoscopic gastrostomy should be employed to make sure a catheter exchange was properly done. However, it is difficult to enforce an inspection using an X-ray or endoscopy in the home care environment. Here we examined the usefulness and problems associated with ultrasound catheter-validation for home care environment. Of 33 patients who received gastrostomy, we focused on 6 patients who had gastrostomy exchanged at home. Four out of 6 patients with a balloon-type gastrostomy exchanged clearly confirmed a good result by ultra sound. However, a patient with bumper-type was unclear. The reason being unclear was due to the material and shape of the appearance by the echo. Left costal arch operations approach is to scan the probe along the left side of the abdomen below the costal arch, so that a replaced gastrostomy catheter could be confirmed by following the low echoic area of the spleen, stomach vault and into the stomach cavity. It is considered that ultrasound examination of the exchanged balloon-type gastrostomy was useful under a consideration of patient's health conditions.     

Optimal therapeutic concentration of tacrolimus in adult patients undergoing reduced-intensity cord blood transplantation

To investigate the effectiveness and safety of GVHD prophylaxis using FK506 alone as a continuous infusion, 104 patients who underwent reduced-intensity cord blood transplantation were retrospectively reviewed. The respective incidence of acute GVHD was 25 grade 1(24. 1%), 19 grade2(18. 3%), 15 grade3(14. 4%), and 4 grade4(3. 8%), which are comparable to that in the literature. The incidences of grade 2 and greater acute GVHD were 32 out of 69(46. 4%)for those whose wholeblood concentration of FK506 werele ss than 13 ng/mL, whereas 6 out of 35(17. 1%)for those FK5 06 were greater than 13 ng/mL. The differenceies between above and below 13 ng/mL were statistically significant(p=0. 008). There were 19 cases(18. 3%)of renal dysfunction, although none required hemodialysis. There were only 4 patients who discontinued FK506, which further confirmed the safety of FK506 alone. Together with our previous report on the upper limit of FK506(17 ng/mL)and these results, we recommend the optimal serum concentration of FK506 to range from 13 to 17 ng/ mL.     

A case of metastatic liver tumor from gastric carcinoma curatively undergoing left hemihepatectomy and caudate lobectomy with ivc reconstruction

A 72-year-old male underwent distal gastrectomy with D2 dissection for type 2 advanced gastric carcinoma. Nine months after the surgery, CT scan revealed a solitary liver metastatic legion with IVC invasion. We selected a surgical intervention because of allegic reaction of S-1 and rapid progression of tumor. Left hemihepatectomy and caudate lobectomy with IVC reconstruction was performed. IVC was resected partially and repaired with polytetrafluoroethylene (PTFE) patch graft. The postoperative course was uneventful. The patient was discharged on the 11th postoperative day. He is alive without a recurrence 9 months after surgery and is undergoing weekly paclitaxel. Although the indication of extended hepatectomy is controversial, aggressive surgery with chemotherapy would contribute to improve a prognosis of the patients with metastatic liver tumor from gastric carcinoma.     

Effective chemotherapy with S-1 alone in a patient with lung metastases of breast cancer

We report a 50-year-old female with pulmonary metastases from breast cancer who responded to S-1. In September 2003, she underwent surgery for breast cancer. Four years 8 months after the operation, lung relapse was detected. After the treatment failure of FEC60 (5-FU 500 mg/m2, epirubicin 60 mg/m2, cyclophosphamide 500 mg/m2) and taxane antitumor drugs, oral administration of S-1 80 mg/body/day was initiated. At the end of three courses, thoracic CT revealed the disappearance of the lung metastasis. Advanced reactions during the administration period were mild. After 14 courses of S-1 therapy (during 11 months), a complete response was clinically maintained. S-1 showed a good antitumor effect and tolerance, and it might be useful for treating metastatic and recurrent breast cancers.     

Pharmacological aspects of the acetylcholinesterase inhibitor galantamine

Several lines of evidence suggest that cholinergic deficits may contribute to the pathophysiology of psychiatric disorders as well as Alzheimer's disease. There is growing clinical evidence that galantamine, currently used for the treatment of Alzheimer's disease, may improve cognitive dysfunction and psychiatric illness in schizophrenia, major depression, bipolar disorder, and alcohol abuse. Since galantamine is a rather weak acetylcholinesterase inhibitor, but has additional allosteric potentiating effects at nicotinic receptors, it affects not only cholinergic transmission but also other neurotransmitter systems such as monoamines, glutamate, and γ-aminobutyric acid (GABA) through its allosteric mechanism. It is likely that these effects may result in more beneficial effects. To understand the underlying mechanism for the clinical effectiveness of galantamine, neuropharmacological studies have been performed in animal models of several psychiatric disorders. These studies suggest that not only the nicotinic receptor-modulating properties but also the muscarinic receptor activation contribute to the antipsychotic effect and improvement of cognitive dysfunction by galantamine. This review summaries the current status on the pharmacology of galantamine, focusing on its effect on neurotransmitter release and pharmacological studies in animal models of psychiatric disorders.