Pulmonary Waldenstr?m's macroglobulinemia--a case report

A case of Waldenstr?m's macroglobulinemia (WMG) with principally pulmonary manifestation is presented. A 47-year-old man was admitted to our hospital with complaints of shortness of breath and an increasingly enlarged right pulmonary nodule, which had first been discovered about 2 years prior to admission. The liver, spleen and lymph nodes were not enlarged. Hematological examination revealed Hb 12.8 g/dl, platelet 28.2 x 10(4)/microliters and WBC 7,400/microliters without pathological cells. A bone marrow aspirate showed no remarkable abnormalities. A quantitative measurement of serum immunoglobulin gave values for IgG of 2,264 mg/dl, IgA of 393 mg/dl and IgM of 1,332 mg/dl, and M-protein of IgM, K type was observed on serum immunoelectrophoresis. Chest X-ray film showed a 5 x 4 cm poorly defined mass in the right middle lobe. Histological examination of a mass obtained by an open lung biopsy revealed diffuse proliferation of lymphoplasmacytoid cells. Monoclonal IgM, K was demonstrated in the cytoplasma of these cells by the PAP method. These data established the diagnosis of pulmonary WMG. He received VEPA therapy, and pulmonary mass lesion gradually decreased and his serum IgM level had decreased to 465 mg/dl 2 months after the initiation the chemotherapy.     

Relationship between dual‐task performance and neurocognitive measures in older adults with mild cognitive impairment

Aim: The aim of this study was to examine the relationship between dual‐task performance and neurocognitive measures in community‐dwelling older people with mild cognitive impairment (MCI). Methods: A total of 98 subjects (mean age 74.8 years, 52.0% female) participated in the study. We compared 36 participants with amnestic MCI (aMCI) with 62 participants with non‐amnestic MCI (non‐aMCI) on dual‐task performance as measured by reaction time responses. The relationships between dual‐task performance and multiple domains of neurocognitive functions, including general cognitive function, visual memory, working memory, executive function and processing speed, were examined. Results: Although there were no statistically significant group differences in simple reaction times (P = 0.734), the aMCI group showed significantly slower dual‐task reaction times than the non‐aMCI group (P = 0.012). Using multiple regression analysis, we found that there was a significant relationship between executive function and dual‐task reaction times (β = 0.298, P = 0.006). Conclusion: These results showed that aMCI subjects showed a specific deficit in dual‐task performance compared with non‐aMCI subjects, and poor dual‐task performance was associated with declines in executive function in older people with MCI. Future longitudinal and interventional studies should investigate the use of dual‐task testing with varying levels of cognitive demand in older adults at risk of dementia. Geriatr Gerontol Int 2013; 13: 314–321 .     

Metallic stent deployment in endosonography‐guided biliary drainage: Long‐term follow‐up results in patients with bilio‐enteric anastomosis

Background and Aim: Although reports on endosonography‐guided biliary drainage (ESBD) have been increasing, only a few reports on deployment of a self‐expandable metal stents (SEMS) have been reported. The aim of the present study was to evaluate the safety and efficacy of SEMS deployment in ESBD. Methods: Of 42 patients who underwent ESBD during the period from January 2007 to August 2011, 21 patients with unresectable malignant biliary obstruction in whom SEMS deployment had been attempted were included. In the first session, a plastic stent or SEMS was placed in a bilio‐enteric anastomosis (BEA) method. SEMS was deployed with the one‐step technique or with replacement of a plastic stent with a SEMS in the second session. The technical success, early and late complications, and stent patency of SEMS were evaluated. Results: One‐step SEMS deployment was attempted in seven patients, and SEMS was deployed with stent exchange in 14. SEMS deployment was successful in all patients without any complications. Finally, SEMS was placed in a BEA method in 16 patients (extrahepatic bile duct, 13; intrahepatic bile duct, three), and with antegrade deployment in five. Late complications occurred in three patients who underwent deployment of SEMS in a BEA method (stent obstruction in two and reflux cholangitis in one). The mean stent patency period was 433 days. Conclusions: As SEMS deployment in ESBD is safe and provides long stent patency, a SEMS seems to be the stent of choice in ESBD for patients with unresectable malignant biliary obstruction in whom long survival is expected.     

Clinical effects of terodiline hydrochloride for urinary frequency and sense of residual urine

The clinical effects of terodiline hydrochloride were evaluated in forty-four patients with urinary frequency and/or sense of residual urine. After a four-week treatment with 24 mg terodiline hydrochloride once daily, subjective symptoms were improved and micturition frequency was decreased significantly. Slight dysuria was reported as a side effect only in one patient. Terodiline hydrochloride is considered to be superiorly effective and safe for the treatment of urinary frequency and sense of residual urine.     

Immunoelectron microscopic examination of IgA deposition in dermatitis herpetiformis

Ultrastructural localization of IgA in the skin of three Japanese patients with dermatitis herpetiformis (DH) was studied with the immunoelectron microscopic technique using periodate-lysine-paraformaldehyde fixation. In direct immunofluorescence studies, two of the three cases showed fine fibrillar deposition of IgA and the other case fine granules in the dermal papillae. In the former, the reaction products of IgA were present in the upper dermis forming various-sized aggregates which were occasionally arranged perpendicularly to the epidermis and appeared to be associated with microfibrillar bundles of the elastic tissue. Reaction products were also deposited to a lesser extent on the microfibrillar component of the elastic fibers at the lower part of the dermal papillae. However, in the latter, the reaction products were found to form smaller aggregates on and around the collagen fibrils rather than on the elastic tissue. Such a localization of IgA reaction products has not yet been reported in DH. The difference of the distribution patterns of IgA and the possible singularity of Japanese DH cases are discussed.