Santorinicele in a patient with unresectable pancreatic cancer

A santorinicele is defined as a focal cystic dilatation of the terminal portion of the dorsal pancreatic duct at the minor papilla; most cases have been reported in patients with pancreas divisum. It has been suggested that a santorinicele results from a combination of a minor papilla obstruction which prevents the flow of pancreatic juice and a weakness of the duodenal wall where the dorsal pancreatic duct terminates. However, these conditions can occur in patients with invasive ductal cancer in the pancreatic head. We encountered a rare case of a santorinicele with unresectable adenocarcinoma of the pancreatic head in an 81-year-old woman.     

A case of cutaneous tuberculosis under steroid & immunosuppressant therapy for dermatomyositis

A 44-year-old man had been admitted for high fever and leg edema on November 1998. By the laboratory data, electromyography, and muscle biopsy, he was diagnosed as having polymyositis. Steroid (prednisolone 60 mg/day) and immunosuppressant (methotrexate 7.5 mg/week) therapy was administered and the symptoms were improved, so he had been followed up in out-patient clinic. After half a year, high fever and leg edema relapsed and erythema on the bilateral forearms appeared, so he was admitted again on January 2000. The symptoms, skin involvement and laboratory data suggested the disease of dermatomyositis. Steroid pulse therapy was administered again. But the symptoms were not improved. Skin biopsy was performed but it showed only inflammatory changes. Several antibiotics and cyclospolyn A were undertaken but they were not effective. On February 12th he passed away because of respiratory failure. The autopsy was undertaken and it revealed tuberculosis in the skin, subcutaneous tissues and muscles, however, pulmonary tuberculosis was not found. The patient with collagen disease is considered to be "compromised host", especially during corticosteroid therapy. We must keep in mind potential incidence of tuberculosis and do careful clinical observation for early diagnosis and be prepared for antituberculous chemotherapy. Chemoprophylaxis for tuberculosis seems to be desirable for higher risk patients.     

Efficacy of Once‐weekly Intravenous Administration of Epoetin‐β as a Maintenance Treatment for Anemia in Japanese Hemodialysis Patients: A Multicenter,Open‐label Clinical Study

Epoetin‐β is extremely useful as a drug for treating anemia in hemodialysis (HD) patients and is widely used for that purpose. The aim of this study was to determine whether once‐weekly intravenous administration of epoetin‐β is as effective in maintaining hemoglobin (Hb) concentration as the same weekly dose administered 2 or 3 times per week as maintenance treatment of anemia in HD patients. The subjects were stable HD patients who had been receiving HD for at least 12 months. Using a fixed weekly dose of 3000 or 6000 IU of epoetin‐β, this study evaluated maintenance of improvement of anemia by comparing Hb concentration in the study period (once‐weekly) with Hb concentration in the prestudy period (2 or 3 times per week). Of the 112 patients treated with epoetin‐β, 111 patients (full analysis set; 3000 IU, 52 patients; 6000 IU, 59 patients) were evaluated, after excluding one patient whose dose was changed immediately before study initiation. The change in the Hb concentration was maintained within ±1.5 g/dL in 89.2% of patients (3000 IU, 88.5%; 6000 IU, 89.8%). The mean Hb concentration was 10.42 ± 0.73 g/dL at study initiation and 10.14 ± 1.00 g/dL at study completion. Adverse reactions occurred in 9.8% of patients (11 out of 112 patients). The main adverse reactions were malaise and increased blood pressure. Once‐weekly intravenous administration of epoetin‐β is useful as maintenance treatment of anemia in HD patients and may be a treatment option.     

Gelation and Retrogradation Mechanism of Wheat Amylose

The flow behavior, dynamic viscoelasticity, and optical rotation of aqueous solutions of wheat amylose were measured using a rheogoniometer and a polarimeter. The amylose solutions, at 25 °C, showed shear-thinning behavior at a concentration of 1.2%, but plastic behavior at 1.4 and 1.6%, the yield values of which were estimated to be 0.6 and 1.0 Pa, respectively. The viscosity of the wheat amylose increased a little with increase in temperature up to 10 or 20 °C at 1.2% or 1.4 and 1.6%, which was estimated to be a transition temperature. The elastic modulus increased with increase in concentration, and increased with increasing temperature up to 20, 25 and 30 °C, which was estimated to be a transition temperature, respectively, then decreased gradually but stayed at a large value even at high temperature (80 °C). A very low elastic modulus of the wheat amylose was observed upon addition of urea (4.0 m) and in alkaline solution (0.05 m NaOH) even at low temperature. The optical rotation of wheat amylose solution increased a little with decreasing temperature down to 25 °C, then increased rapidly with further decrease in the temperature. The mode of gelation mechanism of amylose molecules, which was previously proposed, was confirmed and a retrogradation mechanism of wheat amylose was proposed.     

Changes of Cytokines in Direct Endotoxin Adsorption Treatment on Postoperative Multiple Organ Failure

Abstract: Multiple organ failure (MOF) is a serious condition that involves simultaneous or consecutive functional failure of several important organs. Furthermore, sepsis is known to play an important role in the occurrence of MOF. Hemoadsorption therapy with the endotoxin adsorption column containing polymyxin B immobilized fibers by direct hemoperfusion (PMX‐DHP) is reportedly effective in the treatment of septic shock. This study examined the changes induced on cytokines upon PMX‐DHP treatment in 25 patients who underwent emergency abdominal surgery and were immediately started on a postoperative regimen of continuous hemodiafiltration (CHDF) and PMX‐DHP. Postoperative MOF was observed in these patients with a mean APACHE II SCORE of 25.5. Eighty percent of patients survived for more than 1 month. We were able to reduce the necessary dose of dopamine in 85.7% of patients because hemodynamic stability improved after administration of PMX‐DHP. Interleukin 6 blood levels did not change significantly before or after PMX‐DHP treatment in either the surviving or nonsurviving patients. Blood interleukin 1 receptor antagonist levels decreased in both groups. Intercellular adhesion molecular‐1, NOx, and thrombomodulin did not change significantly during the course of treatment in either group. Decreased blood levels of PAI‐1 levels were found in the surviving patients whereas increased levels of PAI‐1 were found in the nonsurviving patients. In conclusion, PMX‐DHP treatment may be limited clinically in its ability to remove inflammatory cytokines and humoral mediators. However, PMX‐DHP treatment is useful for hemodynamic stabilization, which prevents development of MOF.     

Disparity between serotonin- and acetylcholine-provoked coronary artery Spasm

Background and hypothesis: Intrinsic vasoactive substances, such as serotonin and acetylcholine, are known to provoke coronary artery spasm in patients with vasospastic angina. It remains unclear, however, whether these different agents, which activate different receptors, produce spasms at the same sites in these patients. The present study was designed to clarify the disparity of receptor agonist-induced coronary artery spasms in the same patients. Methods: We conducted sequential provocative tests of coronary artery spasm by acetylcholine, serotonin, and ergonovine in 20 patients with rest angina examined with quantitative coronary angiography. Results: Coronary artery spasms were provoked in all patients at 27 spastic sites. In 13 patients, ergonovine provoked spasms and in 10 of 13 patients who were diagnosed with variant angina, both acetylcholine and serotonin provoked spasms at the same sites where ergonovine also did. In 4 of 13 patients, spasms were provoked by serotonin but not by acetylcholine. In the remaining seven patients, whose spasms were induced by ergonovine, spasms were produced by acetylcholine but not by serotonin. On coronary angiography, the spastic sites for both acetylcholine and serotonin, and those for serotonin alone, were located in the proximal segments of coronary arteries, whereas the spastic sites for acetylcholine alone were located in the distal segments. Conclusions: This study documented the disparity between serotonin- and acetylcholine-induced spasms. Provocative tests using agents that activate different receptors may produce coronary artery spasms at the same and/or different sites, and this disparity may reflect the clinical heterogeneity of vasospastic ischemic syndrome.