Primary cutaneous cryptococcosis in a patient with minimal change nephrotic syndrome.

Sir, Cryptococcosis is the infectious disease that usually affectsthe respiratory tract and subsequently disseminates to otherorgans such as the central nervous system, the urinary tract,etc. Cryptococcosis is frequently found in immunosuppressedpatients, especially HIV positive patients (2–10% of AIDSpatients). Approximately 15% of the patients with systemic disseminationof cryptococcosis have secondary involvement of the skin. However,primary cutaneous cryptococcosis (PCC) without systemic infection     

Surgical treatment for the patient with atrial septal defect and Andersen syndrome

An 18-year-old girl with atrial septal defect and Andersen syndrome is reported. Andersen syndrome was described as a hereditary disease characterized by periodic paralysis, prolongation of the QT interval with ventricular arrhythmia and characteristic physical features including low set ear and micrognathia. We successfully performed cardiac operation for this rare associated malformation.     

Preoperative natural killer cell activity as a prognostic factor for distant metastasis following surgery for colon cancer

BACKGROUND/AIMS: To determine whether preoperative natural killer (NK) cell activity has any prognostic significance in colon cancer patients. METHODS: The study population consisted of 140 patients with colon cancer. NK cell activity was determined within 2 weeks before surgery in 128 patients and at the time of diagnosis in the remaining 12 patients who either did not undergo surgery or who underwent palliative surgery only. Disease progression and postoperative prognosis were examined in relation to NK cell activity. RESULTS: Decreases in NK cell activity did not necessarily correspond to tumor stage. In curatively operated stage I-III diseases, preoperative NK cell activity of 20% or less correlated with poor survival. Lower activity was also associated with metachronous distant metastases but not with local recurrences. In particular, more than half the stage III patients with attenuated NK cell activity developed metastases. Multivariate analysis indicated that attenuated NK cell activity was a significant parameter for predicting distant metastasis following curative surgery for colon cancer. CONCLUSION: Preoperative NK cell activity has a significant prognostic value in curatively operated colon cancer, particularly for the development of metachronous distant metastasis in stage III patients.     

Remitting seronegative symmetric synovitis with pitting edema: scintigraphic and magnetic resonance imaging findings

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) was first reported by McCarty et al in 1985 and refers to a rheumatologic set of symptoms with acute onset, with no erosive bone lesions, with seronegative findings, affecting the elderly more frequently, and showing an excellent prognosis with low-dose steroid therapy. Although these characteristics make it possible to differentiate it from rheumatoid arthritis and rheumatic polymyalgia, there have been very few reports on the imaging findings. The authors present scintigraphic and magnetic resonance images in a case of RS3PE.     

Spontaneous remission of myasthenia gravis in patients with thymoma

In 42 cases of myasthenia gravis with thymoma, the tumor was removed surgically. In four of these cases, myasthenic symptoms had remitted before operation. However, in two of these four cases, myasthenic symptoms returned after operation, despite apparently total thymectomy. In two of the four cases that remitted before operation, the thymus was found to be highly involuted, without germinal centers; in another case, the thymus was found to be moderately involuted, and germinal centers were found. In the nonrelapsing cases, only the tumor itself was removed, with residual thymic tissue being left behind. The thymoma in all cases consisted of polygonal epithelial cells and lymphocytes.     

A case of rectal cancer treated by preoperative chemoradiation

Fifty-one-year-old male visited our hospital suffering from anal pain and subileus. Further examination revealed that advanced rectal cancer which invaded to presacral space (Ai, N 0, P 0, H 0, M(-), stage IIIa) caused such symptom. We administered neo-adjuvant chemoradiotherapy for fear of non curative resection of the rectum. The regimen was once weekly administration of intravenous CPT-11 40 mg, plus daily oral administration of UFT-E 600 mg/day and Uzel 75 mg/day for 4 weeks. In addition we underwent radiation 2.4 Gy/day and intravenous low-dose cisplatin (CDDP) 5 mg/day, 5 days/week for 3 weeks. Four weeks after the first administration, a partial response was confirmed on CT, and so we carried out an abdominoperineal resection. The postoperative course is almost uneventful without a little perineal infection. The specimen revealed that no malignant lesion remained, which changed to necrotic tissue. The side effects were not so severe. For example, diarrhea, nausea, and mucosal dysfunction were each less than grade 2, and there was much tolerate for renal, liver, and bone marrow function. This combination chemoradiotherapy is considered to be effective for locally advanced rectal cancer.