Clinical significance of endothelial vasodilatory function evaluated by EndoPAT in patients with systemic sclerosis

Endothelial dysfunction is a hallmark of vasculopathy associated with systemic sclerosis (SSc). Reactive hyperemia peripheral arterial tonometry is a rapid and non-invasive technique to assess peripheral microvascular endothelial function by measuring changes in digital pulse volume during reactive hyperemia. Low scores of the reactive hyperemia index (RHI) imply an impaired vasodilatory response and, accordingly, impaired endothelial and vascular health. To investigate the clinical significance of the RHI in SSc patients, RHI values were measured in 43 SSc patients and 10 healthy controls. In diffuse cutaneous SSc (dcSSc) patients, RHI values were significantly decreased compared with healthy controls, and inversely correlated with disease duration. In total SSc patients, there was a significant inverse correlation between RHI values and skin score, and interstitial lung disease was associated with the decrease in RHI values. Among vascular symptoms, the current and past history of digital ulcers was seen more frequently in patients with decreased RHI values than in those with normal RHI values. Although no SSc patients had pulmonary arterial hypertension, an inverse correlation was evident between RHI values and mean pulmonary arterial pressure measured by right heart catheterization. These results indicate that the decrease in RHI values is associated with skin fibrosis, interstitial lung disease, digital ulcers and pulmonary vascular involvement leading to pulmonary arterial hypertension, supporting the canonical idea that endothelial dysfunction is a critical event underlying the development of tissue fibrosis and vascular complications in SSc.     

Serum vaspin levels: A possible correlation with digital ulcers in patients with systemic sclerosis

Vaspin is an adipokine implicated in vascular inflammation and remodeling. We herein evaluated the clinical correlation of serum vaspin levels in systemic sclerosis (SSc). Consistent with previous reports, 12% of subjects exhibited serum vaspin levels over 10 ng/mL, likely due to genetic effects. Excluding these subjects, despite no difference between SSc and control subjects, serum vaspin levels were significantly decreased in SSc patients with digital ulcers compared with those without, suggesting the potential contribution of vaspin to digital ulcers of this disease.     

Small invasive colon cancer with adenoma observed by endocytoscopy: A case report

BACKGROUND Endocytoscopy is a next-generation endoscopic system that facilitates real-time histopathologic endoscopic diagnosis of colorectal lesions by virtue of its 520 × maximum magnification.CASE SUMMARY We present the case of a 63-year-old man with sigmoid colon cancer who was regularly referred for follow-up colonoscopy after endoscopic resection of T1 rectal cancer. Colonoscopy revealed a 12 mm reddish polyp, including a depression and a flat area in the sigmoid colon. Endocytoscopic observation showed unclear gland formation and agglomeration of distorted nuclei(depression), suggesting a submucosal invasive(T1) cancer. In the flat area, slitlike smooth lumens and regular pattern of fusiform nuclei were found, suggesting an adenoma. On the basis of these endocytoscopic findings, we predicted this lesion as T1 cancer(depression) with adenoma(flat area) and performed endoscopic resection corresponding to the final histopathological diagnosis.CONCLUSION We could perform an optical diagnosis of T1 sigmoid cancer with adenoma by using endocytoscopy before treatment.     

Gene Polymorphisms in the CCL5/CCR5 Pathway as a Genetic Biomarker for Outcome and Hand–Foot Skin Reaction in Metastatic Colorectal Cancer Patients Treated With Regorafenib

Background

The C-C motif chemokine ligand 5/C-C motif chemokine receptor 5 (CCL5/CCR5) pathway has been shown to induce endothelial progenitor cell migration, resulting in increased vascular endothelial growth factor A expression. We hypothesized that genetic polymorphisms in the CCL5/CCR5 pathway predict efficacy and toxicity in patients with metastatic colorectal cancer (mCRC) treated with regorafenib.

Primary non-hodgkin’s lymphoma of the breast: a report of two cases

Background: Primary non-Hodgkin’s lymphoma of the breast (PBNHL) is a rare neoplasm and PBNHL occuring in a man is extremely rare. Method: We report herein two cases of PBNHL and discuss methods of diagnosis and treatment. Results: The first patient was a 35-year-old woman who presented with an elastic-hard mass in her left breast and adenopathy in her left axillary fossa. Mammography and ultrasonography suggested left breast cancer. Frozen sections demonstrated PBNHL histologically. Quadrantectomy of the breast was performed followed by chemotherapy. The second patient was a 65-year-old man with an elastic-hard mass in his left breast and left axillary lymphadenopathy. Mammography and ultrasonography suggested breast cancer or a soft tissue tumor. Intraoperative histological examination revealed a diagnosis of non-Hodgkin’s lymphoma (NHL). A simple mastectomy and postoperative chemotherapy were performed and the patient had a good prognosis. Conclusion: A multidisciplinary approach including surgery, chemotherapy, and radiotherapy is indispensable in treating PBNHL, after diagnosis by excisional biopsy or aspiration cytology.     

Analgesia after upper abdominal surgery with extradural buprenorphine with lidocaine

Purpose

To determine whetherthe continuous low thoracic extradural administration of the same dose of lidocaine at low concentration with a high infusion rate or at high concentration with a low infusion rate in combination with a fixed dose of buprenorphine (0.4 ing·day^?1) modifies postoperative pain relief.

Methods

Twenty-eight patients undergoing elective upper abdominal surgery were randomly allocated to one of two groups to receive lidocaine 2% — buprenorphine at a rate of 6.3 ml· hr^?1 (2% group, n = 13) or lidocaine 6% — buprenorphine at a rate of 2.1 ml· hr^?1 (6% group, n = 15). During suture of the peritoneum, mepivacaine 2% (8 ml) with 0.1 mg (0.5 ml) buprenorphine was infused extradurally. After extubation, the continuous extradural infusion was initiated. Patients were assessed for the level of analgesia with the 10 cm VAS score at rest and with the Prince Henry Pain Scale (PHPS) at 3, 6, 9, 12, 18, and 24 hr postoperatively.

Results

The visual analogue scale (VAS) scores at rest did not differ between the two groups except at 18 hr after surgery. The Prince Henry Pain Scale (PHPS) scores were not different between the two groups post-operatively.

Conclusion

There was no difference in analgesia produced by the continuous extradural infusion of lidocaine 2% — buprenorphine at a rate of 6.3 ml· hr^?1 and that of lidocaine 6% — buprenorphine at a rate of 2.1 ml· hr^?1 following upper abdominal surgery.