Molecular diagnosis and characterization of a culture-negative mycotic aneurysm due to ST54 Haemophilus influenzae type b with PBP 3 alterations

Mycotic aneurysm is a rare but life-threatening disease that warrants an integrated therapeutic approach involving surgical intervention and prolonged antibiotic use. However, the causative organisms are often unidentified because antibiotics started empirically render blood and tissue cultures negative. Molecular diagnosis has been reported to be useful in such culture-negative cases. We report a case of a culture-negative mycotic aortic aneurysm due to Haemophilus influenzae, diagnosed by direct 16S rRNA polymerase chain reaction (PCR) and sequencing of the resected aneurysm tissue. PCR for serotype revealed type b, and PCR and sequencing of the ftsI gene revealed alterations in penicillin-binding protein 3, suggesting resistance to ampicillin. Multilocus sequence typing demonstrated that the isolate belonged to sequence type 54.     

Clinical outcomes of a novel therapeutic vaccine with Tax peptide‐pulsed dendritic cells for adult T cell leukaemia/lymphoma in a pilot study

Adult T cell leukaemia/lymphoma (ATL) is a human T cell leukaemia virus type‐I (HTLV‐I)‐infected T cell malignancy with poor prognosis. We herein developed a novel therapeutic vaccine designed to augment an HTLV‐I Tax‐specific cytotoxic T lymphocyte (CTL) response that has been implicated in anti‐ATL effects, and conducted a pilot study to investigate its safety and efficacy. Three previously treated ATL patients, classified as intermediate‐ to high‐risk, were subcutaneously administered with the vaccine, consisting of autologous dendritic cells (DCs) pulsed with Tax peptides corresponding to the CTL epitopes. In all patients, the performance status improved after vaccination without severe adverse events, and Tax‐specific CTL responses were observed with peaks at 16–20 weeks. Two patients achieved partial remission in the first 8 weeks, one of whom later achieved complete remission, maintaining their remission status without any additional chemotherapy 24 and 19 months after vaccination, respectively. The third patient, whose tumour cells lacked the ability to express Tax at biopsy, obtained stable disease in the first 8 weeks and later developed slowly progressive disease although additional therapy was not required for 14 months. The clinical outcomes of this pilot study indicate that the Tax peptide‐pulsed DC vaccine is a safe and promising immunotherapy for ATL.     

Phonatory function following esophagectomy for esophageal cancer

BACKGROUND/AIMS: Quality of life can be adversely affected in many patients who suffer phonation disorders such as hoarseness and dysphonia following esophagectomy. The present study investigated postoperative phonation disorders in 15 patients who underwent esophagectomy for esophageal cancer. METHODOLOGY: None of the patients had signs of hoarseness before or after surgery. Aerodynamic testing to assess phonatory function testing and laryngoscopy for observing laryngeal movements were performed before and after surgery. As a control, the same tests were conducted in 20 patients treated for gastric cancer by gastrectomy. RESULTS: For esophagectomy patients, mean postoperative flow rate was significantly increased and maximum postoperative phonation time was significantly decreased after operation. Laryngoscopy confirmed postoperative paralysis of left laryngeal movements and excessive adduction of the right, unaffected vocal cord during phonation in 8 of 15 esophagectomy patients, although hoarseness was not reported by any patient. No significant changes were observed for mean postoperative flow rate or maximum postoperative phonation time following surgery in gastrectomy patients. CONCLUSIONS: Surgical procedures in the vicinity of the recurrent laryngeal nerve appear to be the cause of postoperative phonation disorders in patients undergoing esophagectomy for esophageal cancer, and these disorders can occur in the absence of symptoms such as hoarseness and dysphonia.     

Delorme’s Procedure for Rectal Prolapse

PURPOSE: Clinical and physiological results of Delormes procedure were assessed retrospectively in patients undergoing this procedure for rectal prolapse. METHODS: A consecutive series of 31 patients (7 males, 24 females; age, 14–93, mean 70 years) with full-thickness, rectal prolapse were treated by Delormes procedure between 1994 and 2002. Median follow-up was 39 (range, 6–96) months. RESULTS: Good results were achieved in 27 patients (87 percent), prolapse recurrence was observed in 4 (13 percent), and mean recurrence time was 14 (range, 3–25) months. There were no postoperative deaths. Minor complications occurred in four patients. The median changes in preoperative and postoperative physiologic patterns in 16 patients were as follows: resting pressure from 21.0 (range, 5–48) to 23.5 (range, 12–76) cm H2O (P = 0.030), squeeze pressure from 64.0 (range, 27–248) to 108.0 (range, 32–264) cm H2O (P = 0.041), volume at first sensation from 100 (range, 70–180) to 70 (range, 40–130) ml (P = 0.002), maximum tolerated volume from 260 (range, 120–400) to 160 (range, 70–400) ml (P = 0.001). Incontinence improved in 63 percent. No patient became constipated, and 38 percent of those constipated preoperatively improved. The preoperative incontinence score improved from 11.5 (range, 1–20) to 6.0 (range, 0–20) after operation (P < 0.0001). CONCLUSION: Delormes procedure had a low morbidity, did not lead to constipation, improved anal continence, and had a reasonably low recurrence rate. Improved anal sphincter and rectal sensation were associated with a reduced incidence of defecatory problems after Delormes procedure.     

Three cases of patients in their eighties who received anti-EGFR antibody mono-therapy as first-line treatment for metastatic colorectal cancer

We report three cases of patients in their eighties who received anti-EGFR antibody mono-therapy as first-line treatment for metastatic colorectal cancer. CASE 1: An 86-year-old woman who received cetuximab after a colostomy for unresectable rectal cancer with synchronous liver and lung metastases. Serum levels of CEA and CA19-9 showed a significant decrease at 2 months, after which they showed a gradual increase. Computed tomography (CT) revealed a reduction in the rectal tumor. CASE 2: An 82-year-old woman who received cetuximab for peritoneal metastases after a transverse colectomy. Serum levels of CEA and CA19-9 decreased to normal levels at 2 months, and CT imaging revealed disappearance of the tumor in the peritoneal cavity. CASE 3: A 79-year-old man who received panitumumab for lung, liver and para-aortic lymph node metastases after a descending colectomy. Serum levels of CEA and CA19-9 showed a decrease at 1 month, after which they showed a gradual increase. No marked change in the tumor was observed by CT. No change was observed in performance status or Vulnerable Elders Survey( VES-13) score, and the effect on overall condition was minimal. Grade 1-2 acneiform skin rash, paronychia, and desquamation, and grade 2-3 dry skin and pruritis were observed. More precise instructions on measures for dealing with skin rash are necessary to obtain higher drug compliance.     

Rituximab monotherapy with eight weekly infusions for relapsed or refractory patients with indolent B cell non-Hodgkin lymphoma mostly pretreated with rituximab: a multicenter phase II study

Information regarding rituximab monotherapy with eight weekly infusions for relapsed or refractory indolent B cell non-Hodgkin lymphoma (B-NHL), in particular for patients pretreated with rituximab, is limited. To evaluate the efficacy and safety of eight doses of rituximab monotherapy, 52 patients with relapsed or refractory indolent B-NHL were enrolled in the present study. Forty of 45 eligible patients (89%) had follicular lymphoma and 24 (53%) were at intermediate or high risk group according to the Follicular Lymphoma International Prognostic Index. The median number of prior chemotherapy regimens was 1 (range 1-7). At the median follow-up of 12.2 months, the overall response rate (ORR), complete response rate (%CR), and median progression-free survival (PFS) were 69% (95% confidence interval [CI] 53%-82%), 47% (95% CI 32%-62%), and 15.6 months (95% CI 10.6- months), respectively. In the 33 patients pretreated with rituximab, the ORR, %CR, and median PFS were inferior compared with values for the 12 patients who had not received rituximab previously (64%vs 83% for ORR; 39%vs 67% for %CR; and 13.8 vs 17.5 months for median PFS, respectively). All mild-to-moderate infusion-related toxicities were reversible. Grade 3/4 non-hematologic adverse events occurred in six of the 52 patients. Two patients developed Grade 4 late-onset neutropenia and a decrease (>50%) in serum immunoglobulin was observed in six patients. In conclusion, rituximab monotherapy with eight weekly infusions is effective in relapsed patients with indolent B-NHL, with acceptable toxicities, including in patients pretreated with rituximab; however, careful monitoring is recommended for infections associated with late-onset neutropenia and hypogammaglobulinemia. (University Hospital Medical Information Network no. UMIN000002974.)