Enterocolic granulomatous phlebitis associated with epidermal growth factor-containing fibulin-like extracellular matrix protein 1 deposition and focal amyloid properties: A case report

A woman in her 60s with rheumatoid arthritis was admitted with fever and abdominal pain. Laparoscopic examination with the differential diagnosis of peritoneal neoplasm and infection revealed granulomatous phlebitis in the resected greater omentum. Amorphous eosinophilic deposits observed in the resected tissue exhibited focal, weak positivity for Congo red but were strongly positive for thioflavin S, confirming their focal amyloid properties. Marked degeneration of elastic fibers was also evident. Electron microscopy revealed deposits around the affected elastic fibers. Immunohistochemistry revealed the deposition of epidermal growth factor-containing fibulin-like extracellular matrix protein 1 (EFEMP1) along with T-cell-predominant lymphocytic inflammation. The definitive diagnosis was granulomatous enterocolic lymphocytic phlebitis (ELP) associated with EFEMP1 deposition exhibiting focal amyloid properties (EFEMP1/AEFEMP1), supported by proteomics analysis. This type of vasculitis is similar to amyloid-β-related angiitis of the central nervous system. Thus, we speculate that granulomatous ELP also results from an immune response that recognizes EFEMP1/AEFEMP1 deposits as foreign material and attempts to remove them. Confirmation of EFEMP1/AEFEMP1 deposition with Congo red staining is challenging, particularly in the presence of inflammation, and warrants comprehensive evaluation.

Exercise-induced acute renal failure in 3 patients with renal hypouricemia

Three cases of exercise-induced non-oliguric acute renal failure in patients with renal hypouricemia, an isolated defect of the renal urate transport system, are described. During acute renal failure, the serum uric acid levels were 5.6, 2.7 and 5.8 mg/dl, respectively, and were within normal limits. The values representing the fractional excretion of uric acid (FEUA) were 28.7, 60.0 and 12.7%, with accompanying serum creatinine levels of 8.1, 3.9 and 3.3 mg/dl, respectively. After recovery, the serum uric acid fell to 0.6, 0.7 and 1.0 mg/dl and the FEUA increased to 79.3, 52.8 and 43.2%, respectively. Two of the patients examined exhibited decreased reabsorption of filtered urate. These 3 examples of renal hypouricemia represented 23% of 13 cases of mild exercise-induced acute renal failure encountered within our experience.

Effect of phenylalanine on pancreatic amylase secretion in chicks (Gallus domesticus)

1. Effect of phenylalanine (Phe) on pancreatic amylase secretion in growing chicks was investigated in four experiments. 2. In Experiment 1, birds were injected through a wing vein with 0.25 ml Phe at 0, 0.1, 0.5, 2.5 and 12.5 mM in physiological saline. No significant difference was observed in amylase secretion among treatments. 3. Effect of various concentrations of Phe with cholecystokinin (CCK, 0.31 Crick unit) on amylase secretion was investigated in Experiment 2. Amylase secretion increased with time, although no significant effect was detected in Phe treatment. 4. Efficacy of Phe and tyrosine (Tyr) injection with CCK on amylase secretion was compared. There was no significant difference between Phe and Tyr treatments. 5. Birds were injected intraperitoneally with dl-p-chlorophenylalanine (p-CP), which is an inhibitor of phenylalanine hydroxylase, or saline 1 day before the collection of pancreatic amylase in Experiment 4. Both chicks showed increased amylase secretion with CCK (0.31 Crick unit), whereas the response was at a drastically reduced rate in chicks with the p-CP treatment.

Effects of diltiazem hydrochloride on the reduction of blood pressure, and cardiac and renal functions in essential hypertensive patients with renal dysfunction

Diltiazem hydrochloride was administered at a dose of 180 mg/day for 12 weeks to 10 essential hypertensive patients with slightly or moderately decreased renal plasma flow (RPF) in order to study its antihypertensive effect as well as the effects on cardiac and renal functions. The administration of diltiazem hydrochloride produced significant decreases in systolic pressure, diastolic pressure, and mean blood pressure. Right and left ventricular ejection fractions, max. dv/dt, and min. dv/dt assessed by cardiac pool scintigraphy were slightly increased, but these changes were not statistically significant. The glomerular filtration rate (GFR) and RPF were slightly increased, while renovascular resistance (RVR) was significantly reduced. No consistent tendency was observed in changes in plasma renin activity (PRA) and plasma aldosterone level. From these results, it was suggested that diltiazem hydrochloride is a potent antihypertensive drug which has no adverse effects on cardiac and renal functions in the treatment of essential hypertensive patients with slightly or moderately decreased RPF.

[An autopsy case of triple cancer associated with superior vena cava syndrome]

In recent years, because of advances in diagnostic techniques and therapy for malignant tumors, it is not rare to encounter cases of primary multiple malignant neoplasms. However, triple cancer is still rare. We report a case of triple cancer--gastric cancer, sigmoid colon cancer and malignant fibrous histiocytoma. To our regret, we could not make a diagnosis while the patient was alive. Careful examination of a cancer patient is important because malignant tumors may develop at any time.

Sex differences in acquired cystic disease of the kidney on long-term dialysis

Acquired cystic disease of the kidney in chronic glomerulonephritic patients who had been on hemodialysis more than 3 years (4.5 +/- 1.2 years at the base line examination), were followed for 3.6 +/- 0.5 years (at the follow-up examination) by computed tomography (CT scan). The renal volume in the 25 male patients was significantly greater at the follow-up examination than at the base line examination. On the other hand, the renal volume in the 12 female patients was similar on both examinations. The enlargement of kidney volume more than twofold during the follow-up was seen in 9 of 25 male and none of 12 female patients. The grade of cystic transformation was increased in male patients during the follow-up period. These results indicate that sex-related endogenous substances might play a role in the pathogenesis of acquired cystic disease.

[Clinical application of a right ventricular pressure-volume loop determined by gated blood-pool imaging and simultaneously measured right ventricular pressure]

The data obtained by ECG-gated radionuclide angiography were collected simultaneously with right ventricular pressure and thermal cardiac output (CO) obtained by a Swan-Ganz catheter in Scintipac 1200 ( Shimazu Co) in order to create a right ventricular pressure-volume (RV P-V) loop. Subjects consisted of 15 patients with old myocardial infarction (MI group), seven with angina pectoris (AP group), six with congestive cardiomyopathy (CCM group) and five with neurocirculatory asthenia (NCA group). Right ventricular end-diastolic volume ( RVEDV ) was calculated as RVEDV = CO/(EF X HR) (CO = cardiac output; HR = heart rate). Systolic work (Ws), diastolic work (WD) and net work (WN) were calculated from a RV P-V loop by Simpson's method. The measurements were performed before and 5 min after sublingual administration of nitroglycerin (NG) (0.3 mg). The results were as follows: RV P-V loops shifted towards the left lower part of the P-V plane after sublingual administration of nitroglycerin, indicating the reduction of pressure and volume of the right ventricle. Right ventricular ejection fraction (RVEF) in the MI, AP and CCM groups showed smaller values than that of the NCA group. The CCM group presented a significantly smaller value than the NCA group (p less than 0.005). RVEF of each group increased after NG. In the AP and CCM groups, it increased significantly (p less than 0.005). Right ventricular end-diastolic volume index ( RVEDVI ) showed a converse relation with RVEF. The MI and CCM groups demonstrated significantly higher values (p less than 0.05). After NG, RVEDVI of each group decreased significantly (p less than 0.001 in the MI and NCA groups, and p less than 0.005 in the AP and CCM groups). Cardiac index in all groups decreased after NG and a statistical significance was seen in the MI, AP and NCA groups (p less than 0.05). RV Ws, RV WD and RV WN showed no difference among each group in the control state, and significantly decreased after NG. This was due to the reduction of RV pressure and volume. It was indicated that the principal cause was the systemic volume reduction. We conclude that the present method using RV P-V loop might be useful as a noninvasive bedside monitoring and permits the evaluation of RV function in a clinical setting.