Pyoderma gangrenosum and underlying diseases in Japanese patients: A regional long-term study

Pyoderma gangrenosum (PG) is a chronic inflammatory disease of unknown cause that presents as an inflammatory and ulcerative disorder of the skin. PG is often associated with an underlying systemic disease. However, the frequencies of the underlying diseases are unclear in Japanese patients. In this retrospective, observational study, all patients diagnosed with PG who visited dermatology departments of nine regional hospitals in and around Ibaraki Prefecture were collected from 1982 to 2011 or 2014. The diagnoses of PG were based on the characteristic clinical and histological appearances and ruling out of infection. Sixty-two PG patients, including 29 males and 33 females, were identified. The ages of onset were 16-89 years, and the mean age was 50.2 years. Fifty (80%) of the 62 patients presented with an ulcerative PG, and the lower leg was the most common site (74%). Forty-six (74%) PG patients had underlying diseases. The most frequent was ulcerative colitis (32%), followed by myelodysplastic syndrome (11%), rheumatoid arthritis (6%) and aortitis syndrome (5%). For treatment, 54 cases (87%) received systemic corticosteroids and 10 received additional treatment with cyclosporin. There was no significant correlation between underlying diseases and response to the initial treatment. Multivariate analysis revealed that the number of affected sites negatively correlated with successful initial treatment. Fifteen (24%) of the 62 cases relapsed. In conclusion, ulcerative colitis and hematological disorders were frequently associated with PG while approximately a quarter of the cases were idiopathic.

[S-1 treatment for elderly patients over 75 years with gastric cancer]

BACKGROUND

In our hospital, the starting dose of S-1 for patients over 75 years of age with advanced gastric cancer was determined by body surface of area, creatinine clearance, performance status(PS)and the presence of complications. The objective of this retrospective study was to investigate the proper administration of S-1 in elderly patients by comparing patients given a standard dose of S-1 to those given a reduced dose.

METHODS

Twenty patients participated. Six patients were administered S-1 at a standard dose(standard group)and fourteen patients with at a reduced dose(reduced group). Safety, feasibility and anti-tumor effects were assessed.

RESULTS

Three cases of grade 3 adverse events were found in the standard group, and one case was found in the reduced group. Time to treatment failure was 4. 4 months for the standard group and 8. 2 months for the reduced group. The overall response rate was 25% in the standard group and 30% in the reduced group.

CONCLUSIONS

It is important to reduce S-1 administration to patients over 75 years of age with caution, and take into account the patient's renal function, PS and Ccr complications.

MicroRNA-mediated downregulation of mTOR/FGFR3 controls tumor growth induced by Src-related oncogenic pathways

The tyrosine kinase c-Src is upregulated in various human cancers, but the molecular mechanisms underlying c-Src-mediated tumor growth remain unclear. Here we examined the involvement of microRNAs in the c-Src-mediated tumor growth. Microarray profiling revealed that c-Src activation downregulates a limited set of microRNAs, including miR-99a, which targets oncogenic mammalian target of rapamycin (mTOR) and fibroblast growth factor receptor 3 (FGFR3). Re-expression of miR-99a suppressed tumor growth of c-Src-transformed cells, and this effect was restored by the overexpression of mTOR. The downregulation of miR-99a was also observed in epidermal growth factor- and Ras-transformed cells, and it was suppressed by inhibiting the mitogen-activated protein kinase (MAPK) pathway. Furthermore, miR-99a downregulation is associated with mTOR/FGFR3 upregulation in various human lung cancer cells/tissues. The tumorigenicity of these cells was suppressed by the introduction of miR-99a. These findings suggest that the miR-99a-mTOR/FGFR3 pathway is crucial for controlling tumor growth in a wide range of human cancers that harbor upregulation of the Src-related oncogenic pathways.

Application of RT-PCR to clinical diagnosis of micrometastasis of colorectal cancer: A translational research study

We previously reported in a retrospective study that CEA-based RT-PCR was useful for predicting the prognosis of patients with node-negative colorectal cancer. RT-PCR is well established for laboratory use, but many issues remain to be resolved prior to its clinical application. In addition to the false positive rate of RT-PCR, we addressed several issues, including the timing of lymph node sampling, stability of RNA after surgery, and reproducibility of results. After appropriate modification, including development of a tissue sampling kit, a multi-institutional clinical study was commenced prospectively from November 2001, and 100 patients were enrolled for examination of micrometastasis. RNA was stable in lymph nodes for up to 3 h after surgical resection. This range of sampling time was acceptable to the surgeons. RNA was well preserved in RNA later at -20 degrees C for 3 weeks. Dilutions of MKN45 and LoVo cells served as positive controls for conventional PCR since these controls were found to be highly stable and ensured reproducibility. Moreover, simultaneous use of quantitative PCR (Light Cycler) ensured double confirmation of the results. Our clinical study showed that the quality of RNA was excellent or good in most samples (98 of 100; 98%). Twenty-four of 98 (24.5%) cases were judged to be micrometastasis-positive. In conclusion, the current translational research study established a clinically feasible RT-PCR system for micrometastasis. Our system could potentially be useful as a clinical tool.

PyNPase expression in human colon cancer

Although colorectal cancer tissue is rich in pyrimidine nucleoside phosphorylase (PyNPase), there is no consensus as to whether cancer cells or stromal cells predominately express PyNPase. We micro-dissected OCT compound embedded frozen tissue sections into epithelial and stromal components and then analyzed the extracted samples separately. The PyNPase expression level was higher in stromal cells than in cancer cells and the difference increased with inflammation induced by the immunostimulator OK432. These results suggest that stromal cells are the major PyNPase source in colorectal cancer.

[P53 protein expression and proliferative potential in non-recurrent and recurrent meningiomas]

Evaluation of the p53 gene protein expression and proliferative potential with MIB-1 monoclonal antibody (MBL Co.), a new marker of cellular proliferation that binds Ki67 in paraffin sections, by immunohistochemical studies were made in 10 cases of the non-recurrent meningiomas and the 8 cases (17 samples) of the recurrent meningiomas. Tissue samples were embedded in paraffin after fixation in 10% formalin, and 3-microns sections were activated by microwave heating before being immersed with p53 protein or MIB-1 monoclonal antibody. The positivity of immunostaining for p53 protein and MIB-1 was calculated as the % values of tumor cell nuclei stained to all tumor cell nuclei examined within several fields under a light microscope. The mean % value of the proliferating cell index (PCI) stained with MIB-1 monoclonal antibody was 2.1% in the non-recurrent meningiomas, and high values of 11.9% were obtained for the recurrent meningiomas. High values of PCI exceeding 3% were indicated in most of the cases of recurrent meningiomas. p53 protein was not found in the 10 cases of non-recurrent meningiomas. However, it was positive showing values of 0.5-8.5% (mean; 3.4%) in 5 of the 8 cases of recurrent meningiomas. 2 of 4 cases of recurrent meningiomas with a benign type of histology at both initial discovery and recurrence revealed p53 protein expression in the tumor tissues. 3 of 4 cases of recurrent meningiomas, which were of the benign type at the initial operation but transformed to the malignant (atypical) type on recurrence, demonstrated positive staining for p53 protein in the tumor tissues. Although positivity for p53 protein was observed in the recurrent meningiomas with high values of PCI with MIB-1, no significant correlation between the values of PCI with MIB-1 and those for the p53 protein expression was found. The p53 gene protein may be altered on tumor recurrence and/or malignant transformation in meningiomas. It is concluded that evaluations of the p53 protein expression and proliferative potential with MIB-1 are important as additional factors for the prediction of tumor recurrence in meningiomas.

[Solitary plasmacytoma of the rib--a case report and review of Japanese literatures]

A 72-year-old woman with solitary plasmacytoma of the right fifth rib was surgically treated. She underwent radical resection of the bony chest wall including the right fifth rib, the ribs above and below the involved rib, the intercostal muscle, and the parietal pleura. Histological finding of the tumor was plasmacytoma of the rib. The type of monoclonal protein was IgG and lamda. She is doing well one year and eleven months after surgery without any signs of recurrence. Solitary plasmacytoma is rare as compared with multiple myeloma. Patients with solitary plasmacytoma originating in the rib have a feasibility of operative indication, and radical treatment is expected to be by adequate surgical resection. Seventeen cases of solitary chest wall plasmacytoma described in the Japanese literature are reviewed.

[Assessment of tumor extent in extrahepatic bile duct cancers--utility of intraductal ultrasonography]

Intraductal ultrasonography (IDUS) were performed in patients with extrahepatic bile duct cancer and compared to other diagnostic modalities and to resected specimens. Endoscopic ultrasonography (EUS) is a non-invasive diagnostic method useful for screening patients with bile duct cancers and determining whether they are resectable or not. While, EUS was not useful for the differential diagnosis of advanced and early tumors, and less useful in case of bile duct tumors located at the hilus hepatitis. IDUS proved useful without blind spot even in case of bile duct cancers at the hilus hepatis. IDUS was especially useful for the differential diagnosis of advanced and early tumors. IDUS is the very accurate diagnostic modality which make up for EUS and essential to determine the appropriate operation plan.

[Two episodes of fatal ventricular arrhythmia associated with use of electrosurgical unit during redo MVR procedure]

We report a case of ventricular fibrillation in the first episode and ventricular tachycardia in the second episode that occurred with use of electrosurgical unit during redo MVR procedure. Both arrhythmia occurred five to ten seconds after application of the electrosurgical knife in the coagulation mode to the sternal periosteum. The patient was immediately resuscitated with return to sinus rhythm using direct-current electroshock. In the literature, it was reported that large direct-current potentials were generated during electrosurgery and that these potentials increased with increasing sparking at the active electrode. Care should be always taken because they may cause fatal ventricular arrhythmia.

Determination and developmental changes in carbonic anhydrase III in swine liver

1. CA-III was measured by enzyme-immunoassay in the livers of male and female swine aged from the fetus to 5 years old. 2. No sexual dimorphism in porcine liver could be detected at 6 months, but stag showed twice as much as swine of the same age. 3. The concentration of CA-III in the liver increased during development up to 6 months of age, followed by decline due to senescence.

Isolated coronary ostial stenosis compared with left main trunk disease

Isolated coronary ostial stenosis (OS) is a rare disease of unknown etiology. Five cases of OS were observed amongst 700 elective coronary bypass patients, and were compared with 111 cases of atherosclerotic left main trunk disease (LMTD) to clarify clinical characteristics. Mean age for LMTD patients was 61.2 years, while, it was 43.0 years for OS patients. 4 patients out of the 5 cases (80%) in the OS group were female, but there were only 10 females (9%) in the LMTD group. 60% of the OS group presented unstable angina without any episodes of myocardial infarction. 69.4% of the LMTD group presented stable angina, and 42% had a previous myocardial infarction. Left ventricular function was well preserved in the OS group compared to the LMTD group. Aorto-coronary bypass grafting was the only surgical method of our choice in both groups. The average number of grafts were 2.2 for the OS group, and 2.4 for LMTD group. Operative mortality was 0% for the OS group and 0.9% for the LMTD group. Clinical and angiographic profiles of ostial stenosis suggest that this group may represent a distinct entity, different from the more common atherosclerotic left main trunk stenosis. Coronary bypass grafting can provide good operative prognosis in ostial stenosis as well as in left main trunk stenosis.

[A case experienced a difficulty in removing a catheter of IABP because of coagula formed in the balloon]

This is a report of a rare complication of intraaortic balloon pumping (IABP). A 71-year-old woman with ischemic heart disease and severe atherosclerosis had experienced a difficulty in removing the catheter of IABP because of coagula formed in the balloon and treated surgically by arteriotomy. The coagula was formed from blood entering into the balloon through a pin hole, which was most likely suspected to be made during insertion procedure or coronary angiography and percutaneous transluminal coronary angioplasty (PTCA) procedure done under IABP.

[Intrahepatic portal vein aneurysm: report of two cases]

We present two cases of intrahepatic portal vein aneurysm. The lesions were seen as low density mass on precontrast CT, hypoechoic mass with connecting vascular structures on ultrasonogram and dilatated branch of portal vein on MRI. Definite diagnosis were obtained by arteriogram. Only 15 cases of portal vein aneurysm were reported in Japan up to now in the literature.

Distally based lateral plantar artery island flap

We report on the reconstruction of the lateral metatarsal head defect by a distally based lateral plantar artery island flap using the flexor digitorum brevis muscle. The pedicle for this flap was provided by a retrograde lateral plantar artery. We found that this flap was relatively simple and easy to perform and could cover large defects better than any other conventional local flap.

[Microangiopathic hemolytic anemia associated with gastric cancer]

A case of advanced gastric cancer associated with metastatic carcinomatosis of the bone marrow, microangiopathic hemolytic anemia (MAHA) and disseminated intravascular coagulation (DIC) was reported. A 71-year-old woman complained of lumbago and general fatigue. At the time of admission, besides anemia, jaundice and a tendency to bleeding, the laboratory data showed, hyperbilirubinemia, elevated FDP and hemolytic anemia with fragmented red cells. The bone marrow was infiltrated by carcinoma, and an upper GI series examination showed Borrmann II type gastric cancer on the greater curvature of the antrum. After remission of both MAHA and DIC by mitomycin C, neothramycin and FOY, the patient successfully underwent subtotal gastrectomy. However, she died of cerebral hemorrhage on the 96th postoperative day.