: We describe a 38-year-old woman with itching and eruption that had migrated from the lower legs to the upper body. The glucagon level was 2,100 pg/ml (upper limit of normal, 180 pg/ml). Computed tomographic scan of the abdomen revealed a 3.5 cm mass in the tail of the pancreas. The tumor was removed and found to be a glucagonoma. The clinical eruption resolved promptly and the glucagon level decreased to the normal range after surgical excision. The patient was alive with no recurrence 4 years after surgery.
AIM:To investigate the usefulness of chromoendoscopy, using an acetic acid indigocarmine mixture (AIM), for gastric adenoma diagnosed by forceps biopsy.
Although determination of the presence of antibodies to HTLV-1 in cerebro-spinal fluid (CSF) is very important for the diagnosis of HTLV-1-associated myelopathy (HAM), these antibodies in CSF have not yet been completely investigated so far in patients without overt HAM. We examined antibodies to HTLV-1 in CSF of leukemia patients who were infected with this virus via blood transfusion. All of 5 patients showed positive antibody titer, one of 5 patients was a patient with overt HAM. According to Western-blotting analysis in CSF, IgG p-19, 24 and 28 antibodies were positive in 4 patients without overt HAM, but IgM antibody was negative. In contrast, IgG antibodies as well as IgM p-24 antibody were positive in patients with overt HAM. These results suggest that further studies on antibodies to HTLV-1, especially on IgM antibody, in CSF of HTLV-1 infected patients with or without overt HAM may be helpful to better understanding of the mechanism on onset of HAM following blood transfusion.
5-fluoro-2'-deoxyuridine (FUdR) inhibits thymidylate synthase. We have been investigated the molecular mechanisms of cell death in mouse mammary tumor FM3A cells, F28-7 strain and its mutant F28-7-A strain, after treated with FUdR. Previously, we have been reported that F28-7 strain induced DNA cleavage into chromosomal sized fragments and subsequently develop necrosis, but F28-7-A strain induced DNA cleavage into oligonucleosomal sized fragments and subsequently develop apoptosis after treated with FUdR. To understand the molecular mechanisms of regulate of two differential cell death necrosis and apoptosis, we identify cell death regulator by using proteome and transcriptome analysis. When compared with the proteome of F28-7 and F28-7-A strain after treated with FUdR, it was found that 5 proteins were up-regulated and 11 proteins were down-regulated in F28-7-A strain. Furthermore, transcriptome analysis shows that 94 genes were up-regulated and 164 genes were downregulated in F28-7-A strain. Identified proteins and genes were involved in various cellular processes such as cell cycle regulation, apoptosis, proliferation, and differentiation. Our results suggested that numerous features indicated the coordinated regulation of molecular networks from various aspects of necrosis or apoptosis at the proteome and transcriptome levels.
Intracellular signaling via the B-cell antigen receptor (BCR) regulates cellular dynamics in B cells, in a similar way to signaling via the T-cell receptor (TCR) in T lymphocytes. Cross-linking of BCR increases Ca2+ influx as a first event, which then activates Ca2+-dependent signaling molecules. Calcineurin and nuclear factor of activated T cell (NFAT) are Ca2+-mobilizing elements that are considered to be important in regulating proliferation of T cells. However, little is known about their expression in B cells, especially in the germinal center, where apoptosis and proliferation of B cells actively take place for clonal selection. We investigated the expression and the localization of Ca2+-mobilizing molecules, including calcineurin and NFAT, in germinal center B cells by immunofluorescence. The results revealed a dramatic increase of intracellular Ca2+, a constitutive expression of calcineurin, and a unique localization of NFATc2. Interestingly, several germinal center B cells expressed nuclear-imported NFATc2, which suggests the activation of NFATc2 and its involvement in the dynamics of B cells in the germinal center. Moreover, double immunofluorescence experiments demonstrated the co-expression of NFAT and cleaved-caspase 3 in apoptotic B cells of the germinal center. Thus, these results indicate that NFAT may participate in the regulation of B-cell dynamics such as apoptosis in the germinal center.
Treatment guidelines for patients with idiopathic thrombocytopenic purpura (ITP) have been changed recently due to the clinical application of Helicobacter pylori (H. pylori) eradication but there has been no detailed multi-center analysis of the hematological effects of H. pylori eradication. The Clinical Hematology Forum consists of 11 large hematological departments and divisions in the Hokkaido area. We sent questionnaires to these 11 hematological departments and divisions in March 2003 to obtain information on current treatment strategies for patients with ITP and hematological results after the eradication of H. pylori. Questionnaires were returned by 9 (81.8%) of the 11 departments. Doctors in all hospitals had experience in diagnosis and treatment of H. pylori infection. Diagnostic examinations for H. pylori infection were performed in 54.3% of the registered cases. H. pylori infection was detected in 68.1% of the examined cases, and eradication treatment was performed in 87.7% of H. pylori-positive patients. H. pylori was eradicated in 52 (83.9%) of the 62 patients in whom the results of treatment could be evaluated. Among the patients whose platelet counts were less than 10.0 x 10(4)/microl, platelet recovery was observed in 48.8% of cases with successful eradication, a percentage similar to previously reported percentages in Japan. There was no prognostic factor to predict good responders before eradication treatment. Since the side effects of eradication treatment, including gastrointestinal symptoms and skin eruptions, were not serious, this method might become a front-line treatment for patients with ITP. Patient selection for eradication as an up-front treatment, analysis of the pathophysiology of platelet recovery after eradication and long-term effects should be investigated to make new treatment guidelines for newly diagnosed patients with ITP.
A 71-year-old man visited our hospital because ofepigastralgia and anorexia. Upper gastrointestinal endoscopy revealed type 1 gastric cancer. Contrast-enhanced abdominal CT revealed gastric wall thickening in the midgastric region and direct invasion ofthe transverse colon. CT findings also revealed a suspicion ofdissemination on the omentum and para-aortic lymph node swelling. We diagnosed gastric cancer with transverse colon invasion. Therefore, we performed distal gastrectomy with transverse colectomy and D2+No.16b1 lymph node dissection after obtaining patient consent. We observed direct tumor invasion into the transverse colon and seeding nodules on the omentum. Liver metastasis was not seen, and ascitic cytology was negative. He was discharged 16 days postoperatively, without any complications. Histopathological analysis revealed poorly differentiated adenocarcinoma and gastrocolic fistula. Postoperatively, S-1 was administered for 4 years as adjuvant chemotherapy. There has been no recurrence for 9 years after surgery.
