Serotypes and genotypes of 154 Erysipelothrix rhusiopathiae strains from slaughter pigs at Sueyoshi and Kanoya Meat Inspection Centers in southern Kyushu during the period of April 2004 to March 2006 were determined. The strains were classified into four serotypes, 1a (53 strains), 1b (4 strains), 2 (95 strains) and 11 (2strains). Randomly amplified polymorphic DNA (RAPD) analysis categorized the strains into four genotypes, A (47 strains), B (6 strains), C (91 strains) and D (10 strains). Combination of the serotypes and genotypes formed two major types, 1a-A (47 strains; 29.9%) and 2-C (91 strains; 54.5%). The strains belonging to the major type la-A were isolated only from internal iliac lymph nodes and arthritic fluid, while the strains of the another major type 2-C were isolated from urticaria, kidneys, spleens, and knots of endocarditis. Multiple RAPD types were detected from some farms, but each major RAPD type appeared at the individual farms where the incidence of erysipelas was found to be high. The prevalence of acryflavin resistance among the strains was31.0%(47/154).
Evaluation of the malignant potential of a pheochromocytoma (PCC) remains controversial. PCC is regarded as a neuroendocrine tumor (NET), and the classification of NETs has gradually been defined over the last decade, particularly for gastroenteropancreatic NET. The present study describes a case of locally advanced, carcinoma‑like, nonfunctional PCC, which may be regarded as neuroendocrine carcinoma (NEC) rather than a malignant PCC. A 72‑year‑old man was referred to Saitama Red Cross Hospital (Saitama, Japan), presenting with a 2‑month history of right flank pain. Computed tomography revealed a right adrenal gland tumor, which measured 6.0 cm in diameter, invading the hilum of the right kidney, liver and inferior vena cava (IVC). Radical surgery was performed with en bloc resection of the right kidney, and adjacent parts of the liver and IVC. Immunohistochemical examination demonstrated that all of the resected tissues were positive for cytokeratin AE1/AE3, chromogranin A, synaptophysin, cluster of differentiation 56 and Ki-67, and the specimen had a Ki‑67 index of 80%. A diagnosis of carcinoma‑like PCC or NEC of the adrenal gland was confirmed. Reports of NEC of the adrenal gland are extremely rare in the literature, and classification of PCC as a NET has not yet been fully discussed. The present case may therefore contribute to the classification of NETs in the adrenal gland.
Objectives To determine the incidence and preoperative risk factors of post‐excisional hypoglycemia in patients undergoing pheochromocytoma resection. Methods Patients who underwent surgical resection of pheochromocytoma at a single institution were retrospectively enrolled in the present study. The primary end‐point was the development of post‐excisional hypoglycemia; that is, a serum glucose level <70 mg/dL. The serum levels of immunoreactive insulin and glucose levels during the preoperative oral glucose‐tolerance test and surgery were analyzed to elucidate the mechanism of hypoglycemia. Results A total of 49 patients underwent surgical resection of pheochromocytoma, of which 21 patients (43%) developed post‐excisional hypoglycemia. The incidence of hypoglycemia was not statistically different between patients with adrenal tumors and those with extra‐adrenal tumors (18/41 [44%] vs 3/8 [38%], respectively, P = 0.73). There was no difference in the immunoreactive insulin/glucose ratio during the preoperative oral glucose‐tolerance test between patients with and those without post‐excisional hypoglycemia. The intraoperative immunoreactive insulin/glucose ratio was significantly higher in patients with hypoglycemia than in those without hypoglycemia. A higher 24‐h urinary epinephrine level, but not norepinephrine level, was a predictive factor for post‐excisional hypoglycemia. Conclusions Post‐excisional hypoglycemia is a frequent complication of pheochromocytoma resection, irrespective of the tumor location, and might be common in patients with epinephrine‐predominant tumors. All patients undergoing resection of adrenal and extra‐adrenal pheochromocytoma require intensive monitoring of serum glucose levels during and after surgery.
