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A 41-year-old Japanese man presented in October 2013 with a 2-week history of pruritic, erythematous papules. He had diabetes mellitus, hyperlipidemia, and hypertriglyceridemia, but had stopped treatment 5 years prior to this visit. He also suffered from acute pancreatitis, and was admitted to the Department of Medicine, Japan Community Healthcare Organization Osaka Hospital, 1 day prior. Topical steroid ointment prescribed during a previous visit to another clinic was ineffective for the treatment of the papules. At the time of consultation, he presented with multiple, approximately 5-mm, pruritic, yellowish, erythematous papules on the trunk and extensor surfaces of the extremities (Fig. 1A). Dermoscopic examination of the papules clearly revealed granular yellowish characteristics (Fig. 1B). The laboratory findings (normal values are in parentheses) were: white blood cell count, 13.3×103 (4.0×103~8.5×103)/µl; neutrophils, 83.5% (38%~58%); alkaline phosphatase, 369 (115~359) U/L; C reactive protein, 5.91 (<0.3) mg/dl; hemoglobin A1c, 9.2% (4.6%~6.2%); amylase, 340 (40~130) IU/L; lipase, 960 (11~53) U/L; triglyceride, 6,784 (30~150) mg/dl; total cholesterol, 803 (130/219) mg/dl; high density lipoprotein cholesterol, 12 (42~74) mg/dl; low density lipoprotein cholesterol, 23 (70~140) mg/dl; remnant-like lipoprotein particle cholesterol, 84.4 (<7.5) mg/dl; apolipoprotein (Apo) A-I, 89 (119~155) mg/dl; Apo A-II, 12.6 (25.9~35.7) mg/dl; Apo B, 135 (73~109) mg/dl; Apo E, 11.0 (2.7~4.3) mg/dl; Apo C-II, 16.5 (1.8~4.6) mg/dl; Apo C-III, 28.3 (5.8~10.0) mg/dl. A skin biopsy sample obtained from papules on the waist revealed foamy cells that infiltrated the dermis. At higher magnification, foamy cells and extracellular lipids were present (Fig. 2). Therefore, we diagnosed the patient as having eruptive xanthoma with type V hyperlipoproteinemia according to Fredrickson's classification of hyperlipoproteinemias. We treated the acute pancreatitis with fasting, nafamostat mesilate, and ulinastatin, and the hypercholesterolemia with bezafibrate. The acute pancreatitis improved 16 days after admission. Serum triglyceride and total cholesterol values decreased to within normal range 1.5 months after the initiation of treatment. The eruptive xanthoma lesions rapidly resolved as the hyperlipidemia improved.
Fig. 1
(A) Clinical appearance and (B) dermoscopic appearance of multiple yellowish erythematous papules on the patient's back in October 2013.
Fig. 2
Skin biopsy from the erythematous papules present on the patient's waist. (A) At lower magnification, numerous pale areas containing foamy cells infiltrate the dermis, especially the upper dermis and perivascular areas (H&E, ×40). (B) ...
Hyperlipidemia is divided into six subgroups. Cutaneous xanthomatous lesions can occur in all six types of hyperlipidemia1. Cutaneous xanthomas can be divided into subgroups, including eruptive xanthomas, tuberous xanthomas, tendon xanthomas, xanthelasmata, and plane xanthomas2. Eruptive xanthomas can be associated with hypertriglyceridemia (Type I, IV, or V hypercholesterolemia), particularly when diabetes is poorly controlled2,3. Eruptive xanthomas contain more triglycerides and fewer cholesteryl esters than other types of xanthomas, and lipids present in xanthomas are derived from circulating plasma lipoproteins. Triglyceride is mobilized more rapidly than cholesterol, so resolving eruptive xanthomas are rich in cholesterol4. Hypertriglyceridemia also increases the risk of acute pancreatitis, and the risk of eruptive xanthoma and pancreatitis increases when the serum triglyceride concentration reaches the thousands5. Eruptive xanthomas manifested in this patient 2 weeks before his visit, followed by acute pancreatitis. Dermatologists should carefully consider the possibility of acute pancreatitis with hypertriglyceridemia in eruptive xanthoma patients.
Introduction: Helicobacter pylori (Hp) leads to chronic gastritis and eventually causes gastric cancer. Recently, several studies have shown the existence of a small number of Hp—negative gastric cancers (HPNGC). With the decline of the Hp infection rate, the HPNGC should increases. However, the clinichopathological and endoscopic features of HPNGC are still unclear. The aim of this study is to clarify the characteristics of HPNGC. Methods: We analyzed 628 lesions of early gastric cancer that underwent endoscopic resection at our hospital from April 2009 to June 2017, retrospectively. Thirty—five HPNGC cases (38 lesions, 6.1%) were enrolled in this study, and evaluated clinichopathologically. Hp—negative status was defined as the fulfillment of all the following criteria: no eradication history, no mucosal atrophy in endoscopic and pathological findings, negative rapid urease test or urease breathe test or serum Hp—immunoglobulin G test or stool antigen. Results: In HPNGC (n=38), the frequency according to the histology was as follows: gastric adenocarcinoma of fundic gland type (GAFG) / gastrointestinal phenotype of well—differentiated adenocarcinoma (GI—WDA) / gastric phenotype of WDA (G—WDA) / signet—ring cell carcinoma (Sig) = 23(60.5%) / 7(18.5%) / 1(2.5%) / 7(18.5%). GAFG was presented as a whitish elevated lesion in the upper to middle part of the stomach. Although GAFGs exhibited submucosal invasion despite the small size of the lesions, neither lymphatic nor venous invasion was observed. GI—WDA presented as a reddish lesion in the lower part of the stomach. G—WDA presented as a whitish elevated lesion in the upper part of the stomach. Sig presented as a whitish flat or depressed lesion in the middle to lower part of the stomach. In magnifying endoscopy simple diagnostic algorithm for gastric cancer (MESDA—G) diagnosis, WDA was diagnosed as a cancer, GAFG and Sig were diagnosed as non—cancer. Conclusion: HPNGC has distinct endoscopic and clinicopathological features by each histological type and may be classified into 3 types; 1. Whitish elevated lesion in the upper or middle part of the stomach (GAFG and G—WDA), 2. Reddish lesion in the lower part of the stomach (GI—WDA), 3. Whitish flat or depressed lesion in the middle or lower part of the stomach (sig). Early detection of HPNGC enables minimally invasive treatment which preserves the patient's quality of life. Endoscopists should fully understand the characteristics and endoscopic findings of HPNGC.1219 Figure 1 No Caption available.
Carbon isotopic composition of sterols in marine Holocene sediments, marine sinking particles, tree leaves, and soils were determined. δ13C values of algae-derived sterols such as 24-methylcholesta-5, 22-dien-3β-ol and dinosterol in the marine sediments range from −22.1 to −25.2‰, while those of 24-ethylcholest-5-en-3β-ol (24-ethylcholesterol) range from −22.6 to −24.3‰. We conclude that 24-ethylcholesterol in the marine sediments derives from marine algae, because their δ13C values are markedly different from those of the leaves of C3 (∼−29‰) and C4 (−14‰) plants and similar to those of the algal sterols.
Background/Aims: To evaluate the usefulness of linked color imaging (LCI) and blue LASER imaging (BLI) in Barrett’s esophagus (BE) compared with white light imaging (WLI). Methods: Five expert and trainee endoscopists compared WLI, LCI, and BLI images obtained from 63 patients with short-segment BE. Physicians assessed visibility as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and one (decreased). Scores were evaluated to assess visibility. The inter- and intra-rater reliability (intra-class correlation coefficient) of image assessments were also evaluated. Images were objectively evaluated based on L* a* b* color values and color differences (ΔE*) in a CIELAB color space system. Results: Improved visibility compared with WLI was achieved for LCI: 44.4%, BLI: 0% for all endoscopists; LCI: 55.6%, BLI: 1.6% for trainees; and LCI: 47.6%, BLI: 0% for experts. The visibility score of trainees compared with experts was significantly higher for LCI (p = 0.02). Intra- and inter-rater reliability ratings for LCI compared with WLI were “moderate” for trainees, and “moderate-substantial” for experts. The ΔE* revealed statistically significant differences between WLI and LCI. Conclusion: LCI improved the visibility of short-segment BE compared with WLI, especially for trainees, when evaluated both subjectively and objectively.
Abstract The effects of chemical compositions, rolling conditions, and homogenization treatment on hydrogen induced cracking (HIC) have been studied metallurgically using laboratory heats of chemical compositions corresponding to those of the center segregation zones in continuous cast slabs. The hardness of the center segregation zones in steel plates is one of the predominant factors affecting the HIC susceptibility of high-strength line pipe steels. An increase of the carbon equivalent (Ceq) or phosphorus content hardens the center segregation zones in conventional carbon steels produced by the controlled rolling (CR) process. Lowering the carbon content to the range of 0.01 to 0.05% markedly decreases the hardness of center segregation zone and reduces the HIC susceptibility, regardless of the increases in other alloy elements. Hot rolling at relatively lower temperature increases the hardness of the center segregation zone and results in a slightly high HIC susceptibility. The design of the chemical ...
The organic and isotopic geochemical study of two sediment cores (KH‐79‐3, L‐3, and KH‐79‐3, C‐3) from the Oki Ridge in the Japan Sea has revealed that total organic carbon (TOC) mass accumulation rates are extremely high in the 12–11 ka (calendar age) interval and TOC in the sections in the 24–17 ka interval is depleted in 13 C by 3.5‰ relative to Holocene sediments. Alkenone sea surface temperature (SST) shows a decrease from 18° to 14°C from 17.5 to 11.6 ka and a sharp increase from 14° to 19°C from 11.6 to 11.1 ka. The SST changes are associated with the inflow of cold seawater with the vertical water mixing and the inflowof warm Tsushima Current into the Japan Sea. The δ 13 C values for both 24‐methylcholesta‐5,22‐dien‐3β‐ol (diatom marker) and dinosterol (dinoflagellate marker), are at their minimum from 24 to 17 ka, while those for long‐chain alkenones are not. The theoretical considerations on δ 13 C for biomarkers suggest low photosynthetic carbon demand of diatoms and dinoflagellates from 24 to 17 ka.
A 49-year-old female presented with productive cough, fever and chest pain, and was admitted to Nagoya University Hospital. Her chest X-rays, taken previously and on admission, showed infiltrative shadows in both upper lung fields and left-sided pleural effusion. Rheumatoid factors were positive in serum and the pleural effusion. Antibiotics were ineffective. Transbronchial lung biopsy revealed intraalveolar fibrosis as well as interstitial inflammation. Idiopathic BOOP was suspected on the basis of clinical findings together with the histological features. However, open lung biopsy revealed lymphoid hyperplasia with germinal center formation. The patient was diagnosed as having lung involvement antedating rheumatoid arthritis, despite the absence of joint symptoms at present.
