Tetsuya Inatome

Acinar cell carcinoma of the pancreas with elevated serum α-fetoprotein levels: A case report and a review of 28 cases reported in Japan

SummaryA 60-year-old male with elevated serum AFP levels is reported. Other tumor markers apart from AFP were normal. Serum AFP did not bind to Con A or Lentil-lectin by affinity chromatography. Abdominal ultrasonography, computed tomography and endoscopic retrograded cholangiopancreatography demonstrated a tumor extending from the body to the tail of the pancreas. The tumor was strongly suggested to be an acinar cell carcinoma of the pancreas, based on the histological findings of the resected specimen. The peroxidase-antiperoxidase method showed cancer cells to be positive for AFP. In Japan; only 27 cases of pancreatic cancer with elevated serum AFP level have been reported. This is the first Japanese case of pancreatic cancer in which the binding of serum AFP to lectins was investigated.

Incidence of fundic gland polyps in patients without familial adenomatous polyposis

The incidence of fundic gland polyps was evaluated using a high-resolution videoendoscope. In 1388 upper gastrointestinal endoscopic studies, 26 cases of fundic gland polyps (1.9% of the studied cases) were found. None of these patients had evidence of familial adenomatous polyposis. Fifteen of these patients (58%) had a solitary polyp in the gastric body, most of which were small sessile polyps of less than 2 mm in diameter. The results of this study indicated that a small solitary fundic gland polyp is not a rare gastric lesion and that little relationship exists between these solitary fundic gland polyps and familial adenomatous polyposis.

Fentanyl for sedation during upper gastrointestinal endoscopy

The effects of sedation by intravenous fentanyl on the rate-pressure product (pulse rate x systolic blood pressure/100), arterial oxygen saturation, electrocardiographic change, and serum cortisol concentration were studied during gastroduodenoscopy in 84 patients randomized to receive fentanyl or no intravenous sedative (controls). Fentanyl administration increased the tolerance of patients and attenuated the endoscopy-induced rise in rate-pressure product and serum cortisol concentration. Desaturation of arterial oxygen was minimal and there was no difference in arterial oxygen saturation between the fentanyl group and the control group. Therefore, fentanyl appears to be a favorable sedative for upper gastrointestinal endoscopy, since its administration increased the tolerance of patients and decreased cardiac oxygen consumption.

Arterial oxygen saturation, blood pressure, and pulse rate during upper gastrointestinal endoscopy — Influence of sedation and age

We studied the effect of sedation by I.V. meperidine on blood pressure, pulse rate, and arterial oxygen saturation during upper gastrointestinal endoscopy. Meperidine increased the tolerance of the patients and attenuated the endoscopy-induced rise in blood pressure and pulse rate. Arterial oxygen saturation was transiently depressed in the first few minutes of the endoscopic procedure even without sedation, and meperidine administration did not aggravate this oxygen desaturation. Therefore, meperidine may be a favorable sedative for upper gastrointestinal endoscopy because its treatment increases the tolerance of patients and decreases cardiac oxygen demand without decreasing arterial oxygen saturation.

Serum beta2-microglobulin concentration as a novel marker to distinguish levels of risk in acute heart failure patients

BACKGROUND Recently, serum beta2-microglobulin, an endogenous marker for renal function, has been shown to be an independent predictor of mortality in older adults. However, the prognostic role of beta2-microglobulin in heart failure has not been elucidated. METHODS We prospectively evaluated serum beta2-microglobulin and creatinine concentrations, creatinine-based renal parameters (estimated glomerular filtration rate and creatinine clearance), and echocardiographic data in 131 patients with acute heart failure and creatinine concentrations < or =3.0mg/dL admitted to our hospitals. RESULTS During 2.3+/-1.3 years, 42 patients died of cardiovascular causes and 12 died of noncardiac causes. Cardiovascular events were observed in 63 patients: 53 were readmitted due to worsening heart failure, 5 readmitted for cerebral embolism, and 5 died from sudden cardiac death. According to multivariate stepwise Cox proportional hazard analysis, higher baseline serum beta2-microglobulin concentrations (X(2)=16, p<0.0001), previous congestive heart failure (X(2)=11, p<0.001), presence of chronic obstructive pulmonary disease (X(2)=8, p<0.01), and lower diastolic blood pressure (X(2)=6, p<0.05) were independent predictors of increased cardiovascular events. Also, higher baseline serum beta2-microglobulin (X(2)=20, p<0.0001), lower systolic blood pressure (X(2)=11, p<0.001), higher relative left ventricular wall thickness (X(2)=6, p<0.05), and lower body mass index (X(2)=5, p<0.05) were independent predictors of increased cardiac mortality. The adjusted hazard ratio for cardiovascular events increased with baseline serum beta2-microglobulin above 2.1 mg/L: 2.9 with beta2-microglobulin of 2.2-2.6 mg/L (95%CI 1.2-6.9, p<0.05), 2.9 with beta2-microglobulin of 2.7-3.9 mg/L (95%CI 1.2-7.2, p<0.05), and 4.7 with beta2-microglobulin of > or =4.0 mg/L (95%CI 2.0-11, p<0.001). CONCLUSIONS Higher baseline serum beta2-microglobulin concentration could be a promising risk marker in acute heart failure patients with creatinine < or =3.0 mg/dL.

Clinical evaluation of observations in poorly contracting and nondilated left ventricles (nondilated cardiomyopathy)

Abstract Idiopathic cardiomyopathy is defined as a heart muscle disease of unknown etiology and classified in 3 categories: dilated, hypertrophic and restrictive cardiomyopathy. 1 We occasionally encounter cases not classifiable in any of these 3 categories. 2–4 Cases with poorly contracting left ventricles without dilatation and hypertrophy are difficult to classify if intracardiac pressure does not have any restrictive feature. This study examines the pathophysiology of patients with poorly contracting and nondilated left ventricle (nondilated cardiomyopathy).