Yuji Oka

Early gastric cancer with Krukenberg tumor and review of cases of intramucosal gastric cancers with Krukenberg tumor

A 47-year-old woman was admitted because of hypermenorrhea. Transvaginal ultrasonography revealed an ovarian tumor and myoma uteri, and total hysterectomy with bilateral salpingo-oophorectomy was performed. Histology revealed signet-ring cell carcinoma in the right ovary. In order to find out the primary site of this tumor, gastroendoscopy was performed after the operation, and showed a IIc lesion in the lower body of the stomach; biopsy specimens showed signet-ring cell carcinoma similar to that in the right ovary. Total gastrectomy revealed that the lesion was an early gastric cancer confined to the mucosa, but there was lymphatic invasion slightly beneath the muscularis mucosa, with regional lymph node metastasis. In the light of a review of the seven cases of early gastric cancer with Krukenberg tumor previously reported, lymphatic metastasis seemed to be the most likely pathway of ovarian metastasis in early gastric cancers.

Space-Time Database for Standardization of Adult Magnetocardiogram-Making Standard MCG Parameters

Background: The magnetocardiogram (MCG) is a promising medical tool for detecting and visualizing abnormal cardiac electrical activation in heart‐disease patients. However, there is no large‐scale MCG database of healthy subjects, and there is little knowledge of gender‐ and age‐related influences on MCG data.

Repolarization Spatial‐Time Current Abnormalities in Patients with Coronary Heart Disease

Background: Magnetocardiography (MCG) is a new technique for visualizing a current distribution in the myocardium. In recent years, current distribution parameters (CDPs) have been developed based on the distribution. The CDPs reflect spatial‐time current abnormalities in patients with coronary heart disease (CHD). However, the criteria and scoring method of the abnormalities using CDPs are still controversial.

Standard Template of Adult Magnetocardiogram

Background: We need to know the magnetocardiogram (MCG) features regarding waveform and two‐dimensional current distribution in normal subjects in order to classify the abnormal waveform in patients with heart disease. However, a standard MCG waveform has not been produced yet, therefore, we have first made the standard template MCG waveform.

Retroperitoneal lymphangioma with a duodenal lesion in an adult.

A multilocular-cystic and cavernous, retroperitoneal tumor was found in a 40-year-old man whose past medical history was unremarkable. On admission, he complained of a large and still growing intra-abdominal mass associated with dull pain and a low-grade fever. Laboratory findings revealed leukocytosis and C-reactive protein elevation, compatible with inflammation of the tumor. Percutaneous aspiration of the tumor was performed under transabdominal ultrasonographic guidance, and continuous drainage of fluid from within the tumor ameliorated his symptoms. From preoperative examinations, including radiological imaging, fluid aspiration, and endoscopy with biopsy, a diagnosis of retroperitoneal lymphangioma was made. Laparotomy revealed extensive adhesions between the tumor and both the duodenum and the pancreatic head. A pancreaticoduodenectomy was therefore performed. At 3-year follow-up, there was no sign of recurrence. Retroperitoneal lymphangioma is an uncommon disorder, and the cavernous type is extremely rare. The duodenal lesion was an important feature of the present case, and endoscopic biopsy of this lesion facilitated precise preoperative diagnosis of retroperitoneal lymphangioma.

Multiple gastric involvement by myeloid antigen CD13‐positive non‐secretory plasma cell leukaemia

Gastrointestinal tract involvement is a rare complication of plasma cell neoplasia. We present a case of non‐secretory type primary plasma cell leukaemia (PCL) with multiple gastric involvement. Dual surface antigen analysis of bone marrow cells revealed that atypical plasma cells coexpressed CD38 and myeloid antigen CD13. Upper gastrointestinal endoscopy disclosed multiple submucosal masses in the body of the stomach. Endoscopic biopsy specimens showed marked infiltration of atypical plasma cells consistent with a diagnosis of gastric involvement by PCL. Since CD13 antigen is identical to aminopeptidase N, a membrane‐bound glycoprotein thought to be involved in the process of tumour invasion, CD13 expression on neoplastic plasma cells may be related to the gastric involvement in this patient.

HCV RNA monitoring for tailored regimens of interferon therapy in hepatitis C

Sustained non-viraemia is prerequisite for a virological cure of hepatitis C virus (HCV) disease. We monitored serum HCV RNA in our patients during interferon therapy and for 6 months of follow-up. The rate of sustained responders (RNA-negative at the end of follow-up) differed significantly by whether or not RNA became sero-negative within 24 weeks of the initiation of therapy (71% vs 7%); and also by whether or not the RNA-seronegativity lasted for 12 weeks during therapy (88% vs 11%). Thus, by monitoring viraemia in individual patients, we can tailor the duration of therapy and minimize waste of interferon.

A patient with isolated adrenocorticotropin deficiency presenting with repetitive oesophageal ulcer and stenosis

Isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) is a potentially fatal condition that is difficult to diagnose. The authors diagnosed IAD in a patient who presented with recurrent oesophageal ulceration resulting in oesophageal stenosis. The recurrent oesophageal ulcers were due to frequent nausea and vomiting that were the presenting digestive symptoms of adrenal insufficiency. Severe hypoglycaemia during this patients course suggested the diagnosis of adrenal insufficiency. This case is educational because digestive symptoms are the most common symptoms in patients with adrenal insufficiency, but the diagnosis of adrenal insufficiency in such patients is not easy.

Acute Graft‐Versus‐Host Disease of the Large Intestine after Bone Marrow Transplantation

Abstract: A 13‐year old male with acute lymphocytic leukemia was admitted to our hospital for bone marrow transplantation (BMT). Lower abdominal pain and bloody diarrhea developed during the fourth post‐BMT week. Colonoscopy revealed edematous mucosa, erosions and multiple irregular ulcers in the rectum and sigmoid colon. Histologically, multiple apoptotic lesions were recognizable in the crypt basement membrane. Most infiltrating lymphoid cells were mature memory T lymphocytes bearing LFA‐la‐, CD43 and CD45RO antigens. HLA‐DR and ICAM‐1 immunostaining was seen on the vascular endothelium and the epithelium stained positively for HLA‐DR antigens.

Intranephron distribution of epidermal growth factor immunoreactivity in the mouse.

Using a specific and sensitive epidermal growth factor (EGF) radioimmunoassay, the distribution of EGF in mouse kidneys was studied. In five portions (outer cortex, inner cortex, outer medulla I, II, and papilla) of kidney slices, the outer medulla revealed the highest immunoreactive EGF (iEGF) per wet weight of tissue. In microdissected nephron segments, the predominant iEGF per millimeter length was observed in the medullary and cortical thick ascending limbs of Henles loop compared with other segments. It became more apparent when expressed per milligram protein. Fluorescence microscopy showed prominent staining for EGF in the thick ascending limbs of Henles loop. The significance of the nephron heterogeneity in EGF contents is discussed.