センコウセイ フクマクエン デ ハッショウ シタ ショウチョウ gastrointestinal stromal tumor ノ 1レイ

We report a case of gastrointestinal stromal tumor (GIST) with perforation in the jejunum and peritoneal dissemination. A 64 year-old man admitted our hospital with severe abdominal pain. He had findings of panperitonitis and the abdominal CT examination revealed free air and an intraabdominal abscess. We suspected perforation of the small intestine and operated. There were two adjacent tumors (6cm in diameter each) of the jejunum and peritoneal dissemination, and one of them was perforated. We performed a jejunojejunostomy and resected as all disseminated tumors as possible. Histopathological findings showed that the tumors were composed of spindle cell proliferation with three or four mitoses per high-power fields (HPF). Because tumor cell were positive for c-kit and CD34, and negative for alpha-smooth muscle actin and S-100 immunohistochemically, we diagnosed these tumors as “maligmant GIST of small intestine, uncommitted type”. Perforation of GIST is rare. Only 20 cases of GIST with peritonitis due to perforation have been reported in Japan, including the present case. Of 20 cases, 14 were small intestinal GIST. Small intestinal GIST should be recognized as a high-risk group of malignancy and perforation

ホウシャセン タンドク リョウホウ ガ ソウコウ シタ Merkel サイボウガン ノ 1レイ

A ９１-year-old man was diagnosed with Merkel cell carcinoma after removal of a mass about １ cm in diameter from the right upper eyelid on August ５, ２０１X. Curative surgery was recommended, but the patient declined. Lymph node metastases to the right lateral angle of the eye and in front of the right ear, and cancer pain in the stump recurrence manifested. Accordingly, irradiation of the right upper eyelid was started from October ３ at ２．５Gy/fraction, and the right lateral corneal lymph nodes were included from October １１, ending at ３５ Gy in １４ fractions. From November ２２，irradiation of the lymph node metastasisin front of the right ear was started, ending at ３２. ５ Gy in １３ fractions. During irradiation, cancer pain was alleviated with opioids. Stump recurrence and lymph node metastases were decreased in size, and Computed Tomography indiated complete response. Radiation monotherapy of Merkel cell carcinoma appears to offer a treatment that should be proactively applied when curative surgery proves difficult or not desired by the patient. Use of opioids during radiotherapy may improve quality of life and enhance the therapeutic effect

PET investigation of monkey brain activation during intravenous cocaine self-administration

Drug addiction is characterized by psychic dependence, namely constant uncontrollable craving for drugs. This state may result from an aberrant memory of the drug-induced feeling, acompanied with the brain plasticity, such as long-term potentiation (LTP), that play a crucial role for learning and memory. Also, the development may be caused by the increase in extracellular dopamine concentration induced by the exposure to the addicitive drugs. It is well known that as an animal model, drug addicition (psychic dependence) can be represented by intravenous self-adminstration of drug, especially with progressive ratio (PR) schedule of reinforcement, in which the number of lever presses required on each consecutive run increase by a fixed gain. However, there is so far no distinctive literature showing in vivo neural substrates underlying the psychic dependence on drugs. Now, we aim to explore in vivo functional substrates underlying the psychic dependence on cocaine by measuring regional cerebral blood flow (rCBF) when macaques were performing intravanous self-administration of cocaine on PR schedule using positron emssion tomography (PET) with O-15 labeled water. In this study, when a LED was turned on as a visual cue for the initiation of the task, two rhesus monkeys (males, weighting 5-7 kg) were required to press a lever on a PR (1.2 increment ratio) schedule of reinforcement (cocaine or food). Before the PET scan session, we measured reinforcement strenghth of both cocaine and food reinforcement as stable breaking points of their lever-pressing behaviors. Our PET results showed the increases of rCBF in dorsolateral prefrontal cortex (PFC), orbitoforntal cortex, anterior cingulate cortex, nucleus accumbens (NAc), striatum, thalamus, and ventral tegmental area (VTA) in cocaine reinforcement condition, relative to food (banana-flavored pellet) reinforcement condition as control. These findings are consistent with the reports from a series of in vitro studies showing the plasticity, starting with LTP in VTA, NAc to PFC. Therefore, PET measurement may be very useful for demonstrating in vivo functional organization responsible for drug addiction.38th Annual Meeting of Society for Neuroscienc

Plasma Amino Acid Profile in Severely Frail Elderly Patients in Japan

Summary: Background: Severe frailty, which is the highest level of frailty, leads to multiple health impairments that may individually affect the plasma-free amino acid (PFAA) profile. However, the PFAA profile of severely frail patients has not been clarified. The aim of this study was to describe the PFAA profile of severely frail elderly patients. Methods: Elderly patients (aged ≥65 years) who were admitted to the Nukada Institute for Medical and Biological Research (Chiba, Japan) were included. Severe frailty was defined using the Canadian Study of Health and Aging Clinical Frailty Scale. Subjects were divided into non-frail and severely frail groups. The PFAA profile and clinical characteristics of the subjects were analyzed. Results: Compared to the non-frail group (n = 31), the severely frail group (n = 28) had lower body mass index (BMI), serum albumin, serum prealbumin, hemoglobin, and blood pressure and higher C-reactive protein. Seventy-nine percent of severely frail patients had cognitive impairment. Severely frail patients had significantly lower essential amino acid (EAA) plasma concentrations than non-frail patients. Multiple linear regression analysis identified that valine (p = 0.005) was strongly associated with BMI. Valine (p = 0.004), leucine (p = 0.004), tryptophan (p = 0.006), lysine (p < 0.001), and total EAA (p < 0.001) levels were significantly associated with serum prealbumin levels. Conclusion: Severely frail patients had multiple health impairments. BMI and nutritional status were most significantly associated with low EAA levels. Keywords: body mass index, elderly, frailty, nutritional status, prealbumi