Wernicke\u27s Encephalopathy after Gastrectomy and Adjuvant Chemotherapy Using S-1 for Gastric cancer :Report of a Case

Wernicke\u27s encephalopathy is a disease usually related to chronic alcoholism. We reported a case of Wernicke\u27sencephalopathy after distal gastrectomy and chemotherapy using S-1 despite of no history of alcoholism.A 58-year-old woman underwent distal gastrectomy for gastric carcinoma in February, 2005. Shereceived adjuvant chemotherapy using S-1, since histological examination of the removal specimens showedregional lymph nodes metastasis. After this therapy, she rapidly developed diplopia, ataxia and disturbanceof consciousness. Although brain CT and the routine laboratory data showed no abnormal changes, brainMRI showed a symmetrical high-intensity area in the third ventricle and periaqueductal regions;this wascharacteristic of Wernicke\u27s encephalopathy. She was immediately treated with thiamine, and recoveredconsciousness within a few hours. S-1 based on 5-fluorouracil( 5-FU) which reduced the thiamine levels inthe patient, may have worsened the thiamine deficiency caused by distal gastorectomy. Therefore, cliniciansshould pay attention to suspicious symptoms of thiamine deficiency in patients who have undergone gastrectomy,particularly those who receive adjuvant chemotherapy with S-1 or 5-FU

Renal Arteriovenous Malformation Showing Peripelvic Extravasation and Elevated Urine Catecholamine

Renal arteriovenous malformation (AVM) shows extrarenal bleeding with asyrntomatic gross hematuria. A 48-year-old woman presented with a chief complaint of gross hematuria and right flank pain. Abdominal ultrasonography demonstrated a mass in the right renal pelvis. Computed tomography and magnetic resonance imaging showed a retroperitoneal mass, 5cm in diameter, adjacent to the renal pelvis. Urine dopamine and noradrenalin were elevated. Renal angiography failed to show the tumor. Right radical nephrectomy was performed under the diagnosis of catecholamine-producing retroperitoneal tumor, which invaded the right renal pelvis. The renal pelvis was filled with clots. The retroperitoneal mass seemed to be a hematoma. A hematoma due to extravasation showed a tumor- like mass in this case

Thrombophlebitis in Central Vein Caused by Indwelling Catheter for Total Parenteral Nutrition : A Case Report and Venous Angiographic Study of 27 Cases with Central Vein Catheterization

A fifty-three-year-old man developed thrombophlebitis in the left subclavian and jugular vein after 16-days total parenteral nutrition (TPN) with a catheter indwelling in the central vein via the left subclavian vein for nutritional management during perioperative period of distal gastrectomy. We herein report the case with a venous angiographic study of 27 cases that underwent central vein catheterization for TP

Combination Therapy Consisting of Low-dose Cyclosporin A, Low-dose Prednisolone and Enalapril in Children with Steroid-Sensitive Nephrotic Syndrome

To evaluate the extent to which combined low-dose cyclosporin A (CsA), low - dose glucocorticoid and enalapril would permit decreasing 1) steroidal toxicity, 2) the frequency of relapse of nephrotic syndrome and 3) adverse effects due to CsA, in children with steroid - dependent nephrotic syndrome. Eight children with steroid-dependent nephrotic syndrome underwent CsA therapy (mean : 2.7 mg/kg/day) for more than 24 months. Renal biopsy was performed at 24 months of CsA treatment. Height development was assessed by comparing with normal level. The changes in prednisolone dosage, as well as in the frequency of relapse, were studied. Prednisolone dosage significantly (p < 0.05) decreased to 0.20 ± 0.14 mg/kg/day after start of CsA therapy, being 0.64 ± 0.35 mg/kg/day before it. The frequency of relapse significantly (p < 0.05) decreased to 0.13 ± 0.12 times per month after start of CsA therapy, its initial frequency being 0.48 ±0.11 times per month. There were no severe histological abnormalities. The height development delay was progressed in only one patient. There were no adverse effects of CsA. It may be safely said that low-dose CsA (2.5～3.0 mg/kg) was effective in pediatric steroid-dependent nephrotic syndrome and that the trough levels of CsA of 100 to 150 ng/ml were not necessary when combined with low - dose prednisolone which would not induce major side effects

Effects of Cytokines and Immunosuppressants on the Production of Serum Amyloid A Protein and C-reactive Protein in HepG2 Cells

C-reactive protein (CRP) and serum amyloid A protein (SAA) are acute- phase proteins produced by the liver in response to inflammatory cytokines. The concentrations of these proteins in serum vary in parallel in most pathological conditions, but sometimes vary independently. CRP and SAA were determined in HepG2 cell culture medium supplemented with five immunosuppressants (corticosteroid, gusperimus hydrochloride, cyclosporin A, mizoribine and tacrolimus hydrate), with or without interleukin-1β(IL-1β) and interleukin-6 (IL-6). We also examined the effects of the immunosuppressants on the production of cytokines and changes in CRP and SAA production in HepG2 cells stimulated with the culture fluid from lipopolysaccharide (LPS) - treated monocytes. In HepG2 cells, production of CRP and SAA was greatly affected by IL-6 and IL-β, respectively. Prednisolone (PSL) suppressed CRP production, while it enhanced SAA production. The other four immunosuppressants did not affect CRP production, but inhibited SAA production. PSL significantly inhibited cytokine production in monocytes, while the other immunosuppressants enhanced it. In HepG2 cells incubated with the culture fluid from LPS-stimulated monocytes, CRP production was suppressed, while SAA production was enhanced. PSL suppressed CRP production in HepG2 cells by inhibiting IL-6 production in monocytes, whereas PSL increased SAA production through a direct action on the hepatoma cells. In contrast, the other immunosuppressive agents enhanced IL-β production in monocytes. The agents induced SAA production in the HepG2 cells but did not affect CRP production

キュウセイ ジンフゼン, コウCPKケッショウ オ トモナイ, キュウゲキ ニ ケトアシドーシス オ テイシタ ヒ ジコ メンエキセイ ゲキショウガタ 1ガタ トウニョウビョウ ノ 1レイ

We present a 40 year male patient who developed diabetic ketoacidosis with acute renal failure and high serum values of CPK and uric acid. Because of acute onset of ketoacidosis during several days with an elevation of serum amylase, negative findings of antibodies associated with autoimmune type 1 diabetes mellitus, he was diagnosed of a non-autoimmune, fuluminant, type 1 diabetes mellitus, which is a newly established subtype of type 1 diabetes mellitus. Since the patient\u27s post-prandial plasma glucose was extremely high (1123 mg/dl) when he developed ketoacidosis, the severe dehydration due to extreme hyperglycemia might have caused acute renal failtire and rhabdomyolysis

ガンカ リョウイキ ニオケル カンセンショウ ト サイキン ノ ドウコウ (<トクシュウ カンセンショウ ノ サイキン ノ ドウコウ)

眼科領域(眼瞼,涙器,眼窩,結膜,角膜,網膜)における感染症の病態,診断,治療について概説し,近年の感染性疾患の動向と特徴を取り上げた.眼球は,視機能を扱うという特殊性と,結膜,角膜,ぶどう膜,網膜といった微細な解剖学的構造から,他科の感染症診療とは異なる領域であると考えられ,角膜と網膜の感染症は,重篤化すると視力障害をきたし外科的処置の適応となりうることから特に重要であると思われた.近年の医学の進歩により原因が解明されつつあり,薬物や外科的治療により失明を免れることが可能になってきた疾患として急性網膜壊死があり,院内感染防止の側面からは依然としてウイルス性結膜炎の注意が必要である.白内障手術などの術後眼内炎は,昨今の眼科手術件数の増加とその重篤性から的確な診断と早期の治療が考慮されるべきである

コシガヤ ビョウイン ビョウリブ ノ ビョウリ カイボウ ニオケル カンセンショウ タイサク (<トクシュウ> カンセンショウ ノ サイキン ノ ドウコウ)

1984年から2002年までの19年間における獨協医大越谷病院の病理解剖症例の総計1260体の中で危険な感染症としてウイルス性肝炎が133例,肺結核症が34例の合計167例認められた.これらの疾患が解剖数に占める割合は,ウイルス性肝炎の19年間の年平均は10.5%であるが,1991年と1996年でそれぞれ15.8%と20.3%と高い割合を示した.肺結核症については,年平均2.7%であるが,1998年以降は減少している.感染対策として,当病理部では1990年以降,感染症のあるご遺体に対して,エンバーミング処理を施している.エンバーミングは,ホルマリンを主とする防腐,固定,殺菌作用のある薬液を血管から全身に灌流させるので,ご遺体からの感染の危険性をほとんどゼロまで減少させる効果がある.当病理部では,他に感染対策として解剖施設の改築を1998年に行い,感染症用解剖室を別に設置した.解剖台,排水,排気,室内消毒設備などは感染対策を講じた設備とし,ご遺体からの血液や体液はすべて回収し感染性廃棄物として焼却処分している.Totals of autopsy cases in Koshigaya Hospital for 19 years from 1984 to 2002 were 1260 cases, including 167cases of dangerous infection of viral hepatitis and pulmonary tuberculosis. The year average for 19 years of viral hepatitis and pulmonary tuberculosis are 10.5 % and 2.7 % respectively. In 1996 the ratio of viral hepatitis was the highest with 20.3 %. As an infection countermeasure, in our pathology division the embalming processing has been conducted for the infected cadaver since 1990. It is effective to decrease the infectious danger from the cadaver, because the embalming makes the whole body pass the chemicals with corrosion prevention, fixation, germicidal action. As other infection countermeasures, the autopsy room for the infected cadaver was founded in 1998. Blood and body fluid from the cadaver are recovered in all and it has been incinerated as an infectivity material

ジュツゴツウ ラット モデル ニオケル シンケイ セイチョウ インシ ト ロイコトリエンB4 ノ サヨウ

術後痛における神経成長因子(NGF)とロイコトリエンB4(LTB4)の役割を調べるために,Brennanの術後痛ラットモデルを用いて,足底部の皮膚切開部位にNGF,LTB4,抗NGF抗体,LTB4受容体括抗薬であるONO4057を投与して,その疼痛閾値に対する効果をvon Frey testで検討した.結果はNGFとLTB4投与で術後痛は変化しなかったが,抗NGF抗体とONO4057投与により術後痛は有意に減少した.よって抗NGF抗体とONO4057は,術後痛を抑制する可能性が示唆された.To examine the role of nerve growth factor (NGF) and leukotoriene B4 (LTB4) in postoperative pain, we examined whether a Peripherally administered NGF, LTB4, anti-NGF and anti-LTB4 would be the effect for incision-induced mechanical hyperalgesia. We used a rat model of postoperative pain introduced by Brennan et al. Rats underwent a plantar incision, and responses to mechanical stimuli was measured using von Frey filaments. Rats were tested 1 and 96 H after the skin incision. Anti-NGF and anti-LTB4 significantly decreased the response frequencies to mechanical stimulation, however, NGF and LTB4 did not evoke mechanical hyperalgesia. We conclude that anti-NGF and anti-LTB4 can inhibit the mechanical hyperalgesia induced by a surgical incision