A Case of Hemangiosarcoma of the Liver which led to a Diagnosis with Hemoptysis

Angiosarcoma is a vascular endothelium-derived malignant tumor that arises in blood vessel walls, accounting for only 2.3% of soft tissue sarcomas in adults. Primary hepatic angiosarcoma(PHA)is rare, comprising< 5% of all angiosarcomas. We report a case of PHA in a 61-year-old man evaluated by another clinic around our hospital for a chief complaint of hemoptysis in May 2012. Chest computed tomography(CT) showed abnormal shadows in bilateral lung fields, so he was referred to Department of Respiratory Medicine at our hospital in late July. However, no definitive diagnosis was not made, even after bronchoscopy. In mid-August, he presented to the outpatient clinic of the respiratory department with a chief complaint of right-sided abdominal pain. Abdominal CT showed a liver lesion, and he was urgently admitted to our department. Initial physical examination was unremarkable except for palpable liver in the right hypochondrium. Tumor markers for liver and biliary cancers were all within normal limits, and negative results were obtained for hepatitis B and C virus. CT, ultrasonography, and(MRI)identified a large lesion replacing the right hepatic lobe and medial segment of the left hepatic lobe. Hemangioma or hepatic angiosarcoma was suspected, accompanied by intraperitoneal rupture. Transcatheter arterial embolization was attempted, but had to be discontinued, and the patient died from hemorrhagic shock due to tumor rupture after onset of abdominal pain. The PHA which assumes hemoptysis primary symptom is extremely rare, and by reports for the past ten years searched using PubMed, this is the second report in the world

Measurement of Tissue Stiffness with Virtual Touch Tissue Quantification in Two Cases of Spleen Tumor

We performed non-invasive measurement of tissue stiffness in the spleen for two patients using virtualtouch tissue quantification (VTTQ). Case 1 was an 82-year-old woman with Hodgkin lymphoma. Stiffnessmeasured using VTTQ was lower than normal spleen in tumor areas and higher than normal spleen in nontumorareas. Case 2 was a 66-year-old man with ascites and gastric cancer involving the entire spleen. Stiffnessof the spleen tumor as measured by VTTQ was higher than normal spleen. These cases demonstratedtwo new factors associated with elevated spleen stiffness:compression of healthy spleen tissue by tumorand cancer invasion

Mechanism of Airway Remodeling Induced by Repeated Inhalation of Methacholine in a Mouse Model of Asthma

Background:Increased severity of asthma is contributed by airway tissue remodeling, which may be associated with chronic allergic inflammation. A recent study revealed the potential capacity of repeated bronchoconstriction, e.g. induced by a muscarine agonist, methacholine(Mch)challenge, to involve in airway remodeling, even though allergic inflammation is not implicated. We have evaluated the influence of repeated bronchoconstriction induced by Mch inhalation on airway remodeling in a murine model of asthma and have examined its machanisms. Methods:Mice were immunized with ovalbumin(OVA), and consequently, challenged by either daily OVA inhalation(the OVA group;a model of asthma with allergic inflammation)or daily Mch inhalation(the Mch group;a model of asthma without allergic inflammation). Lung tissues were obtained and were evaluated histologically after 5, 10, and 15 consecutive inhalation challenges of both OVA and Mch.Results:Eosinophilia in the airway observed only on the OVA group. Subepithelial collagen-band thickness increased also in the OVA group(p<0.01)after 15 challenges, but not in the Mch group. Significant increase in thickness of airway smooth muscle layer and the number of goblet cells were revealed in both the OVA and Mch group after 10(p<0.05 and p<0.01, p<0.01 and p<0.05, respectively, for the comparison of the two challenge groups with the control group)and 15 challenges(p<0.05 and p<0.01, both p< 0.01, respectively, for the comparison with control), further, all these measurements were greater in the OVA group than in the Mch group after both 10 and 15 challenges(both p<0.05 and p<0.01, respectively). An increase in mast cell counts within the airway wall was shown in the OVA group after 10 challenges (p<0.01 compared with control), not in the Mch group at all. Epithelia expression of transforming growthfactor b (TGF-b)increased in both challenge groups after 15 challenges(both p<0.05 compared with control), and was higher than in Mch(p<0.05).Conclusion:Repeated Mch inhalation may induce airway remodeling, while comparatively mild, potentially resulting in progressive severity of asthma. The results implicate that the potential risk associated with Mch challenge should be considered

A Case of Inflammatory Pseudotumor of the Breast after Augmentation Mammoplasty

Inflammatory pseudotumor is a benign reactive lesion which forms due to diverse tissue responses of inflammatory cells and mesenchymal cells. It can occur in various organs of the body but rarely in the breast. We report a case of inflammatory pseudotumor of the breast after augmentation mammoplasty. The patient was a 78-year-old woman who noticed a mass in her right breast in July 2012. She had a history of augmentation mammoplasty at age 24 years. She was referred to our hospital for thorough examination. A 3-cm immovable induration was palpated in the upper lesion of the right breast. Ultrasound examination revealed a hypoechoic mass at the same site. The mass was 2.9×1.7 cm with irregular, ill-defined borders. Mammography revealed some areas of elevated density with coarse, lucent-centered calcifications in bilateral breasts but no clear findings of malignancy. Core needle biopsy of this site revealed marked fibrous hyperplasia and proliferation of fibroblast-like spindle cells. Infiltration of neutrophils and plasma cells was observed in the stroma. There were spindle cells with no atypia and scarce mitotic figures. Thus, the patient was diagnosed with inflammatory pseudotumor. The patient received only follow-up observation without surgical resection as per the patient\u27s wishes. There has not been any change as of May 2013

Positioning of novel tumor marker NX-PVKA-R in the diagnosis of hepatocellular carcinoma in comparison with PIVKA-II

Background/Aims:To compare the use of protein induced by vitamin K absence or antagonist II( PIVKA-II) measured conventionally with the ratio between PIVKA-II measured using P-11 and P-16 antibodies(NX-PVKA) and PIVKA-II measured conventionally (NX-PVKA-R) in terms of false-positive resultsfor hepatocellular carcinoma( HCC). Methodology:Subjects comprised 318 patients with chronic liver disease,including 8 patients receiving warfarin treatment, which can result in false-positive results for HCC.HCC was present in 65 patients (HCC group) and absent in 253 (non-HCC group). PIVKA-II was measuredconventionally. NX-PVKA-R was calculated as PIVKA-II/NX-PVKA. Results:Both PIVKA-II andNX-PVKA-R were significantly higher in the HCC group than in the non-HCC group (p<0.0001 each).False-positive results were seen in 9.5% of non-HCC patients with PIVKA-II, and in 10.3% with NX-PVKA-R. False-positive results were seen for all 8 patients (100%) on warfarin with PIVKA-II, but for 0%with NX-PVKA-R. Sensitivity, specificity, and accuracy were all lower for NX-PVKA-R than PIVKA-II.Conclusions:NX-PVKA-R is not more useful than PIVKA-II for diagnosing HCC, but is very useful insubpopulations such as patients on warfarin and patients with jaundice. The characteristics of NX-PVKA-Rcan be best exploited by selecting patients in which these factors are present

Incidents of Violence and Verbal Abuse from Patients and Their Relatives against Nurses in Dokkyo Medical University Koshigaya Hospital

This study aimed to understand the nature and frequency of violence and verbal abuse toward nurses ina Japanese general hospital. Questionnaires concerning violence and verbal abuse against nurses were distributedto 440 nurses employed at a university hospital and a total of 438 nurses responded to the questionnaire.Over one third reported attempted incidents of violence, whereas further one quarter reported beingactually pinched, touched unnecessarily, or kicked. More than a half reported being yelled at, being complainedto unreasonably about a medical service, and experiencing overbearing voices. The most commonemotion experienced after facing violence or verbal abuse was embarrassment and discomfort, followed byanger. Nurses in the emergency and intensive care units and some surgical wards experienced higher levelsof violence and verbal abuse than those in other wards. These findings prove the urgent need for the developmentof preventive actions to address the problem of workplace adversity

Long Term Evaluation of Glycemic Control in Patients with Type 2 Diabetes Receiving Either Alogliptin and Lansoprazole or Alogliptin Mono-therapy for 3 Months Followed by Alogliptin Mono-therapy:A Retrospective Analysis

Aims:This study was the retrospective analysis of the previous study named as APPLE study( study of combination effect of AlogliPtin and lansoPrazoLE on glycemic control in patients with type 2 diabetes), in which the effect of the combination therapy of alogliptin (a dipeptidyl peptidase-4 inhibitor, DPP4-I) and lansoprazole (a proton pump inhibitor, PPI) was compared with alogliptin mono-therapy without PPI on glycemic control in a randomized open-label study design. The aim of this study was to investigate whether so called legacy effect of proton pump inhibitor on glycemic control is observed. Patients and Methods:In the patients that participated in the APPLE study( 3 months observation;total: 100 patients), the patients who continued the intake of alogliptin at least more than 1 year after the registration(enrollment)in APPLE study was evaluated on glycemic control retrospectively. As a rule, the administration of lansoprazole in combination group was discontinued after the finish of 3 months- of the APPLE study. Twenty-six patients in the alogliptin mono-therapy group and 26 patients in combination group met the requirement in this analysis. Mean observation periods were respectively 16 months. In these patients, the number of patients in whom all diabetic drugs were not changed in observation-period was respectively 18 in alogliptin mono-therapy group and 17 in combination group.Results:The decrease of HbA1c was maintained also after long term observation (16 months) in both alogliptin mono-therapy and combination groups (the decrease was respectively -1.054±0.548 and - 1.123±0.723%), which was similar compared with that observed in 3 months-APPLE study. There were no significant differences in change of HbA1c and fasting plasma glucose (FPG) at the time in enrollment of APPLE study and at final visit( approximately 16 weeks) between these groups. The significant difference in change of HbA1c and FPG was not found also between alogliptin mono-therapy and combination group in the subgroup of patients where all diabetic drugs were unchanged during observation period.Conclusion:This study found that the legacy effect of PPI on glycemic control was not apparent more than 9 months after the APPLE study. Based on the results in the previous APPLE study and in this current retrospective study, we concluded that the add-on effect of PPI for DPP4-I on glycemic control in patients with type 2 diabetes is not clinically apparent

The Effect of Switching from Either Mitiglinide or Glimepiride to Repaglinide on Both Glycemic Control and Oxidative Stress in Patients with Type 2 Diabetes

Aims:The goal of this study was to investigate the effect of switching from either the low dose sulfonylurea glimepiride(1?mg once daily)or the glinide mitiglinide(10?mg three times daily)to repaglinide(0.5?mg three times daily)on both glycemic control and oxidative stress in patients with type 2 diabetes.Patients and Methods:Finally 17 patients(patients treated with either glimepiride:n=11 or mitiglinide:n=6)completed the study. The type and dose of all drugs, including the anti-diabetic treatments, were not changed for at least 1?month prior to the study.Results:Both groups showed a significant decrease in HbA1c levels. FPG showed a tendency(not significant)toward a decrease in the mitiglinide-treated group, while no change was found in the glimepiride-treated group. A significant decrease in 8-iso-PGF2α levels was found only in the glimepiride-treated group. There was a significant correlation between the difference in 8-iso-PGF2α levels and that in either FPG or HbA1c before and after the switch only in the mitiglinide-treated group.Conclusions:Repaglinide may have an anti-oxidative effect probably due to the strong postprandial glucose lowering observed in patients with type 2 diabetes

SIADH induced by pneumonia in a patient with Shy-Drager syndrome

Patients with Shy-Drager syndrome have impaired baroreceptor-mediated vasopressin release when inan upright position. We report a case of Shy-Drager syndrome in which the syndrome of inappropriate secretionof antidiuretic hormone (SIADH) developed with pneumonia. It has been speculated that pneumonia-induced SIADH is caused by baroreceptor-mediated vasopressin release. Our case presents the possibilitythat pneumonia-induced SIADH is caused by non-baroreceptor-mediated ADH release

Association Between Nerve Conduction Velocity and Clinical Parameters Related to Diabetic Complications inPatients with Type 2 Diabetes

The main purpose of the study was to investigate the association of median motor nerve conduction velocity(MCV) and sural sensory nerve conduction velocity( SCV) with parameters related to diabetic complicationsin patients with type 2 diabetes. A total of 263 patients hospitalized for glycemic control from 1999to 2006 who underwent single or multiple nerve conduction velocity tests (at least a right median MCVtest) were enrolled in the study retrospectively. Right median MCV showed a significant negative correlationwith age and diabetic duration, and was also significantly negatively correlated with systolic blood pressure(SBP) and log urinary albumin excretion (UAE). Right median MCV showed strong positive correlationswith left median MCV and right median SCV, and significant but relatively mild positive correlationswith right peroneal MCV and right sural SCV. In multiple regression analysis, only SBP and diabetic durationshowed a significant association with right median MCV. Although right sural SCV showed significantnegative correlations with SBP and log UAE, the correlations were relatively weak compared with those forright median MCV. Of 215 patients who underwent complete sural SCV measurements, right and left suralSCV were detected in 159( 74%) and 163 patients( 76%), respectively. In conclusion, these results suggestthat median MCV is more closely associated with markers related to diabetic complications such as SBP orUAE, compared with sural SCV, but that sural SCV is more sensitive than median MCV for detection of diabeticneuropathy