A Japanese Patient with Gastric Cancer and Dihydropyrimidine Dehydrogenase Deficiency Presenting with DPYD Variants

A 63-year-old Japanese male with stomach adenocarcinoma received oral 5-fluorouracil derivative, cisplatin and trastuzumab chemotherapy. On day 8, severe diarrhea and mucositis developed; chemotherapy was stopped. On day 14, the patient developed renal dysfunction and febrile neutropenia. He also suffered from pneumonia due to Candida albicans. Systemic symptoms improved after intensive conservative treatment. Best supportive care was continued until the patient died from gastric cancer. The dihydropyrimidine dehydroge-nase protein level was low at 3.18 U/mg protein. The result of DPYD genotyping revealed three variants at posi-tions 1615 (G > A), 1627 (A > G), and 1896 (T > C) in exons 13, 13, and 14, respectively

Clinical Outcomes of Endoscopic Hemostasis in Marginal Ulcer Bleeding

The usefulness of endoscopy in marginal ulcer bleeding has rarely been studied, and the optimal method for preventing rebleeding is unclear. Here we assessed the efficacy of endoscopy in marginal ulcer bleeding and examined the efficacy of proton pump inhibitors (PPIs) in the prevention of rebleeding. A total of 28 patients with marginal ulcer bleeding (21 men, 7 women; median age 58.5 years) were treated by endoscopy. We analyzed the clinical characteristics, results of endoscopic therapy, characteristics of rebleeding patients, and relation between the use of PPIs and the duration of rebleeding. Sixteen patients had active bleeding. Initial hemostasis was achieved in all patients. There were no procedure-related adverse events. Rebleeding occurred in one patient within the first month and in 7 patients thereafter. There was a significant difference in the rebleeding rate between the patients who received a PPI and those who did not. In a multivariate analysis, the non-use of PPIs was a risk factor for rebleeding (hazard ratio, 6.22). Therapeutic endoscopy is effective in achieving hemostasis from marginal ulcer bleeding. PPIs may prevent rebleeding from marginal ulcers

Hepatitis C virus antibody titration in patients with chronic hepatitis C, before and after interferon treatment.

We measured hepatitis C virus antibody titers in 13 patients with chronic hepatitis C to determine whether titration of hepatitis C virus antibody was useful or not, to predict and evaluate the efficacy of interferon (IFN) treatment. During administration of IFN, hepatitis C virus titers declined in all patients. Antibody titers performed before treatment as well as just at the end of treatment did not correlate with change of the alanine aminotransferase levels during administration of IFN. Antibody titers declined continuously after treatment in 5 patients with normal alanine amino-transferase levels for over 6 months after discontinuation of IFN. Antibody titers rose again in 6 patients whose alanine aminotransferase levels fluctuated after treatment. An exceptional pattern of change occurred in 2 patients whose antibody titers declined continuously although their alanine aminotransferase levels fluctuated after treatment. Repeated titration of hepatitis C virus antibody appears to be useful for evaluating the long-term efficacy of IFN treatment.</p

Endoscopical Segmental Piecemeal Tumorectomy for Nodular Elevation of Colorectal Tumor: Applicability and Patient's Quality of Life

Endoscopical segmental piecemeal tumorectomy (ESPT) for nodular elevation of colorectal tumor is advantageous in terms of minimizing both surgical invasion and postoperative burden to the patients. Nodular elevation of colorectal tumors is said to occur when the body of the tumor is adenomatous and the surface of the focal cancer grows more horizontally into the lumen than vertically. We report here four cases of nodular elevation of colorectal tumors which were each treated by different surgical procedures.</p

Immunohistological study of humoral and cellular immune events in the small intestinal mucosa of patients with liver cirrhosis

消化管粘膜は,種々の食餌性抗原をはじめとし,細菌・ウィルスなどの外因性抗原や腸内細菌およびそれらが産生する内因性抗原に絶えず曝されている.これらの抗原に対しては,gut associated lymphoid tissue(GALT)が,構成するリンパ球ならびにsecretory IgA(sIgA)を産生することにより防御機構をなしている.そして,sIgAの分泌機構は免疫組織学的に詳細に検討され1,2),腸粘膜の免疫グロブリン(以下Ig)保有細胞やリンパ球についても,モノクローナル抗体の普及とともに検討されてきている3,4).既に,潰瘍性大腸炎5)やceliac disease6)などでは,その本態を検討する目的で腸粘膜内のIg保有細胞やT cell subsetsの変化についての免疫組織学的検討が少数ながら報告されている.しかしながら,肝炎をはじめとする肝疾患,特に細胞性免疫の低下7)や高γグロブリン血症の認められる肝硬変症例における腸管免疫の実態については,ほとんど検討がなされていない.そこで,著者は,酵素抗体法を用い,肝硬変症例の腸管局所における液性および細胞性免疫能の変動を明らかにする目的で,肝硬変症例の十二指腸生検組織を用いて,その腸管粘膜のIg保有細胞,secretory component(SC)およびリンパ球のsubpopulationならびにsubsetsについて免疫組織化学的に詳細に検討したので報告する.Using an immunoperoxidase method, we analyzed T cell subpopulation, subsets and immunoglobulin-containing cells in the mucosa of small intestines obtained from 19 patients with liver cirrhosis and 8 patients without any liver disease (controls). Percentages of IgA-containing cells in the lamina propria of the small intestines from the liver cirrhosis patients tended to be higher than in the same tissue of the controls. In contrast, percentages of pan T cells and cytotoxic/suppressor T cells in the lamina propria and numbers of intraepithelial pan T and cytotoxic/suppressor T cells in the tissues from liver cirrhosis patients tended to be lower than in the controls. Furthermore, the percentage of IgA-containing cells in the lamina propria was significantly higher and the percentage of pan T and cytotoxic/suppressor T cells in the lamina propria was significantly lower in the small intestines of patients with decompensated liver cirrhosis than in the small intestines of the controls. The lower percentage of pan T and cytotoxic/suppressor T cells observed in the small intestine of patients with liver cirrhosis, especially decompensated liver cirrhosis, may be related to general impairment of cellular immunity in liver cirrhosis and to enhanced humoral immunity in the small intestine as shown by the increase in IgA-containing cells

Rapidly Progressed Primary Intestinal Follicular Lymphoma with Elevation of Soluble Interleukin-2 Receptor Levels

A 62-year-old Japanese male was diagnosed with primary intestinal follicular lymphoma involving the duodenum, jejunum, and rectum without lymph node involvement. The patient was classified as low risk by the follicular lymphoma international prognostic index (FLIPI) system. Treatment was deferred because he had no symptoms. Eleven months after the diagnosis, his soluble interleukin-2 receptor (sIL-2R) levels had risen from 383 to 617 U/mL. Lymphoma progression involving an enlarged perigastric lymph node was also documented. This report illustrates a case of rapidly progressed intestinal follicular lymphoma, suggesting the possible usefulness of sIL-2R levels as an indicator of lymphoma progression