Suspected Case of Combined Immunodeficiency Autopsy Case

An autopsy case of combined immunodeficiency of 3 year 11 months old boy is presented. He had stomatitis, chronic protracted diarrhea, fever, growth retardation which are characteristic symptomes in severe combined immunodeficiency (SCID). IgA was low and IgG and IgM decreased towards the terminal stage. SK-SD skin reaction was negative and DNCB sensitized skin reaction was negative indicating the lack of delayed type of hypersensitivity. Compared to the typical case of primary immunodeficiency, the degree of abnormality of humoral and cellular immune functions is milder in this case. Autopsy revealed the remaining lymph nodes and histologically formation of lymphoid follicles was not distinct and lymphocyte depletion in thymic-dependent area was seen. These lesions varied in degrees depending on the location within the lymph nodes. Thymus weighed 2.2g and had Hassal\u27s corpuscles with calcification. These findings are somewhat different from the typical case of primary immunodeficiency. We consider this case as suspected case or borderline case of combined immunodeficiency by correlation of clinical and histopathological aspect. Generalized cytomegalic inclusion disease is this direct cause of death

Endosonography-Guided Pancreatic Duct Drainage for Chronic Pancreatitis: A Case Report and Review

A 50-year-old man was admitted to our department, complaining of epigastric pain and high fever. CT revealed a pseudocyst at the pancreatic head with upstream dilatation of the pancreatic duct (PD) and fluid collection surrounding the pancreas. Endosonography-guided PD drainage (ESPD) was performed because of unsuccessful ERCP. With a curved linear array echoendoscope, a 7.2 F catheter was placed in the PD. Laboratory data showed improvement in a few days and revealed disappearance of the fluid collection. Ten days after ESPD, a 7 F stent was placed in the PD via the puncture tract across the papilla of Vater followed by transpapillary replacement with a 10 F stent. CT showed a reduction in diameter of the PD and disappearance of the pseudocyst. ESPD is a feasible and useful procedure in selected patients with chronic pancreatitis showing stenosis of the main PD when transpapillary approach is impossible

Effects of cellooligosaccharide or a combination of cellooligosaccharide and live Clostridium butyricum culture on performance and intestinal ecology in Holstein calves fed milk or milk replacer

The effects of oral administration of a prebiotic (cellooligosaccharide [CE]) and a combination of a probiotic (a commercial Clostridium butyricum strain) and prebiotics (referred to as symbiotics [SB]) on performance and intestinal ecology in Holstein calves fed milk replacer (MR) or whole milk were evaluated. Forty female calves (experiment 1) and 14 male and female calves (experiment 2) were used in this study. Calves were fed MR (experiment 1) or whole milk (experiment 2) necessary for daily weight gain of 0.3 kg based on birth weight in two daily feedings and weaned at 46 days. Calves were divided into a CE feeding group, SB feeding group (only in experiment 1), and control group. The CE and SB groups were fed CE at 5 g/day before weaning and 10 g/day postweaning. Only the SB group received 108 colony-forming units (CFU) of C butyricum culture per day. Commercial calf starter was offered for ad libitum intake. Health and feed intake of the animals were monitored daily, and body weight was measured weekly. Fecal samples were analyzed for determination of bacterial community composition by an RNA-based method (sequence-specific SSU rRNA cleavage method) and for organic acid profiling. In 49-day experiments, feed intake, daily gain, and occurrence of diarrhea of the calves were unaffected by either CE supplementation or SB supplementation, and all calves were healthy during each experiment. The fecal bacterial community compositions and the organic acid profiles were not different among groups in experiment 1. In experiment 2, the level of the Clostridium coccoides-Eubacterium rectale group was higher in the feces of CE group than controls at 4 weeks of age and fecal butyric acid concentration was higher (8.0 vs. 12.2 [mmol/kg feces], P <0.05) at that time. There were no differences in prebiotic bacteria (the genera Lactobacillus and Bifidobacterium) between groups at this time point. These results suggested that CE and C. butyricum supplementation have less effect on the performance of healthy calves fed MR. However, prebiotic supplementation seems effective for modulation of the intestinal bacterial community of calves when administered with whole milk.ArticleLIVESTOCK SCIENCE. 153(1-3):88-93 (2013)journal articl

A Case of Mucosal Cancer of the Stomach Treated by Endoscopic Submucosal Dissection after Which Nodal Metastasis Became Evident

An 82-year-old male was referred to our institution for evaluation and treatment of a protruding lesion in the stomach. Esophagogastroduodenoscopy (EGD) showed a small protruding lesion and a large superficial elevated lesion on the lesser curvature of the stomach (macroscopic type: 0-I and 0-IIa, resp.). CT and endoscopic ultrasonography (EUS) visualized a small round lymph node (LN) 11 mm in size near the lesser curvature, although submucosal invasion was not evident. These two lesions were resected en bloc by endoscopic submucosal dissection (ESD). Pathological examination of the resected specimen showed moderately differentiated tubular adenocarcinoma (tub2) and well-differentiated tubular adenocarcinoma (tub1), respectively, which were limited to the mucosal layer. Because lymphatic-vascular involvement was not detected by hematoxylin and eosin (HE) staining, additional gastrectomy was not performed. Two months after ESD, follow-up EUS and CT showed an enlarged LN. EUS-guided fine needle aspiration (EUS-FNA) for the LN revealed metastasis. Therefore, total gastrectomy with LN dissection was performed. His postoperative course was uneventful. After discharge, he has been followed up at the outpatient department without any sign of recurrence for 5 years. Histological reexamination of the ESD specimen using immunohistochemistry showed lymphatic invasion of cancer cells in the lamina propria of the 0-I lesion 13 mm in size

Newly Developed Fully Covered Metal Stent for Unresectable Malignant Biliary Stricture

We herein report two patients with unresectable malignant biliary stricture who underwent stenting with a newly developed fully-covered metal stent. In the first case of lower-middle bile duct cancer, a stent was placed through the stenosis. In the second case of middle bile duct stricture due to lymph node metastases from gallbladder cancer, a stent was placed in the bile duct across the stenosis. No procedure-related complications were observed. Unevenness of the outer surface and a low shortening ratio are expected to lessen the occurrence of complications characteristic of covered metal stents such as stent migration and bile duct kinking