Late recurrence of acinic cell carcinoma of the parotid gland

Acinic cell carcinoma of the salivary glands is a rare cancer representing a low grade malignancy. The recurrence of a tumor is sometimes encountered, usually within 5years of initial operation. We describe an unusual recurrence after a long interval following primary surgery. In1987, a 60-year-old woman underwent excision of a mass in the superficial lobe of the right parotid gland under the preoperative diagnosis of a benign tumor. A histologic diagnosis of acinic cell carcinoma was made by examining sections from the resected mass. The patient noted several small nodules in the right parotid region in 1995, but she did not visit our clinic until 1998 when tenderness developed. A locally recurrent tumor and cervical lymph nodes containing metastases were resected and postoperative radiotherapy was given11years after the first operation. At least 10years of follow-up may be necessary for patients with acinic cell carcinoma because of slow-tumor growth

Upregulation of Histidine Decarboxylase Immunoreactivity in Neointimal Smooth Muscle Cells of Balloon-injured Porcine Coronary Arteries

粥状動脈硬化により狭窄した冠動脈にバルーンを挿入して拡張する経皮的冠動脈形成術(PTCA)はステントと併用して広く行われているが、術後の再狭窄が問題となっている。再狭窄の主な原因は、血管中膜平滑筋細胞の内膜への遊走と増殖による内膜肥厚である。この過程には、血小板由来増殖因子など種々のペプチド性増殖因子の関与が示唆されているが、非ペプチド性因子の関与については明らかでない。我々は、ブタ冠動脈バルーン障害モデルの内膜肥厚部位に、著しいヒスタミン含量の増加を見出し報告して来た。一般に、組織中のヒスタミンは、肥満細胞中に貯蔵され遊離されるか、ヒスチジン脱炭酸酵素(HDC)により新規に合成分泌される。そこで、本研究では、ブタ冠動脈バルーン障害モデルにおけるHDCの分布を免疫組織化学的に検討し、内膜肥厚部位に著しいHDCの発現を明らかにした。また、ウェスタンブロット解析の結果、内膜肥厚部位を含む血管に63kDaのHDC陽性バンドを検出した。このことからヒスタミンは、内膜肥厚部位の平滑筋細胞から合成分泌されていることが示唆された。(著者抄録

Nonalcoholic Steatohepatitis with Improved Hepatic Fibrosis after Weight Reduction

A 65-year-old woman was admitted to our hospital for an investigation of liver dysfunction. She had mild obesity with hyperlipidemia, but no history of alcohol abuse. Other known causes of liver dysfunction, such as viruses, autoimmunity and drug effects, were excluded. The liver histology was consistent with nonalcoholic steatohepatitis (NASH). After diagnosis of NASH, the patient started diet and exercise therapy and, in parallel with weight reduction, her liver function improved. One year after the therapy, a liver biopsy showed that steatosis, necroinflammation and even fibrosis were improved. Hence, here we report a case of NASH in which weight reduction was effective in improving both biochemical and histological findings

Relationship between Urinary Liver-Type Fatty Acid-Binding Protein (L-FABP) and Sarcopenia in Spontaneously Diabetic Torii Fatty Rats

Background. Type 2 diabetes (T2D) is a known risk factor for diabetic kidney disease (DKD) and sarcopenia in older patients. Because there may be an interaction between DKD and sarcopenia, the aim of the present study is to investigate the relationship between urinary levels of liver-type fatty acid-binding protein (L-FABP) and sarcopenia using a novel rat model of T2D. Methods. Male spontaneously diabetic Torii (SDT) fatty rats (n=5) at 16 weeks of age were used as an animal model of T2D. Age- and sex-matched Sprague-Dawley (SD) rats (n=7) were used as controls. Urine samples were obtained from the rats, and muscle strength was evaluated with the use of the forelimb grip test at 16, 20, and 24 weeks of age. Serum, kidney, soleus, and extensor digitorum longus (EDL) muscle samples were collected at 24 weeks of age. Urinary L-FABP levels were measured using dedicated enzyme-linked immunosorbent assays. Results. Increased urinary L-FABP levels, focal glomerular sclerosis, moderate interstitial inflammation and fibrosis, and accumulation of renal oxidative proteins were significantly observed in the SDT fatty rats, compared to the SD rats. Muscle weight, muscle strength, cross-sectional areas of both type I and type IIb muscle fibers, and increasing rate of muscle strength were significantly decreased in the SDT fatty rats compared to the SD rats at 24 weeks. Urinary L-FABP levels at 20 and 24 weeks were significantly negatively correlated with muscle strength. Urinary L-FABP levels at 16 weeks were significantly negatively correlated with the increasing rate of muscle strength. Conclusions. Urinary L-FABP reflects the degree of muscle strength and weight, as well as cross-sectional areas of muscle fibers. Although further clinical study is needed, urinary L-FABP may be useful to monitor the progression of sarcopenia and DKD in T2D patients

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era