Bullous Variant of Sweet's Syndrome after Herpes Zoster Virus Infection

Aim: Cutaneous manifestations of Sweet’s syndrome (SS) are typically painful plaque-forming erythematous papules, while bullae are quite uncommon. We present a case of bullous variant of SS in acute myeloid leukaemia. In this case, herpes infection of the left mandible had preceded the development of SS. Case Report: A 75-year-old male with myelodysplastic syndrome first presented with herpes zoster virus infection-like bullae and erosive plaques on the left side of the face and neck. Treatment with valacyclovir and antibiotics was effective only for the initial lesions, whereas the other bullae kept developing predominantly on the left side. Histopathological study revealed epidermal bulla formation, pandermal neutrophilic infiltration, erythrocyte extravasation and subepidermal oedema, but no vasculitis. The findings suggested the diagnosis of bullous variant of SS. Discussion: Our case was unique in that bullous SS symptoms developed predominantly on one side of the cheek and neck where the herpes zoster infection occurred prior to SS. The tendency may explain the possible association between viral infection and development of SS

Interferon and pancreatitis

インターフェロンは慢性肝炎や悪性腫瘍の治療など,広く臨床の場に用いられるようになった｡その副作用の一つとして,膵炎があり,その多くは急性膵炎である,慢性膵炎の報告もあり,膵炎はインターフェロンを用いる場合に知っておくべき副作用である｡そこで,膵炎とインターフェロンの関係について現在までに知られている知見について概説する｡Pancreatitis is known to be one of the adverse effects of interferon, which has been widely used for treatment of chronic hepatitis and malignant diseases. In this paper, we reviewed pancreatitis as adverse effects of interferon and effect of interferon on the pancreas

膵癌における癌遺伝子および癌抑制遺伝子

Recent advances in molecular biology have revealed that a number of oncogenes (K-ras, erbB-2, and Met) and tumor suppressor genes (p53, p16, APC, and DCC) contribute to the development of pancreatic cancer. This paper reviewed the present knowledge of oncogenes and tumor suppressor genes relevant to pancreatic cancer. Further studies on molecular alterations in pancreatic cancer may lead to a better understanding of tumor biology, offering a possibility of development of new diagnostic and therapeutic approaches in the future.膵癌の予後は惨憺たるものである｡一方で,最近の分子生物学の分野での研究の進歩により,遺伝子レベルでの異常が膵癌では数多く存在することも明らかになってきた｡膵癌の予後を改善するために,発展が期待される膵癌における遺伝子診断や遺伝子治療に向けて現在までの膵癌で明らかになった癌遺伝子(k-ras,erbB-2,Met),癌抑制遺伝子(p53,p16,APC,DDC)について,概説した

Study of the preparation with sodium picosulfate and PEG intestinal lavage solution for total colonoscopy.

Total colonoscopyの前処置における被検者の負担軽減と良好な腸管洗浄を得る目的で,50例の大腸内視鏡検査において,前日の食事制限せず, sodium picosulfate 20mℓ前夜服用,検査当日PEG腸管洗浄液1ℓ以上服用する前処置法の有用性について検討した。本前処置法によってPEG腸管洗浄液平均1230mℓの服用により,50例中48例で観察可能な腸管洗浄が得られ,PEG腸管洗浄液の服用量の減量が可能であった｡腹痛,嘔気,腹鳴などの症状出現例は認めたが,重篤な副作用は認めなかった｡腸管洗浄度の点で,高齢者の大腸内視鏡検査の前処置として有用である｡以上よりSodium Picosulfate 20mℓをPEG腸管洗浄液と併用することにより,優れた腸管洗浄度を得られると同時にPEG腸管洗浄液服用量の減量か可能であり,total colonoscopyの前処置として有用であることが示された。The following results were obtained from a total colonoscopic study of 50 patients who received preparation with 20mℓ of sodium picosulfate (Laxoberon®) and PEG intestinal lavage solution (Niflec®) prior to the examination. (l) The present method in combination with a mean of 1230mℓ of PEG intestinal lavage solution allowed colonic cleaning for which observation was available in 48 of 50 patients. (2) With this method. no adverse reactions were observed except for mild abdominal pain, nausea, and rugitus in a few patients. (3) This method was particularly as a preparation for colonoscopic examination in elderly patients. Thus, we conclude that preparation with 20mℓ of sodium picosulfate and PEG intestinal lavage solution is useful for colonoscopic examination

Endoscopic aspiration of pure pancreatic juice is useful in diagnosis and treatment of chronic pancreatitis.

内視鏡的純粋膵液採取法の慢性膵炎診療における意義を検討した｡本法を用い,セクレパン100単位静注後10分間膵液を採取するintaraductal secretin test(IDST,膵管内セクレチン試験)はこれまで膵外分泌機能検査のgold standardである十二指腸液を採取するセクレチン試験に代用ができ,しかも10分間の採取時間で終了する利点を有する｡本法を施行することにより,蛋白栓が除去され,痔痛の消失に有用である｡また,慢性膵炎と鑑別を要する膵癌を除外診断するために,本法によって採取した膵液の細胞診,腫瘍マーカー,癌遺伝子の検出は有用である｡Endoscopical aspiration of pure pancreatic juice is useful in following aspects. Firstly, intraductal secretin test by using this method can be substituted for duodenal secretin test, which is a gold standard examination for estimation of exocrine pancreatic function. In addition, endoscopic aspiration of protein pluge eliminates abdominal pain of some painful patients with chronic pancreatitis. Cytological examination, determination of tumor marker, and detection of oncogene in the obtained pancreatic juice are complementary diagnostic approach to pancreatic cancer, which must be differentially diagnosed from chronic pancreatitis

A case of multiple pancreatic cysts with K-ras point mutation in pure pancreatic juice

膵癌の早期診断を行うために,最近の進歩の著しい遺伝子診断を用いて,膵液中のK-ras遺伝子の点突然変異の検討がなされている｡われわれは膵液の細胞診は陰性であるが,K-ras遺伝子の点突然変異を認め,膵全体に多発する膵嚢胞の1例を経験した｡本例は悪性であるとの確診が得られないことや切除するとなれば膵全摘となることなどのために,経過観察を行っているが,18カ月後の現在,嚢胞の増大など認めていない｡膵癌の遺伝子診断の文献的考察を含め,報告する｡Pancreatic cancer is the one of the leading causes of death among cancer deaths and the early diagnosis is one of the main topics of pancreatic research. Mutation of K-ras oncogene at codon 12 has been reported in pancreatic adenoma, hyperplasia of the pancreatic duct, and also in pancreatic cancer, Recently, detection of K-ras point mutation in pure pancreatic juice is underinvestigation as a potential tool of early diagnosis of pancreatic cancer by setting a certain cut-off value. We recently experienced a case of multiple pancreatic cysts without any malignant cells in pancreatic juice, but with a positve point mutation of K-ras oncogene. Operation was deferred after obtaining informed consent from the family, because the lesions were so multiple and extensive as to require total pancreatectomy. Eighteen months follow-up studies did not reveal any deterioration in imaging tests as well as clinical picture

Activation of the pentose phosphate pathway in macrophages is crucial for granuloma formation in sarcoidosis

肉芽腫形成に特異的な代謝経路の発見 --ペントースリン酸回路の制御による新規治療--. 京都大学プレスリリース. 2023-12-01.More than skin-deep: Kyoto researchers discover metabolic pathway specific to granuloma formation in patients. 京都大学プレスリリース. 2023-12-07.Sarcoidosis is a disease of unknown etiology in which granulomas form throughout the body and is typically treated with glucocorticoids, but there are no approved steroid-sparing alternatives. Here, we investigated the mechanism of granuloma formation using single-cell RNA-Seq in sarcoidosis patients. We observed that the percentages of triggering receptor expressed on myeloid cells 2–positive (TREM2-positive) macrophages expressing angiotensin-converting enzyme (ACE) and lysozyme, diagnostic makers of sarcoidosis, were increased in cutaneous sarcoidosis granulomas. Macrophages in the sarcoidosis lesion were hypermetabolic, especially in the pentose phosphate pathway (PPP). Expression of the PPP enzymes, such as fructose-1, 6-bisphosphatase 1 (FBP1), was elevated in both systemic granuloma lesions and serum of sarcoidosis patients. Granuloma formation was attenuated by the PPP inhibitors in in vitro giant cell and in vivo murine granuloma models. These results suggest that the PPP may be a promising target for developing therapeutics for sarcoidosis

Diagonosis of pancreatic cyst using post-ERCP CT examination.

ERCP直後にCTを撮影するERCP後CTはERCPの際に膵内に注入された造影剤をCTで検出するため,ERCPでは得られない情報が得られる利点がある｡われわれはERCP後CTが診断や治療方針の決定に有用であった膵嚢胞の4例を経験した｡膵嚢胞では主膵管との連絡,嚢胞の部位,性状診断にERCP後CTは有用な検査法であり,文献的考察を含めて報告した｡Post-ERCP CT (computed tomography (CT) examination performed immediately after endoscopic retrograde cholangiopancreatography) detects the contrast medium injected into the pancreatic duct and cystic lesions at the time of ERCP and, therefore, has the advantage of obtaining information which cannot be obtained by ERCP alone. We have experienced four cases of pancreatic cysts in which post-ERCP CT was useful for diagnosis and in deciding on treatment plans. The post-ERCP CT was proved to be a useful method for examining the site and characteristics of the cysts which communicated with the main pancreatic duct

Usefulness of retinol binding protein as a marker for the assessment of nutritional uptake for the preparation of colonosocpy

大腸内視鏡検査の前処置を栄養面から評価する目的で前処置前後にrapid turnover proteinである血中レチノール結合蛋白の変動を検討した｡前日に普通食を用い,当日ニフレックを使用した10例,検査1日前に低残渣食を用いた27例,通常の前処置では良好な腸管洗浄が得られないために検査前2日間低残渣食を用いた27例の3群について,前処置開始前と検査終了後に血中レチノール結合蛋白の変動をみたところ,検査前2日間低残渣食服用群で有意の低下を認めた｡前日普通食群では検査前後で変化を認めず,1日低残渣食服用群では低下傾向を認めたが,有意差は認めなかった｡これまで前処置の成否は腸管洗浄度の面で評価されてきたが,血中レチノール結合蛋白を目標として用いることにより栄養面から評価することができることが考えられた。The objective of this study was to evaluate the usefulness of retinol binding protein (RBP), one of rapid turnover proteins, for the assessment of nutritional aspect of the preparation for colonoscopy. Blood samples were drawed before the preparation and after the colonoscopic examination and serum RBP was determined by laser nephrometory. Group A consisted of 10 patients who were administered intestinal lavage solution (Niflec) without no low residual diet. Group B consisted of 27 patients who were adminstered low residual diet for 1 day. Group C consisted of 27 patients who were administered low residual diet for the two consecutive days before colonosocopic examination with intestinal lavage solution and magnesium citrate because sufficient cleanup of intestine were not expected by using the ordinary preparations. The values of serum RBP significantly decreased in group C after the preparation although no significant changes were observed in group A and Group B. We emphasized in estimating the preparation for the colonoscopy assessment of nutrition using serum RBP was needed as well as colonic cleaning