Ornithine decarboxylase (ODC) is a key enzyme in the biosynthesis of polyamines, which are essential for cell proliferation. ODC activity was measured in 47 colorectal cancer patients, 5 patients with adenoma of colorectum and 4 healthy volunteers. Mean ODC activities of cancer tissue, non-cancerous mucosa from cancer-bearing colorectum, adenoma tissue, and normal mucosa from healthy volunteers were 435±392, 154±173, 295±202, 103±60 pmol CO2/h/mg protein, respectively. ODC activity of cancer tissue or adenoma tissue was significantly higher than that of the others. Among colorectal cancer patients, ODC activity in cancer tissue was correlated with T factors, lymph node metastasis and stages. Patients with tumors that had high ODC activity (≥ 350 pmol CO2/h/mg protein) showed a poor 10-year survival rate. These results suggest that ODC activity may be a useful marker for patients' prognosis after surgery.

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A 43-year-old man, a regular drinker, developed a pseudocyst in the pancreatic tail as a result of acutely worsening chronic pancreatitis. Because the pseudocyst, 10 cm in diameter, did not disappear despite conservative treatment, an internal drainage stent was placed transgastrically under endoscopic ultrasound (EUS) guidance. However, cyst infection occurred, and EUS-guided drainage was performed, when the gallbladder was punctured inadvertently. Immediately a nasocystic drain was placed in the gallbladder. Owing to this timely measure, only mild and localized peritonitis developed. Conservative treatment with fasting and an antibiotic was administered, and peritonitis subsided quickly. On the same day, another nasocystic drain was placed for the pancreatic pseudocyst, and it disappeared. As far as we know, this is the first case in which gallbladder puncture was inadvertently performed during EUS-guided drainage of a pancreatic pseudocyst.

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Background: In the posterior cervical spine approach, the form of the cervical spinous process tip is one important landmark for level determination. However, it is still controversial whether the most caudal level of the bifurcated spinous process is C5 or C6 in previous reports.
Methods: The study samples consisted of 47 bleached bones and 3 fixed bodies for anatomical practice. According to the classification of Okuwa, patients who showed remarkable bifurcation of the spinous process tip were regarded to have “ remarkable bifurcation” , those who showed unclear indentation in the spinous process tip to have “ slight bifurcation” , and those who showed no bifurcation and no indentation to have “ lack of bifurcation”.
Results: The spinous process tips from C2 to C5 bifurcated in 26 out of 50 cervical spines (52%), and those from C2 to C6 in 20 (40%). There was no significant difference in the frequency of bifurcation of the spinous process tip between males and females.
Conclusion: The results of the present study indicate that it does not seem useful to use bifurcation of the cervical spinous processes for anatomical landmarks.

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We present a case of late-onset ulcerative colitis (UC) complicated with cytomegalovirus (CMV) pneumonia revealed by autopsy. A 77-year-old woman had a diagnosis of UC, and received high-dose steroids and leukocytapheresis. Then she received ganciclovir because CMV-pp65 antigenemia test revealed positive which suggested systemic or colonic CMV infection. But ganciclovir was discontinued because of thrombocytopenia and liver dysfunction. After that she had interstitial pneumonia and died of a respiratory failure. Autopsy revealed CMV colitis based on UC, and CMV pneumonia with diffuse alveolar damage. Evaluation of CMV infection in patients with steroid-refractory UC should be considered before proceeding with immunosuppressive therapy or surgery, especially in elderly patients.

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We present a patient, a sixty-seven-year-old woman, who had refractory accumulation of synovial fluid in the knee joints with pustulotic arthro-osteitis for more than 10 years. Fifty ml of synovial fluid from her right knee contained 6,480 pg/ml of interleukin-8 (IL-8) and 15,000/mm³ of neutorophils. At first, she was treated with 400 mg/day of indomethacin farnesil (a prodrug that is converted to indomethacin after intestinal absorption) for 24 weeks. Although, the volume of synovial fluid in her right knee had decreased to 35 ml at the 16th week, it increased to 50 ml at the 24th week again. She was treated with Kampo medicine, Keishikajutsubuto (Guizhi-shu-fu-tang). In the present case, Keishikajutsubuto showed more therapeutic effect to pustulotic arthro-osteitis to reduce volume of synovial fluid to almost 0 ml, IL-8 concentration to 673 pg/ml and number of neutrophils to 660/mm³. Our data showed that Keishikajutsubuto might be suitable for this patient to regulate synovial fluid volume, reduce IL-8 concentration in synovial fluid, and block neutrophils migration to synovial fluid compared to indomethacin therapy.

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Of pancreatic pseudocysts, approximately 30% are complicated by abscess formation, perforation into the abdominal cavity, penetration to the gastrointestinal tract, or bleeding. We report two cases of pancreatic abscess complicating severe acute pancreatitis in which the abscess penetrated to the gastrointestinal tract during the course of treatment with endoscopic ultrasound (EUS)-guided pseudocyst drainage. In these cases, neither aggravation nor recurrence of the pancreatic abscess has been identified since the event occurred. The EUS-guided treatment was effective for improvement of severe inflammation of the pseudocyst as an initial treatment. However, drainage tube placement limitations pertained because the pseudocyst was present with multilocular infection. Penetrations eventually contributed to their resolution because the fistulas were used as wide drainage routes. It is important to understand the courses of these cases for preparation of therapeutic strategies to treat pancreatic pseudocyst/abscess.

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A 60-year-old woman was diagnosed with esophageal small cell carcinoma in October 2004 and received chemotherapy. However, the tumor grew gradually and multiple bone metastases occurred. Anorexia, nausea, emesis, numbness in both hands, and disturbed consciousness developed at the end of January 2006, and the patient was admitted to Fukushima Medical University Hospital. Abdominal pain, marked hypercalcemia and hyperamylasemia were noted and the patient was diagnosed with severe acute pancreatitis. Because the level of blood parathyroid hormone-related protein was elevated, we considered that esophageal small cell carcinoma caused human hypercalcemia of malignancy and that metastatic bone tumors caused local osteolytic hypercalcemia, eventually leading to severe acute pancreatitis. This is an extremely rare case of esophageal small cell carcinoma associated with hypercalcemia causing severe acute pancreatitis.

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