Objective It has recently been reported that 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is useful for estimation of the chemotherapy effect. Thus, we examined the value of FDG-PET in assessing the efficacy of chemotherapy in advanced pancreatic cancer, and compared this modality with tumor markers (TMs) and CT. Patients and Methods Nineteen patients with unresectable pancreatic adenocarcinoma were enrolled. All patients received chemotherapy with gemcitabine and S-1, an oral derivative of 5-fluorouracil, and underwent FDG-PET, CT, and serological examination for TMs before and after chemotherapy. Results Standardized uptake value in FDG-PET before treatment and survival time were not correlated. A good prognosis was seen after 1 course of chemotherapy in patients whose tumors were in partial or complete remission as assessed by FDG-PET [median of survival time (MST), 12.5 months] or TMs (MST, 13.5 months), but not in CT responders (MST, 10.3 months). Furthermore, patient prognosis correlated with PET and TM assessment of the best tumor response through all courses. Namely, both PET and TM were useful for the prediction of survival or chemotherapy sensitivity of the patients. Conclusion FDG-PET and TMs can each play an adjunct role to CT for estimating the effect of chemotherapy and predicting survival by distinguishing between responders and non-responders among patients with advanced pancreatic cancer.
Background Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) have been shown to have a significant cardioprotective effect in high-risk patients after myocardial infarction (MI). However, there are few data on the effects of these drugs on left-ventricular (LV) remodeling after MI in Japanese patients. Methods and Results We randomly assigned 100 patients with anterior-wall MI who had received reperfusion therapy to treatment with either enalapril (n=50) or losartan (n=50), and calculated the LV ejection fraction (LVEF) and LV end-diastolic volume index (LVEDVI) in these patients at baseline and after 6 months of treatment. While a significant increase in the LVEF as compared with that at the baseline was observed in both groups, no significant difference was found in the rate of change of this parameter between the two groups. However, inverse correlations were observed between the baseline LVEF and LVEDVI and also the rates of change of the two parameters, suggesting that the greater the compromise of the LV function at baseline, the greater the preventive effect of both classes of drugs on LV remodeling. Conclusion The results of this study suggest that neither enalapril nor losartan is superior to the other in terms of the effect on LV remodeling after MI in Japanese patients. In addition, the suppressive effect of both classes of drugs on LV remodeling was greater in patients with more extensive infarction and greater compromise of LV function at baseline.
Objective We compared the effect of treatments in the long-term renal survival of IgA nephropathy. Methods One hundred and fourteen patients with biopsy-proven IgA nephropathy were retrospectively divided into 4 groups, reflecting shifts in treatment trends from 1985 to 2005: patients without treatment (no treatment group; n=36), patients treated only with anti-platelet drugs (anti-platelet group; n=12), those treated mainly with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) (ACEI/ARB group; n =29), and prednisolone-treated patients (PSL group; n =37). Results Baseline blood pressure, serum creatinine and renal histological findings were similar among the 4 groups; however, the urinary protein level was significantly severer in the PSL group. After a mean follow-up of 7.0±0.5 years, end-stage renal disease occurred in 11 patients (31%) in the no treatment group, 5 patients (42%) in the anti-platelet group and 3 patients (8%) in the PSL group, but in only 1 patient (3%) in the ACEI/ARB group. Kaplan-Meier renal survival after 20 years was significantly better in the ACEI/ARB group than in the anti-platelet group or in the no treatment group (p<0.05). The patients that reached complete remission (CR) by steroid therapy showed less baseline urinary protein and milder histological lesions than those who did not reach CR. The non-CR group showed increases in serum creatinine and eGFR reduction rate. Conclusion Treatment with renin-angiotensin system inhibitors showed the greatest improvement of 20-year renal survival in IgA nephropathy patients. Steroid therapy achieved complete remission in some early-stage cases.
Objective To elucidate the background and clinical features of intrapulmonary hemorrhage in collagen-vascular diseases (CVD) patients. Patients and Methods The charts of collagen-vascular diseases patients who were hospitalized and had intrapulmonary hemorrhages between 1981 and 2006 were retrospectively examined for underlying diseases, clinical and laboratory features, and treatments and outcomes. Results Of 4,017 patients, 11 females aged 52.1±12 had total of 17 episodes of diffuse or non-diffuse intrapulmonary hemorrhage. Fourteen episodes of diffuse alveolar hemorrhage (DAH) developed in 4 microscopic polyangiitis (MPA) patients having a high MPO-ANCA level, 4 systemic lupus erythematosus (SLE) patients having a high SLEDAI score, and 1 SLE/MPA patient having a high MPO-ANCA level. Among the 9 DAH patients, 2 had complicated Goodpasture syndrome, 3 had thrombotic thrombocytopenic purpura (TTP), and 1 had disseminated intravascular coagulation. In DAH the peripheral blood hemoglobin level decreased from 9.3±2.2 (n=13) to 6.8±1.5 g/dL (n=14, p<0.0001) at 0.5±0.7 g/dL/day, and the lymphocyte count decreased from 854±424 to 462±376 /μL. No patient died of DAH, including 1 who spontaneously remitted. The 3 episodes of non-DAH included 2 pulmonary aneurysm ruptures in 1 SLE patient, and 1 thromboembolism that developed in 1 SLE patient who had anti-phospholipid antibody; their SLEDAI scores were low and these remitted spontaneously. Conclusion Of intrapulmonary hemorrhage in CVD patients, DAH developed with active MPA or SLE, upon which Goodpasture syndrome or TTP was occasionally superimposed. With DAH, the magnitude of peripheral blood Hb level decrease was approximately 0.5 g/dL/day, and the lymphocyte count decreased. No patient died of DAH.
Objective We aimed to investigate relative values of the intervals between symptom onset and clinical presentation in cancer patients and to correlate them with diagnosis of distant metastasis. Methods Cancer registry and medical records of all cancer patients for over a 10-year period in a medical center of Japan were reviewed. We examined the intervals of symptom onset to clinical presentation and the presence of metastasis at diagnosis. Results In 3,893 cancer patients, the mean interval of symptom onset to clinical presentation was 89 days (median, 30 days). The cancer group with a short interval of only days to weeks included hepatobiliary, ovary, brain, and acute leukemia. The group with a long interval of months to years included head and neck, thyroid, and skin cancers. Other types of cancer were included in the middle group with an interval of weeks to months. Among patients with head & neck, skin, and ovarian cancers, the longer interval was significantly associated with a lower likelihood of distant metastasis. A longer interval with an increment of each month was associated with a lower likelihood for distant metastasis with an odds ratio of 0.97 (95% CI, 0.96-0.99). Conclusion Hepatobiliary, ovary, brain, and acute leukemia are among the cancer types with an interval of days to weeks, while head and neck, thyroid, and skin cancers are among the types with an interval of months to years. Among patients with solid tumors, those with metastasis are likely to present to a physician more promptly.
A 38-year-old woman died of hemorrhagic shock caused by idiopathic bleeding in the abdominal cavity. At autopsy, more than 5,000 mL hemoperitoneum was detected. There was no remarkable bleeding site except for a small tear in the surface of the spleen. Microscopic examination suggested that isolated splenic vein thrombosis induced coagulative necrosis of the spleen and subsequently caused splenic laceration. Whenever a case of hemoperitoneum is encountered, splenic rupture should be included in the differential diagnosis; it is imperative to manage such cases as promptly as possible.
We report a case of paclitaxel-eluting stent implantation in an angina patient who developed interstitial pneumonia a few days afterward, and succumbed to fatal respiratory dysfunction despite corticosteroid therapy. Paclitaxel is an anti-neoplastic agent currently used as a coating substance for coronary stents to reduce the rate of restenosis. Pulmonary toxicity related to paclitaxel is not very common; however, this adverse event may on occasion be lethal. Although the efficacy and safety of drug-eluting stents for the treatment of ischemic heart disease is well established, physicians should keep in mind that paclitaxel-eluting stents have the potential to cause interstitial pneumonia.
We report a case of diabetic mastopathy in a man with type 2 diabetes. The patient was a 62-year-old man who had been diagnosed with type 2 diabetes at the age of 46 years. He had been treated with oral hypoglycemic agents. He noticed a mass in his left breast in February 2007, when HbA1c was 7.6% with the treatment using oral hypoglycemic agents, including acarbose, glimepiride, buformine, and pioglitazone. Mammography of the breast showed increased density, and ultrasonography showed a regular-shaped hypoechoic mass. Core needle biopsy was performed, and diabetic mastopathy was confirmed pathologically. Diabetic mastopathy usually occurs in women with type 1 diabetes. This case, a man with type 2 diabetes, is very rare.
We report a case of an acute stroke patient with pulmonary embolism (PE) caused by delayed-onset heparin-induced thrombocytopenia (HIT). She was treated with heparin to prevent neurological deterioration. However, 5 days after heparin had been given for 7 days, she developed PE. Heparin was re-started, but the platelet count decreased significantly, and a right ventricular thrombus appeared. She was finally diagnosed as having PE due to delayed-onset HIT because the HIT antibody was positive. When a patient develops thrombotic events during or after heparin therapy, the possibility of HIT should be considered.
A 29-year-old man with a history of resected bulbar hemangioblastoma was admitted to hospital with nighttime breathing disturbance, but with apparently normal breathing while awake. After diagnostic work-up, including polysomnographic testing, he was diagnosed as having central alveolar hypoventilation syndrome due to surgical resection for bulbar hemangioblastoma. Non-invasive positive pressure ventilation (NIPPV) via oronasal facemask was given for nocturnal ventilatory support. Two months after leaving our hospital, he was readmitted because of aspiration pneumonia. The pneumonia was successfully treated with antibiotics, but the desaturation during sleep worsened despite non-invasive ventilatory support. Higher bi-level positive pressure using a full facemask successfully alleviated sleep hypoventilation and apnea. To the best of our knowledge, this is the first case report of central alveolar hypoventilation syndrome due to surgical resection for bulbar hemangioblastoma.