Objective Due to their rarity, the endoscopic features and clinical backgrounds of colorectal follicular lymphoma lesions have not yet been fully investigated. The aim of this study was to reveal the characteristics of this disease entity. Methods A database search performed at the Department of Pathology of our institute identified 12 follicular lymphoma patients with involvement in the cecum, colon, and/or rectum. Data regarding the endoscopic, radiological, biological, and pathological examinations performed were retrospectively reviewed from their clinical records. Results The mean age of the patients (5 men, 7 women) was 58.7 years. Five patients were classified as being Lugano system stage I, while the other seven patients were stage IV. In all of the patients, colorectal follicular lymphoma presented with papular (n=4), polypoid (n=4), and flat elevated lesions (n=4). No erosions or ulcers were seen in any of the lesions. The initial pathological diagnoses included extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (n=2) and colitis/proctitis with infiltration of inflammatory cells (n=3), in addition to the correct diagnosis of follicular lymphoma (n=7). Conclusion Colorectal involvement of follicular lymphoma shows no erosions or ulcers. These lesions could be macroscopically observed as papular, polypoid and flat elevated lesions. Making a correct diagnosis of this disease based on the findings of biopsied samples is sometimes challenging. In such cases, multiple biopsies and/or endoscopic mucosal resection is required, in addition to appropriate consultation with pathologists.
Objective To compare the nephrotoxicity of iodixanol in elderly patients who underwent a renal artery intervention (RAI) with those who underwent an other peripheral vascular intervention (OPI). Methods Three hundred fifty-four consecutive patients (>60 years old) received iodixanol during RAI (n=150) or OPI (n=204). The level of serum creatinine (SCr) was measured at the baseline, 24 hours, 48 hours, 72 hours and 1 month after intervention. Results Within 72 hours after the intervention, the adjusted mean of the peak SCr increase was 11.22 umol/L 〔95% confidence interval (CI): 9.21-13.24〕 in the RAI group and 12.40 umol/L (95%CI: 10.7-14.09) in the OPI group. The difference in the peak SCr increase was -1.17 umol/L (95%CI: -3.94-1.60; p=0.406). Contrast-induced nephropathy occurred in 26 patients (17.3%) of the RAI group and in 27 patients (13.2%) of the OPI group (p=0.286). Patients who underwent an RAI showed no increased risk for contrast-induced nephropathy in comparison with patients who underwent an OPI 〔adjusted odds ratio (OR)=1.108; 95%CI: 0.540-2.273; p=0.780〕. Conclusion The nephrotoxic effect of iodixanol in elderly patients who underwent RAI or OPI was comparable.
Objective The modified Medical Research Council (mMRC) scale is recommended for conducting assessments of dyspnea and disability and functions as an indicator of exacerbation. The aim of this study was to investigate whether the mMRC scale can be used to predict hospitalization and exacerbation in Japanese patients with chronic obstructive pulmonary disease (COPD). Methods In a previous 52-week prospective study, 123 patients with COPD were classified into five groups (grades 0 to 4) according to the mMRC scale and four groups (stages I to IV) according to the spirometric Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. The frequency and period until the first event of hospitalization and exacerbation were compared among the groups. Results The population of patients who experienced hospitalization and exacerbation during the 52-week study period, with an mMRC scale grade of 4, 3, 2, 1 and 0 was 50.0 and 100, 55.6 and 88.9, 21.1 and 73.7, 2.6 and 48.7, and 4.0 and 22.0%, respectively. A multivariate analysis adjusted for the GOLD stage and age showed that the patients with an mMRC scale grade of ≥3 had higher frequencies of hospitalization and exacerbation than those with lower grades. Meanwhile, the patients with an mMRC scale grade of ≥2 showed a significantly earlier time until the first exacerbation, but not hospitalization, in comparison with those with grade 0. Conclusion The present results indicate that, among Japanese patients with COPD, those with an mMRC scale grade of ≥3 have a significantly poorer prognosis and that the mMRC scale can be used to predict hospitalization and exacerbation.
A 36-year-old woman was admitted to our hospital due to swelling and redness of the left lateral malleolus and dorsum of the left foot with severe pain, with a flare-up of ulcerative colitis (UC). A pathologic examination by skin biopsy led to a diagnosis of pyoderma gangrenosum (PG). She was treated with the intravenous administration of prednisolone (60 mg/day), and granulocyte and monocyte adsorption apheresis (GMA) was performed twice-a-week for 5 weeks. This treatment dramatically improved both the skin and colonic mucosal lesions. These results suggest that a combination of GMA and corticosteroids might be recommendable to induce the remission of serious PG complicated with UC.
A 60-year-old woman was admitted to our hospital with upper abdominal pain and jaundice. Computed tomography showed a 9-cm mass that was penetrated by the common hepatic artery in the pancreatic head area. Endoscopic retrograde pancreatography revealed no stenosis or obstruction of the main pancreatic duct, and a cytologic examination of the patient's pancreatic juice was negative. Next, endoscopic ultrasound-guided fine needle aspiration was performed. The immunohistological findings of the specimen revealed a diffuse large B-cell lymphoma. The size of the tumor was significantly reduced after 8 cycles of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone).
A 69-year-old man was admitted to hospital with abdominal pain. In the four years prior to his presentation, he had undergone repeated transarterial chemoembolizations and injections for hepatocellular carcinoma. He underwent his 8th transcatheter arterial therapy one month prior to admission. Abdominal X-rays and contrast-enhanced computed tomography showed large amounts of small intestinal gas and venous thrombosis from the portal vein to the superior mesenteric vein, respectively. The thrombosis was reduced after anticoagulation therapy (heparin, antithrombin III, danaparoid sodium and warfarin). This is the first case report of paralytic ileus due to superior mesenteric venous thrombosis after transcatheter arterial therapy for hepatocellular carcinoma with an arterioportal shunt.
An 82-year-old woman with autoimmune hepatitis had been treated with 5 mg prednisolone (PSL) orally to maintain normal transaminase levels. The subsequent transaminase levels were elevated and remained unchanged despite increasing the dose of PSL to 20 mg and introducing ursodeoxycholic acid (UDCA) at a dose of 900 mg. This combined treatment with UDCA was, however, ineffective. Treatment with Saireito at a dose of 9.0 g in conjunction with PSL was then initiated, which led to the subsequent normalization of her transaminase levels. Oral administration of PSL was discontinued eight weeks after the co-administration of Saireito. The patient had a significant response to this treatment.
Myxoma is a common benign cardiac tumor that may rarely cause an acute myocardial infarction. A 77-year-old woman was admitted to our hospital with chest pain. Electrocardiography showed an ST elevation in leads V3-6. Transthoracic echocardiography revealed an ovoid mass with fragmentation in the left atrium and hypokinesia of the left ventricular apex. Coronary angiography indicated the presence of a coronary embolism that was suspected to be from the left atrial mass. The mass was removed by emergency surgical resection to avoid a further systemic embolism and was diagnosed pathologically as a myxoma. The patient was discharged after 13 days with no complications.
Cardiac events associated with congenital coronary abnormalities are rare but potentially life-threatening in a young population. Most of these patients are not diagnosed before their initial cardiac event. Amongst such coronary artery anomalies, sudden death is frequently seen in an anomalous origination of a coronary artery from the opposite sinus. We herein present the case of a patient who presented with sudden cardiac arrest associated with an anomalous right coronary artery originating from the left sinus of Valsalva. Surgical treatment was selected because there was evidence of reversible ischemia based on the findings of a stress test.
A 39-year-old woman with a 9-week abdominal pregnancy noted pain in her lower abdomen and left leg. Since successive thrombi were observed extending from the left common iliac vein to the popliteal vein along with a thrombus in the left pulmonary artery, we diagnosed her with pulmonary thromboembolism with deep venous thrombosis (DVT). May-Thurner syndrome may have contributed to DVT in the left leg when the left iliac vein was compressed by the right iliac artery. She underwent anticoagulant therapy with heparin, followed by the subcutaneous injection of heparin at home after discharge. We herein report the case of a pregnant woman with May-Thurner syndrome who safely gave birth.
A 28-year-old man was admitted to our hospital with nausea, headache and weakness of the left hand. He had severe uremia without hypertension due to recurrent/chronic pyelonephritis. Brain magnetic resonance imaging showed reversible vasogenic edema in the brainstem and bilateral frontal centrum semiovale. All of his neurological symptoms immediately improved after the introduction of hemodialysis. When a patient with uremia presents with neurological symptoms, posterior reversible encephalopathy syndrome should be considered in the differential diagnosis even if high blood pressure is not observed. Brain magnetic resonance imaging may be helpful in such a case, and an appropriate therapy could be subsequently initiated.
This report describes three patients with chronic myelogenous leukemia who developed gastric antral vascular ectasia (GAVE) during treatment with imatinib mesylate (IM). Cessation and/or switching from IM to nilotinib resulted in the alleviation of gastrointestinal (GI) bleeding and ectatic lesions. Furthermore, GI bleeding recurred after the re-administration of IM in one patient. Thus, we consider that the occurrence of GAVE in our patients was induced by IM. Although the precise mechanism of IM-GAVE is not understood, all patients took at least 400 mg/day of IM at the onset of GAVE. Thus, higher doses of IM (≥400 mg/day) may be a risk factor for IM-GAVE.
A 68-year-old man with persistent bacteremia accompanying a large iliopsoas abscess, vertebral osteomyelitis, discitis and central venous port infection caused by methicillin-resistant Staphylococcus aureus (MRSA) was admitted to our hospital. During the course of treatment, the emergence of a daptomycin (DAP)-resistant MRSA strain was confirmed; the minimum inhibitory concentration was 1 to 2 μg/mL for vancomycin and more than 1 μg/mL for DAP. Although the bacterial cell wall was not significantly thickened, an increased positive surface charge and single-nucleotide polymorphism within mprF have been confirmed in DAP-resistant strains. Still rare, but clinicians need to be cautious of the emergence of DAP-resistant MRSA during treatment.
Scedosporium prolificans, a hyaline filamentous fungus, is widely distributed in the environment and is currently an emerging human pathogen, especially among immunocompromised patients. However, S. prolificans endocarditis is rare. We herein report a case of S. prolificans endocarditis in a 64-year-old patient with breast cancer in complete remission for 30 years after chemotherapy and radiation treatment who was not cured. Susceptibility testing showed resistance to all antifungal drugs, except echinocandin. A review of the literature revealed 10 cases of S. prolificans endocarditis; of these, only one involved an immunocompetent host with no risk factors and only two patients survived. In order to improve the mortality rate, it is necessary to establish rapid diagnostic methods and efficient therapeutic approaches.
A 34-year-old woman who had been using oral contraceptives for 10 years developed hypertensive crisis with papilloedema after an upper respiratory infection. Laboratory data showed hyperreninemic hyperaldosteronism and elevated levels of fibrinogen, fibrin, and fibrinogen degradation products. Echocardiography demonstrated two masses (18 mm) in the left ventricle. On the fourth hospital day, cerebral infarction, renal infarction, and upper mesenteric artery occlusion suddenly occurred despite the blood pressure being well-controlled using anti-hypertensive drugs. Echocardiography revealed the disappearance of the left ventricular masses, which suggested left ventricular thrombi. Cessation of the contraceptives and administration of heparin, warfarin, and anti-platelets drugs improved her general condition.