Autoerythrocyte sensitization syndrome with vertigo and hemilateral auditory impairment

Autoerythrocyte sensitization syndrome (AES) is characterized by recurrent, painful purpura or ecchymosis. Testing for the reappearance of lesions after injection of the patient's own erythrocytes is usually useful for the diagnosis of AES, but the significance of this test is still controversial. As the lesions often appear in patients with psychiatric disorders, mental factors such as depression and stress are considered to be involved in the occurrence and exacerbation of AES. We report a 28-year-old woman who presented recurrent episodes of painful purpura with vertigo and hemilateral auditory impairment after difficulties at her workplace. After the diagnosis of AES, she was referred for psychiatric counselling, after which the symptoms disappeared. These findings suggest that treatment for psychological disorders is important in patients with AES.

Significance of the expression of thymidylate synthase in prostate cancer

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Background: Thymidylate synthase ( TS ) is an important enzyme in de novo DNA synthesis pathway. 5-Fluorouracil ( 5-FU ), an anticancer chemotherapeutic agent used clinically against a variety of cancers including prostate cancer, inhibits DNA synthesis by binding TS. In the present study, we examined TS expression in prostate cancer and investigated its prognostic significance. Methods: Fifty-two prostate cancer tissue specimens were obtained from patients who underwent radical prostatectomy for prostate cancer without neoadjuvant hormonal therapy. Forty-eight prostate cancer tissue specimens were also obtained from patients who underwent radical prostatectomy for prostate cancer with neoadjuvant hormonal therapy. We examined prostate cancer tissue and normal prostate tissue for TS expression by immunohistochemistry. Results: TS was expressed at higher levels in prostate cancer without neoadjuvant hormonal therapy, compared with normal prostate.TS expression in stage T3 prostate cancer was higher than that in stage T2 prostate cancer. In addition, the level of TS expression in Gleason score 7 or greater prostate cancer was higher than that in Gleason score less than 7 prostate cancer. Patients with prostate cancer with negative TS expression without neoadjuvant hormonal therapy had a longer postoperative recurrence-free rate than those with positive expression in the 5 year follow-up. In addition, patients with Gleason score less than 7 prostate cancer with negative TS expression had a much longer postoperative recurrence-free rate than those with positive expression in the 5-year follow-up. TS expression was significantly decreased in prostate cancer patients who received neoadjuvant hormonal therapy, especially stage T2 prostate cancer patients. Conclusions: The current study has demonstrated for the first time that TS expression may be a prognostic parameterr for prostate cancer patients undergoing radical prostatectomy.

No significant financial relationships to disclose.

Antineutrophil cytoplasmic antibody-associated vasculitis with oculomotor nerve palsy

We report a patient with antineutrophil cytoplasmic antibody-associated vasculitis with oculomotor nerve palsy. The patient presented with a high fever, diplopia, blepharoptosis and impairment of ocular movement of the left eye except for lateral gaze. Multiple erythematous and livedoid lesions were observed on the forehead, both cheeks and both legs. Laboratory examination showed positive results for myeloperoxidase antineutrophil cytoplasmic antibodies. Skin biopsy revealed leucocytoclastic vasculitis of the small arteries in the lower dermis. The patient was successfully treated with systemic corticosteroids.

Can we develop biomarkers that predict response of cancer patients to immunotherapy?

PRIMARY OBJECTIVE

The primary objective is to delineate the potential utility of cancer biomarkers that correlate and predict response to immunotherapy in cancer patients who are refractory to conventional therapeutics. Unlike significant development of biomarkers that predict response to chemotherapy, very few biomarkers have been developed to predict the response to immunotherapy.

MAIN OUTCOMES AND RESULTS

This article describes briefly the importance of characterizing and validating biomarkers for immunotherapy. A few examples have been provided, such as the transcription factor NF-kappaB, the transcription repressor Yin-Yang 1 (YY1), the pro-apoptotic gene product (Smac/DIABLO) and the circulating Fas and Fas ligand. These biomarkers have been determined to be of prognostic significance in different cancers.

CONCLUSIONS

Immunotherapy is considered as an alternative therapy in the treatment of cancer patients who are refractory to chemotherapy/radiation/hormonal therapies. Cross-resistance to apoptosis develops between cancer cells that are resistant to conventional therapeutics and immunotherapy. Therefore, it is important to develop biomarkers that will determine patient response to immunotherapy.

Severe hypoglycaemia in a person with insulin autoimmune syndrome accompanied by insulin receptor anomaly type B

AIMS

A rare case of the insulin autoimmune syndrome (IAS) accompanied by insulin receptor anomaly is reported.

METHODS

Antibodies to insulin and insulin receptor were determined in the patient with severe hypoglycaemia before and after the treatment with prednisolone.

RESULTS

Titers of antibody to insulin and insulin receptors were 73.0% and 41.5%, respectively. Drug-induced lymphocyte stimulation tests were all negative for the suspicious drugs. Her HLA-DR was DRB1*0403/04051. Following steroid therapy, the formation of antibodies was suppressed and alleviated her symptoms. Scatchard analysis yielded findings specific to polyclonal antibodies.

CONCLUSIONS

The changes in autoantibodies resulted in alleviation of the hypoglycemic symptoms as a result of steroid therapy.

25-Gauge peripheral iridectomy during vitrectomy

PURPOSE

To report peripheral iridectomy using a 25-gauge vitreous cutter in a 42-year-old man with pupillary block due to adhesion of the internal iris surface to the continuous circular capsulorhexis.

METHODS

A corneal opening was made at 10 o'clock during vitrectomy. A 25-gauge vitreous cutter was inserted into the anterior chamber with the port facing downward, and peripheral iridectomy at the 12 o'clock position was performed. The vitreous cutter was set at a cutting speed of 2500 cpm and the aspiration pressure at 600 mmHg.

RESULTS

A 25-gauge vitreous cutter with a fine shaft could easily be inserted into the peripheral anterior chamber, and there was no contact with the corneal endothelium even when the anterior chamber became shallow in association with iridectomy. In this patient, pupillary block resolved with peripheral iridectomy, and ocular pressure was also controlled.

CONCLUSIONS

25-gauge peripheral iridectomy is a simple technique that permits iridectomy of appropriate size at any desirable location.

Effect of low-intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial

Randomized controlled study in 80 postmenopausal women with osteoporosis was conducted to investigate the effect of a home-based, simple, low-intensity exercise. Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength.

INTRODUCTION AND HYPOTHESIS

Back-strengthening exercise is effective in increasing back extensor strength and decreasing risk of vertebral fractures. We hypothesized that a home-based, simple, low-intensity exercise could enhance back extensor strength and improve the quality of life and/or spinal range of motion in postmenopausal women in a short-term follow-up.

METHODS

Eighty postmenopausal women with osteoporosis were randomly assigned to a control group (n = 38) or an exercise group (n = 42). Subjects were instructed to lift their upper trunk from a prone position antigravity and maintain the neutral position. Isometric back extensor strength, spinal range of motion, and scores for quality of life were evaluated at baseline and 4 months.

RESULTS

Back extensor strength significantly increased both in the exercise group (26%) and in the control group (11%). Scores for quality of life increased in the exercise group (7%), whereas it remained unchanged in the control group (0%). There was a significant difference in quality of life score between the groups (p = 0.012).

CONCLUSIONS

Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength in patients with osteoporosis.

Enhanced orotate phosphoribosyltransferase activity in renal cell carcinoma and its prognostic significance

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Background: 5-Fluorouracil ( 5-FU ) is an anticancer agent clinically used against various cancers including renal cell carcinoma ( RCC ). 5-FU is a prodrug and orotate phosphoribosyltransferase ( OPRT ) is the principal enzyme which directly converts 5-FU to an active anticancer metabolite, 5-fluoro-2’-deoxyuridine 5’-monophosphate. Furthermore, OPRT is the key enzyme in the de novo DNA and RNA synthetic process, which converts orotic acid to orotidine 5’-phosphate. Little is known about the significance of OPRT in a variety of cancers including RCC. We investigated OPRT activity in 83 RCC and evaluated the association between OPRT activity and the stage/grade of RCC. The relationship between OPRT activity in RCC cells and their sensitivity to 5-FU was also examined. Methods: OPRT activity in non-fixed fresh frozen RCC and normal kidney were determined enzymatically by the 5-FU phosphorylation assay. The sensitivity of RCC cells to 5-FU was assessed by the microculture tetrazolium dye assay. Results: OPRT activity was approximately 8.5-fold higher in RCC compared to normal kidney. OPRT activity in T3/4 RCC was 3-fold higher than that in T1/2 RCC. OPRT activity in M1 RCC was 2.5-fold higher than that in M0 RCC. In addition, OPRT activity in Stage III/IV RCC was 3-fold higher than that in Stage I/II RCC. The level of OPRT activity in Grade 3 RCC was 3-fold higher than that in Grade 1/2 cancer. Patients with RCC with low OPRT activity had a longer postoperative disease-specific survival than those with high activity in the 5-year follow-up. OPRT activity in RCC cells positively correlated with their sensitivity to 5-FU. Conclusions: The present study has demonstrated that OPRT activity in RCC was higher than that in normal kidney, and that OPRT activity positively correlated with the stage/grade of RCC. Moreover, higher OPRT activity in RCC predicted worse prognosis and higher sensitivity to 5-FU. These results suggest that OPRT activity may be used as both a prognostic parameter and a predictive indicator for 5-FU efficacy in RCC.

No significant financial relationships to disclose.

Restless legs syndrome in hemodialysis patients: health-related quality of life and laboratory data analysis

AIMS

To compare clinical data, sleep quality and health-related quality of life (HRQOL) with and without RLS in HD patients.

MATERIALS AND METHODS

The international RLS study group diagnosis questionnaire was completed by 228 HD patients. The Pittsburg Sleep Quality Index (PSQI) for the evaluation of sleep quality and the Kidney Disease Quality of Life (KDQOL-SF) for the analysis of HRQOL were also used.

RESULTS

53 (23%) patients were diagnosed as RLS. Age and age at the initiation of HD were significantly younger in the RLS group. Serum calcium concentration (Ca) was significantly higher in the RLS group. Sleep quality evaluated by PSQI was significantly lower in the RLS group. In SF-36 domains of KDQOL-SF, bodily pain, general health perceptions, vitality, role functioning emotional, mental health and mental component score were significantly lower in the RLS group. In kidney targeted scales of KDQOL-SF, symptoms/problems, burden of kidney disease, cognitive function, quality of social interaction, sleep and patient satisfaction were significantly lower in the RLS group.

CONCLUSION

High Ca was possibly connected to the pathophysiology of RLS which impaired sleep quality as well as HRQOL including mental health and many kidney disease related scales.

Efficacy of sildenafil for Japanese patients with audio-visual sexual stimulation (AVSS) test by the RigiScan Plus

Sildenafil is most effective in men with mild-to-moderate ED, but not severe ED in Japan. In order to evaluate the efficacy of sildenafil, we conducted the present study using the AVSS test by the RigiScan Plus. The subjects were 56 patients (age: 34-82 years, mean: 60.5 years) with ED. The IIEF5 questionnaire and the AVSS test were conducted before and after administration of sildenafil. The penile rigidity could not be measured in 19 patients. Of these 19, sildenafil was effective in 7 and not effective in 12. The 7 cases in whom sildenafil was effective were all false-negatives. The sensitivity of sildenafil was 84%, and its specificity was 100%. This study suggests that the AVSS test by RigiScan Plus can objectively evaluate the efficacy of sildenafil, and shows potential for predicting that efficacy.

Salvage chemotherapy with paclitaxel, ifosphamide and nedaplatin for cisplatin refractory germ cell tumors

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Background: Only 20–30 % of patients with cisplatin (CDDP) refractory germ cell tumor (GST) will remain continuously disease free with salvage chemotherapy. The present study investigated the chemotherapy with paclitaxel (TXL) in combination with ifosphamide (IFM) and nedaplatin (NDP), which is a derivative of CDDP, as salvage chemotherapy for CDDP refractory GCT. Methods: Between 2000 and 2005, 33 patients with CDDP refractory GCT were enrolled. All patients were male, with median age 30 (range: 17–45). Median number of previous regimens was 2 (range: 1–4). The combination chemotherapy consisted of TXL: 200 mg/m2 on day 1, NDP: 100 mg/m2 on day 2 and IFM: 1.2 g/m2 on day 2–6 every three weeks. Results: A median of 5 cycles was administered to 33 patients. Grade 3/4 toxicity were reported as follows: neutropenia: 90%, thrombocytopenia: 70%, anemia: 70%, nausea/vomiting: 90%, diarrhea: 6%, alopecia: 97%. No treatment related death was observed. Response rate was 82% (CR: 9%, PRm−: 67%, PRm+: 6%, NC: 6%, PD: 6 %). Nineteen (58%) patients achieved a no evidence of disease status with a median duration of follow-up of 18 months (7–60 months). Six patients (18%) remain alive with disease. However, 8 patients (24%) died of the disease. Conclusions: This study demonstrates that the chemotherapy with TXL in combination with IFM and NDP showed a significant anticancer activity for patients with CDDP refractory GCT. These findings suggest that the combination chemotherapy may be one of the options of salvage chemotherapy for CDDP refractory GCT.

No significant financial relationships to disclose.

Prognostic significance of the level of serum osteoprotegerin in patients with bladder cancer

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Background: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) plays an important role in cytotoxic T lymphocyte-mediated and natural killer cell-mediated apoptosis against cancer cells. Since Osteoprotegerin (OPG) is a soluble decoy receptor for TRAIL, circulating OPG has been implicated in protection from TRAIL-mediated apoptosis. This possibility was examined in patients with bladder cancer. Methods: Serum OPG levels of 185 patients with bladder cancer were determined by using an enzyme-linked immunosorbent assay. Anti-autologous tumor cytotoxic activity of peripheral blood lymphocytes was assessed by the 12-h Cr release assay. Results: The mean serum OPG level in patients with bladder cancer was approximately 3-fold higher than that in normal donors. The serum OPG level in patients with muscle-invasive bladder cancer was higher than that in superficial bladder cancer. Furthermore, serum level of OPG in patients with metastatic bladder cancer was higher than that in muscle-invasive bladder cancer. Serum OPG level in Grade 2 bladder cancer was higher than that in Grade 1 cancer. Moreover, serum OPG level in Grade 3 bladder cancer was higher than that in Grade 2 cancer. Patients with superficial bladder cancer with low serum OPG level had a longer postoperative tumor-free rate than those with high level in the 5-year follow-up. In addition, patients with muscle-invasive bladder cancer with low serum OPG level had a higher disease-specific survival rate when compared with patients with high level in the 5-year follow-up. There was an inverse correlation between serum OPG level and anti-autologous tumor cytotoxic activity. Conclusions: The present study is the first to demonstrate that the serum OPG level correlates with the stage/grade of bladder cancer, and that elevated level serum OPG predicted early recurrence in patient with bladder cancer. These findings suggest that serum OPG level may be used as a prognostic parameter in patients with bladder cancer, and that OPG may be a molecular therapeutic target in bladder cancer.

No significant financial relationships to disclose.

Clinical outcome of postchemotherapy salvage surgery for metastatic germ cell tumors in Japan

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Background: Salvage surgery including retroperitoneal lymph node dissection (RPLND) following chemotherapy has been considered a critical component in the comprehensive management of advanced germ cell tumors (GCT). The objectives of this study were to determine the pathologic findings and clinical outcome of patients with metastatic GCT who underwent postchemotherapy salvage surgery. Methods: From 1980 to 2004, 157 patients with metastatic diseases underwent postchemotherapy salvage surgery at three institutions. Surgical resection was indicated in the presence of residual radiographic abnormalities. The cause-specific survival rate was calculated using the Kaplan-Meier method. Results: The histology of GCT was pure seminoma in 49 patients and non-seminoma in 108 patients. As first-line chemotherapy, 30 patients were treated with PVB (cisplatin, vinblastine and bleomycin) regimen, 107 patients with PEB (cisplatin, etoposide and bleomycin) regimen and 20 patients with other regimens. Salvage surgery was performed after first-line chemotherapy in 87 patients and after salvage chemotherapy in 70 patients. As salvage surgery, RPLND was performed in 135 patients, resection of pulmonary metastasis in 38, hepatotomy in 2 and resection of metastatic brain tumors in 3. The pathological findings at surgery were necrosis in 87 (55%) patients, mature teratoma in 34 (22%) and residual cancer in 36 (23%). Five of 36 patients with residual cancer performed salvage surgery in the state of marker positive. Of the 31 patients who had residual cancer with normalized marker, salvage surgery was performed after salvage chemotherapy in 11 patients. The sites of residual cancer were retroperitoneal lymph nodes in 34 patients, lung in 4, brain in 2 and liver in 1. The cause-specific 5-year survival rates for patients who had necrosis, mature teratoma and residual cancer were 95%, 96% and 68%, respectively. Conclusions: Residual cancer could not reliably be predicted or discriminated from necrosis or mature teratoma. Therefore, salvage surgery to remove postchemotherapy residual masses remains essential in the successful treatment of metastatic GCT.

No significant financial relationships to disclose.

Do motorcyclists have erectile dysfunction? A preliminary study

The aim of the present study was to evaluate the relationship between motorcycling and erectile dysfunction (ED). We investigated the relationship between motorcycling and erectile function using the 5-items version of the International Index of Erectile Function (IIEF5) in 234 motorcyclists (response rate 75%) and 752 healthy controls (response rate 66%). In all, 161 (69%) of 234 motorcyclists were diagnosed as ED based on IIEF5. The prevalence of ED in the motorcycle group increased by age as: 58, 63, 76 and 93%, for motorcyclists in 20-29, 30-39, 40-49 and 50-59 years, respectively. There was a significant difference in the prevalence of ED between the motorcycle group and the control group in all age groups. On stepwise logistic regression analysis, motorcycling was the strongest risk factor for ED. Although the severity of ED in motorcyclists was not so severe, motorcycling may be one of risk factors for ED.

Carbonate-containing hydroxyapatite derived from calcium tripolyphosphate gel with urea

Carbonate containing hydroxyapatite (CO3HAp) is one of the candidate materials as a bioresorbable bone substitute. In the present work, CO3HAp was efficiently prepared by a hydrothermal treatment of calcium tripolyphosphate gel with urea at 140 degrees C for 24 h. Chemical potential plots of the CO3HAp for estimation of its dissolution behavior suggested that the CO3HAp is more soluble than hydroxyapatite (HAp) and is as soluble as octacalcium phosphate (OCP) and/or beta -tricalcium phosphate (TCP). This material is expected to be applied to bioresorbable materials such as bone fillers.