Leptomeningeal signet-ring cell carcinomatosis presenting with ophthalmoplegia, areflexia and ataxia

We report a very rare case of occult leptomeningeal carcinomatosis (LC) in whom repeated cytological examination did not show malignant cells in cerebrospinal fluid (CSF) and the primary focus was not discovered by extensive survey. The patient presented with ophthalmoplegia, ataxia and areflexia mimicking Miller Fisher syndrome (MFS) at the initial stage, and later, the clinical profile and laboratory findings including CSF examination simulated tuberculous meningitis. Postmortem autopsy disclosed metastatic signet-ring cell carcinoma infiltrating into cranial nerves and leptomeninges. We would like to emphasize that LC sometimes shows symptoms and signs similar to MFS or tuberculous meningitis.

Effect of translocation of cirrhotic liver on hepatic venous hemoglobin oxygen saturation during hepatectomy

BACKGROUND/AIMS

Comparison of conventional abdominal approach and right thoracoabdominal approach for the resection of hepatocellular carcinoma in cirrhotic liver located at right upper lobe was made in accordance with the effect of translocation of right lobe on hepatic venous hemoglobin oxygen saturation.

METHODOLOGY

From 1990-1994, 92 initial hepatectomies were performed in patients with hepatocellular carcinoma at our department. Nine patients underwent resections of hepatocellular carcinoma located at the right upper lobe with the right thoracoabdominal approach. On the other hand, 10 patients underwent resections of hepatocellular carcinoma at the same location but with the abdominal approach. We evaluated the effect of translocation of liver by monitoring the hepatic venous hemoglobin oxygen saturation.

RESULTS

The outcome was favorable for the right thoracoabdominal approach for those patients with liver cirrhosis considering less reduction in frequency and degree of hepatic venous hemoglobin oxygen saturation during operation.

CONCLUSIONS

The right thoracoabdominal approach may cause less damage to the liver with severe cirrhosis and preferable to this type of operation compare to the abdominal approach.

HTLV-I-associated myelopathy manifested after renal transplantation

We report a patient with HTLV-I-associated myelopathy (HAM), who developed symptoms of myelopathy 4 years after cadaveric renal transplantation. Since he was seronegative before the transplantation, it is suggested that HTLV-I infection was transmitted via renal graft transplantation. He has been treated with immunosuppressive agents such as cyclosporin A (CsA), mycophenolate mofetil (MMF), and prednisolone (PSL) to prevent graft rejection. This case suggested that these immunosuppressive agents are poorly effective in suppressing either the onset or progression of HAM/TSP.

Spontaneous rupture of hepatocellular carcinoma of the caudate lobe

A rare case of ruptured hepatocellular carcinoma (HCC) of the caudate lobe is reported. A 67-year-old man came to the hospital with complaints of abdominal pain and distension. Computed tomography (CT) showed haemoperitoneum and a mass in the caudate lobe. Angiography demonstrated a tumor stain. However, extravasation of the contrast medium was not clear. Although transcatheter arterial embolization (TAE) was performed, bleeding from the tumor could not be controlled. The caudate lobe, including the tumor, was resected. The patient died of multiple organ failure despite intensive care. This case suggests that TAE is not always effective and may not be safely or easily performed when treating ruptured HCC in the caudate lobe. This is attributed to the multiple feeding arteries of the tumor, derived from the proximal portion of the right and left hepatic arteries. If bleeding from the ruptured HCC in the caudate lobe is not controlled, immediate resection of the tumor is recommended.

Gallbladder torsion: case report and review of 245 cases reported in the Japanese literature

We report here a case of torsion of the gallbladder in a 73-year-old woman. The patient was admitted to our hospital with right hypochondralgia. Ultrasonography and computed tomography demonstrated a distended gallbladder, with a multilayered wall, which contained no stones. Since the symptoms did not respond to antibiotics, laparotomy was performed. The gallbladder was found to be twisted around its pedicle and to be gangrenous. Cholecystectomy was performed, and the patient had an uneventful postoperative course. We also reviewed 245 cases reported in the Japanese literature. The clinical features of gallbladder torsion, which include low frequency of fever and jaundice, poor response to antibiotic therapy, and acute onset of abdominal pain, may be helpful in the differential diagnosis from acute cholecystitis. Moreover, a highly suggestive sign of gallbladder torsion observed by ultrasonography or computed tomography is a markedly enlarged "floating" gallbladder with a continuous hypoechoic line indicating edematous change in the wall.

Cloning and sequencing of a human cDNA encoding ornithine decarboxylase antizyme inhibitor

We report here cloning and sequencing human antizyme inhibitor from a human kidney cDNA library. Amino acid sequence deduced from the nucleotide sequence shows 92.9% identity to that of rat antizyme inhibitor. Northern blot analysis reveals that antizyme inhibitor is expressed in human liver.

Involvement of antizyme-like regulatory protein in polyamine-caused repression of ornithine decarboxylase in insect-derived Trichoplusia ni 5 cells

Addition of spermidine to culture medium of insect cells, Trichoplusia ni 5, at a low cellular density suppressed ornithine decarboxylase (ODC; EC 4.1.1.17) activity and induced ODC inhibitory activity. The inhibitory factor was non-dialyzable, temperature-sensitive, and could reversibly form an inactive complex with ODC. It showed a time-independent and non-stoichiometric pattern of inhibition. Upon addition of spermidine to cultured cells with preinduced ODC, the enzyme decayed more rapidly than after addition of cycloheximide. These data strongly suggested that ODC of Tn5 cells is under negative feedback control by polyamines, in which an antizyme-like regulatory protein plays an essential role.

Control of ornithine decarboxylase activity by polyamines and absence of antizyme in Tetrahymena

1. In cells of Tetrahymena pyriformis and thermophila, ODC activity was significantly suppressed but ODC decay was not stimulated by putrescine. 2. Free antizyme and ODC-antizyme complex were both not detected in extracts of cells of T. pyriformis treated with putrescine. 3. It was concluded that in Tetrahymena, unlike vertebrate cells, ODC is not subject to polyamine-induced destabilization mediated by antizyme.

Atomic-Scale Images of the Growth Surface of Ca 1– x Sr x CuO 2 Thin Films

The surface microstructure of c-axis (Ca,Sr)CuO(2) thin films, grown by laser molecular beam epitaxy on SrTiO(3)(001) substrates, was studied by ultrahigh-vacuum scanning tunneling microscopy (STM). Images were obtained for codeposited Ca1-xSrxCuO(2) thin films, which show a layered-type growth mode. The surfaces consist of atomically flat terraces separated by steps that are one unit cell high. A pronounced dependence of the growth mechanism on the Sr/Ca ratio of the films was observed. Atomic resolution STM images of the CuO(2) sheets in the ab plane show a square lattice with an in-plane spacing of 4 angstroms; the lattice contains different concentrations of point defects, depending on the polarity of the sample-tip bias.

Eyelid metastasis originated from gastric-cancer

The incidence of cutaneous metastasis from neoplasms of internal organs is uncommon, and in particular eyelid metastasis from gastric cancer is extremely rare. We report on such a case together with a review of a total of 6 cases. Of the 6 cases, 5 were males and 4 were pathologically low-grade differentiated adenocarcinoma. The presentation of eyelid mass was 3 nodular, 2 diffuse and one ulcerative without characteristics of its location. All the cases involved systemic disease and the effective treatment was not performed. We consider that the number of cases with eyelid metastasis from gastric cancer is actually much higher and that gastroenterologists should pay more attention to such cases in order to adequately grasp the pathogenesis.

Per-rectal portal scintigraphy with technetium-99m pertechnetate for esophageal varices

Per-rectal portal scintigraphy is a non-invasive method in which a radioisotope is used for imaging of the portal collaterals. Per-rectal portal scintigraphy with 99m-technetium pertechnetate (99mTcO4-) was performed in 42 subjects to evaluate the portal hemodynamics. Ten healthy controls, 13 cases of liver cirrhosis without esophageal varices, 15 cases of liver cirrhosis with esophageal varices, and 4 cases of portal systemic shunt were included in this study. Moreover, in 4 patients who underwent transabdominal esophageal transection, per-rectal portal scintigraphy was repeated one month postoperatively. Portosystemic shunt index was calculated by the following equation. Shunt Index (%) = (99mTcO4 Counts of Heart/99mTcO4 Counts of Liver and Heart) x 100. The results, expressed as shunt index (SI) were: 8.8 +/- 5.2 in controls, 21.2 +/- 8.0 in cirrhotic patients without esophageal varices, 31.0 +/- 18.5 in cirrhotic patients with esophageal varices, and 49.0 +/- 6.9 in patients with portosystemic shunt. After transabdominal esophageal transection, the shunt indices were decreased in all four cases. Morphological improvements of the esophageal varices were also observed. These results suggest that the shunt index measured by per-rectal portal scintigraphy may be useful for assessment of portal collaterals, especially for patients with esophageal varices.