A resected case of gallbladder metastasis with symptoms of acute cholecystitis in multiple metastatic ductal carcinoma of the breast

Gallbladder metastasis from breast cancer, especially from ductal carcinoma, is rare. Herein, we report a rare case of gallbladder metastasis from ductal carcinoma of the breast that was diagnosed after laparoscopic cholecystectomy (LC) for acute cholecystitis. A 78-year-old woman presented with right upper abdominal tenderness and positive Murphy's sign during chemotherapy for advanced multiple metastases of the breast cancer. Abdominal ultrasonography and computed tomography showed a slightly thickened gallbladder wall and two calculi. After a diagnosis of acute calculous cholecystitis was established, LC was performed. Pathological examination revealed poorly differentiated adenocarcinoma infiltrating the submucosal and subserosal layer over the entire gallbladder, and a lymph node metastasis in the gallbladder neck. Immunohistochemical examination revealed that the tumor cells tested positive for estrogen receptor and negative for progesterone receptor, which was consistent with primary breast cancer. The patient was uneventfully discharged without abdominal pain 7 days later. Although she subsequently underwent several chemotherapies, she died 16 months later. In conclusion, gallbladder metastasis should be considered in patients with multiple metastatic breast cancer who present with signs or symptoms of cholecystitis. Moreover, LC should be considered to relieve the symptoms of cholecystitis for improved prognosis, even in a patient with multiple metastases.

Kidney enlargement and multiple liver cyst formation implicate mutations in PKD1/2 in adult sporadic polycystic kidney disease

Distinguishing autosomal-dominant polycystic kidney disease (ADPKD) from other inherited renal cystic diseases in patients with adult polycystic kidney disease and no family history is critical for correct treatment and appropriate genetic counseling. However, for patients with no family history, there are no definitive imaging findings that provide an unequivocal ADPKD diagnosis. We analyzed 53 adult polycystic kidney disease patients with no family history. Comprehensive genetic testing was performed using capture-based next-generation sequencing for 69 genes currently known to cause hereditary renal cystic diseases including ADPKD. Through our analysis, 32 patients had PKD1 or PKD2 mutations. Additionally, 3 patients with disease-causing mutations in NPHP4, PKHD1, and OFD1 were diagnosed with an inherited renal cystic disease other than ADPKD. In patients with PKD1 or PKD2 mutations, the prevalence of polycystic liver disease, defined as more than 20 liver cysts, was significantly higher (71.9% vs 33.3%, P = .006), total kidney volume was significantly increased (median, 1580.7 mL vs 791.0 mL, P = .027) and mean arterial pressure was significantly higher (median, 98 mm Hg vs 91 mm Hg, P = .012). The genetic screening approach and clinical features described here are potentially beneficial for optimal management of adult sporadic polycystic kidney disease patients.

Effect of L-carnosine on the hyperglycemia caused by intracranial injection of 2-deoxy-D-glucose in rats

Effects of a chicken essence and one of its components, L-carnosine, on the hyperglycemia caused by intracranial injection of 2-deoxy-D-glucose (2DG-hyperglycemia) in unanesthetized rats were examined. The chicken essence inhibited the 2DG-hyperglycemia. Central or peripheral administration of specific doses of L-carnosine reduced the 2DG-hyperglycemia. L-carnosine inhibited neural activities of sympathetic efferent nerves innervating the adrenal gland and liver and facilitated the activity of vagal celiac nerve innervating the pancreas in urethane anesthetized rats. Specific doses of histamine also suppressed the 2DG-hyperglycemia, and thioperamide eliminated the inhibiting actions of both histamine and L-carnosine on the 2DG-hyperglycemia. Considering mammalian muscles contain L-carnosine, these facts suggest a possibility that L-carnosine might be an endogenous control factor of the blood glucose level through autonomic nerves via H3-receptor.

Increase in peripheral blood flow due to extraocular direct irradiation of visible light in rats

We have conducted experiments to clarify the existence of extraretinal photosensitivity in mammals through the measurements of skin blood flow variation due to light irradiation. We found that blood flow shows a synchronized transient increase with a irradiation-nonirradiation sequence. The action spectrum of the phenomenon was found to show peaks at approximately 410-420 nm, 540-550 nm, and 570- 580 nm. These peaks coincide with the specific optical absorption peaks of B and Q (alpha,beta) bands in sixfold coordinated ferruos-heme complexes such as nitric oxide (NO)-Hb. The blood flow increase in the irradiated duration disappears when the rats are intraperitoneally injected with 1H-[1,2,3]oxydiazolo[4,3-a] quinoxalin-1-one (ODQ), which is an inhibitor of guanylate cyclase, and N(G)-monomethyl-L-arginine acetate and N(G)-nitro-L-arginine methyl ester, which are inhibitors of NO synthase. On the basis of the present results, we propose a photochemical model of the photosensitivity mechanism where optical absorption of the sixfold coordinated ferrous heme-NO complex plays a main role.

[Detectability of simulated nodules on chest phantom by Fuji computed radiography: comparison of different nodule sizes, configurations and tube voltages]

The detectability of simulated nodules placed on a chest phantom and shown on FCR images has been studied. Different tube voltages (130 kVp, 100 kVp), presence or absence of compensation filter, various sites and different sizes (5 mm/10 mm) and configurations (spherical or broad based) of the nodule were examined. 112 FCR chest phantom images were evaluated by ten radiology specialists utilizing ROC analysis. The detection rate for nodules was influenced in general by the site. The detection rate was as follows in decreasing order: intercostal, overlaid with one rib, two ribs, diaphragm and heart. Detection of nodules of 10 mm in height was mainly influenced by the density of the lung where the nodule was located, whereas that of nodules of 5 mm in height was more dependent on the site of the nodule, probably greatly influenced by the amount of structure mottle. Spherical nodules of 5 mm in height were more frequently recognized than the broad-based ones. High kVp (130 kVp) resulted in a higher detection rate for both sizes of nodules than low kVp (100 kVp). Detection of spherical nodules overlying the heart or diaphragm was improved with the use of a compensation filter.

Quantitative fecal culture for early diagnosis of Corynebacterium (Rhodococcus) equi enteritis in foals

Quantitative culture of Corynebacterium (Rhodococcus) equi from feces of 17 foals on a farm (A) with an endemic C. equi infection problem and 26 foals on a farm (B) without the disease in the past decade was done with a selective medium at weekly or monthly intervals from April to August of 1984. Corynebacterium equi was observed in the feces of 16 of 17 foals on farm A, and 19 of 26 foals on farm B. The mean viable count of C. equi in one gram of feces was 4.1 +/- 3.7 (log10) on farm A, and 3.9 +/- 3.4 (log10) on farm B. Corynebacterium equi was recovered from feces of foals as young as two weeks old. Almost all foals at an age between two to four weeks shed the bacteria in the feces. During the observation period two foals showed clinical signs: fever, diarrhea, and cough, at four or five weeks old. At the same time the bacterial count per gram of feces increased from 4 to 7 or 8 (log10). They shed large number of bacteria in the feces and continued to show the clinical signs until death at 10 or 11 weeks old. One of the foals was diagnosed as having had C. equi enteritis and pneumonia by the postmortem recognition of lesions with bacteriological confirmation. The quantitative culture of the feces of foals at weekly intervals after birth on farm A was found to be very useful as an aid in early diagnosis of C. equi enteritis in foals.