Case report: hypoechoic submucosal nodules: a sign of Epstein-Barr virus-associated early gastric cancer

Knowledge about human brain temperature is still very limited, despite evidence demonstrating the critical influence of mild increases in temperature on the ischaemic brain. It has been suggested that in passive and exercise hyperthermia the brain may be protected against thermal damage by a mechanism of selective brain cooling (SBC). It is said to bring about suppression of the temperature of the brain, rendering it significantly lower than trunk and arterial blood temperature. Yet very little is known about the possible role of this mechanism in fever, a condition fundamentally different from "physiological" hyperthermia, especially when it occurs in brain-damaged patients. In our investigation we retrospectively analysed the results of direct recordings of cerebral temperature within the subdural space (Tsd) and within the brain parenchyma (Tbr-16 cases) in 63 unanaesthetized patients following neurosurgical procedures, including 23 with fever > 38 degrees C. The difference between trunk temperature, measured in the rectum (Tre) or in the oesophagus (Tes), and the intracranial temperature, were calculated in all subjects. A statistically significant reduction of these differences, in step with increasing fever, would be compatible with demonstrating a process of selective brain cooling. The offsets Tre-Tsd, Tre-Tbr, and Tes-Tsd were plotted against Tre over a wide range of body temperature and near zero correlation was found. This finding suggests that brain temperature in fever was not selectively suppressed by any specific thermolytic mechanism and that dissipation of the main bulk of cerebral metabolic heat both in normothermia and in fever depends on heat uptake by arterial blood. The results suggest that the brain in fever can be seriously jeopardized by heat stress and no specific cooling mechanism exists, to reduce it below body temperature in feverish neurosurgical patients. Tbr and/or Tsd remained the highest body temperature in 14 out of the 23 patients during fever.     

Resection of liver metastasis from alpha-fetoprotein-producing early gastric cancer: report of a case

Compression of the crus cerebri against the free edge of the tentorium contralateral to a supratentorial mass, the so-called Kernohan's notch, can be a cause of false localizing sign. Kernohan's notch has been thoroughly studied clinically and pathologically, but not radiographically. The authors describe a case of left chronic subdural hematoma, which resulted in left hemiparesis caused by Kernohan's notch. Injury to the contralateral cerebral peduncle was clearly shown by magnetic resonance imaging (MRI) performed in the postoperative period. A 43-year-old man was transferred to our hospital in deep coma with dilated pupils, unreactive to light. Computed tomography (CT) scans obtained on admission revealed a left chronic subdural hematoma and a midline shift to the right. After drainage and irrigation of the left chronic subdural hematoma through a single burr hole, his clinical condition improved gradually. But 1 month after the operation, mild left hemiparesis still persisted. MRI T2-weighted images demonstrated an abnormally increased signal area in the right cerebral peduncle. T1-weighted coronal images showed the anatomical relationship between the hypointense lesion in the right cerebral peduncle and tentorial edge. Three-dimensional-MRI (3D-MRI) clearly demonstrated the surface image of Kernohan's notch. We emphasize the utility of 3D-MRI for detecting evidence of brain stem injury, such as Kerno han's notch.     

Malignant gastric teratoma: case report

Gastric teratomas are rare and usually benign. A 4 month old boy presented with an abdominal mass and computed tomographic and ultrasound examination demonstrated a large multi-loculated tumour which was totally excised. The pathological diagnosis was of a malignant gastric teratoma and 12-month follow-up was uneventful.     

Detection of early esophageal and gastric cancers by mass screening

The purpose of mass screening is to decrease the mortality rate of diseases which are fatal if advanced by detecting them at an early and curable stage. From this point of view, we describe here the present state of mass screening, its problems, and the future of mass screening for esophageal and gastric cancer in Japan. The conventional X-ray examination commonly used to detect esophageal cancer does not seem to be effective in detecting the malignancy at an early stage. Therefore, endoscopic examination with Lugol staining for high-risk groups is recommended for the purpose. In contrast, mass screening for gastric cancer by X-ray examination, which has been applied until now, has reduced the mortality rate of gastric cancer. At the same time, however, as various problems are pointed out, some additional investigations have been undertaken to further reduce the mortality rate of gastric cancer. As social circumstances change, and therapy as well as diagnosis for the disease improves, it is necessary to evaluate the accuracy, problems, and limits of the present system to conduct effective and functional mass screening program. The present system must be adapted it to reflect improvements and changes.     

Left multicystic dysplastic kidney with contralateral ureteropelvic obstruction: report of one case

PURPOSE: The technique of administration and the resulting volume and concentration of the dye delivered to the eye via dye-impregnated paper strips are not standardized or known. The purpose of this study was to use a standard technique for preparation of rose bengal dye from commercially available paper strips to determine the variability in concentration based upon soak time, and to determine the volume delivered by such a technique to a model eye. METHODS: Rose bengal filter paper strips were wetted for either 15, 30, or 45 s, and the resulting concentration of dye eluted was determined by spectrophotometry. With the same preparation technique and a 15-s soak time, the strip was applied to wetted filter paper, as a model for the moist surface of the eye. The volume of solution delivered was calculated by weight. RESULTS: Concentrations of rose bengal for the various soak times were: 15 s: 7.64 (+/- 1.11) by 10(-6) g/ml; 30 s: 9.70 (+/- 1.79) by 10(-6) g/ml; and 45 s: 10.27 (+/- 0.66) by 10(-6) g/ml. The volume delivered to the eye model with this technique was 17.43 microliters (+/- 3.09). CONCLUSIONS: The concentration of rose bengal dye delivered to the ocular surface by means of a wetted strip is relatively low and soak time/technique-dependent. This suggests a possibility that results in clinical studies with rose bengal strip application may be different than if controlled volume applications of commercially available 1% liquid rose bengal dye are used.     

Chorionicity inaccurately predicted by early ultrasound: a case report

Ultrasound has been found to be extremely accurate in diagnosing the chorionicity of multiple gestations. Prenatal counselling and/or planning for selective termination is most often based on the sonographic prediction of chorionicity. We present a case of triplet pregnancy in which early sonographic prediction of chorionicity did not match the pathological diagnosis at delivery.     

Evidence of Epstein-Barr virus in lymphoepithelioma-like carcinoma of the uterine cervix: a case report

The prevalence of Loa loa infections in non-endemic areas such as Korea is very low, even though it is quite common in the endemic regions of West and Central Africa. We describe a patient who presented with temporary localized edema (classical Calabar swellings) after travelling to Cameroon and in whom the diagnosis of loiasis was made by ELISA. This is the second reported case of loiasis in Korea. As international travel is becoming more frequent, Loa loa infection should be considered in the differential diagnosis for patients with eosinophilia and Calabar swellings in Korea.     

Rosai-Dorfman disease mimicking multiple meningioma: case report

Rosai-Dorfman disease is a rare idiopathic histioproliferative disease affecting the lymph nodes. Extranodal involvement has also been recognized, but central nervous system manifestations are extremely rare. Only 12 patients with intracranial involvement have been reported previously, and they all presented with clinical and radiological findings suggestive of meningioma. We report multiple meningeal nodules in a patient presenting with seizures whose pathological findings at surgery confirmed the diagnosis of Rosai-Dorfman disease. A review of all previously reported intracranial lesions is presented.     

Dissociation of declarative and nondeclarative memory after bilateral thalamic lesions: a case report

The case of a 63-year-old woman who suffered bilateral ischemic damage in the region of blood supply of the paramedian thalamic arteries is reported. She displayed severe deficits on immediate and delayed recall of both verbal and visuospatial material in the presence of intact IQ and attentional abilities. Performance on tests of all major components of nondeclarative memory (skill acquisition, perceptual priming, classical conditioning) was also preserved. The present report, thus, provides a further example for dissociations of declarative and nondeclarative memory functions following bilateral thalamic damage.     

A case report: multiple liver metastasis of gastric cancer responding to intraarterial infusion of MTX and 5-FU

In a 63-year-old male patient with gastric cancer having multiple liver metastases, the metastatic lesions responded well to postoperative staggered intraarterial infusion therapy with MTX and 5-FU. The intraarterial infusion therapy was administered once a week. A total of 5 courses of this therapy produced marked regression of liver metastases and remarkable necrosis. The effect was thus rated as PR. The patient is healthy and has been successfully rehabilitated. His dose is oral 5-FU (200 mg x 2).     

Successful early separation of a premature xipho-omphalopagus conjoined twins: a case report

Premature xipho-omphalopagus conjoined twins were successfully separated at 7 days of age. The total body weight of the twins before separation was 3502 g. One twin had persistent patent ductus arteriosus and signs of cardiac failure at 4 days of age. This was managed with indomethacin. Thirty-six hours later the second twin became anuric, necessitating early emergency separation. The twins were joined from the lower sternum to the infraumbilical area. The liver was fused, but there was no major vascular connection. There were no other major anomalies. The babies stood the procedure well and were healthy at follow-up 8 months after separation.     

Endoscopic treatment of a gastric phytobezoar using electrohydraulic lithotripsy: a case report]

The Authors report a case of spontaneous large gastric phytobezoar in an unoperated stomach and describe this pathology especially with regards to pathogenesis, diagnosis and endoscopic treatment.     

Left gastric artery aneurysm--a case report

The elevated activity of brain opioids has been implicated in the pathogenesis of autistic disorder. Research on plasma and cerebrospinal fluid levels of endogenous opioids in subjects with autistic disorder has produced conflicting results. The author suggests that the level of brain opioid activity is a contributing but not the determining factor in the pathogenesis of autistic disorder. The author further suggests that the development of autistic disorder is related to the interaction between the endogenous opioid system and various neurotransmitter systems in the brain.     

Epstein-Barr virus and gastric carcinoma

Immunohistopathological staining for p53, PCNA and Ki67 was performed in 120 specimens from previously untreated laryngeal carcinomas using the avidin-biotin method with peroxidase as a marker enzyme and diaminobenzidine as a chromogen. A 5-grade staining score system was used. Statistically significant correlations (Chi-square) were seen between T- and N-stage and histopathological grading. p53 and Ki67 scoring correlated with T- and N-stage whereas PCNA with T-stage. All staining correlated with histopathological grading. The score of staining for p53, PCNA and Ki67 correlated with each other. The patients with recurrences within 3 years had mainly carcinomas with higher staining scores. Using Chi-square analysis the p53, PCNA and Ki67 staining scores were also independent prognostic indicators.     

Pontine-crossed paralysis consequent to multiple trauma: case report

The case of a multiple trauma victim with a brain-stem injury, resulting in a syndrome of pontine-crossed paralysis, is presented. Demonstration of these disorders in the setting of multiple trauma is highly unusual, but the diagnosis is established quickly and accurately through magnetic resonance imaging. A possible mechanism of injury is presented for discussion.     

Epstein-Barr virus associated natural killer cell leukemia: report of an autopsy case

A 20-year-old female was admitted because of high fever, hepatosplenomegaly, severe hepatic dysfunction and coagulopathy. Peripheral blood showed pancytopenia and granular lymphocytes bearing the natural killer cell phenotype (CD2+CD3-CD16+CD56+CD57-TCR alpha beta-TCR gamma delta-) constituted 97% of leucocytes. Southern blot analysis of DNA obtained from peripheral blood mononuclear cells showed germ-line configuration of TCR beta, gamma and delta chain genes. EBV-DNA was detected in a single episomal form by using EBV-terminal repeat probe. Bone marrow findings were consistent with hemophagocytic syndrome and administration of VP-16 was effective transiently. After ten months she died from massive gastrointestinal bleeding. An in situ hybridization study identified EBV-RNA (EBER-1) in atypical lymphocytes infiltrating bone marrow, spleen and lymph nodes. Sections of liver showed steatosis and infiltration of T cells (CD3+ and EBER-1-negative) in the portal areas and few atypical lymphocytes in sinusoids. The patients developed an EBV-associated clonal proliferation of natural killer (NK) cells, but the clinical features were suggestive of chronic active EBV infection or virus-associated hemophagocytic syndrome (VAHS) rather than leukemia. Bone marrow transplantation for NK cell leukemia is an issue to be discussed.     

Development of synchronous bilateral lung cancers after esophagectomy for esophageal cancer: report of a case

It is well known that squamous cell carcinoma of the esophagus can be associated with carcinoma of other organs. We report herein the rare case of a 60-year-old man who developed synchronous bilateral lung cancers after undergoing esophagectomy for esophageal cancer. Staged bilateral lobectomy was successfully performed to minimize respiratory complications 3 years after his esophagectomy. This case report serves to demonstrate that aggressive and careful surgical approach with adequate followup offers the chance of long-term survival for patients with multiple primary cancers.     

A case of multiple early gastric cancer showing complete response to UFT-E after endoscopic mucosal resection

The aim of this study was to investigate whether MR imaging of trabecular bone structure using magnetic inhomogeneity measurements is related to the amount of bone mineral in human vertebrae. Weight, bone mineral content (BMCDXA), bone mineral per area (BMADXA) and bone mineral density (BMDCT) were determined in 12 defatted human lumbar vertebrae (L2-L4) by weighing, dual X-ray absorptiometry (DXA) and CT. Inhomogeneity caused by susceptibility differences between trabecular bone and surrounding water was studied with MR imaging at 1.5 T using the GESFIDE sequence. The pulse sequence determines the transverse relaxation rate R2(*) and its two components, the non-reversible transverse relaxation rate (R2) and the reversible transverse relaxation rate (R2'; i. e. relaxation rate due to magnetic susceptibility) in a single scan. Voxel size was 0.9 x 1.9 x 5.0 mm. Positive significant correlations between R2' and weight, BMCDXA, BMADXA and BMDCT were observed (r > 0.61 and p < 0.05 for all). Unexpectedly, R2 was also positively correlated with weight, BMCDXA and BMDCT (r > 0.66 and p < 0.05 for all), but not with BMADXA. Thus, R2' measurements are related to the amount of bone mineral, but they also provide information which is not obtainable from bone mineral measurements.