Differentiating autoimmune encephalitis from schizophrenia spectrum disorders among patients with first-episode psychosis.

BACKGROUND: Although differential diagnosis between autoimmune encephalitis and schizophrenia spectrum disorders is crucial for a good outcome, the psychiatric symptoms that distinguish these two conditions have not been identified even though psychiatric symptoms are often the main manifestation of autoimmune encephalitis. Also, there are many situations in clinical psychiatry in which laboratory testing and imaging studies are not available. Because no comparative study of the psychiatric symptoms between these two conditions has been carried out, we explored diagnostically useful psychiatric symptoms in a retrospective case-control study. METHODS: We recruited 187 inpatients with first-episode psychosis who were admitted to our psychiatric unit and categorized them into two groups: the autoimmune encephalitis group (n = 10) and the schizophrenia spectrum disorders group (n = 177). Differences in the symptoms and signs between the two groups were investigated. RESULTS: Schneider's first-rank symptoms (e.g., verbal commenting hallucinations and delusional self-experience) were observed only in the schizophrenia spectrum disorders group, whereas altered perception was found more frequently in the autoimmune encephalitis group. Functional status was worse in the autoimmune encephalitis group, and neurological and neuropsychological signs were revealed almost exclusively in this group. A history of mental illness was more frequently reported in the schizophrenia spectrum disorders group than in the autoimmune encephalitis group. CONCLUSIONS: The psychiatric symptoms, i.e., Schneider's first-rank symptoms and altered perception, together with neurological and neuropsychological signs, functional status, and past history, may help clinicians accurately differentiate these two conditions among patients with first-episode psychosis.

[Primary adenocarcinoma of small intestine with peritoneal dissemination treated with S-1 and CPT-11 combination chemotherapy].

A 62-year-old woman was admitted for epigastralgia, nausea and tarry stool.Abdominal CT showed a tumor to the jejunum from the duodenum, and peritoneal dissemination.Gastroduodenoscopy showed a type 2 tumor, and the histopathological examination revealed a well-to moderately-differentiated adenocarcinoma.Accordingly, she was diagnosed with primary adenocarcinoma of the small intestines and underwent surgery.The first-line chemotherapy with S-1/CPT-11 was started after surgery, and the tumor marker returned to normal.The treatment of 14 courses was continued until PD due to the enlargement of the peritoneal dissemination.Second - and third-line chemotherapy were performed; however, she died 20 months after the initial treatment.Although the incidence of primary adenocarinoma of the small intestines is relative- ly low, and there is no established chemotherapy at present, this case suggested that S-1/CPT-11may be an effective regimen for advanced primary adenocarcinoma of the small intestines.

[A long survival case of unresectable pancreatic cancer by chemoradiotherapy with gemcitabine as key drug].

A 64-year-old man complaining of left hypochondriac pain visited our hospital. He was diagnosed as locally advanced unresectable cancer of the pancreatic body over 4 cm in size, because the pancreatic cancer involved the main artery and portal vein. Although chemotherapy of gemcitabine(GEM)(1.2 g/body/week)was started, he developed meningeal carcinomatosis after 2 courses of GEM. The size of the primary lesion decreased at this period, and total brain irradiation was selected to treat the meningeal carcinomatosis. He sequentially received GEM alone afterward until radiotherapy was performed for the progression of the primary lesion 24 months after the diagnosis. Although GEM alone was continued thereafter, vertebral metastases were detected 30 months following the diagnosis. He was treated with combined chemotherapy of GEM and S-1 that was effective. Finally, he died of peritoneal dissemination 42 months after diagnosis. The dose of GEM was reduced during the radiotherapy, and the total dose was 113.2 g.

[Prolonged complete response obtained by single agent S-1 in a case of peritoneal metastasis from gastric remnant cancer].

A 58-year-old man underwent cholecystectomy and partial resection of the stomach with the preoperative diagnosis of acute cholecystitis and submucosal tumor of the stomach. The submucosal tumor was found postoperatively to be a T3 stage gastric cancer with well-differentiated phenotype through histopathologic examination of the resected specimen. The patient rejected a subsequent offer of either reoperation or chemotherapy, and underwent close follow-up. Serum tumor markers rose a few months later, and cancer recurrence was confirmed by the finding of a measurable peritoneal metastasis by computed tomography. He was treated with single agent S-1, obtained a complete response 10 months later, and went on to receive the drug for 42 months. He remains disease-free for over 30 months after cessation of S-1. S-1 is recommended as a first-line chemotherapy for recurrent gastric cancer, but the treatment schedule and follow-up schedule after obtaining a complete response remain an issue.

[A case of recurrent gastric cancer with peritoneal dissemination responding to doxifluridine/paclitaxel combination chemotherapy as third-line treatment].

A 50-year-old man had undergone total gastrectomy and splenectomy for advanced gastric cancer in October 2000, and was then treated with postoperative adjuvant chemotherapy for 2 years. In June 2005, we made a diagnosis of recurrent gastric cancer with peritoneal dissemination. Although the chemotherapy with TS-1/CPT-11 was started, it was discontinued after 2 courses because of subileus. Despite a change to second-line chemotherapy with CPT-11/CDDP, progressive disease due to a large amount of ascites was confirmed after 3 courses. Therefore, chemotherapy with doxifluridine (5'-DFUR)/paclitaxel (PTX) was selected as third-line treatment. After completion of 3 courses, abdominal computed tomography revealed a marked decrease of ascites. After 8 courses we discontinued 5'-DFUR/PTX chemotherapy, so the increase of ascites was remarkable. All response time was 197 days. The patient had good quality of life. 5'-DFUR/PTX combination chemotherapy can be expected to improve patient quality of life and show good therapeutic efficacy against recurrent gastric cancer with peritoneal dissemination.

Transhepatic portal venous angioplasty with stenting for bleeding jejunal varices.

A 54-year-old woman, who had undergone pancreatoduodenectomy with resection of the portal vein and intraoperative radiation therapy for cancer of the lower bile duct 16 months before, visited our institution complaining of melena. To identify the cause of bleeding and severe anemia, we performed gastrointestinal endoscopy but could detect no obvious source. The portal phase of the superior mesenteric arteriography and percutaneous transhepatic portography revealed severe stenosis of the extrahepatic portal vein, which corresponded to the end-to-end anastomosis of the portal vein, and hepatofugal collaterals. Extravasations into the afferent loop of the jejunum were detected only with portography. These findings suggested that portal hypertension due to extrahepatic portal obstruction led to bleeding varices. Subsequent to percutaneous transhepatic portography, we dilated the stenosis of the extrahepatic portal vein using a balloon catheter and placed an expandable metallic stent there. Portography after the treatment revealed the disappearance of the hepatofugal flow to collaterals and extravasations, and the patient has had no further episodes of gastrointestinal bleeding since. In conclusion, for patients with bleeding varices due to extrahepatic portal obstruction, especially after abdominal surgery, percutaneous transhepatic angioplasty is considered to be the treatment of choice because of its efficiency and minimal invasiveness.

Gene therapy for hepatocellular carcinoma using sonoporation enhanced by contrast agents.

We examined whether sonoporation enhanced by a contrast agent (BR14) was effective in gene therapy for hepatocelluar carcinoma (HCC). Human hepatic cancer cells (SK-Hep1) and plasmid cDNAs expressing green fluorescent protein (GFP), interferonbeta (IFNbeta), and LacZ were used. In vitro, SK-Hep1 cell suspensions with DNA and BR14 were sonoporated. Expressions of every plasmid cDNA and the antitumor effect of IFNbeta were analyzed. In vivo, GFP and IFNbeta genes with BR14 were directly injected into subcutaneous tumors using SK-Hep1 in nude mice, and transcutaneous sonoporation of the tumors was performed. GFP gene transfections and tumor diameters after IFNbeta gene transfection were examined. In vitro, no SK-Hep1 cells were transfected without sonication, whereas transfections were successful after sonication with BR14. Antitumor effect of IFNbeta gene transfection by ultrasound (US) and with BR14 was revealed. In vivo, the SK-Hep1 cells expressed GFP, and the IFNbeta gene transfection by US with BR14 reduced tumor size significantly. In conclusion, gene therapy with sonoporation enhanced by a contrast agent may become a new treatment option for HCC.