[A case of primary gastric malignant lymphoma with chylous ascites].

An 87-year-old man presented with appetite loss and abdominal distension. Routine blood tests revealed hypoproteinemia. Abdominal computed tomography revealed ascites, which was subsequently drained. Biochemical analysis of the ascitic fluid detected chyle. Esophagogastroduodenoscopy revealed nodular swelling of the mucosa, swelling folds, and widespread erosions in the stomach. Stage I diffuse large B-cell gastric malignant lymphoma was diagnosed on the basis of the Lugano International Conference classification system. Six courses of R-CHOP [rituximab, cyclophosphamide, hydroxydaunorubicin (doxorubicin), vincristine (Oncovin(®)), and prednisolone] therapy were administered, following which complete remission was achieved and the chylous ascites mostly disappeared.

Effect of nateglinide on the size of LDL particles in patients with type 2 diabetes.

The objective of the present study was to evaluate the efficacy of nateglinide in controlling blood glucose levels and regulating lipid metabolism in patients with type 2 diabetes by focusing attention particularly on low-density lipoprotein (LDL) particle size. The subjects were 23 patients with type 2 diabetes who were given nateglinide, 90 to 270 mg/d. Laboratory studies were conducted at treatment initiation and 3 mo later. Despite a decline that occurred in the level of fasting plasma glucose before and after administration of nateglinide, no significant difference was recognized. Hemoglobin A1c decreased significantly from 6.37+/- 0.75% to 5.91+/-0.64% (P<.001). A significant decline was also seen in the fasting level of immunoreactive insulin, from 9.82+/-5.69 microU/mL to 8.59+/-4.05 microU/mL (P<.05), and in the homeostasis model assessment for insulin resistance, from 3.06+/-1.83 to 2.55+/-1.26 (P<.05). Regarding lipids, triglycerides significantly decreased from 140.7+/-61.8 mg/dL to 117.3+/-34.7 mg/dL )P<.05). The significant reduction in migration index value, which was used as an index to LDL particle size, from 0.374+/-0.034 to 0.357+/-0.035 (P<.05), confirmed that LDL particle size had increased. The results of the present study show that nateglinide is effective in controlling blood glucose and improving insulin resistance, hypertriglyceridemia, and LDL particle size in patients with mild type 2 diabetes. These effects suggest that nateglinide may effectively control coronary artery disease in this population.

Glucose area under the curve during oral glucose tolerance test as an index of glucose intolerance.

HbA1c and fasting plasma glucose (FPG) levels are commonly recognized as diagnostic indices for diabetes and glucose intolerance. However, they are not sufficient for clear detection of glucose intolerance in the early stage unless an oral glucose tolerance test (OGTT) is performed. Moreover, even in case of an OGTT, 2-h postprandial plasma glucose (PG) levels, a criterion for glucose intolerance in OGTTs, may not provide complete information regarding glucose tolerance. Whole glucose excursion after OGTT is considered to represent glucose tolerance well, and the glucose area under the curve (AUC) can be an index of glucose excursion. However, few studies have investigated measurement of the glucose AUC in glucose intolerance screening. In the present study, data from 520 OGTTs were analyzed to define the cutoff value for the glucose AUC for glucose intolerance screening. Our results showed that a cutoff value of 290 mg h/dl for the glucose AUC was highly sensitive and specific (90 and 93 %, respectively) for detecting diabetes, impaired glucose tolerance (IGT), and group at increased risk of diabetes (normal glucose tolerance with 1-h PG levels of ≥180 mg/dl after glucose load) and showed a better concordance rate than the use of HbA1c, FPG, or 2-h PG levels. Moreover, the cutoff value for the glucose AUC calculated using the diagnostic criteria in the OGTT (305 mg h/dl) was consistent with the value determined from OGTT analysis. These data suggest a possibility that glucose intolerance screening using a glucose AUC cutoff value of 290 mg h/dl could be useful.

Isolated home hypertension in the morning is associated with target organ damage in patients with type 2 diabetes.

To investigate the relationship between the blood pressure control level and cardiovascular risk in type 2 diabetic patients, we evaluated home blood pressure, office blood pressure, biochemical data, and carotid echographic and echocardiographic findings in 148 patients with type 2 diabetes. According to the criteria for hypertension in the guidelines of the Japanese Society of Hypertension, we classified patients into a normotensive group with home systolic blood pressure in the morning (morning HSBP)<135 mmHg and office systolic blood pressure (OSBP)<140 mmHg, an office hypertension group with a morning HSBP<135 mmHg and OSBP>or=140 mmHg, an isolated home hypertension in the morning group with morning HSBP>or=135 mmHg and OSBP<140 mmHg, and a sustained hypertension group with morning HSBP>or=135 mmHg and OSBP>or=140 mmHg. In the isolated home hypertension in the morning group, the fasting insulin level, urinary albumin excretion, maximum carotid artery intima-media complex thickness, and left ventricular posterior wall thickness were significantly higher and the coefficient of variation for RR intervals was significantly lower than in the normotensive group. These results suggest that isolated home hypertension in the morning is a risk factor for target organ damage in type 2 diabetic patients.

[Ruptured aneurysm of pancreaticoduodenal artery, report of two cases].

We describe two cases of ruptured areurysm of pancreaticoduodenal artery (PDA), whose chief complaints were right upper abdominal pain. They were diagnosed to retroperitoneal hematoma around the duodenum and the uncus of the pancreas by Computed tomography and aneurysm of pancreaticoduodenal artery by Angiography. The patients underwent a coil embolization of the eneurysms, one ending to successful, the other to unsuccessful, so, underwent pancreatioduodenectomy. In our both cases, no history of chronic pancreatitis, trauma, infection and connective tissue disorders, and celiac axis stenosis or occulusion, were found. We reviewed 71 case repotrs of PDA aneurysm in Japanese literature and the treatment of PDA aneurysm.

Carcinosarcoma of the Extrahepatic Bile Duct Presenting with Stone-like Radiological Findings.

A 73-year-old woman was referred to our hospital due to epigastralgia and jaundice. The radiological findings showed a stone-like tumor in the extrahepatic bile duct. The patient was initially thought to have adenocarcinoma of the bile duct based on the findings of a pathological examination of the bile duct biopsy specimen and underwent pancreaticoduodenectomy; the final diagnosis of the lesion was so-called carcinosarcoma of the extrahepatic bile duct. She died of liver metastasis six months after the surgery. This case suggests that surgical resection is not adequate for achieving a radical cure, and the optimal treatment for extrahepatic bile duct carcinosarcoma should be established immediately.

Malignant endocrine tumor of the pancreas associated with von Recklinghausen's disease.

We describe a case of malignant endocrine tumor of the pancreas associated with von Recklinghausen's disease. A 66-year-old woman with familial von Recklinghausen's disease was admitted to our hospital with weight loss and lower abdominal pain. Endoscopy revealed a submucosal tumor in the second part of the duodenum. Contrast-enhanced computed tomography showed a heterogeneous low-density tumor, measuring 20 x 15 mm, in the head of the pancreas, and metastatic lymphadenopathy. Angiography showed faint tumor staining without encasement or apparent increase in vascularity. Pancreatoduodenectomy was performed. Macroscopically, there was a solid tumor, measuring 20 x 18 mm, in the head of the pancreas. Histologically, a malignant endocrine tumor was shown, with direct invasion to the duodenum, and lymph node metastases. This is the thirteenth case of pancreatic malignant tumor and the fourth case of pancreatic endocrine tumor associated with von Recklinghausen's disease reported in the world literature.

Regression of follicular lymphoma of the duodenum following eradication of H. pylori infection.

A 64-year-old woman was referred for an examination of the upper gastrointestinal (GI) tract. Endoscopy showed an elevated lesion in the duodenum with central depression and multiple white granules. Biopsy specimens revealed lymphoid follicles composed predominantly of centrocytes with scattered centroblasts. The tumor cells were positive for bcl-2. The patient was diagnosed with follicular lymphoma and underwent antibiotic therapy for Helicobacter pylori (H. pylori) infection. The regression of the lesion was obvious. After 5.5 years of follow-up, there has been no evidence of recurrence. This case suggests that H. pylori eradication therapy is effective for treating follicular lymphoma in the duodenum.

Multiwavelength distributed-feedback dye laser array and its application to spectroscopy.

A multiwavelength, multistripe tunable laser array is proposed, and its application to absorption spectroscopy is demonstrated. Laser waveguides doped with Rhodamine 6 G dye were integrated on a plastic chip, and simultaneous output at different wavelengths was obtained by use of a distributed-feedback technique. A very low threshold of 3 muJ was attained, and spectrally narrowed output (<0.1 nm) was obtained. A scheme for digital spectroscopy is also proposed based on this laser array, and absorption spectroscopy of sodium atoms without wavelength scanning is demonstrated by use of a sodium-vapor cell.

Fabrication of a distributed-feedback dye laser with a grating structure in its plastic waveguide.

Two approaches of fabricating grating structures for waveguided plastic dye lasers are described and compared for lasing performance. Rhodamine6G-doped poly(methyl methacrylate) (PMMA) film on a PMMA substrate was used for the waveguide, and a distributed-feedback (DFB) laser operation with a single-propagation mode was demonstrated. The performances of both types of permanent grating structured DFB dye laser were better than those of a DFB dye laser on a plain waveguide with a dynamic grating formed by the interference of two pump beams. Wide tuning range is expected by use of a multistripe DFB laser with different grating pitches.

Feasibility of nonlinear Raman lidar based on stimulated Raman gain spectroscopy without a tunable laser.

A novel technique of lidar for atmospheric gas detection by use of stimulated Raman gain spectroscopy without any tunable laser is proposed. Detection sensitivity and detectable range are estimated on the basis of the lidar equation for CO2, CH4, and H2 in the atmosphere. The feasibility study clearly shows that the technique has a potential for application to lidar and that, in addition, the construction of the system is simpler than those of traditional differential absorption lidars.

Tuning of a Ti3+:sapphire laser by an electro-optic beam deflection method.

A wavelength-switching method for tuning a self-injection-seeded Ti3+:sapphire laser that uses an electro-optic beam deflection technique is reported. A LiNbO3 prism was employed in a tuning arm of the dual-cavity Ti3+:sapphire laser, and wavelength tuning of approximately 94 pm was attained by altering the deflection angle with the application of an electric field of 10 kV/cm to the prism. The spectral characteristics of the output laser were mainly determined by the diffraction grating in the dual-cavity laser, and the electro-optic prism just behaved as a light-beam deflector for the wavelength tuning purpose. This configuration can allow a simple tuning approach where fast and stable electronic wavelength switching is required in a narrow tuning range, on an order between a few tens of picometers to nanometers, without involving any mechanical movement.