Primary jejunal gastrinoma: a case report and review of the literature.

BACKGROUND: Primary jejunal gastrinomas are exceedingly rare, and data for long-term follow-up is limited. Until now, only six cases of gastrinomas arising from the jejunum have been reported in the English literature. CASE PRESENTATION: Presented is a case of a primary gastrinoma located in the proximal jejunum. After surgical resection of the tumor, eugastrinemia was quickly achieved and after a 10-year follow-up period, the patient was still disease-free. CONCLUSIONS: This case report demonstrates that surgical resection of a primary jejunal gastrinoma without evidence of metastasis can be curative, with a good long-term prognosis.

Pachymeningeal en plaque metastasis from gastric cancer mimicking subdural hematoma: illustrative case.

BACKGROUND: Pachymeningeal metastasis associated with gastric cancer, especially in its early stages, is extremely rare. OBSERVATIONS: The authors describe a 77-year-old man with a past medical history of lung cancer and previously treated chronic subdural hematoma who was admitted to their hospital because of hematemesis and newly diagnosed gastric cancer. He became unconscious during the hospitalization. The preoperative brain imaging studies had the appearance of recurrent subdural hematoma and extracranial tumor with skull invasion. Craniotomy revealed pachymeningeal carcinomatosis and en plaque metastasis of tumor. The histopathology of the tumors was consistent with metastatic gastric adenocarcinoma. LESSONS: This is the first reported case of metastatic gastric cancer as a pachymeninges-based en plaque entity. This report highlights the rare radiological presentation and operative findings in this case. The authors also summarize those case reports associated with dural metastasis arising from gastric cancer.

Precursor B-cell acute lymphoblastic leukemia after thymoma and myasthenia gravis: report of a case and review of the literature.

The association of thymoma, myasthenia gravis (MG) and pure red cell aplasia (PRCA) is well recognized. The association of T-cell lymphoblastic lymphoma and thymoma/MG/PRCA is less distinctive but reported occasionally. We present a 35-year-old female patient who was diagnosed with thymoma and myasthenia gravis. She underwent a thymectomy shortly after the diagnosis. One year later she developed precursor B-cell acute lymphoblastic leukemia (ALL). Complete remission was achieved after induction chemotherapy but the disease relapsed and she expired two years after the diagnosis of ALL despite allogeneic stem cell transplantation. This association has never before been reported and the pathogenesis needs to be clarified. Aberrant thymus function in myasthenia gravis, immunosuppressive therapy and thymectomy are considered to account for the leukemia development in this patient.

Impact on neonatal outcome and anthropometric growth in very low birth weight infants with histological chorioamnionitis.

BACKGROUND/PURPOSE: Chorioamnionitis (CAM) is one of the main causes of preterm labor. The specific aim of our study was to evaluate neonatal outcome and anthropometric growth at the corrected age of 2 years after exposure to an adverse intrauterine event of CAM in very low birth weight (VLBW, less than 1500 g) infants. METHODS: One hundred and nineteen VLBW infants had adequate placental histological data available for the study. Maternal and perinatal characteristics and neonatal morbidity were determined. The infants were followed up prospectively and their anthropometric growth was recorded in the neonatal follow-up clinic for 2 years. RESULTS: Histological CAM was evident in 64 cases (53.8%, CAM group). Patients with histological CAM delivered earlier (27.8 +/- 2.9 vs. 29.6 +/- 3.6 weeks, p = 0.003), and they had higher incidence of preterm premature rupture of membranes (PPROM, p less than 0.001) and longer ventilation days (p = 0.001). After adjusting for gestational age, sepsis (aOR, 3.355), bronchopulmonary dysplasia (aOR, 3.018) and mechanical ventilation (aOR, 4.094) had a higher incidence in the CAM group. At the corrected ages of 6, 12, 18 and 24 months, anthropometric measurements, including body weight, body height and head circumference, were similar for the study and control infants. CONCLUSION: Histological CAM was associated with a higher incidence of PPROM, sepsis, bronchopulmonary dysplasia, more mechanical ventilation and longer ventilation days. However, at the age of 2 years, CAM had no impact on anthropometric growth.

Hypertension due to co-existing paraganglioma and unilateral adrenal cortical hyperplasia.

A rare case of combined unilateral adrenal hyperplasia and paraganglioma is reported. A 27-year-old woman presented with hypertension, palpitation, dizziness, and headache for about 3 months. Elevated plasma aldosterone with low renin and a high level of urine vanillylmandelic acid (VMA) were found. Computed tomography showed a microadenoma of the left adrenal gland and a well demarcated left retroperitoneal para-aortic mass. Adrenal vein sampling for aldosterone and renin levels suggested left adrenal lesion. Surgical removal of the left adrenal gland and para-aortic mass was performed. Pathologic examination of the resected left adrenal gland showed adrenal cortical hyperplasia and the left retroperitoneal para-aortic mass showed a paraganglioma. Postoperatively, blood pressure, plasma renin, aldosterone and urine VMA all returned to within normal ranges. The possible relationship of these two diseases is discussed.

Neurodevelopmental outcome of very-low-birth-weight infants with chorioamnionitis.

BACKGROUND: Chorioamnionitis (CAM) is one of the main causes of preterm labor and has been associated with an adverse perinatal outcome in preterm infants. OBJECTIVE: The specific aim of our study was to evaluate whether there is significant difference in the Bayley developmental index scores at 6, 12, 18 and 24 months of corrected age for very-low-birthweight (birth body weight <1500 gm, VLBW) infants with or without placental CAM. METHODS: Ninety-five cases (54 in CAM and 41 in non-CAM groups) available for the study were all VLBW infants with adequate histologic placental material for analysis. Neonatal characteristics and morbidities were recorded. The infants were followed up prospectively with Bayley Scales of Infant Development in the Neonatal Follow-up Clinic for 2 years. RESULTS: We found that 56.8% of placentas presented a picture of CAM. In comparison of the neonatal characteristics, VLBW infants with CAM had shorter gestational age (27.9 +/- 2.8 vs. 30.0 +/- 3.7 weeks, p = 0.003), lower Cesarean delivery rate (48.1% vs. 73.2%, p = 0.011), more maternal steroid use (44.4% vs. 12.2%, p = 0.004) and higher incidence of preterm premature rupture of membrane (PPROM, 37.0% vs. 12.2%, p = 0.009). In comparison of neonatal outcomes, the CAM group had higher incidence of bronchopulmonary dysplasia (BPD, 40.7% vs. 19.5%, p = 0.044), more mechanical ventilation (87.0% vs. 27/41, p = 0.023) and intubation (68.5% vs. 46.3%, p = 0.049), and more median days of ventilation (23.1 +/- 29.1 vs. 7.8. +/- 13.7 days, p = 0.001). As for the follow-up, at any test age, either the mean (Mental Development Index (MDI) / (Psychomotor Development Index (PDI) scores of Bayley test or the incidence of score below 85, there was no significant difference in both groups. CONCLUSIONS: The VLBW infants with histologic chorioamnionitis were not associated with an increased risk of lower MDI or PDI scores at the corrected ages of 6, 12, 18 and 24 months compared with the non-CAM control group.

Quercetin inhibition of ROS-dependent and -independent apoptosis in rat glioma C6 cells.

In the present study, we investigated the protective mechanism of quercetin (QUE) and its glycosides, rutin (RUT) and quercitrin (QUI), on reactive oxygen species (ROS)-dependent (H(2)O(2)) and -independent (chemical anoxia) cell death in rat glioma C6 cells. Induction of HO-1 protein expression was detected in QUE- but not RUT- or QUI-treated C6 cells, and this was prevented by cycloheximide and actinomycin D. Incubation of C6 cells with QUE, but not RUT or QUI, protected C6 cells from H(2)O(2)- and chemical anoxia-induced cytotoxicity according to the MTT and LDH release assays. Apoptotic characteristics including chromatin condensation, DNA ladders, and hypodiploid cells appeared in H(2)O(2)-and chemical anoxia-treated C6 cells, and those events were significantly suppressed by adding QUE (but not RUT or QUI). Increases in caspase 3, 8, and 9 enzyme activities with decreases in pro-PARP and pro-caspase 3 protein levels and an increase in cleaved D4-GDI protein were identified in H(2)O(2)-and chemical anoxia-treated C6 cells, and these were blocked by the addition of QUE, but not by RUT or QUI. Intracellular peroxide levels increased with H(2)O(2) and decreased with chemical anoxia, and the addition of QUE reduced the intracellular peroxide levels induced by H(2)O(2). Results of an anti-DPPH radical assay showed that QUE, RUT, and QUI dose-dependently inhibited the production of DPPH radicals in vitro; however, QUE (but not RUT or QUI) prevention of DNA damage induced by OH radicals was identified with a plasmid digestion assay. Increases in phosphorylated ERK and p53 protein expressions were detected in H(2)O(2)- but not chemical anoxia-treated C6 cells, and the addition of QUE significantly blocked H(2)O(2)-induced phosphorylated ERK and p53 protein expressions. Adding the HO-1 inhibitors, SnPP, CoPP, and ZnPP, reversed the protective effect of QUE against H(2)O(2)- and chemical anoxia-induced cell death according to the MTT assay and morphological observations. Additionally, QUE exhibited inhibitory effects on LPS/TPA-induced transformation in accordance with a decrease in MMP-9 enzyme activity and iNOS protein expression in C6 cells. Taken together, the results of this study suggest that QUE exhibits an inhibitory effect on both ROS-dependent and -independent cell death, and induction of HO-1 protein expression is involved.

Lipopolysaccharide enhancement of 12-o-tetradecanoylphorbol 13-acetate-mediated transformation in rat glioma C6, accompanied by induction of inducible nitric oxide synthase.

Lipopolysaccharide (LPS) from Gram-negative bacterial has been identified as an important molecule involved in the inflammatory process through inducing nitric oxide (NO) production. However, the effect of LPS in carcinogenesis is still undefined. In the present study, the biological effect of LPS was examined in 12-o-tetradecanoylphorbol 13-acetate (TPA)-treated rat glioma cells C6. Results of MTT assay showed that LPS and TPA exhibited no significant cytotoxicity in glioma C6 cells. Interestingly, transformation foci were found in LPS/TPA-treated glioma C6 cells, but not in LPS- or TPA-treated cells. The transformation foci induced by LPS/TPA were also observed in the absence of serum. It indicates that induction of transformation foci formation by LPS and TPA is independent on the serum in glioma C6 cells. Induction of iNOS gene expression and NO production was examined in LPS/TPA-treated cells, but not obvious in LPS- or TPA-treated cells. NO donor sodium nitroprusside (SNP) induces transformation in glioma C6 cells in according with elevating NO production. In addition, LPS/TPA induces metalloproteinase 9 (MMP9) activity by gelatin activity assay in gel. Wogonin and quercetin but not rutin, inhibitors of iNOS gene expression and NO production induced by LPS, showed the significant inhibition on LPS/TPA-induced transformation foci formation, accompanied by inhibiting iNOS gene expression, NO production and MMP9 activity. Results of the present study provide scientific evidences to link the inflammatory responses and carcinogenesis, and suggest that NO derived from inflammation may contribute to the progression of carcinogenesis; natural products with anti-inflammatory effects such as wogonin and quercetin possess the ability to block transformation induced by LPS/TPA.

Comparison of rabeprazole-based four- and seven-day triple therapy and omeprazole-based seven-day triple therapy for Helicobacter pylori infection in patients with peptic ulcer.

BACKGROUND AND PURPOSE: Rabeprazole is a new proton pump inhibitor producing rapid inhibition of gastric acid secretion. This may potentiate the inhibitory effect of antibiotics against Helicobacter pylori. This study compared the efficacy, safety, and tolerability of 4- and 7-day rabeprazole-based triple therapies versus 7-day omeprazole-based triple therapy. METHODS: A total of 70 H. pylori-infected peptic ulcer patients were randomly assigned to 1 of 3 groups: RAC4 (rabeprazole 20 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily for 4 days), RAC7 (rabeprazole 20 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily for 7 days), and OAC7 (omeprazole 20mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily for 7 days). Endoscopy, Campylobacter-like organism (CLO) test, H. pylori culture, and 13C-urea breath test were performed before randomization and 8 weeks after the start of triple therapy. RESULTS: Intention-to-treat (ITT) eradication rates for the RAC4, RAC7, and OAC7 groups were 87% (20/23), 83%(19/23), and 88% (21/24), respectively, and per-protocol (PP) eradication rates were 91% (20/22), 95% (19/20), and 100% (21/21), respectively. There was no significant difference among the ITT or PP eradication rates of the 3 groups. All 3 regimens were well tolerated and compliance was excellent. CONCLUSIONS: One-week RAC and 1-week OAC are equally effective for H. pylori eradication in peptic ulcer patients. The duration of RAC triple therapy can be shortened to 4 days without compromising its efficacy.

Small bowel intussusception due to metastatic intestinal carcinosarcoma from a pulmonary primary.

Metastatic small bowel tumors are rarely encountered. They usually present with small bowel obstruction, perforation, bleeding, or, rarely, intestinal intussusception. Only a few case reports have mentioned bowel symptoms due to metastatic malignancies. We report a seldom encountered clinical condition of intestinal intussusception from metastatic lung malignancy. Pathology demonstrated both epithelial and mesenchymal content, and the final diagnosis was carcinosarcoma. This case report indicates that intestinal metastases should be considered in the differential diagnosis for patients with lung malignancy and abdominal symptoms.

Comparison of liver histopathology between chronic hepatitis C patients and chronic hepatitis B and C-coinfected patients.

BACKGROUND: The aim of the present study was to compare the histological characteristics of livers between chronic hepatitis C (CHC) patients with and without hepatitis B virus (HBV) coinfection. METHODS: A total of 336 CHC patients (male/female: 204/132, mean age: 46.1 +/- 11.7 years) were enrolled in the study; 32 patients (9.8%) were positive for hepatitis B surface antigen (HBsAg). The histological characteristics of livers were described according to the Knodell and Scheuer scoring system. RESULTS: The proportion of non-intralobular necrosis (score 0) was significantly lower and the mean intralobular necrosis score was higher among CHC patients with HBV coinfection than those without coinfection (43.8% vs 64.5%; 0.84 +/- 1.05 vs 0.53 +/- 0.89). The epidemiological and virological parameters, and other histological scores (periportal necrosis, portal inflammation, total necroinflammation and fibrosis) were not significantly different between these two groups. CONCLUSION: Chronic hepatitis C patients with HBV coinfection tend to have more severe intralobular necrosis than those with isolated HCV infection.

Reduced Fhit expression in cervical carcinoma: correlation with tumor progression and poor prognosis.

OBJECTIVE: The fragile histidine triad (FHIT) gene is located at chromosome 3p14.2 and encompasses the common fragile site, FRA3B, which may contribute to chromosome breakage and rearrangement of cancer cells. Aberrant protein expression and inactivation of the FHIT gene have been identified in a variety of precancerous and cancerous lesions. To identify the potential implications of the FHIT gene in the development of cervical carcinoma and explore the clinical importance of change in gene expression, we assessed the level of Fhit protein in precancerous lesions and carcinomas of the cervix. METHODS: In our study, 15 low-grade squamous intraepithelial lesions (LSIL), 35 high-grade squamous intraepithelial lesions (HSIL), 12 microinvasive carcinomas, and 103 invasive carcinomas were evaluated. The expression of Fhit was studied by immunohistochemistry using a polyclonal antibody specific for the protein. RESULTS: All samples of normal epithelium and LSIL exhibited intermediate to strong immunostaining of Fhit. Reduced Fhit protein expression was observed in 30 of 103 (29.1%) invasive carcinomas, 1 of 12 (8.3%) microinvasive carcinomas, and 3 of 35 (8.6%) HISL. Compared with normal epithelium and dysplasia, microinvasive and invasive carcinomas showed significantly lower Fhit expression. Fhit expression was also correlated with clinicopathological status. Reduced Fhit expression was significantly associated with lymph node metastasis (P = 0.005), parametrial invasion (P = 0.023), and vaginal involvement of the tumor (P = 0.016). In univariate analysis, Fhit expression was found to be a significant predictor of survival (relative risk 2.54, P = 0.0091): the patient with reduced Fhit expression had a 154% higher risk of dying from cervical cancer than the patient with opposite values. CONCLUSION: Our results indicate that immunostaining of Fhit expression has potential as a prognostic marker in the management of cervical cancer. The trend of reduced Fhit expression in microinvasive and invasive carcinomas suggests that down-regulation of Fhit is strongly linked to cancer progression. Moreover, loss of Fhit expression was related to lymph node metastasis, parametrial invasion, and vaginal involvement in cervical carcinoma. These results imply that loss of Fhit protein is associated with highly aggressive phenotypes of cervical carcinoma.