[Therapy-related acute promyelocytic leukemia developing during chemotherapy for thymic carcinoma].

A 74-year-old man was admitted to hospital due to suspected acute leukemia. He had a history of thymic carcinoma, which had been treated with carboplatin in combination with either paclitaxel or amrubicin. However, the tumor remained unresponsive to these treatments. Administration of tegafur/gimeracil/oteracil (TS-1) was initiated, which resulted in tumor size reduction and a partial response. However, leukopenia persisted after the last TS-1 treatment, and four years after the initial treatment, increased blast cell counts were found in a blood film . Bone marrow analysis showed blasts with Auer rods, faggot cells, and dysplastic promyelocytes. Flow cytometry was positive for CD13, CD33, CD34, CD117, and myeloperoxidase, but negative for HLA-DR. PML-RARA fluorescence in situ hybridization was positive. Cytogenetic analysis revealed 47,XY,t (15;17) (q22;q21),+21. Thus, therapy-related acute promyelocytic leukemia (tAPL) was diagnosed. The patient achieved and maintained complete remission for more than 20 months by a de novo APL-treatment regimen including all-trans retinoic acid, arsenic trioxide and tamibarotene. Moreover, the thymic carcinoma has remained stable. Although secondary malignancies of thymic carcinoma have been previously reported, therapy-related leukemia, especially tAPL, is very rare.

Comparison of endometriotic cysts and ovarian cancer in association with endometriotic cysts.

OBJECTIVE: The aim of this study was to clarify the clinical, laboratory, and imaging findings of ovarian cancer in association with endometriotic cysts by detailed comparison of the findings of benign and malignant tumors. METHODS AND MATERIALS: This was a retrospective study of 138 women who had an operation for ovarian tumors at the Department of Obstetrics and Gynecology of Kochi Health Sciences Center between September 1, 2011, and July 30, 2015. The ovarian tumors were divided into two groups: the benign group (endometriotic cysts) and the malignant group (ovarian cancer in association with endometriotic cysts). RESULTS: Of the 138 patients, 28 had malignant disease, and 110 had benign endometriotic cysts. Patients in the malignant group were significantly older than patients in the benign group. The mean maximum tumor diameter was also significantly larger for the malignant tumors. Unilocular-solid and multilocular-solid type tumors were present in 25.0% and 75.0% of malignant tumors, and in 9.1% and 19.1% of benign tumors, respectively. The mean maximum solid component diameter and height were significantly larger in the malignant tumors than in the benign tumors. The solid components were present on the abdominal side of the cyst wall in 12.5% of benign tumors and in 51.9% of malignant tumors. CONCLUSION: In elderly patients, the presence of large solid components in large endometriotic cysts, especially the abdominal side of the cyst wall, might suggest malignancy. MICRO ABSTRACT: The aim of this study was to clarify the findings of ovarian cancer in association with endometriotic cysts by detailed comparison of the findings of benign and malignant tumors. The presence of solid components in large endometriotic cysts, especially the abdominal side of the cyst wall, might suggest malignancy.

Minimally Conjoined Omphalopagus Twins with a Body Stalk Anomaly.

Introduction This report will discuss a case of minimally conjoined omphalopagus twins (MCOTs) with a body stalk anomaly (BSA). Case Report We experienced monochorionic diamniotic (MD) twins born at 31 weeks. One infant was suspicious of BSA before birth, and another infant was normal. But normal infant had anal atresia with small intestine which was inserted behind the umbilicus. Twins had very short common umbilicus and infant with BSA had intestinal conjunction, two appendixes at the site of the colon, and a blind-ending colon. We diagnosed MCOTs. Discussion On the basis of the Spencer hypothesis, the etiology of MCOTs was that MD twins shared a yolk sac. However, this could not explain the presence of a BSA. It is necessary to consider the possible reasons for a singleton BSA. In addition, intestinal fusion occurred unequally in this case, although two appendixes were found in the same place, which might have occurred because of the balanced fusion.

Bombesin can minimize impairments of interstitial cells of Cajal induced by FK506 in small bowel transplantation.

PURPOSE: Interstitial cells of Cajal (ICC) are known as intestinal pacemaker cells and express c-kit on their membrane. Previously, we reported that FK506 had neurotoxicity to enteric ganglia, and bombesin (BBS) preserved them against FK506. The aim of this study was to investigate whether ICC was impaired by FK506 and whether ICC was preserved by BBS against FK506. METHODS: Twelve rats underwent allogeneic SBTx heterotopically and were divided into 2 groups as follows: group A underwent SBTx with FK506 and group B with FK506/BBS. All rats were administered FK506 daily. Either BBS or normal saline was infused continuously from day 14 to 28. Analysis of ICC was performed immunohistochemically with c-kit. Interstitial cells of Cajal were evaluated by counting the number of c-kit-positive clusters in each graft. RESULTS: The expression of c-kit accumulated around 60% of PGP9.5-positive enteric ganglia. The number of c-kit-positive clusters in group A was 22.3 +/- 5.5 clusters per cross section (C/CS) and that in group B was 36.3 +/- 5.1 C/CS. Interstitial cells of Cajal were well preserved in group B. There was a significant difference between groups A and B (P <.001). CONCLUSION: Interstitial cells of Cajal were impaired by FK506 in allografts, and BBS could minimize the impairment of ICC against FK506.

Pycnogenol increases the probability of the contraction state in chick embryonic cardiomyocytes, indicating inotropic effects.

The influence of pycnogenol on the probability of contraction was studied in chick cardiomyocytes. Ventricles from 9-11 day chicken embryos were cultured. After 10-11 days in culture, stable spontaneous contractions were recorded and the contraction kinetics analysed. Isoproterenol and pycnogenol increased the probability of the contraction state. After pretreatment with the beta-receptor antagonist, propranolol reduced the isoproterenol- and pycnogenol-increased probability of contraction state. These data suggested that pycnogenol has inotropic effects via stimulation of beta-receptor mediated activity.

Bombesin can rescue the enteric ganglia from FK506 neurotoxicity on small bowel transplantation.

BACKGROUND/PURPOSE: FK506 has been reported to have neurotoxic effects. The aim of this study was to investigate whether FK506 causes neurotoxic effects on the transplanted graft enteric ganglia (TGEG) and whether bombesin (BBS) can prevent such atrophy. METHODS: Thirty rats heterotopically underwent small bowel transplantation and were divided into 5 groups as follows: group A, syngraft (SYN) alone; group B, SYN with FK506; group C, SYN with FK506 and BBS; group D allograft with FK506; group E, allograft with FK506 and BBS. From postoperative days 14 to 28, either BBS or normal saline was administered continuously. All recipients except for group A received FK506 daily. The ganglionic count was obtained by counting the number of protein gene product 9.5 immunohistochemically stained ganglia in the cross sections of each graft. RESULTS: The number of TGEG in groups A, B, and C was 69.7 +/- 6.0, 51.5 +/- 7.7, and 84.8 +/- 10.2 ganglia per cross section, respectively. There was a significant difference between each group (P < .001). The number of TGEG in groups D and E was 44.6 +/- 7.5 and 65.1 +/- 9.5 ganglia per cross section, respectively. There was a significant difference between the 2 groups (P < .001). CONCLUSIONS: FK506 causes severe neurotoxicity in transplanted grafts, and BBS protects graft enteric ganglia against the neurotoxic effects of FK506.

Spontaneous rupture of choledochal cyst with pseudocyst formation-report on 2 cases and literature review.

Spontaneous rupture and subsequent bile peritonitis are rare complications of choledochal cysts. Of these complications, the formation of a biliary pseudocyst is an unusual form, and its preoperative diagnosis is difficult. In this report, we describe 2 cases showing spontaneous rupture with biliary pseudocyst formation. Inflammatory tissue surrounded those pseudocysts, one of which was adjacent to the perforation and the other formed in the transverse mesocolon apart from the biliary tract. These pseudocysts were removed by careful dissection, and single-stage cyst excision with biliary reconstruction was successfully performed in both cases.

Preoperative bombesin administration can protect the rat small bowel allograft from ischemic reperfusion injury.

BACKGROUND/PURPOSE: Ischemic reperfusion injury (IR/I) should be minimum for the success of small bowel transplantation (SBTx). This study investigated whether preoperative administration of neuropeptide bombesin (BBS) had a protective effect against IR/I and subsequent acute rejection. METHODS: Allogenic SBTx was performed heterotopically in rats (n = 18). All rats were administered FK506 (0.32 mg/kg per day) everyday. The rats were divided into 3 groups of 6 rats each: group 1, BBS(-)5: warm ischemic time (WIT), 5 minutes without BBS; group 2, BBS(-)15: WIT, 15 minutes without BBS; group 3, BBS(+)15: WIT, 15 minutes with BBS. The specimens were obtained from the stoma site at 1 hour after reperfusion and on postoperative day (POD) 1 and 7. The graft mucosal state and degree of acute rejection were evaluated by H&E staining. The apoptotic cells in the crypt lesion was evaluated using terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling immunohistochemistry. Apoptotic index (AI) was calculated for quantitative analysis. RESULTS: H&E staining revealed that the mucosal villi on POD 1 remained shortened in the BBS(-)15 group than in the other two groups. One hour after reperfusion, the AI in the BBS(-)15 group was 145.0 per thousand +/- 37.2 per thousand, which was significantly higher (P < .05) than in the BBS(-)5 group (32.6 per thousand +/- 5.0 per thousand) or the BBS(+)15 group (32.0 per thousand +/- 3.0 per thousand). On POD 7, the AI in the BBS(-)15 group was 63.7 per thousand +/- 5.03 per thousand, which was significantly higher (P < .05) than in the BBS(-)5 (17.3 per thousand +/- 4.6 per thousand) or the BBS(+)15 group (12.3 per thousand +/- 3.06 per thousand). CONCLUSIONS: Even a short WIT of 15 minutes induced considerable allograft mucosal damage, which also worsened acute rejection. Exogenous BBS could prevent mucosal damage by IR/I and was also beneficial for the prevention of acute rejection.

Mucoepidermal carcinoma of the lung detected by positron emission tomography in a 5-year-old girl.

The authors describe a rare case of mucoepidermal carcinoma of the lung incidentally identified in preoperative assessments for inguinal hernia repair in a 5-year-old girl. This patient was referred for right external inguinal hernia, and a 3.0-cm round-shaped lesion was found in the right lower lung field of a chest x-ray film. She had no respiratory tract complaints, but her serum carcinoembryonic antigen concentration was markedly elevated (21.2 ng/mL). Chest and abdominal computed tomography/magnetic resonance images could not determine the nature of the lesion, but 2-[18 F]fluoro-2-deoxy- d -glucose positron emission tomography (FDG-PET) indicated a malignant tumor pattern. The patient underwent a computed tomography-guided needle biopsy of the lesion (S8), which was soon followed by a right lower pulmonary lobectomy. Histopathology of the resected specimen showed mucoepidermal carcinoma with no regional lymph node metastasis. In childhood asymptomatic pulmonary lesions, it is often difficult to rule out the possibility of malignancy. In the present case, FDG-PET scanning appropriately indicated the therapeutic priority of pediatric thoracic surgery.

Sensitive determination of a beta-lactam antibiotic, cefaclor by liquid chromatography with chemiluminescence detection.

We present a sensitive method for the determination of cefaclor (CCL), a beta-lactam antibiotic. It was based on the chemical derivatization of the drug with 4-(2'-cyanoisoindolyl)phenylisothiocynate (CIPIC) under the reaction conditions with heating at 80 degrees C for 7 min in the presence of pyridine. The CIPIC reagent could react with the primary amino group of the drug to form the CIPIC-conjugated CCL. The derivatives emitted not only fluorescence (FL) at maximum emission wavelength of 410 nm with irradiation at 310 nm, but also chemiluminescence (CL) in the presence of H(2)O(2), borate buffer (pH 9.6) and acetonitrile. After separation of the CIPIC derivatives of CCL and cephradine as internal standard in human serum by reversed-phase liquid chromatography, the derivatives could be monitored with both FL and CL detections. The detection limit (S/N=3) in the chromatograph was 1 pmol by the CL detection and 10 pmol by the FL detection. The proposed CL method permitted the most sensitive determination of CCL in the human serum after its oral administration.

Chromatographic determinations of a beta-lactam antibiotic, cefaclor by means of fluorescence, chemiluminescence and mass spectrometry.

We report analytical informations on the quantification of cefaclor (CCL), a beta-lactam antibiotic by three detection methods. The methods were based on the chemical derivatization of the drug with 4-(2'-cyanoisoindolyl)phenylisothiocyanate (CIPIC) under the reaction conditions with heating at 80 degrees C for 7 min in the presence of pyridine. The CIPIC reagent could react with the primary amino group of the drug to form CIPIC-conjugated CCL. The derivative emitted not only fluorescence (FL) at maximum emission wavelength of 410 nm with the irradiation at 310 nm excitation, but also chemiluminescence (CL) in the presence of H(2)O(2), borate buffer (pH 9.5) and acetonitrile. After reversed-phase liquid chromatographic separation of the CIPIC-conjugated CCL in blood, the derivative could be monitored with a FL detector, indicating the detection limit (S/N=3) of 10 pmol/injection. The CIPIC-conjugated CCL was further monitored most sensitively by a CL detector after simply mixing H(2)O(2) and borate buffer with the column eluate. The CL detection limit was 1.0 pmol/injection. In addition, we attempted to detect the CIPIC-conjugated CCL by liquid chromatographic-mass spectrometry (LC/MS). The MS method permitted the specific detection of the CIPIC derivative of the drug, though the sensitivity was 10(4)-times lower than that of the CL detection.