A pediatric case of Burkitt's lymphoma with bile duct obstruction requiring surgical biliary reconstruction.

BACKGROUND: Biliary obstruction due to compression by a B-cell solid tumor occurs rarely. A few reports have described biliary reconstruction surgery for obstructive jaundice caused by Burkitt's lymphoma. However, there are no detailed reports on pediatric cases. We report a pediatric case of obstructive jaundice due to malignant lymphoma treated with biliary reconstruction surgery. CASE PRESENTATION: A 5-year-old girl presented to our hospital with a massive abdominal tumor that caused biliary stricture. Chemotherapy was initiated after an open tumor biopsy. However, endoscopic biliary stent placement was performed owing to elevated bilirubin levels. We treated the patient with chemotherapy for 9 months while endoscopically replacing the biliary stent every few months. She achieved complete tumor remission. However, sclerotic lymph nodes were persistent on the dorsal side of the cholecystic duct junction, and biliary stricture at the same site had changed to stent-dependent biliary obstruction. Therefore, we performed choledochojejunostomy and retrocolic Roux-en-Y reconstruction 15 months after initial admission. There were no postoperative complications or tumor recurrences, and the bilirubin level remained low. Histopathologically, the resected bile duct wall was fibrotic and thick, and the bile duct lumen narrowed. CONCLUSIONS: Biliary reconstruction is effective to achieve long-term biliary patency in pediatric patients with stent-dependent biliary obstruction due to malignant lymphoma. However, the decision on when to stop biliary stent replacement and proceed to biliary reconstruction surgery is a matter of debate. Further case studies are required to address this issue.

Good stress management capability is associated with lower body mass index and restful sleep in the elderly.

Psychosocial stress is generally associated with adverse health behaviors and has been linked to the development of cardiovascular diseases (CVD). Recently, an individual's sense of coherence (SOC), which is a concept that reflects the ability to cope with psychosocial stress, has been recognized as an essential component of long-term health and stress management. The association between SOC and traditional and alternative atherosclerotic markers in a community sample, however, has not been thoroughly investigated. In the present study, we evaluated stress management capability and psychological conditions using the Japanese version of the Sense of Coherence-13 (SOC-13) Scale, supplemented by the General Health Questionnaire-12 (GHQ-12) that screens for minor psychiatric disorders. The study subjects were 511 adults, median age 64 years (range 48-70), who participated in a regular medical screening program in Nagasaki Prefecture, Japan. We then correlated our findings with atherosclerotic risk factors in the same community sample, such as body mass index (BMI) and proper and regular sleeping habits. We found that close association between good stress management capability and lower BMI and/or regular sleeping habits in elderly Japanese. This provides strong evidence that BMI and sleep management are contributory to SOC. If the ability to cope with psychosocial stress is important to the prevention of CVD, then weight control and proper sleep habits must be emphasized from a psychosocial stress-management perspective as well as a physical one.

Suitability of tartrate-resistant acid phosphatase type 5b as a screening marker for bone mineral density in community-dwelling elderly individuals.

Osteoporosis is a common disorder in aging populations that imposes considerable health problems. Tartrate-resistant acid phosphatase type 5b (TRAP-5b) is derived from osteoclasts, and is involved in normal bone homeostasis. Recently, a novel assay system for TRAP-5b, the fragments absorbed immunocapture enzymatic assay method, has been developed. To evaluate the suitability of TRAP-5b as a screening marker for bone mineral density (BMD), we explored the correlations between serum TRAP-5b concentrations and laboratory findings, body mass index, or BMD in 462 community-dwelling elderly individuals (249 men and 213 women, age 73.4±6.5 years) who participated in a regular medical screening program. By multivariate linear regression analysis adjusted for confounding factors, TRAP-5b was significantly correlated with body mass index (ß=-0.005, p=0.043), alkaline phosphatase, a marker for osteoid formation and calcification (ß=0.001, p<0.001), and triglyceride (ß=-0.097, p=0.016) in men, and with body mass index (ß=-0.009, p=0.025), alkaline phosphatase (ß=0.001, p<0.001), calcium (ß=-0.059, p=0.039), and bone trabecular area ratio (ß=-0.47, p=0.025) in women. In conclusion, the elevated serum level of TRAP-5b is independently correlated with the decreased BMD in women, but not in men. Because measurement of TRAP-5b is not affected by food intake, and blood samples can be collected at any time of the day, we suggest the suitability of serum TRAP-5b as a simple marker for the evaluation of BMD in women.

Human papillomavirus genotypes in penile cancers from Japanese patients and HPV-induced NF-κB activation.

The causal relationship between chronic inflammation and cancer is widely accepted. Numerous investigations have identified nuclear factor-κB (NF-κB) as an important modulator in driving chronic inflammation to cancer. This study aimed to determine the prevalence of human papillomavirus (HPV) in penile cancer in Japanese patients and whether NF-κB is subsequently overexpressed in penile cancer. Thirty-four specimens of penile tissue (16 malignant and 18 benign cases) were examined to determine the association of HPV infection. An in situ hybridization (ISH) method was used to detect and localize HPV-DNA. A sensitive HPV polymerase chain reaction (PCR) procedure was used for the detection of HPV-DNA, and DNA sequencing was used to identify the HPV genotype. HPV-DNA was detected in 37.5 and 75% of cases of penile cancer, using ISH and PCR, respectively. Our efforts to detect HPV genotypes were unsuccessful as HPV-DNA could not be extracted from these materials. Using ISH, a prevalence of 68.2% of HPV infection was found in penile cancer in Kenyan patients in east Africa. In the present study, all 9 HPV-positive cases, (100%) were NF-κB-positive in the nucleus and/or cytoplasm. In contrast, of the 25 HPV-negative cases, 15 (60%) were NF-κB-positive in the nucleus and/or cytoplasm. Therefore, ISH is a method which is able to prove infection of a large quantity of HPV more effectively when compared with PCR. Thus, a large quantity of HPV infection leads to the activity of NF-κB. The most prevalent genotype was the HPV-22 found in 83.3% of the penile cancer cases. In addition, HPV-11 was found in 81.8% of the non-cancer cases. For cases with a high level of infection, the activity of NF-κB increased compared with those with a low level of HPV infection.