Acute Abdomen and Adrenal Swelling as the First Manifestations of TAFRO Syndrome.

TAFRO syndrome, a rare systemic inflammatory disorder, commonly develops in an acute or subacute manner, with an aggressive clinical behavior. A substantial number of cases of TAFRO syndrome presenting with abdominal pain, and adrenal abnormalities on imaging have also been reported. A 54-year-old man developed severe acute abdominal pain. Bilateral adrenal swelling was detected on computed tomography. Although the abdominal pain resolved spontaneously, a fever and anasarca were observed. The patient was eventually diagnosed with TAFRO syndrome, and corticosteroid administration resulted in remission. TAFRO syndrome should be included in the differential diagnosis of acute abdomen and adrenal abnormalities.

Water-phase synthesis of Au and Au-Ag nanowires and their SERS activity.

Metal nanowires (NWs) with a diameter of a few nanometers have attracted considerable attention as a promising one-dimensional nanomaterial due to their inherent flexibility and conductive properties and their weak plasmon absorption in the visible region. In a previous paper, we reported the synthesis of ultrathin 1.8 nm-diameter Au NWs using toluene-solubilized aqueous solutions of a long-chain amidoamine derivative (C18AA). This study investigates the effect of different organic solvents solubilized in C18AA aqueous solutions on the morphology of the Au products and demonstrates that solubilizing methylcyclohexane yields thick 2.7 nm-diameter Au NWs and 3.3 nm-diameter Au-Ag alloy NWs. Further, the surface-enhanced Raman scattering sensitivity of ultrathin Au NWs, thick Au NWs, and thick Au-Ag alloy NWs were assessed using 4-mercaptopyridine and found that their enhancement factors are 104-105 and the order is Au-Ag NWs > thick Au NWs > ultrathin Au NWs.

Gastrointestinal Stromal Tumor in a Patient with Neurofibromatosis Type 1 That Was Successfully Treated with Regorafenib.

An unconscious 55-year-old man with a history of neurofibromatosis type 1 (NF1) was transported to the emergency department and was diagnosed with acute renal failure owing to a large bladder tumor. A submucosal tumor was also identified in the duodenum. The patient was diagnosed with a primary gastrointestinal stromal tumor (GIST) of the bladder and duodenum. After six cycles of regorafenib therapy, 18F-fluorodeoxyglucose accumulation in the duodenal GIST on positron emission tomography-computed tomography (PET-CT) showed a partial metabolic response. Currently, no standard drug therapy for unresectable or relapsed NF1-associated GIST has been established. Regorafenib may thus be considered as and appropriate initial therapy.

Differences in the incidence of postoperative pneumonia after percutaneous endoscopic gastrostomy between liquid and semi-solid nutrient administration.

BACKGROUND/OBJECTIVES: This historical control study examined the differences in the incidence of postoperative pneumonia between patients administered liquid and semi-solid nutrients after percutaneous endoscopic gastrostomy (PEG). SUBJECTS/METHODS: The medical records of adult patients who underwent PEG between March 1999 and March 2014 were investigated. The patients were administered either liquid or semi-solid nutrient and examined for gastroesophageal reflux via radiography after PEG. The study period was divided into periods I (liquid nutrient to all patients), II (semi-solid nutrient to patients with reflux and liquid nutrient to those without), and III (semi-solid nutrient to all patients). The patient characteristics and incidence of postoperative pneumonia were stratified by the periods. To assess the relationship between postoperative pneumonia and the periods, a logistic regression analysis was performed. RESULTS: Of 370 patients enrolled, 149 were in period I, 64 in period II, and 157 in period III. Postoperative pneumonia was more frequently observed in period I (20.8%) than in periods II (7.8%) and III (10.2%). The odds ratios were higher in period I (period I vs. II: 3.10 [95% confidence intervals: 1.15-8.38]; period I vs. III: 2.32 [1.21-4.44]). The incidence of gastroesophageal reflux did not greatly differ between periods II (25.0%) and III (35.0%). CONCLUSIONS: The incidence of postoperative pneumonia after PEG was lower in the patients administered semi-solid nutrient than in those administered liquid nutrient, suggesting that semi-solid nutrient administration to patients with PEG tubes is preferable to prevent postoperative pneumonia. Furthermore, it may be favored especially in those with gastroesophageal reflux.

[Improvement of hepatomegaly after treatment with autologous hematopoietic stem cell transplantation followed by bortezomib and dexamethasone in Bence-Jones protein κ-type of multiple myeloma with systemic amyloidosis].

A 51-year-old man was admitted to our hospital complaining of right upper quadrant abdominal and back pain. Severe hepatomegaly (six fingerbreadths) was detected by liver palpation. Blood test results showed cholestatic liver disease. He was diagnosed with amyloidosis by liver biopsy. Bone marrow aspiration revealed 15% of contents to be plasma cells. BJPκ was detected by urine electrophoresis. Therefore, he was diagnosed with the BJPκ type of multiple myeloma with systemic amyloidosis. The patient was treated with bortezomib, dexamethasone and high-dose melphalan with autologous peripheral blood stem cell transplantation. He achieved VGPR (very good partial response) after transplantation. Hepatomegaly improved but swelling persisted, and he was therefore treated with 1.3 mg/m(2)/day of bortezomib and 20 mg/day of dexamethasone on day 1 and day 15 in 28-day cycles. Upon finishing 22 cycles in June 2014, his liver had returned to normal size. Restoration of normal liver size after treatment is rare in cases with severe hepatomegaly due to systemic amyloidosis. We thus report our case with a review of the relevant literature.

[A long term survivor of advanced gastric cancer treated with multi-drug combination chemotherapy].

We report a case of 70-year-old man who was admitted to our hospital due to hematemesis in June 2004. He was diagnosed by gastroscopy as having a type III moderately-poorly differentiated adenocarcinoma. A computed tomography (CT) scan revealed multiple lymph nodes swelling (#13, #16), finally he was diagnosed with gastric cancer stage IV (cT3, cN3, cM1). He was treated with S-1, but lymph nodes swelling increased in size, and then in March 2005, the treatment was changed to a second-line chemotherapy consisting of CPT-11 and CDDP. Abdominal CT scan showed a remarkable reduction of #16b1 lymph node, and the second-line chemotherapy was continued until 23 courses. But in April 2007, gastroscopy revealed the enlargement of gastric lesion. He was treated by third-line chemotherapy consisting of paclitaxel and doxifluoridine. This therapy was effective and continued until 7 courses. However, the treatment gradually became resistant and he died in May 2008, which was 4 years since the initial diagnosis.

Host-guest complexation affected by pH and length of spacer for hydroxyazobenzene-modified cyclodextrins.

Three modified beta-cyclodextrins appended with a hydroxyazobenzene as a dye unit, 1, 2, and 3, each incorporating a different length spacer between the beta-CD and the dye unit with a bis(propyl(oxyethylene)), butylene, and amide bond spacer, respectively, were synthesized in order to investigate their spectroscopic changes induced by pH and host-guest complexation as well as to investigate their conformations and guest-binding properties by means of absorption and induced circular dichroism spectroscopies in aqueous solutions. All hosts accommodated the dye unit in their own CD cavities with an orientation parallel to the CD axis, forming intramolecular complexes. When the pH of the solution changed, the structure changed in response to pH without conformational changes. Existing as the phenol form under acidic condition, they were converted to the yellow phenolate form by dissociation of a proton of the hydroxyl group in the dye unit with increasing pH (pK(a1); 7.62 for 1, 7.44 for 2, 8.00 for 3). Further increase in pH led to the dissociation of the ammonium proton in the secondary amine group in the spacer of 1 and 2 (pK(a2); 8.76 for 1, 8.67 for 2). Upon addition of 1-adamantanol (AN) as a guest, all hosts accommodated AN in their CD cavities, forming 1:1 host-guest inclusion complexes. The complexation phenomena were accompanied with changes in the conformation of the hosts, in which the dye units of 1 and 2 are excluded to outside of the cavity, but not for 3. The dye unit of 3 remained in the cavity, where the guest was also included partly. Therefore, the guest-binding abilities of 1 and 2 were larger than that of 3, which has poor binding ability. The binding constants of 1, 2, and 3 for AN are estimated to be 7400, 1940, and 140 M(-1) at pH 3.2, respectively. However, the guest-binding abilities of 1 and 2 were dependent on the pH of the solution. The ability of 1 under weak alkaline condition was stronger than under acidic or alkaline conditions, while that of 2 increased with increasing pH. Under the condition from neutral to weak alkaline media, 1 and 2 demonstrated color changes from colorless to yellow upon formation of inclusion complexes. When 1-adamantanecarboxylic acid (AC) was used as the charged guest, 1 and 2 bound to AC with a larger binding constant than AN. On the other hand, 1 and 2 bound to 1-adamantineamine (AA) with a smaller binding constant than AN. All these results demonstrate that the complexation phenomena depend on the pH of the solution as well as the length of the spacer of the hosts and that the electrostatic interaction between the host and the guest is also important for forming a stable complex.

[Mixed warm and cold antibody-type autoimmune hemolytic anemia in a healthy pregnant woman with primary cytomegalovirus infection].

A 25-year-old previously healthy pregnant woman was admitted to our hospital because of severe anemia (Hb 6.7 g/dl), and diagnosed as having mixed-type autoimmune hemolytic anemia (AIHA) due to de novo cytomegalovirus (CMV) infection. After daily administration of prednisolone, the anemia gradually resolved and the patient delivered a healthy baby. This is the first report of a healthy person suffering from mixed-type AIHA due to de novo CMV infection.