Autoimmune pancreatitis detected as a mass in the tail of the pancreas.

A mass in the tail of the pancreas was detected in a 62-year-old male patient who had hypergammaglobulinaemia, and was positive for antinuclear antigen and anti-SS-A antibody. Endoscopic retrograde pancreatography revealed focal irregular narrowing of the main pancreatic duct in the tail of the pancreas. Dynamic computed tomography showed swelling of the pancreatic tail, which was enhanced on delayed phase. Autoimmune pancreatitis was suspected and corticosteroid therapy was commenced. This led to significant resolution of the pancreatic stricture. It is important to recognize this clinical entity as corticosteroid therapy may avoid unnecessary surgery.

[A clinical study on the cases of ischemic colitis: comparison of clinical images based on time from onset of the disease to detection of bloody stool].

A study was performed on 28 cases of ischemic colitis. The patients were divided into three groups: Group A (9 cases with bloody stool detected within 2 hours after the onset of abdominal pain), Group B (7 cases with bloody stool detected in 2 to 6 hours), and Group C (12 cases with bloody stool detected after more than 6 hours). These cases were comparatively studied. Variables used were as follows: (1) age, (2) sex, (3) constipation, (4) vomiting, (5) peak value of WBC count (/microliter) after admission, (6) peak value of log CRP (microgram/dl), (7) presence of ulcerative lesion in endoscopic findings in acute stage. Using Group A B and C as classification variables, canonical discriminant analysis was performed. As a result, clear linearity was recognized in Group A-->B-->C, and the values (5), (6) and (7) were extracted as the corresponding variables. For these variables, significant difference was also noted in multivariate analysis of covariance. These results suggest that it is possible to predict the severity of the disease to some extent as represented by objective markers of inflammation by finding the time from onset of abdominal pain to detection of bloody stool.

Liver damage in patients with colony-stimulating factor-producing tumors.

PURPOSE: We have demonstrated that colony-stimulating factor (CSF)-producing tumor cell lines produce not only CSF but also interleukin-1 (IL-1) and interleukin-6 (IL-6). Clinically, we have observed that patients bearing such tumors present with liver dysfunction and fever in addition to marked leukocytosis. The purpose of this study was to determine whether or not the liver damage was specifically related to CSF-producing tumors. PATIENTS AND METHODS: Clinicopathologic examinations were performed in six autopsied patients with CSF-producing tumors. We also transplanted two tumor cell lines (KHC287 and CHU-2), which produce granulocyte (G)-CSF, IL-1, and IL-6, to nude mice. RESULTS: Of the six patients, five had G-CSF- and one had granulocyte/macrophage (GM)-CSF-producing tumors. IL-1 and IL-6 concentrations in plasma or culture supernatant were elevated in these patients. Biochemical examinations revealed high serum enzyme levels of the biliary system in contrast to normal or slight increases in transaminase levels in all patients studied. Serum direct bilirubin was elevated in five of the six patients. Three common pathologic changes of the liver were found: (1) focal necrosis associated with neutrophil infiltration in the centrilobular zones, (2) fibrous change and enlargement of the portal area associated with neutrophil infiltration, and (3) intrahepatic cholestasis. The same pathologic changes, except for cholestasis, were reproduced in the liver of mice transplanted with KHC287 or CHU-2. CONCLUSION: These results indicate that patients with CSF-producing tumors have characteristic liver damage, and suggest a new paraneoplastic syndrome of leukocytosis and liver damage.

Cheiro-oral-pedal syndrome.

The cheiro-oral syndrome is a well-known peculiar sensory disturbance seen around the corner of the mouth and in the palm of the hand on the same side. However, sensory disturbance around the corner of the mouth, in the palm of the hand and in the foot on the same side (cheiro-oral-pedal syndrome) has not been reported until now. We examined 2 cases of cheiro-oral-pedal syndrome; the lesion responsible was confirmed by magnetic resonance imaging to be in the medial lemniscus and in the ventral ascending tract of the trigeminal nerve.

Identification of colony-stimulating factor activity in patients with malignant tumors associated with excessive leukocytosis.

We have tried to demonstrate and identify colony-stimulating factor (CSF) activity in the plasma, pleural fluid, ascites or culture supernatant of tumor cells in 11 patients with malignant tumors associated with unexplained persistent leukocytosis. The specimens were treated with anti-granulocyte (G)-CSF or anti-granulocyte/macrophage (GM)-CSF monoclonal antibodies, then added to GM-progenitor (CFU-GM) cultures without exogenous CSFs. In all patients, untreated specimens generated CFU-GM-derived colonies, and colony formation was clearly inhibited by only one of the two antibodies, indicating the presence of either G-CSF or GM-CSF in the specimens. Furthermore, we measured the concentrations of G-CSF or GM-CSF in the specimens using an enzyme-linked immunosorbent assay, and confirmed the results by CFU-GM assay. Two patients were shown to have GM-CSF-producing tumors, while the other patients were G-CSF-producing. These assays are useful in identifying CSF activity in patients with CSF-producing tumors.

[Studies on the usefulness of a long-term, high-dose treatment of methylcobalamin in patients with oligozoospermia].

Methylcobalamin (CH3-B12) was administrated in a dose of 6 mg per day (group A, 16 cases) or 12 mg per day (group B, 23 cases) for 16 weeks to patients with oligozoospermia. There was no difference between group A and group B regarding vitamin B12 concentrations in the serum or seminal fluid. CH3-B12 appeared to be transported to seminal fluid very efficiently. However, results from group A and group B did not differ with respect to this parameter. The efficacy rate for group A was 37.5% and that for group B was 39.1%. From these results, it was concluded that a long-term, high dose treatment of CH3-B12 was useful for the treatment of patients with oligozoospermia. Since the efficacy rates were not different between the two groups, 6 mg per day would be the recommended dose. Clinical adverse reactions were observed in one patient in each group. Drug-related laboratory adverse reactions were observed in only one patient in group B.

[Efficacy of a latex Foley catheter with sustained release of chlorhexidine: 1st report: Clinical trials for the prevention of urinary tract infection].

Seventy five patients requiring urethral catheterization for over 24 hours were treated with a latex Foley catheter with sustained release of chlorhexidine in a closed drainage system. While the catheter was indwelling, urinary concentrations of chlorhexidine were maintained at the level of 1 to 2 micrograms/ml in average in almost all patients. The catheter was highly effective in preventing the acquisition of catheter-associated bacteriuria in patients with initially sterile urine without systemic antimicrobial therapy. The acquisition rate of bacteriuria was 8, 16, 23, 35 and 74% on day 3, 4, 5, 6 and 7 with the catheter indwelling, respectively. The catheter was not effective in eradicating preexisting bacteriuria. Complications of the catheter were minimal.

Serum levels of aminoterminal type III procollagen peptide in normal subjects and hepatic fibrosis.

Serum levels of aminoterminal type III procollagen peptide in normal subjects were determined by radioimmunoassay. The levels of the peptide markedly increase in infants and gradually decrease with age in childhood. The peptide increases again in prepubertal children and then decreases through adulthood. These findings suggest that increased levels of the peptide reflect accelerated collagen synthesis in the human body. Comparison of serum levels of the peptide with the degree of hepatic fibrosis revealed that the peptide increased in parallel with the progress of hepatic fibrosis.

[A clinical evaluation of doxycycline in the treatment of genitourinary infections caused by Chlamydia trachomatis].

The clinical effectiveness of doxycycline (DOXY) in the treatment of chlamydial infections was studied by giving it to 14 patients composed of 9 with nongonorrheal urethritis and 5 with cervicitis, all caused by Chlamydia trachomatis. DOXY was given in an oral dose of 100 mg twice daily for 4 to 19 days. The total dosage ranged from 800 to 3,800 mg. The overall clinical efficacy as assessed on the basis of both bacterial response and relief of subjective or objective symptoms was excellent in all of 12 evaluable patients. Two patients for whom we failed to perform postdose bacteriological examinations were excluded from evaluation. No side effect related to dosing of DOXY developed.

Lymphocyte-mediated enhancement of hepatic fibrosis in chronic active hepatitis.

The effect of the supernatant from a culture of liver specific protein-stimulated lymphocytes on collagen production by cultured fibroblasts was examined. The supernatant from the culture of unstimulated lymphocytes was used as a control. Both supernatants were added to the culture medium of L929 fibroblast monolayer. After incubation for 72 hours, 1 microCi of tritium-labelled proline was added to the culture medium of the monolayer. The radioactivity of tritium labelled hydroxyproline incorporated into collagen was measured. The results demonstrated that the supernatant from the culture of stimulated lymphocytes enhanced collagen production in 5 of 6 cases of chronic active hepatitis and in 2 of 14 cases of chronic inactive hepatitis. These findings suggest that cellular immune regulation may play an important role in the development of hepatic fibrosis in chronic active hepatitis.