Retrospective analysis of progression to multiple myeloma or related disorders in 114 patients with monoclonal gammopathy of undetermined significance in a single institute

In 114 patients with monoclonal gammopathy of undetermined significance (MGUS) followed-up in Tachikawa Sougo hospital, we retrospectively analyzed progression of their disease to multiple myeloma (MM) or related disorders. The analysis was based on a total of 1,170 person-years of follow-up in a cohort with a median age at diagnosis of MGUS of 68 years 3 months, and with a median follow-up period of 9 years 5 months. Of these 114 patients, 13 (11%) showed progression to MM or related disorders with a median time to progression of 9 years 4 months; and the median age of these 13 patients was 78 years 8 months. The cumulative hazard ratio of progression at 5, 10, 15, and 20 years after diagnosis was 3.0%, 9.0%, 11.4%, and 32.1%, respectively. The risk of progression of MGUS to MM or related disorders in Japanese patients was as high as in Western patients studied previously, demonstrating that MGUS should be carefully monitored as a preneoplastic condition.     

The efficacy of continuous subcostal transversus abdominis plane block for analgesia after living liver donation: a retrospective study

Purpose

Postoperative pain management for living liver donors has become a major concern as a result of the increasing number of living liver donations. Transversus abdominis plane (TAP) block has been known to provide effective analgesia for abdominal surgery. The aim of this study was to evaluate the efficacy of ultrasound-guided continuous subcostal TAP block as a part of a multimodal analgesic regimen in comparison with conventional intravenous (IV) fentanyl-based analgesia in living liver donors.

Methods

Thirty-two donors were retrospectively classified into either the continuous subcostal TAP block group (TAP group) or the IV fentanyl-based analgesia group (control group). TAP group donors received bilateral continuous subcostal TAP infusion of 0.125 % levobupivacaine at 6 ml/h. Control group donors did not receive any neural blockade.

Results

Cumulative fentanyl consumption was significantly lower in the TAP group for 48 h (P < 0.01) as compared to the control group. Further, the donors in the TAP group had significantly lower incidence of nausea and vomiting during 24–48 h postoperatively (P < 0.01) and fewer delays in the initiation of oral intake than those in the control group (P = 0.02).

Conclusions

In conclusion, continuous subcostal TAP block provided an effective opioid-sparing analgesia for living liver donors.

     

Relation Between Cochlear Mechanics and Performance of Temporal Fine Structure-Based Tasks

This study examined whether the mechanical characteristics of the cochlea could influence individual variation in the ability to use temporal fine structure (TFS) information. Cochlear mechanical functioning was evaluated by swept-tone evoked otoacoustic emissions (OAEs), which are thought to comprise linear reflection by micromechanical impedance perturbations, such as spatial variations in the number or geometry of outer hair cells, on the basilar membrane (BM). Low-rate (2 Hz) frequency modulation detection limens (FMDLs) were measured for carrier frequency of 1000 Hz and interaural phase difference (IPD) thresholds as indices of TFS sensitivity and high-rate (16 Hz) FMDLs and amplitude modulation detection limens (AMDLs) as indices of sensitivity to non-TFS cues. Significant correlations were found among low-rate FMDLs, low-rate AMDLs, and IPD thresholds (R = 0.47–0.59). A principal component analysis was used to show a common factor that could account for 81.1, 74.1, and 62.9 % of the variance in low-rate FMDLs, low-rate AMDLs, and IPD thresholds, respectively. An OAE feature, specifically a characteristic dip around 2–2.5 kHz in OAE spectra, showed a significant correlation with the common factor (R = 0.54). High-rate FMDLs and AMDLs were correlated with each other (R = 0.56) but not with the other measures. The results can be interpreted as indicating that (1) the low-rate AMDLs, as well as the IPD thresholds and low-rate FMDLs, depend on the use of TFS information coded in neural phase locking and (2) the use of TFS information is influenced by a particular aspect of cochlear mechanics, such as mechanical irregularity along the BM.     

Cloning of B cell-specific membrane tetraspanning molecule BTS possessing B cell proliferation-inhibitory function

Lymphocyte proliferation is regulated by signals through antigen receptors, co-stimulatory receptors, and other positive and negative modulators. Several membrane tetraspanning molecules are also involved in the regulation of lymphocyte growth and death. We cloned a new B cell-specific tetraspanning (BTS) membrane molecule, which is similar to CD20 in terms of expression, structure and function. BTS is specifically expressed in the B cell line and its expression is increased after the pre-B cell stage. BTS is expressed in intracellular granules and on the cell surface. Overexpression of BTS in immature B cell lines induces growth retardation through inhibition of cell cycle progression and cell size increase without inducing apoptosis. This inhibitory function is mediated predominantly by the N terminus of BTS. The development of mature B cells is inhibited in transgenic mice expressing BTS, suggesting that BTS is involved in the in vivo regulation of B cells. These results indicate that BTS plays a role in the regulation of cell division and B cell growth.     

Multifocal lesions with pancreatic atrophy in IgG4-related autoimmune pancreatitis: report of a case

We herein report a case of IgG4-related autoimmune pancreatitis (AIP). A 72-year-old male with jaundice visited our hospital complaining of epigastralgia. A blood chemistry analysis revealed elevated serum levels of total bilirubin and DUPAN-II. Computed tomography (CT) revealed irregularly shaped pancreatic masses with a stricture of the main pancreatic duct (MPD) in the head and tail that were interposed by marked atrophy with MPD dilation in the body. F-18 fluorodeoxyglucose (FDG)-positron emission tomography/CT revealed abnormally intense FDG uptake only at the masses. During surgery, another small tumor was also found in the atrophied body; therefore, a total pancreatectomy was performed under the diagnosis of multiple pancreatic cancers. The histological analysis revealed fibrosis with dense and diffuse infiltrations of lymphocytes and IgG4-positive plasma cells. The pancreatic parenchyma of the body was firmly replaced by fibrosis. AIP can lead to the formation of multiple pancreatic lesions, and thus the correct diagnosis is occasionally difficult to establish in atypical cases.     

Microscopic polyangiitis associated with marked systemic bleeding tendency caused by disseminated intravascular coagulation

A 57-year-old woman was admitted to our hospital because of severe dyspnea due to pulmonary hemorrhage and rapidly progressive renal failure. The patient was positive for perinuclear pattern anti-neutrophil cytoplasmic antibody (p-ANCA) and was manifested with gastrointestinal bleeding and brain hemorrhage. Thus, she was diagnosed as having microscopic polyangiitis (MPA). Laboratory examination demonstrated severe thrombocytopenia, increased prothrombin time and a high concentration of fibrin degradation products. In addition, the elevated plasma levels of D-dimer, thrombin-antithrombin complex and plasmin-plasmin inhibitor complex led us to make a diagnosis of disseminated intravascular coagulation (DIC). Complication of DIC was considered to have caused further deterioration in bleeding tendency due to MPA in the present case. The patient was treated with plasma exchange, hemodialysis, administration of corticosteroid including pulse therapy and cyclophosphamide. Continuous infusion of gabexate mesilate proved effective for improvement of systemic bleeding tendency. However, she finally died of severe infectious diseases. In conclusion, it is suggested that ANCA-associated vasculitis could be accompanied by DIC and gabexate mesilate may be a useful therapeutic agent for these disorders.     

Improved survival rate by temperature control at compression sites in rat model of crush syndrome

Background

Crush syndrome (CS) has been reported in disasters, terrorist incidents, and accidents, and the clinical and pathologic picture has gradually been clarified. Few lethal and reproducible animal models of CS with use of a quantitative load are available. A new model is needed to investigate pathologic and therapeutic aspects of this injury.

Materials and methods

Using a device built from commercially available components, both hindlimbs of anesthetized rats were respectively compressed for 6 h using 3.6-kg blocks. The effects of trunk warming alone without compressed hindlimbs (Group A), non-warming at room temperature (Group B), whole-body warming including compressed hindlimbs (Group C), or warming of compressed hindlimbs alone (Group D) during compression were examined. Survival rates were compared and hematological and histologic analyses were performed at specific time points after compression release.

Results

Limb or whole-body warming significantly worsened the survival of rats. We found a much lower survival rate of 0%–10% in animals, in which the hindlimbs were warmed during compression (Groups C and D) at 12 h after compression release, compared with 90%–100% in animals without warming of the hindlimbs (Groups A and B). Groups C and D showed significantly enhanced hyperkalemia at ≥4 h after compression release and all blood samples from dead cases showed hyperkalemia (>10 mEq/L).

Conclusions

We developed a new lethal and reproducible rat CS model with a quantitative load. This study found that warming of compressed limbs worsened the survival rate and significantly enhanced hyperkalemia, apparently leading to cardiac arrest.