Heterotopic pancreas is an aberrant pancreatic tissue that lacks anatomic and vascular continuity with the main pancreas. Although heterotopic pancreas is a relatively rare entity and usually noted as an incidentel findings at autopsy and during surgery for other causes, it is capable of producing symptoms depending on the site and size of lesions as well as various pathological changes occuring in the pancreas itself. We have recently experienced a case of heterotopic pancreas on the mid-body of posterior wall along the lesser curvatrue of stomach in a 30-year-old man, who visited our hospital for the evaluation of postprandial epigastric discomfort and indigestion for two months. Gastrofiberoscopy revealed a 3x4 cm sized submucosal mass, and subtotal gastrectomy gastrojejunostomy was performed and he was discharged without any postoative complication.
Adult ; Autopsy ; Dyspepsia ; Gastrectomy ; Gastric Bypass ; Humans ; Pancreas* ; Stomach

We present a patient with type 2 diabetes mellitus and metastatic renal cell carcinoma who developed severe hypoglycemia and metabolic encephalopathy after sunitinib treatment. Sunitinib, a multi-target tyrosine kinase inhibitor, is used to treat metastatic renal cell carcinoma. Sunitinib-induced hypoglycemia has been reported and there are rare case reports of severe hypoglycemia due to sunitinib. Therefore, glycemic control should be monitored closely in diabetic patients treated with sunitinib.
Brain Diseases, Metabolic ; Carcinoma, Renal Cell* ; Coma* ; Diabetes Mellitus, Type 2 ; Humans ; Hypoglycemia ; Protein-Tyrosine Kinases

Arsenic trioxide (As2O3) was introduced into the treatment of refractory or relapsed acute promyelocytic leukemia and showed a striking effectiveness in China and United States multicenter study. However, the mechanistic basis for the carcinogenic or therapeutic effects of arsenics is still poorly understood. So, this study is performed to determine whether As2O3 induces apoptosis through intrinsic caspase cascades in acute promyelocytic leukemia HL-60 cells. MATERIALS AND METHODS: HL-60 cells were treated with As2O3 to investigate apoptosis through signaling of caspase cascades and mitochondrial dysfunction. RESULTS: As2O3 (>0.5 uM) decreased the viability of HL-60 cells in a dose-dependent manner, which was revealed as apoptosis shown chromatin condensation and ladder pattern DNA fragmentation. As2O3 increased the catalytic activity of caspase family cysteine proteases including caspase-3 and -9 proteases. Consistently, PARP, an intracellular biosubstrate of caspase-3 protease, was cleaved from 116 kDa to 85 kDa fragments. It also induced the change of mitochondrial membrane potential. Morever, As2O3 resulted in the increase of Bak. CONCLUSION: These data suggest that As2O3 induces apoptosis of HL-60 cells through activation of intrinsic caspase protease with mitochondrial dysfunction.
Apoptosis* ; Arsenic* ; Caspase 3 ; China ; Chromatin ; Cysteine Proteases ; DNA Fragmentation ; HL-60 Cells* ; Humans ; Leukemia, Promyelocytic, Acute ; Membrane Potential, Mitochondrial ; Peptide Hydrolases ; Strikes, Employee ; United States

We experienced a case of acute panmyelosis with myelofibrosis, one of the acute myeloblastic leukemia (AML) subtypes according to WHO classification. A 44 year old man presented with a laborious dyspnea, dizziness, and generalized weakness. On admission, the peripheral blood revealed pancytopenia (hemoglobin 4.0 g/dL, WBC 2, 300/microliter, platelet 92, 000/microliter) with leukoerythroblastosis. The bone marrow (BM) aspirate yielded inadequate material but histological sections showed hyper-cellularity, proliferation of trilineage cell lines (panmyelosis) with extensive myelofibrosis, and clusters of immature cells at paratrabecular area. On ultrasonographic examination, no evidence of hepato-splenomegaly or any other abnormalities were noted. The follow-up BM study after the chemotherapy with Ara C for 7 days and idarubicin for 3 days showed no significant changes in pancytopenia and myelofibrosis but revealed a significant decrease in BM cellularity and blasts. We review and report the literature on acute panmyelosis with myelofibrosis.
Blood Platelets ; Bone Marrow ; Cell Line ; Classification ; Dizziness ; Drug Therapy ; Dyspnea ; Follow-Up Studies ; Idarubicin ; Leukemia, Myeloid, Acute ; Pancytopenia ; Primary Myelofibrosis*

We report a 58-year-old man who developed synchronous gastric non-Hodgkin`s lymphoma (NHL) and renal cell carcinoma. He presented with epigastric discomfort for 2 months. Endoscopic finding of the stomach disclosed a large inegular ulceration with nodular margin on the upper body. Constrast enhanced CT scan of the abdomen showed an ulceration and focal wall thickening in the greater curvature side of stomach, and an enhanced bulging mass in the left kidney incidentally. The tissue obtained by radical proximal gastrectomy and nephrectomy showed diffuse large B-cell lymphoma on stomach and chromophobic type of renal cell carcinoma on kidney. To our knowledge, this is the first report of synchronous gastric NHL and renal cell carcinoma in Korea.
Abdomen ; Carcinoma, Renal Cell* ; Gastrectomy ; Hodgkin Disease* ; Humans ; Kidney ; Korea ; Lymphoma ; Lymphoma, B-Cell ; Middle Aged ; Nephrectomy ; Stomach ; Tomography, X-Ray Computed ; Ulcer

BACKGROUND: Intracellular reactive oxygen species (ROS) have dual effects depending on their cellular level. ROS act as secondary messengers at a low concentration, although ROS exhaust the hematopoietic stem cell (HSC) compartment at a higher oxidized state. So, we investigated whether maintaining a low level of ROS could preserve the hematopoietic stem cell function according to the MnSOD over expression. METHODS: Human MnSOD cDNA was introduced into mouse HSCs and progenitor cells by using a MSCV-PGK-GFP retrovirus. The hematopoietic function of over-expressing MnSOD was evaluated in vitro on a colony-forming cell assay and in vivo in a competitive transplantation model. MnSOD-transduced, lineage negative, GFP+B6.SJL (CD45.1+) mouse bone marrow cells were transplanted into lethally irradiated C57BL/6J (CD45.2+) mice in competition with CD45.1/45.2 double positive bone marrow mononuclear cells. We also measured the basal mRNA levels of antioxidants, including MnSOD, catalase and cellular glutathione peroxidase (GPx1), of C57BL/6J HSCs. RESULTS: On the colony-forming cell assay, a MnSOD over expression significantly preserved the CFU-M with irradiation as compared with the mice without irradiation. HSCs with an MnSOD over expression showed a tendency for higher engraftment ability on the competitive transplantation assay even after 200 cGy re-irradiation, and we observed a significantly higher myeloid differentiation potential after the second serial transplantation. The basal mRNA levels of MnSOD and catalase were less than 1~2% and 2~5%, respectively, in the long-term and short-term HSCs, respectively, and these cells didn't activate in spite of radiation stress. CONCLUSION: These results show that only an over expression of MnSOD without downstream catalase activation can not augment the mouse hematopoietic stem cell repopulation activity.
Animals ; Antioxidants ; Bone Marrow ; Bone Marrow Cells ; Catalase ; DNA, Complementary ; Glutathione Peroxidase ; Hematopoietic Stem Cells ; Humans ; Mice ; Reactive Oxygen Species ; Retroviridae ; RNA, Messenger ; Stem Cells ; Superoxide Dismutase ; Transplants

A 44-year-old male presented with a month history of exertional dyspnea and dizziness. A peripheral blood smear revealed a pancytopenia with 3% of blasts. We were not able to obtain a bone marrow aspirate, but a biopsy specimen showed hypercellularity, proliferation of trilineage cell lines (panmyelosis) with extensive myelofibrosis, and clusters of immature cells at the paratrabecular area. After remission induction therapy with idarubicin 12mg/m2 (D1-3) and cytosine arabinoside 100mg/m2 (D1-7), the bone marrow blast count was decreased, but the marrow fibrosis and pancytopenia persisted. Peripheral blood stem cell transplantation from his HLA-matched brother was performed after administering fludarabine 30mg/m2 for 5 days and busulfan 3.2mg/kg for 2 days. Early engraftment occurred and the bone marrow reticulin fibrosis disappeared. Full-donor chimerism was demonstrated at day 22 by performing short tandem repeats analysis and this was maintained for 1 year. The patient has survived 20 months after transplantation without any complication.
Adult ; Biopsy ; Bone Marrow ; Busulfan ; Cell Line ; Chimerism ; Cytarabine ; Dizziness ; Dyspnea ; Fibrosis ; Humans ; Idarubicin ; Male ; Microsatellite Repeats ; Pancytopenia ; Peripheral Blood Stem Cell Transplantation* ; Primary Myelofibrosis* ; Remission Induction ; Reticulin ; Siblings

Active infective endocarditis, involving native, is often complicated by conduction abnormalities. These conduction disturbances are considered to represent an extension of the infection from the valve to the annulus, and to the surrounding myocardium. We describe a case of a 59-year-old woman who presented with dyspnea due to staphylococcal endocarditis, which was complicated by a complete heart block.
Dyspnea ; Endocarditis ; Endocarditis, Bacterial* ; Female ; Heart Block* ; Heart* ; Humans ; Middle Aged ; Myocardium

In this paper, the authors intended to summarize briefly the features of lymphoma with regard to (18)F-FDG PET for assessment of tumor response to therapy, to describe why assessment of treatment response should be performed, to review what method so far has been used in monitoring treatment response, to discuss what limitations of morphologic imaging criteria for assessing tumor response are, in compared with (18)F-FDG PET, and to introduce recently proposed criteria for assessing tumor response in malignant lymphoma. And also the authors emphasize the need to understand the characteristics of diagnostic performance of (18)F-FDG PET in several clinical settings in order to interpret (18)F-FDG PET results appropriately, and to encourage the use of interval likelihood ratio to enhance clinical implications of test results which, in turns, allows referring physicians to understand the meaning of interpretation with easy. Until recently, treatment response has been assessed according to the morphologic criteria. Metabolic imaging with (18)F-FDG PET was adopted to have important role for treatment assessment in IWC+PET criteria proposed recently by IHP. To accomplish this role, we should perform and interpret (18)F-FDG PET according to IWC+PET criteria. It is important for referring physicians to understand the various limitations of (18)F-FDG PET and pitfalls in PET interpretation, and to understand that clinical information are needed by nuclear medicine physicians to optimize the interpretation of (18)F-FDG PET.
Lymphoma ; Nuclear Medicine ; Positron-Emission Tomography

A 59-year-old male who had suffered from multiple myeloma for nine years and had been administered bisphosphonates for seven years visited a dental hospital for pain relief due to extensive caries in his left maxillary molars. The molars were extracted, leaving an exposed wound for three months. The radiograph showed sequestra formation and irregular bone destruction in the left maxilla. Sudden pain and gingival swelling in the right mandibular molar area occurred six months later. The interseptum of the right lower second molar was observed to be necrotic during surgery. These findings coincided with the features of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this case, the long intravenous administration of bisphosphonates and tooth extraction were likely the etiologic factors of BRONJ in a patient with multiple myeloma; moreover, the bilateral occurrence of BRONJ is a characteristic feature.
Administration, Intravenous ; Bisphosphonate-Associated Osteonecrosis of the Jaw* ; Diphosphonates ; Humans ; Male ; Maxilla ; Middle Aged ; Molar ; Multiple Myeloma* ; Tooth Extraction ; Wounds and Injuries