[Elevation of tumor markers as a diagnostic clue in two cases of symptomless late recurrence after resection of gastric cancer].

We present two cases of late recurrence after gastrectomy for gastric carcinoma. Both patients had medical examinations regularly and had no symptom of recurrence and serum tumor markers remained normal after surgery. 7 and 8 years after resection of gastric cancer, serum tumor marker levels elevated and cancer recurrence was confirmed by lymph node swelling by CT and PET study. Case 1 was a 69-year-old woman. 7 years after distal gastrectomy, CA 19-9 elevated and late recurrence of gastric carcinoma was diagnosed. Case 2 was a 63-year-old woman, 8 years after total gastrectomy, CEA elevated and late recurrence of gastric carcinoma was diagnosed. Late recurrence more than 5 years after resection of gastric cancer is not rare, and periodic examination of tumor markers would be helpful to diagnose recurrence before it becomes symptomatic.

Chronic pericardial constriction induced severe ischemic hepatitis manifesting as hypoglycemic attack.

Ischemic hepatitis, otherwise known as "shock liver", is characterized by a massive, but transient increase in serum transaminase levels, usually associated with cardiac failure. A patient who did not have a predisposition to hypoglycemia was discovered at home with disturbed consciousness caused by hypoglycemia. She had been diagnosed as having constrictive pericarditis several years earlier and had developed ischemic hepatitis. Though the high serum transaminase levels were rapidly normalized, severe jaundice gradually developed and the patient finally died of multiple organ failure. Hypoglycemia, which is considered secondary to reduced gluconeogenesis in the exhausted liver, is a rare complication of constrictive pericarditis.

A case of human fasciolosis: discrepancy between egg size and genotype of Fasciola sp.

In human fasciolosis, differential diagnosis of the causative flukes, Fasciola hepatica and Fasciola gigantica, is problematic. We report a rare case of human fasciolosis in which an adult worm was recovered from the bile duct of a Japanese man. Morphometric data of the worm were consistent with those of F. hepatica, whereas the size of eggs in the stool indicated infection with F. gigantica. Nucleotide sequences of ITS-1 and -2 and CO1 genes of the DNA extracted from the eggs revealed that the genotype was that of F. hepatica. These findings suggest that the size of eggs is not a suitable marker for species identification in human fasciolosis, especially in settings such as the East Asian region where different karyotypes and hybrid genotypes of F. hepatica and F. gigantica have been found.

[A case of minimal invasive carcinoma from intraductal papillary mucinous neoplasm with invasive ductal carcinoma of the pancreas].

A 69-year-old man was referred to our hospital for epigastralgia. He was found to have elevation of serum amylase and CA19-9. Ultrasonography, abdominal CT, MRCP, ERCP and EUS showed the cystic lesion and a possibility of an other tumor. There was a stenosis of the main pancreatic duct (MPD) at the pancreas head and dilatation of the MPD from the body to the tail. Intraductal papillary mucinous neoplasm (IPMN) of the branch pancreatic duct was diagnosed, and there was a likelihood of ductal carcinoma of the pancreas. We therefore performed pancreatoduodenectomy. Pathological finding showed invasive carcinoma from an intraductal papillary mucinous neoplasm with invasive ductal carcinoma of the pancreas.