[A case of curatively resected sigmoid colon cancer after mFOLFOX6 plus panitumumab neoadjuvant chemotherapy].

A 54-year-old man with residual urine, abdominal pain, and a high fever was diagnosed with KRAS wild-type sigmoid colon cancer with urinary bladder invasion. Considering the difficulty of curative resection, we first performed an ileostomy. Remarkable tumor regression was indicated by computed tomography(CT)and colonoscopy after 3 courses of mFOLFOX6 plus panitumumab. A sigmoidectomy and partial cystectomy were performed with a curative intent. Six courses of XELOX adjuvant chemotherapy were administered, and no recurrence has been observed for 9 months. mFOLFOX6 plus panitumumab might be an effective preoperative chemotherapy for patients with locally advanced KRAS wild-type colon cancer.

[Secondary pulmonary alveolar proteinosis associated with myelodysplastic syndrome].

A 51-year-old man with myelodysplastic syndrome (MDS) was admitted to our hospital because of dyspnea on exertion in December 1999. Chest radiography showed ground-glass shadows in the middle and lower fields of both lungs, and chest computed tomography revealed a typical "crazy paving appearance". The bronchoalveolar lavage fluid was milky in appearance, and so secondary pulmonary alveolar proteinosis associated with MDS was diagnosed. Because there was no need to treat his MDS, we twice performed whole-lung lavage under general anesthesia in January and February 2000. The treatments were effective, and his abnormal chest radiography findings, laboratory data and pulmonary function were normalized. This was a rare case of secondary pulmonary alveolar proteinosis associated with MDS successfully treated with whole-lung lavage.

[Eosinophilic pleural effusion associated with dantrolene administration].

A 42-year old man was admitted to our hospital for evaluation of pleural effusion in the right hemithorax. He had been treated for spastic paraplegia with dantrolene sodium for 28 months. The pleural fluid consisted of sterile exudates with a very high eosinophil count, and peripheral blood eosinophilia was noted. Thoracoscopy revealed no apparent abnormalities and a pleural biopsy specimen showed only non-specific inflammation. Two weeks after discontinuing dantrolene therapy, the pleural effusion disappeared. The toxicity of dantrolene in patients with pleural effusion must be taken into consideration when long-term dantrolene therapy is given.

Oncostatin M production by human dendritic cells in response to bacterial products.

Oncostatin M (OSM) is a pleiomorphic cytokine that belongs to the IL-6 cytokine family. It is produced by activated T cells and monocytes/macrophages and plays an important role in the process of inflammatory responses. Although dendritic cells (DCs) have been shown to secrete a variety of cytokines, it is not elucidated whether DCs are able to produce OSM. To clarify this, using human DCs derived from peripheral blood cells, we measured the protein levels of OSM in the supernatants of DC cultures by ELISA and examined the expression of OSM mRNA by RT-PCR after stimulation with lipopolysaccharide (LPS) or fixed Staphylococcus aureus (SACS). Upon stimulation with bacterial products, DCs secreted a large amount of OSM protein in a dose- and time-dependent manner. Concomitantly, the expression of OSM mRNA by DCs was markedly up-regulated. Compared the ability of DCs to produce OSM with that of monocytes, which are major producers of OSM, DCs released significantly higher amounts of OSM protein in the culture supernatants than monocytes. These findings indicate for the first time that human monocyte-derived DCs can synthesize and secrete large amounts of OSM in response to bacterial products, suggesting that OSM produced by DCs at infectious sites may play a role in modulating inflammatory responses.

[Recurrence of inflammatory pseudotumor of the lung with endobronchial lesion after resection].

A 74-year-old man was admitted to our hospital because of an abnormal shadow in the left middle lung field on chest radiography. Since a transbronchial biopsy was not diagnostic, a left lower lobectomy was performed. Histopathologically, the patient was diagnosed as having an inflammatory pseudotumor of the lung. Four months after the surgery, the patient was readmitted with hemosputum. Bronchoscopically, an endobronchial lesion was found in the left main bronchus. Transbronchial biopsy of the lesion showed proliferation of inflammatory cells compatible with inflammatory pseudotumor. Therefore, a recurrent inflammatory pseudotumor was diagnosed. Treatment with corticosteroid resulted in the disappearance of the endobronchial lesion and the erythrocyte sedimentation rate (ESR) returned to normal. The patient showed a prolonged elevation of ESR even after the resection, suggesting that the ESR may be a good indicator of the activity of this disease.

[An autopsy case of cor pulmonale due to a pulmonary tumor embolism as the first clinical manifestation of occult gastric cancer].

A 47-year-old man was admitted to our hospital because of progressive dyspnea and cough. Physical examination and chest radiographs showed the signs of cor pulmonale. A lung scan using perfused radionuclide revealed multiple peripheral perfusion defects and catheterization of the right heart showed severe pulmonary hypertension. A diagnosis of severe pulmonary embolism was made. Despite intensive care with anti-coagulation therapy, the patient died on the third-hospital day. Autopsy disclosed gastric cancer in the pylorus with metastases to the regional lymph nodes. There were no macroscopic pulmonary artery emboli or parenchymal lesions, but more than 60% of the small arteries and arterioles were occluded by casts of tumor cells. Cor pulmonale due to a pulmonary tumor embolism is a rare complication of cancer. This case is particularly unusual because the embolus-caused cor pulmonale was the initial manifestation of clinically occult, but pathologically advanced, gastric cancer.