[A case of adenocarcinoma of unknown primary site successfully treated with gemcitabine monotherapy].

A 68-year-old female diagnosed with adenocarcinoma of unknown primary site (ACUP) by biopsy of supraclavicular lymph node was admitted to our department because of progressive dyspnea with cough. The diagnosis of multiple lung metastases and malignant pleural effusion was made. Marked elevation of serum CA 19-9 and DUPAN-2 urged us to treat her as a case of pancreatic carcinoma. Gemcitabine monotherapy yielded resolution of symptoms, decline in the level of tumor markers, shrinkage of lung metastases, and disappearance of pleural effusion. After 10 cycles, the chemotherapy was terminated. However, clinical deterioration was observed two months later. The re-treatment with gemcitabine was started, and a good response was obtained again. Gemcitabine monotherapy can be one of the treatment options for ACUP.

Risk evaluation of coronary heart disease and cerebrovascular disease by the Japan Atherosclerosis Society Guidelines 2002 using the cohort of the Holicos-PAT study.

Our purpose in this study was to evaluate the new JAS guidelines as a risk assessment tool in Japanese patients with hypercholesterolemia, using the cohort of the Holicos-PAT study. The Holicos-PAT study was designed as a prospective observational study. 2039 patients were followed with or without pravastatin for 5 years. We assessed coronary heart disease (CHD) and cerebrovascular disease (CVD) risks by the patient categories described in the JAS guidelines. In the Holicos-PAT study, the primary endpoints were CHD, and the secondary endpoints were CVD and total mortality. CHD event includes onset and worsening of angina pectoris, performing CABG or PTCA, non-fatal and fatal myocardial infarction, and death from CHD including heart death and sudden death. CVD events are onset or recurrence of cerebral infarction, onset of cerebral hemorrhage, and death from cerebral infarction or hemorrhage. The event rates were calculated by the person-years method, and the differences in event rates between category groups were analyzed by chi-square test. The event rates of CHD in Category A, B1, B2, B3, B4 and C, were 1.1, 4.0, 2.8, 5.7, 18.2 and 38.8 per 1,000 person-years. The rates of CHD events in the higher risk category groups, Category B4 group (p = 0.004 in whole patients) and C group (p < 0.001 in whole patients), were significantly higher than that in the combined category groups A + B1 + B2. The event rates of CVD in Category A, B1, B2, B3, B4 and C, were 2.1, 1.8, 1.8, 0.6, 10.8 and 6.4 per 1,000 person-years. The event rates of CHD in men were significantly higher than those in women, in categories B4 (p < 0.001) and C (p < 0.001). From these results, each category classified by accumulation of risk factors, showed increasing event rates of CHD and CVD. The categories in the JAS guidelines are useful to assess CHD and CVD risk in Japanese patients with hypercholesterolemia. However, the risk evaluation by the JAS guideline categories may underestimate the risk in men and overestimate it in women.

Hypertriglyceridemia is an independent risk factor for development of impaired fasting glucose and diabetes mellitus: a 9-year longitudinal study in Japanese.

OBJECTIVE: Hypertriglyceridemia is often associated with impaired fasting glucose (IFG) and diabetes mellitus. But the contribution of hypertriglyceridemia to the development of IFG and diabetes mellitus remains unclear. We evaluated whether or not hypertriglyceridemia is a risk factor for the development of IFG and diabetes mellitus. METHODS: From 1990 through 1999, 7, 222 Japanese with normoglycemia at baseline were followed. Fasting plasma glucose levels were measured. IFG and diabetes mellitus were defined by ADA criteria. RESULT: The multivariate-adjusted relative risks for the development of IFG were 1.38 for hypertriglyceridemia (p=0.001), 1.30 for obesity (p=0.003), 1.29 for hypertension (p=0.007), 1.26 for family history of diabetes (p=0.027), and 1.02 for age (p=0.035). The multivariate-adjusted relative risks for the development of diabetes mellitus were 1.003 for triglyceride level (p=0.013), 1.30 for level of body mass index (p=0.003), and 2.38 for family history of diabetes (p=0.001). CONCLUSION: Hypertriglyceridemia is an independent risk factor for the development of IFG and diabetes mellitus in Japanese patients.