A surgically treated case of severe upper gastrointestinal hemorrhage with gastritis cystica polyposa.

BACKGROUND: Gastritis cystica polyposa (GCP) is a recently recognized entity histologically characterized by hyperplasia and cystic dilatation of the gastric glands spreading through the submucosal layer. Its symptoms include those affecting the upper gastrointestinal tract, such as upper abdominal pain, nausea, and anorexia, although some patients might be asymptomatic. GCP rarely causes severe hemorrhage. Recently, we encountered a GCP case that exhibited severe hemorrhage. CASE PRESENTATION: A 53 year-old man visited the emergency department complaining of hematemesis. He underwent distal gastrectomy and Billroth II reconstruction for duodenal ulcers 32 years ago. Upper gastrointestinal endoscopy detected bleeding from the reddened mucosa at the anastomosis; thus, tentative endoscopic hemostasis was conducted. Despite medical treatment with transfusion, melena with significant hemodynamic impairment persisted. He was treated again with endoscopic hemostasis and interventional radiology (IVR) but remained unresponsive to these procedures. He eventually underwent partial resection of the anastomosis site with Roux-en-Y reconstruction and finally achieved excellent postoperative recovery. Histopathological examination of the resected specimen suggested a GCP bleeding. CONCLUSIONS: GCP can indeed cause severe hemorrhage. Hemorrhage caused by GCP may not respond to endoscopic hemostasis or IVR; therefore, surgical treatment should be decided without delay.

Cardiovascular Instability Preceded by Orolingual Angioedema after Alteplase Treatment.

An 87-year-old man taking antihypertensive medications, including 10 mg enalapril, daily visited our hospital complaining of motor aphasia, dysarthria, and right hemiparesis. Magnetic resonance imaging revealed an ischemic lesion in the left frontal lobe including the insular cortex and severe stenosis of the left middle cerebral artery. After he received intravenous alteplase infusion, he developed orolingual angioedema followed by transient bradycardia with subsequent hypotension, resulting in the deterioration of his neurological signs and expansion of the ischemic lesion. Orolingual angioedema after intravenous alteplase infusion may follow cardiovascular instability and disease progression in stroke patients.

[A case report of suspected Stauffer syndrome presenting with fever, extensive inflammation, and abnormal liver function tests].

A man was referred to our hospital because of malaise and abnormal liver function tests. He had had a kidney removed for early renal cell carcinoma. We performed ultrasonography, CT scan, and liver biopsy, all of which were normal. However, FDG-PET revealed abnormal, diffuse uptake in the bone. A bone biopsy showed abnormal clear cells resembling renal cell carcinoma. Because there was no other primary origin, this histopathological finding led to the diagnosis of bone metastasis of renal cell carcinoma, and the abnormal liver function test was thus inferred to be due to Stauffer syndrome.

Transcriptional readthrough of Hox genes Ubx and Antp and their divergent post-transcriptional control during crustacean evolution.

Hox genes are in principle tandemly arranged in an order colinear with their order of expression along the anterior-posterior axis. Combinations of Hox proteins encode information that specifies the unique characteristics of axial regions in the metazoan body plan. The independent regulation of Hox genes achieved by differential promoter activity is essential for the expression of Hox proteins in distinct territories and thereby creating a full repertoire of Hox codes. Here we report the abundant expression of transcriptional readthrough products of two adjacent Hox genes, Ubx, and Antp, in five crustacean species of Branchiopoda and Malacostraca. Bicistronic mRNA places Antp under the control of the Ubx promoter, which is active in the posterior segments of two branchiopodans Daphnia and Artemia, and would normally reduce the complexity of Hox codes if translated. This does not occur, however, as the translational capability of the bicistronic mRNA is limited. In Daphnia, bicistronic Ubx/Antp mRNA produced no significant level of either UBX or ANTP. In Artemia, on the other hand, the bicistronic mRNA produced only UBX, and replaced the role of monocistronic Ubx mRNA. In this way, multiple post-transcriptional control mechanisms in two extant branchiopodans can be seen as preventing the potentially deleterious consequences of Hox gene fusion.