We report a 50-year-old Japanese woman with typical clinical manifestations of Cronkhite-Canada Syndrome (CCS) and possible novel treatment modality for this disease. The patient was diagnosed as CCS based on the presence of several clinical manifestations, such as a diffuse alopecia, nail deformities, hypogeusia, pigmentation of skin, and abdominal discomfort combined with diarrhea and wasting. In addition, she also had multiple polypoid lesions in the gastrointestinal (GI) tract. She was first treated with hyperalimentation and corticosteroid. While this combination therapy seemed to reduce several clinical manifestations, abdominal symptoms and diarrhea recurred with the beginning of oral nutrition. Endoscopy and histology showed that inflammatory changes remained, especially in the lower intestine. Therefore, mesalazine was started. A few days after this therapy, her clinical symptoms disappeared and the polypoid lesions in the large bowel completely resolved. It was therefore possible to restart oral nutrition. We predict that the administration of mesalazine might be one of the useful therapies for CCS.

Background: Persistence of subtle abnormal myocardial deformation such as postsystolic shortening (PSS) after transient ischemia can be used to diagnose a history of myocardial ischemia (myocardial ischemic memory). Furthermore, early systolic lengthening (ESL) has recently attracted attention as another marker of myocardial ischemia. However, it is unclear whether the persistence of such abnormal deformation can be detected by three-dimensional (3D) speckle-tracking echocardiography, which has relatively low spatial and temporal resolution compared with two-dimensional echocardiography. This study sought to evaluate the diagnostic accuracy of myocardial ischemic memory and its spatial extent by 3D speckle-tracking echocardiography. Methods: The left circumflex coronary artery was occluded for 2 min, followed by reperfusion, in 33 dogs. Their hemodynamic and 3D echocardiographic data were chronologically acquired. Peak systolic strain, early systolic strain index (ESI) as a parameter of ESL, postsystolic strain index (PSI) as a parameter of PSS, and myocardial dysfunction index (MDI) as a combined parameter of ESL and PSS were analyzed in all left ventricular segments. Results: In the center of the risk area, ESI and PSI significantly increased until 20 min after reperfusion compared with baseline, although peak systolic strain recovered by 20 min. MDI significantly increased for more than 20 min after reperfusion and allowed better diagnostic accuracy of ischemic memory than the other parameters. In the 147 risk segments, abnormal values of MDI remained in 49 segments (33%) at 20 min after reperfusion, whereas abnormal peak systolic strain was observed in only 13 segments (9%). Conclusions: ESL and PSS persisted after transient ischemia and could be detected by 3D speckle-tracking echocardiography. Integrated analysis of ESL and PSS provided higher diagnostic accuracy of ischemic memory. This method may be useful for detecting transient ischemic insults in patients after the disappearance of anginal attack.

Longitudinal myocardial strain is considered to deteriorate in the early ischemic stage compared to circumferential and radial strains because the subendocardial inner oblique fibers are generally directed along the longitudinal axis. However, it is unclear whether the decrease in longitudinal strain precedes a decrease in circumferential and radial strains during acute coronary flow reduction. Methods:The left anterior descending artery was gradually narrowed in 13 open-chest dogs.Whole-wall and subendocardial longitudinal, circumferential, and radial strains were analyzed at baseline and during flow reduction. Peak systolic and end-systolic strains, the postsystolic strain index (PSI), and the early systolic strain index (ESI) were measured in the risk area; the decreasing rate in each parameter and the diagnostic accuracy to detect flow reduction were evaluated.Results: Absolute values of peak systolic and end-systolic strains gradually decreased with flow reduction. The decreasing rate and diagnostic accuracy of longitudinal systolic strain were not significantly different from those in other strains, although the diagnostic accuracy of radial systolic strain tended to be lower. PSI and ESI gradually increased with flow reduction. In these parameters, a lower diagnostic accuracy with respect to radial strain was not demonstrated. Conclusion:During acute coronary flow reduction, the decrease in longitudinal systolic strain did not precede that in circumferential systolic strain; however, the decrease in radial systolic strain may be smaller than that of other systolic strains. In contrast, there appeared to be no differences in the PSI and ESI values among the three strains.

The levels of serum pepsinogen I (PG I) and pepsinogen II (PG II) were determined by IRMA (immunoradiometric assay) and the ratio of PG I/II calculated in 37 patients with type A gastritis and concomitant pernicious anemia (PA) and in 97 with chronic gastritis (type B gastritis) among Japanese. In several patients from each group, PG I and PG II in the gastric mucosa were stained by an enzyme antibody assay to compare the percentage of positively stained cells with levels of serum PG I and PG II. The levels of serum PG I and PG II in chronic gastritis decreased as the degree of atrophy increased. Serum PG I and PG II levels in PA were lower than those of patients with severe atrophy. Most of serum PG I levels in PA were less than 10 ng/ml. The PG I/II ratio also decreased as the severity of atrophy increased, distinctly showing that in PA, the ratio were quite low and most of them are less than 1.0. Gastric mucosal pepsinogen showed a tendency similar to that of serum levels and also refrected the degree of atrophy. Therefore, by measuring these parameters it should be easier to determine the extent of atrophy, and to establish a serological diagnosis of type A gastritis associated with PA.

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