T cell infiltration in colorectal cancer is associated with a favorable prognosis, suggesting an occurrence of a certain degree of anti-tumor immunity. T helper type 1 (Th1) and Th2 cells are now known to selectively express CC-chemokine receptor 5 (CCR5)/ CXC-chemokine receptor 3 (CXCR3) and CCR4, respectively. To clarify the mechanism of T cell infiltration, we examined in situ expression of these chemokine receptors and their respective chemokine ligands in 40 cases of human colorectal cancer. Immunohistochemistry showed a predominant accumulation of T cells expressing CCR5 and CXCR3 mainly along the invasive margin, whereas those expressing CCR4 were rare. Flow cytometric analysis showed that more than half of CD8 1 T cells and a fraction of CD4 1 cells isolated from fresh tumor tissues co-expressed CCR5 and CXCR3, and CD8 1 T cells and CD4 1 cells predominantly produced interferon-c (IFN-c) over interleukin-4 (IL-4) after in vitro stimulation. RANTES/CCL5, a ligand of CCR5, was localized within infiltrating CD8 1 T cells in a granular pattern, whereas IP-10/CXCL10, a ligand of CXCR3, was localized in cancer cells and macrophages along the invasive margin. These data were consistent with an active recruitment of T cells expressing CCR5 or CXCR3 into the invasive margin of colorectal cancer. With the previous clinicopathological studies showing a favorable prognostic impact of T cell infiltration in colorectal cancer, our study supports the occurrence of a certain level of Th1-shifted cellular immune responses in human colorectal cancer. ' 2005 Wiley-Liss, Inc.

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A 23 year old pregnant woman presented in her third trimester with severe pancreatitis and hyperlipidemia. Initial investigations suggested that her pancreatitis was induced by profound hypertriglyceridemia, which was the result of an underlying Fredrickson's V type hyperlipoproteinemia exacerbated by pregnancy. Concern for the life of the fetus prompted a caesarean operation and then drainage procedure for pancreatitis. Plasma exchange, carried out to lower the levels of lipids and the pancreatic enzymes, improved the signs and symptoms of the patient. Plasma exchange may be of great use in the management of hyperlipidemic pancreatitis.pancreatitis ; hyperlipidemia ; pregnancy ; plasma exchange CASE REPORTA 23-year-old pregnant woman was admitted to the Department of Obstetrics, Tohoku University Hospital with a history of anterior chest discomfort and epigastralgia. She denied a history of alcohol consumption, pancreatitis, or other kinds of diseases. No diagnosis of hyperlipidemia had been made previously.On admission the patient's temperature was 36.TC, pulse rate 120, and blood pressure 106/76 mmHg. Her weight was 58 kg, and height 153 cm. The patient's conjunctiva was not anemic nor icteric. No cutaneous eruptions, or xanthoma,

A case of a malignant insulinoma in a 53-year-old female is presented. In 1973, the patient underwent caudal pancreatectomy for a malignant insulinoma. Ten years later, it was discovered that the insulinoma had spread to the bones. On admission for cholecystectomy because of a gallbladder polyp and gallstones, she often experienced hypoglycemic attacks, and both calcium and glucagon provocation tests elicited marked release of insulin. Selective angiography of the common hepatic artery showed a tumor blush near the hilum of the liver. Immunohistochemical staining of the gallbladder polyp and the bone tumors proved positive for insulin. Plasma levels of insulin and prolactin were abnormally high. The patient had also been treated for a perforated duodenal ulcer and hyperthyroidism. It is concluded that this may have been a case of a multiple endocrine neoplasia.