Metastasis of colon cancer to the thyroid gland is very rare and we would like to report a case we have experienced, with a review of the literature. A 66-year-old woman noticed a swelling in the anterior neck area and sought medical attention at our department in August 2003. At age 63, she had undergone surgery for cancer of the ascending colon, but subsequently the cancer metastasized to the liver and she underwent an outer hepatic segmentectomy. Fine-needle aspiration cytology indicated adenocarcinoma with characteristic tall columnar cells, confirming our suspicion that metastasis from the ascending colon cancer had already occurred. Furthermore, lung metastasis was also suspected, because several nodules were found in the lungs. On August 13, resection of the left lobe of the thyroid gland and dissection of the cervical lymph nodes were performed. Histopathology showed metastasis of the ascending colon cancer to the thyroid and lymph nodes.

AIM:To evaluate the role of N-myc downstreamregulated gene 1 (NDRG1) expression in prognosis and survival of colorectal cancer patients with different ethnic backgrounds. METHODS:Because NDRG1 is a downstream target of p53 and hypoxia inducible factor-1α (HIF-1α), we examined NDRG1 expression together with p53 and HIF-1α by immunohistochemistry. A total of 157 colorectal cancer specimens including 80 from Japanese patients and 77 from US patients were examined. The correlation between protein expression with clinicopathological features and survival after surgery was analyzed.RESULTS: NDRG1 protein was significantly increased in colorectal tumor compared with normal epithelium in both Japanese and US patient groups. Expression of NDRG1 protein was significantly correlated with lymphatic invasion, venous invasion, depth of invasion, histopathological type, and Dukes' stage in Japanese colorectal cancer patients. NDRG1 expression was correlated to histopathological type, Dukes' stage and HIF-1α expression in US-Caucasian patients but not in US-African American patients. Interestingly, Kaplan-Meier survival analysis demonstrated that NDRG1 expression correlated significantly with poorer survival in US-African American patients but not in other patient groups. However, in p53-positive US cases, NDRG1 positivity correlated significantly with better survival. In addition, NDRG1 expression also correlated significantly with improved survival in US patients with stages Ⅲ and Ⅳ tumors without chemotherapy. In Japanese patients with stages Ⅱ and Ⅲ tumors, strong NDRG1 staining in p53-positive tumors correlated significantly with improved survival but negatively in patients without chemotherapy. CONCLUSION: NDRG1 expression was correlated with various clinicopathological features and clinical outcomes in colorectal cancer depending on the race/ethnicity of the patients. NDRG1 may serve as a biological basis for the disparity of clinical outcomes of colorectal cancer patients with different ethnic backgrounds.

Strict blood glucose (BG) control is proved to improve the outcome in patients with glucose intolerance both in acute and chronic phases, irrespective of whether the patient has diabetes mellitus. However, strict BG control by conventional methods is so complicated that it cannot be performed easily in normal clinical situations. Furthermore, it is sometimes inadequate. Therefore, a clinically applicable, reliable artificial pancreas (AP) has long been sought after for more than 40 years. Considering the present important situations concerning AP, a survey of recent progress in AP is highly desirable. In this review, recent progress in mechanical AP (MAP) and in MAP-related items is presented. MAP is composed of three major components: a BG control algorithm, a drug administration system, and a glucose sensor. Recent progress in development of these components is presented, followed by descriptions of representative MAPs. Although significant progress in the development of MAP has been made, its use in clinical situations is limited or for research purposes at present. The main limiting factor is the slow progress in the development of glucose sensors. However, more widespread clinical application of the MAP will occur in the near future, considering the number of reliable long-life intravenous glucose sensors under development. Another factor is the worldwide recognition of the importance of BG control in acutely ill patients, in whom the period of strict BG control is usually for several days to a few weeks.

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AP = artificial pancreas; AT-III = antithrombin III; BG = blood glucose level; DIC = disseminated intravascular coagulation; ECA = endothelial cell activation; ECI = endothelial cell injury; GT = glucose tolerance; MODS = multiple organ dysfunction syndrome; mMOF = modified multiple organ failure; NIDDM = noninsulin-dependent diabetes mellitus; PAI-1 = plasminogen activator inhibitor-1; PLT = platelet count; PT = prothrombin time; SRH = stress related hormone; TAT = thrombin-antithrombin III complex; TM = thrombomodulin; tPA = tissue plasminogen activator; T 3 = triiodothyronine; T 4 = thyroxine.Available online http://ccforum.com/content/5/2/088 Abstract Background: Glucose tolerance (GT) has not been taken into consideration in investigations concerning relationships between coagulopathy and multiple organ dysfunction syndrome (MODS), and endothelial cell activation/endothelial cell injury (ECA/ECI) in septic patients, although coagulopathy is known to be influenced by blood glucose level. We investigated those relationships under strict blood glucose control and evaluation of GT with the glucose clamp method by means of the artificial pancreas in nine septic patients with glucose intolerance. The relationships between GT and blood stress related hormone levels (SRH) were also investigated.