The results suggest that the point mutation in the 23S rRNA gene is commonly seen in clarithromycin-resistant H. pylori and it contributes to the treatment failure in Japan. The PCR-RFLP system is a sensitive method by which to diagnose H. pylori infection as well as a simple method for detecting clarithromycin resistance without bacterial culture.

The simultaneous association of gastric carcinoma with gastric lymphoma is a rare event. Recent studies have suggested that not only gastric cancer but also primary gastric lymphomas, especially those of mucosa-associated lymphoid tissue (MALT) type, are associated with Helicobacter pylori infection. We report on a 51-year-old woman who was referred to our hospital for the evaluation of abnormal shadows revealed by an upper gastrointestinal radiography series. Endoscopy of the upper gastrointestinal tract revealed early cancer in the middle body of the stomach. Biopsy of the lesion subsequently proved it to be a signet-ring cell carcinoma. Total gastrectomy was performed, under a diagnosis of early gastric carcinoma. The resected specimen revealed two grossly separate lesions. Histological examination confirmed that the gastric body lesion was compatible with early moderately differentiated tubular adenocarcinoma of type 0-IIc, while the lesion of the fundus corresponded to MALT lymphoma. H. pylori was detected, and chronic gastritis was also present in the resected gastric specimen. H. pylori infection may have played a major role in the development of both the MALT lymphoma and the adenocarcinoma of the stomach in this patient.

We conducted a randomized, controlled trial comparing 5-fluorouracil (5-FU) with or without biological response modifiers (BRMs) as a maintenance therapy for hepatocellular carcinoma (HCC) after treatment with percutaneous ethanol injection (PEI), transcatheter arterial embolization (TAE) or arterial infusion of antitumor agents (AI). A total of 58 cases of HCC were classified into 4 groups as follows: group I, PSK with 5-FU (n = 15); group II, lentinan with 5-FU (n = 15); group III, OK-432 with 5-FU (n = 12); and group IV, 5-FU alone as the control (n = 16). The mean survival time, mortality rate, time to progression, and T4/T8 ratio of lymphocytes in the peripheral blood were compared among the four groups. There was no significant difference in the background factors among the groups. In group I, the T4/T8 ratio of lymphocytes was reduced after the therapy. No significant difference was found among the groups in terms of the mean survival time, mortality rate, or time to progression. PEI for initial therapy was superior to the other therapies in terms of the mean survival time and mortality rate. These results suggest that the addition of BRM to maintenance therapy with 5-FU exerts no prognostic benefit on HCC patients treated with PEI, TAE, or AI.

The pharmacokinetic and pharmacodynamic characteristics of this ultra-short-acting beta1-blocker were maintained even in the patients with hepatic impairment. Although we did not observe any drug-related adverse events in these patients, hypotension or bradycardia should be considered, necessitating continuous monitoring of both heart rate and BP in patients with hepatic impairment who receive landiolol hydrochloride.

15-30% of adult patients with dermatomyositis, and 17-18% of them had breast cancer (1). We report an uncommon case of metachronous primary breast cancer associated with dermatomyositis.A 61-year-old woman noticed a left breast mass and was referred to our hospital in August 1999. Pathologically diagnosed as carcinoma, she underwent modified radical mastectomy. Histologic examination revealed invasive ductal carcinoma. Final stage was determined to be T2N0M0, stage IIA. Both estrogen and progesterone receptors were positive.On the 11th day after surgery she developed muscle weakness, dysphasia, and a heliotrope rash on the upper eyelids. According to clinical features and laboratory findings, she was diagnosed with dermatomyositis. Retrospective microscopic examination revealed infiltration of lymphocytes around vessels and edematous changes were detected in the dermis, consistent with the findings of dermatomyositis. After administration of steroids, the symptoms gradually improved.In December 2001, she was withdrawn from steroids. In January 2003, she was diagnosed with right breast cancer and underwent modified radical mastectomy. Histologic examination revealed invasive ductal carcinoma, indicating comedo carcinoma. The findings of the second carcinoma were so inconsistent with those of the first that the final diagnosis of metachronous bilateral primary breast cancer was established. Only progesterone receptor was positive. The final stage was determined to be T3N0M0, stage IIB.The postoperative course was uneventful and administration of steroids was not required. After surgery, endocrine therapy was started. Although 5 months have passed since the second surgery, no recurrence of breast cancer has been detected.The nature of the relationship between dermatomyositis and breast cancer is not well understood. Probably both coincidental and true associations exist. Including our present case, we reviewed the clinicopathologic features of 20 cases of breast cancer associated with dermatomyositis in the Japanese literature. One of them was simultaneous double primary breast cancer in the ipsilateral breast (2). Two cases, including our present case, were metachronous primary breast cancer (3). Others were solitary cancer. As for histopathology, 16 of 23 tumors were invasive ductal carcinoma (69.9%) and 3 were occult carcinoma (13.0%).Treatment for breast cancer was surgery, except in one case of inflammatory breast cancer. Malignancies discovered after onset of dermatomyositis occurred in 8 of 20 patients (40%) and the time to development of carcinoma ranged from 3 months to 11 years (mean 34.8 months). Malignancies preceded by dermatomyositis occurred in 8 of 20 patients (40%) and the time to onset of dermatomyositis ranged from 3 months to 9 years (mean 33.4 months). Simultaneous onset was observed in 4 of 20 patients (20%).In our present case, dermatomyositis may have existed before surgery and symptoms became evident and rapidly progressed after surgery. The most common cause of death in patients with dermat...