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We report a case of an unusual form of cutaneous tuberculosis in an 82-year-old woman. She visited our hospital because of an intractable ulcer on the fifth finger of her right hand. While examining the ulcer surrounding half of her right fifth finger and covered with necrotic tissue, we also perceived a nodule with crust on the forearm, multiple subcutaneous nodules on the right forearm and upper arm, and a hen's-egg-sized agglomerative nodule on the axilla. All the lesions were located on her right arm. Skin biopsy specimens showed granulomatous tissue with necrosis in the lesions. Mycobacterium tuberculosis was identified by culture of a biopsied specimen, so the diagnosis was confirmed. Further examination revealed that she also had pulmonary tuberculosis. Cutaneous tuberculoses are classified morphologically with reference to host immune status, but no satisfactory classification exists. The present case can't be classified into any of the types which have been proposed so far. She is elderly and suffers from liver cirrhosis, hepatocellular carcinoma and myelodysplastic syndrome. The resulting acquired immunosuppression may have caused a unique form of cutaneous tuberculosis.

We present a case of combined large cell neuroendocrine carcinoma (LCNEC), harbouring a BRAF V600E mutation, which significantly benefited from BRAF-targeted therapy. A 57-year-old woman was referred to our hospital for headache and vomiting. A head MRI showed a large tumour in her brain, and a whole-body CT revealed a tumour in the hilum of the right lung and mediastinal lymphadenopathies. Both the resected brain tumour and the mediastinal lymph node tissue contained LCNEC. Next-generation sequencing revealed a BRAF V600E mutation, and a combination therapy with dabrafenib and trametinib was initiated. The patient had a good response to treatment. Like non–small cell lung cancer patients, LCNEC patients should undergo multiplex somatic mutation testing.

ABSTRACT-The tension of isolated rings was measured isometrically to compare the N G -nitro-L-arginineand indomethacin-resistant relaxation by acetylcholine (ACh) in the renal artery from normal rabbits and short term hypercholesterolemia rabbits (0.5% cholesterol chow for 5 weeks). ACh-induced relaxation in the renal artery precontracted with phenylephrine was not influenced by cholesterol-enriched chow. However, in comparison with artery from normal rabbits, the N G -nitro-L-arginine-and indomethacin-resistant endothelium-dependent relaxation by ACh was significantly enhanced by the chow. The resistant part of AChinduced relaxation was significantly inhibited when the artery was treated with tetraethylammonium or SKF 525a. Results suggest that short term hypercholesterolemia modulates endothelium-derived hyperpolarizing factor-mediated relaxation in rabbit renal artery. Keywords: Hypercholesterolemia, Renal artery, Endothelium-derived hyperpolarizing factorIt is well known that the endothelium plays an important role in the management of vascular smooth muscle tone. There are three different relaxing factors in the endothelium: prostacycline, a cyclooxygenase metabolite (1); nitric oxide (NO), an endothelial NO synthase product (2); and endothelium-derived hyperpolarizing factor (EDHF), which is thought to be a cytochrome P-450 monooxygenasearachidonic acids metabolite (3) and suggested to belong to the group of epoxyeicosatrienoic acids (4, 5). It has been postulated that EDHF exists in the vasorelaxation induced by acetylcholine (ACh) and that it is resistant to N G -nitro-L-arginine (L-NOARG), an endothelial NO synthase inhibitor, and indomethacin, a cyclooxygenase inhibitor (6, 7). The resistant part has been reported to be associated with the hyperpolarization of smooth muscle cells through the inhibition of calcium activated potassium channels (6 -8). Chronic hypercholesterolemia is associated with an impairment of endothelium-dependent relaxations such as NO-and EDHF-mediated relaxations (9 -11). The aim of the present study was, therefore, to determine if there is an alteration in L-NOARG and indomethacinresistant endothelium-dependent relaxation in short term hypercholesterolemic rabbit renal artery.Ten-week-old male Jla:JW rabbits supplied by Japan Laboratory Animal, Inc. (Tokyo) were used. Rabbits were fed either normal rabbit chow (control group) or chow enriched with cholesterol (cholesterol group, 0.5% for 5 weeks; Funabashi Nojou, Chiba). The animals were anesthetized with pentobarbital (40 mg/kg, i.v.) and sacrificed by bleeding. The renal artery was isolated and placed in modified Krebs-Henseleit solution having the composition: 118.0 mM NaCl, 4.7 mM KCl, 2.5 mM CaCl 2, 1.2 mM MgSO4, 25.0 mM NaHCO3 and 11 mM glucose, at 37°C gassed with 95% O2 and 5% CO2. The tissue was cleaned by removing connective tissue. The renal artery was cut into rings about 4-mm-long. Contraction was measured by suspending the rings between two stainless-steel hooks, one of which was attached to the end of a bathing t...

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