Search

Objective: The purpose of this report is to estimate the effectiveness of gonadotropin-releasing hormone analogue (Gn-RHa) therapy for peritoneal inclusion cysts. Methods: Patients who had cystic masses that developed after gynecological surgery and were strongly suspected of being peritoneal inclusion cysts based on the results of ultrasound, magnetic resonance imaging (MRI), and tumor marker studies, were treated with a Gn-RHa (buserelin acetate or leuprorelin acetate). Buserelin acetate was administered at a dose of 900 μg/day, and leuprorelin acetate at a dose of 3.75 mg/month. Ultrasonography was performed in the outpatient clinic every 2 weeks after the start of administration to measure the diameter of cysts. Results: We treated 8 patients with peritoneal inclusion cysts conservatively with a Gn-RHa. The cysts resolved in 7 of the patients. Two of them developed a recurrence, but further Gn-RHa therapy was followed by complete resolution of the cysts in one patient and we resume Gn-RHa therapy to the other patient. The peritoneal inclusion cysts failed to shrink in only one patient. Conclusion: It is suggested that Gn-RHa therapy is effective in some cases of peritoneal inclusion cysts.

Dendritic cells (DCs) are widely distributed in the airways and can serve as potent antigen-presenting cells. To clarify their involvement in the cell-mediated immune responses of the lung, we immunohistochemically investigated their distribution and kinetics during pulmonary delayed-type hypersensitivity (DTH) reactions induced in sensitized mice by intratracheal instillation of hapten. Cellular infiltrate appeared around the bronchiole and its accompanying blood vessel at 12 h after elicitation and progressively expanded by 48 h. As quantitated by computer-assisted morphometry, I-A(+) DCs and CD4(+) Th cells significantly increased in number around the bronchiole to a maximum at 24 h, whereas F4/80(+) macrophages were predominantly accumulated around the accompanying vessel with a peak at 48 h. Serial-section analysis revealed that DCs were colocalized with Th cells in the inflamed peribronchiolar tissue. Immunoelectron microscopy demonstrated that DCs found inside and around the capillaries and venules of peribronchiolar interstitium displayed round forms, indicating their emigration from here, while those situated far from the microvessels were elongated, often in close apposition to the lymphocytes. Mitosis of DCs was rarely seen. The present results suggest that peribronchiolar accumulation of DCs resulting from accelerated influx of blood-borne immature DCs and the interaction with T cells at the application site may play inducing roles in the development of pulmonary DTH reactions by enhancing the recruitment of macrophages.

Firstly, the service life of the 28-year-old plastic covering material of cables for the long bridge was evaluated. Mechanical degradation such as crack generation and remarkable bending strength reduction on the plastic covering material was not found because of the past adequate maintenance for coating film layer covered on the plastic covering material. However, by means of chemical evaluation method such as FT-IR, the slight chemical degradation was confirmed and shown as follows. (1) Main molecular chains of the coating film (polyester) and side chains of base resin (PMMA) were detached by hydrolysis. (2) The glass transition temperature of the base resin was raised by polymerization. Secondly, to examine effective degradation detection methods, the degradation experiment was conducted on PMMA test samples without containing anti-oxidants and pigments in the autoclave at 70°C with saturated water and pure O2. Effective degradation detection methods were as follows: inspection with optical microscope, measurement for bending strength, dynamic hardness, dynamic viscoelasticity, FT-IR, DSC, and solid 13CNMR.

縦隔発生の嚢状リンパ管腫は縦隔腫瘍の中でも比較的稀である.症例は36歳, 男性.咳嗽を主訴に近医を受診し, 縦隔腫瘍を疑われ当科紹介された.術前検査にて中縦隔嚢胞性疾患を疑い, 外科的完全摘出術を施行した.腫瘍は周囲との癒着なく容易に剥離できた.摘出腫瘍のサイズは54×70×28mmで単房性, 内容液は褐色透明であった.術後, 特殊染色による病理標本によって本症と診断された.本症の診断方法の主体は画像診断であるが, 特異像はなく, 病理検査による診断例が大半である.また特殊染色による病理検査, 嚢胞液の細胞診検査に加え, 気管支鏡下超音波内視鏡検査も試みられている.治療法は合併症や再発例があることより, 完全摘出が重要であると考える.

Seventy-eight patients who were operated on for colorectal cancer from November 1994 to December 1995 were divided into two groups with random sampling; 33 patients were orally administered antibiotics (kanamycin+clindamycin) for chemical cleaning (Chemical Cleaning Group) and 45 patients were not administered antibiotics (No Chemical Cleaning Group) preoperatively. The frequency of leakage and wound infection were compared between the Chemical Cleaning Group and No Chemical Cleaning Group. There was no significant difference in the frequency of leakage and wound infection between two groups. Furthermore, these patients were divided into another two groups by the presence of stenosis (more than one third of the intestinal lumen was stenosed) based on barium enema study, and a similar study was conducted in the stenotic and non-stenotic groups. Entirly no significant difference in the frequency of leakage and wound infection was noted in non-stenotic cases (x2=0.000, p=1.000). It was thought that non-stenotic cases demanded no chemical cleaning. But, there was a tendency in stenotic cases that the leakage and wound infection were found more frequently in the No Chemical Cleaning Group than in the Chemical Cleaning Group. More studies in stenotic cases are needed. This study suggested that the chemical cleaning would not be necessary for patients with colorectal cancer who had no stenosis.

Background: Although T-cell immunity is thought to be involved in the prognosis of epithelial ovarian cancer (EOC) patients, immunosuppressive conditions hamper antitumour immune responses. Thus, their mechanisms and overcoming strategies need to be investigated. Methods: The role of NF-κB in human EOC cells and macrophages was evaluated by in vitro production of immunosuppressive IL-6 and IL-8 by EOC cells and in vivo analysis of immune responses in nude mice implanted with human EOC cells using an NF-κB inhibitor DHMEQ. Results: In EOC patients, increased plasma IL-6, IL-8, and arginase were observed. The NF-κB inhibitor DHMEQ inhibited the production of IL-6 and IL-8 by EOC cell lines. Immunosuppression of human DCs and macrophages by culture supernatant of EOC cells was reversed with the pretreatment of DHMEQ. Administration of DHMEQ to nude mice implanted with human EOC resulted in the restoration of T-cell stimulatory activity of murine DCs along with the reduction of tumour accumulation and arginase expression of MDSCs. Nuclear factor-κB inhibition in tumour-bearing mice also enhanced antitumour effects of transferred murine naive T cells. Conclusions: NF-κB is involved in the immunosuppression induced by human EOC, and its inhibitor may restore antitumour immune responses, indicating that NF-κB is an attractive target for EOC treatment.

Polysaccharide K (PSK) is widely used in Japan as a biological response modifier for cancer patients. We investigated the effects of PSK with S-1 based chemotherapy for advanced gastric cancer patients in immune response.Nine advanced gastric cancer patients who underwent chemotherapy at the University of Tokushima were included in this study. In all patients, 3g PSK was received orally and S-1 based chemotherapy for 2 weeks alternately for 8 weeks. Serial changes in immunological parameters (Foxp3, Natural killer (NK), CD4/CD8) were monitored.The levels of Foxp3 at 8 weeks was significantly decreased compared with 2 weeks (4.26% vs. 3.11%). In NK activity at 8 weeks was significantly increased compared with 2 weeks (27% vs. 47%).These results of this study suggested that chemotherapy with PSK improved the immune response in advanced gastric cancer patients. Especially Foxp3 was concerned in this mechanism.

The aim of this study was to investigate the impact of preoperative serum C-reactive protein (CRP) level as a prognostic indicator in patients with colorectal carcinoma (CRC).We investigated the correlation between preoperative CRP level and clinicopathological factors including prognosis of 167 patients who underwent resection for CRC retrospectively. Clinicopathological variables were compared between patients with serum CRP levels1mg/dL (29 patients; high-CRP group) and patients with serum CRP levels1mg/dL (138 patients; low-CRP group).In high-CRP group, 9 patients were stage I+II and 20 patients ware stage III+IV. In low-CRP group, 93 patients were stage I+II and 45 patients were stage III+IV. There were significant differences in the clinical stage, tumor diameter, curativity, final stage between the two groups (p0.01). The overall survival and recurrence-free survival rates in high-CRP group were lower compared with the rates in low-CRP group (p0.05 and p=0.14). In addition, the overall survival rate in stage I+II patients with high-CRP was significantly lower than that in patients with low-CRP (p0.05). Using multivariate analysis, the preoperative elevation of serum CRP level was an independent prognostic factor in patients with CRC (p0.05).We found that the preoperative elevation of serum CRP to be an independent prognostic indicator of CRC.

Summary Albatrosses are known to expend only a small amount of energy during flight. The low energy cost of albatross flight has been attributed to energy-efficient gliding (soaring) with sporadic flapping, although little is known about how much time and energy albatrosses expend in flapping versus gliding during cruising flight. Here, we examined the heart rates (used as an instantaneous index of energy expenditure) and flapping activities of free-ranging black-browed albatrosses (Thalassarche melanophrys) to estimate the energy cost of flapping as well as time spent in flapping activities. The heart rate of albatrosses during flight (144 beats min-1) was similar to that while sitting on the water (150 beats min-1). In contrast, heart rate was much higher during takeoff and landing (ca. 200 beats min-1). Heart rate during cruising flight was linearly correlated with the number of wing flaps per minute, suggesting an extra energy burden of flapping. Albatrosses expend only 4.6% ± 1.4% of their time in flapping during cruising flight, which was significantly lower than those during and shortly after takeoff (9.8% ± 3.5%). Flapping activity, which amounted to just 4.6% of the time in flight, accounted for 13.3% of the total energy expenditure during cruising flight. These results support the idea that albatrosses achieve energy-efficient flight by reducing the time spent in flapping activity, which is associated with high energy expenditure.

Study question: What are the reproductive and obstetric outcomes in patients undergoing radical abdominal trachelectomy (RAT) for early-stage cervical cancer? Summary answer: When RAT was performed before a pregnancy achieved with fertility treatments, pregnancy rate of 36.2% was obtained and 71.4% of these women gave birth at ≥ 32 weeks of gestation. What is known already: Reproductive and obstetric outcomes after radical vaginal trachelectomy (RVT) are well documented; however, these outcomes after RAT have not been well studied. Study design, size, duration: This is a retrospective cohort study of patients at a single institution who underwent RAT and became pregnant. Reproductive and obstetric outcomes of 114 patients who had undergone RAT from September 2002 to December 2010 were investigated. Participants/material, setting, methods: Women of reproductive age with early-stage cervical cancer who wished to preserve their fertility were documented. Main results and the role of chance: Patients' median age was 33 years (25-40 years). A total of 31 pregnancies were achieved in 25 patients and 6 patients had 2 pregnancies. Eighteen of 25 patients (72.0%) had infertility problems; 17 patients conceived with IVF-embryo transfer and 1 patient with intrauterine insemination. The pregnancy rate among patients who wished to conceive was 36.2% (25/69). Among 31 pregnancies in 25 patients, 4 patients had first trimester miscarriage and 1 patient had second trimester miscarriage. Excluding the five patients who miscarried and the five ongoing pregnancies, all the 21 patients had deliveries by Cesarean section. Four patients had a preterm birth in the second trimester and 17 patients delivered in the third trimester. Of the 17 pregnancies that reached the third trimester, 2 (11.8%) were preterm births between 29 and 32 weeks, 11 (64.7%) were delivered between 32 and 37 weeks and 4 (23.5%) at ≥ 37 weeks of gestation. Limitations, reasons for caution: Because of the retrospective data collection, not all pregnancies may have been recorded. Wider implications of the findings: Prospective multicenter studies are needed to determine if the results shown in this retrospective cohort can be generalized to all patients with early-stage cervical cancer who wish to undergo the fertility-sparing RAT procedure.

Hydrogen sulfide is a toxic, colorless gas produced by decaying organic matter. Its toxic effects are due to blocking of cellular respiratory enzymes, leading to anoxia.We report a 28-year-old man who attempted suicide using hydrogen sulfide gas. When the emergency service arrived, his friend was dead and the patient was unconscious. He received supportive treatment and survived. In this patient both skeletal muscle and myocardial injury was observed after hydrogen sulfide intoxication. Skeletal muscle damage occurred first, because enzymes peak consisted of creatine phosphokinase, aspartate aminotransferase, and myoglobin was observed on hospital day 4. Myocardial injury was apparent on hospital day 15, because the subsequent enzymes peak was comprised of cardiac enzymes and associated electrocardiographic abnormalities. On hospital day 3, myocardial injury was detected and it evolved over the next 3 weeks to recover completely.The mechanisms of rhabdomyolysis and myocardial injury resulting from hydrogen sulfide poisoning are not known, but may be related to cellular anoxia or a direct toxic effect. This case highlights not only the risk of delayed cardiac damage, but also rhabdomyolysis, and emphasizes that careful monitoring of cardiac function and of the levels of skeletal muscle-related enzymes is essential for victims of hydrogen sulfide poisoning.

Background Fertility preservation is important for women of reproductive age with cervical cancer. The underlying reasons behind suboptimal reproductive results after successful fertility-preserving surgery have not yet been fully revealed. Objective The objective of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer. Methods We conducted interviews with women with cervical cancer who underwent radical trachelectomy using a Grounded Theory methodology with a theoretical framework of symbolic interactionism. Results Our findings articulate a process in which feminine identity is first threatened by a diagnosis of cancer, then repaired by fertility preservation with radical trachelectomy, and finally reconstructed after the surgery, through interactions with self, others, and external events in women with cervical cancer. Feeling incomplete as a woman because of the loss of the uterus was a critical factor in the women's feeling that their feminine identity was threatened. Thus, fertility preservation was significant for these women. The meaning of fertility preservation varied among the women, and their life perspectives were therefore distinct after the surgery. Conclusions Women with cervical cancer who undergo radical trachelectomy experience an identity transformation process, and child bearing is not the only expected outcome of fertility preservation. Implications for practice Nurses should coordinate care through the cancer trajectory. Understanding the identity transformation process helps nurses to assess patients' needs and provide appropriate individual care.

The total syntheses of four fawcettimine-related Lycopodium alkaloids, (±)-fawcettimine, (±)-fawcettidine, (±)-lycoposerramine-Q, and (±)-lycoflexine, were completed in a highly stereoselective manner. The Pauson-Khand reaction of 4-methylidene-6-siloxyoct-1-en-7-yne followed by regio- and stereoselective hydrogenation led to the short-step preparation of the bicyclo[4.3.0]nonenone intermediate bearing a methyl group with the required stereochemistry. The subsequent chemical manipulation of the bicyclic compound afforded the 6-5-9-membered tricyclic dioxo compound, which was then transformed into the four targeted alkaloids in an alternative and more efficient fashion.

Congenital quadricuspid aortic valve is a rare cardiac malformation with an unknown risk of infective endocarditis. We report a case of quadricuspid aortic valve complicated with infective endocarditis. A 53-year-old Japanese woman was hospitalized with leg edema and a fever of unknown origin. Corynebacterium striatum was detected in the blood culture. Echocardiography demonstrated a quadricuspid aortic valve with vegetation and severe functional regurgitation. The condition was diagnosed as a quadricuspid aortic valve with infective endocarditis, for which surgery was performed. The quadricuspid aortic valve had three equal-sized cusps and one smaller cusp (type B according to Hurwitz classification). We dissected the vegetation and infectious focus and implanted a mechanical valve. Following the case report, we review the literature.

本研究では'清見'果実のこはん症発生に伴うK+漏出量ならびに組織構造の変化を調べた。ごはん症は8℃へ昇温するより20℃に昇温した'清見'に顕著に現礼ポリエチレン包装によって軽減された。20℃へ昇温した果実のK+漏出量は障害発生時に急増し, 増加は8℃へ昇温した場合より多かった。両昇温区とも無包装'清見'のK+漏出量は包装果実の漏出量より多かった。走査型電子顕微鏡による観察では, '清見'のこはん症の陥没は油胞間の表皮から数層内部の柔組織細胞の変形によって引き起こされ, 表皮細胞や油胞の破壊によって陥没するのではないことが明らかとなった。

In this paper, we studied the mechanism of the increase of firmness in strawberry fruit treated with 100% CO2. Internal CO2 concentration in treated fruit increased immediately after the treatment and maintained the high level during treatment. But, it decreased rapidly after release of the treatment and reached the same level of untreated ones. This treatment rapidly decreased the ratio of water soluble pectin content against total pectin content and increased the ratio of hexametaphosphate soluble pectin content during and after the treatment, but did not affect the ratio of hydrochloric acid soluble pectin to total pectin in the fruit. Pectin methyl esterase activity was higher in treated fruit than the one in untreated fruit during and after the treatment. The ratio of Ca content of NaCl-soluble fraction (contained pectin substances) to total Ca content was higher in the treated fruit during and after treatment than the one in untreated fruit. These results suggest that the increase of firmness of strawberry fruit by 100% CO2 treatment may be due to the formation of intramolecular bridges in pectin, mediated by Ca2+

Fatigue tests under multiaxial stress conditions were conducted for the three types of butt, scarf and butterfly type butt joints in a variety of scarf angle and adhesive layer thickness

The lower esophageal sphincter (LES) is usually removed during total gastrectomy to successfully perform a curative operation. In this study, the preservation of the LES in curative total gastrectomy was attempted to reduce the reflux. An experimental study using dogs has revealed that the high-pressure zone of the LES can be preserved by making a resection at the gastroesophageal junction, which thus helps to protect the reflux. A previous clinicopathological study revealed that the LES can be preserved without any fear of recurrence at the resection site, if the tumor is located more than 2.0 cm and 3.0 cm from the gastroesophageal junction to the oral margin in node-negative and -positive cases, respectively. Clinically, 8 patients underwent an LES-preserving total gastrectomy [LES(+) gastrectomy] while 19 had an LES(-) gastrectomy in the same period. Of the five LES(+) cases examined, all showed a high pressure zone, whereas none of the four LES(-) cases examined showed such a high-pressure zone after the operation. Endoscopic examination showed that only one of the seven LES(+) cases but six of nine LES(-) cases revealed esophagitis.

実用的な技術として高濃度CO2短期間処理がイチゴ果実の品質,とくに硬度保持に及ぼす影響を調べる目的で,処理温度,品種,収穫熟度による処理効果の差異を調査した.(1) '宝交早生'を市場より購入後直ちに1℃および20℃下で,CO2処理(CO2:02:N2=20:10:70)を24時間行い,20℃に貯蔵したところ,果実硬度は大きくなった.また,処理果で,カビの発生が抑制された.(2) 'Tioga' (100%着色果)を収穫し,20℃下でCO2処理を行い,同温度に貯蔵した.'宝交早生'と比べて処理効果は小さかったが,処理による果実硬度及び外観の保持効果がみられた.(3) '宝交早生'を30%, 70%, 100%着色果に分けて収穫し,1℃下で処理を行い,同温度に貯蔵した.果実硬度は,いずれの熟度でも処理果の方が無処理果よりも大きかったが,30%着色果での処理効果が最も大きかった.貯蔵11日では無処理果の約2倍の硬度(クリープメーター示度)を示した.また,果実の着色も処理果で遅い傾向があり,30%着色果で特に顕著であった.CO2処理が全糖含量,アスコルビン酸含量に及ぼす影響はほとんどなかった.アントシアン含量は,処理果で小さい傾向にあり,30%着色果でその差が大きかった.ペクチン物質について調べたところ,処理果では,処理直後にWSPの比率が急減し,HMPの比率が増加した.(4) これらの結果から,'宝交早生'果実では処理温度に関係なく,CO2処理による果実硬度の増大と品質保持効果のあることが明らかとなった.また,その効果は未熟な果実ほど大きいことがわかった.

A 75 year-old man underwent right hemicolectomy for colon cancer 3 yrs and 6 months ago, followed by chemotherapy with capecitabine. One year and 10 months later, solitary liver metastasis was resected. Five months later, a bulky mediastinal mass of 6 cm in diameter was detected by chest computed tomography and he was referred to our department. The tumor was successfully extirpated by videothoracoscopy-assisted right axillary approach. Histopathology disclosed poorly-differentiated tubular adenocarcinoma and diagnosed as metastatic mediastinal lymph node from the colon cancer. He was discharged on the day 5 and alive without disease 13 months after the mediastinal surgery.

Protein kinase Cι (PKCι) is an important oncogenic K-ras effector, and its expression is correlated with tumor angiogenesis. The role of PKCι in gastric cancer remains unclear. The aim of this study was to clarify the role of PKCι in gastric cancer. Twenty-eight patients with gastric cancer who underwent gastrectomy were enrolled in this study. The expression of PKCι mRNA was determined, as were the clinicopathological factors. The patients were divided into PKCι high and low expression groups. The 5-year survival rate, ERK mRNA level and VEGF mRNA level were compared between the two groups. The prognostic factors were investigated by a multivariate analysis. High expression of PKCι was observed to be associated with a lack of differentiation, tumor invasion ≥muscularis propria≤, stage III and IV disease and peritoneal dissemination. The 5-year survival rate in the PKCι high group was lower than that in the PKCι low group. The multivariate analysis revealed that a high expression level of PKCι was an independent prognostic factor. The expression levels of ERK and VEGF in the PKCι high group were higher than those in the PKCι low group. Our results indicate that PKCι is correlated with tumor progression and angiogenesis. PKCι may be a new prognostic factor for gastric cancer.

This study aimed to evaluate the oncologic significance of opioid use during active treatment for advanced colorectal cancer (CRC). The patients included in this study underwent therapeutic chemotherapy for metastatic and/or recurrent CRC. The primary outcomes measured were the characteristics of CRC patients who were administered opioid to maintain compliance with cancer treatments as well as the impact of opioid use on cancer-specific survival. Of the 245 patients, 117 (48%) were administered opioid during chemotherapy. No significant associations were detected between opioid use and clinicopathological factors, with the exception of age (

Although global microRNA (miRNA) expression patterns of several embryologic, physiological and oncogenic processes have been thoroughly studied, no studies are available on the role of miRNAs in pre-operative chemoradiotherapy (CRT) in rectal cancer. This study aimed to delineate the expression pattern of miRNAs for the prediction of response to CRT in rectal cancer. Rectal cancer patients (n=43), who underwent pre-operative CRT (40 Gy radiotherapy combined with S-1), were studied. RNA harvested from rectal cancer biopsy specimens prior to pre-operative CRT was hybridized to miRNA microarrays (821 genes). The response to CRT was evaluated by histopathological examination of surgically resected specimens, Response Evaluation Criteria in Solid Tumors (RECIST) and downstaging. The data of miRNA microarray were evaluated by real-time reverse transcription-polymerase chain reaction (RT-PCR). Two miRNAs (miR-142-3p, 223) with an increased expression that correctly differentiated responders from non-responders to CRT were identified by histopathological examination. One gene (miR-223) showed a higher, while 8 genes (miR-20b, miR-92a, let-7a*, miR-20a, miR-17*, miR-106a, miR-17 and miR-20a*) a lower expression in responders compared to nonresponders, with regard to RECIST. The 3 genes (miR-223, miR-630 and miR-126*) had a higher expression in responders compared to non-responders, with regard to downstaging. The real-time RT-PCR evaluation analysis detected a higher miR-223 level in responders compared to non-responders. Consequently, candidate miR-223 may be a new biomarker for the prediction of response to CRT and may be useful when establishing tailor-made therapies for rectal cancer.

Laparoscopic skills training is becoming the standard for educating surgical residents. Because of the specific procedure which differs from that of open surgery, it is imperative to establish a unique training system to promote efficiency of learning laparoscopic skills. The aim of this study was to evaluate the efficiency of learning laparoscopic skills with or without authorized experts of JSES.Among 71 patients who underwent laparoscopic colectomy from 2004 to 2009, 30 patients who underwent operation in introduction era without a technical expert (2004-2006), 17 patients who underwent operation in late period of introduction era without a technical expert (2006-2008), 12 patients who underwent operation by resident with technical expert (2008-2009) and 12 patients who underwent operation by technical expert, were investigated. Operative time, amount of blood loss, intra- and post-operative complications and conversion to open surgery were investigated.Operative time: 477:333:262:220 minutes (early period:late period:resident:expert), amount of blood loss: 494:73:21:20mL and complications: ileus: 0:1:0:0, leakage: 1:1:3:0, neurological disturbance: 2:1:0:0.Instruction by authorized technical experts of JSES is helpful to avoid pitfalls which are not seen in open surgery without an expert.

Gastrointestinal stromal tumor (GIST) is the most common sarcoma of the intestinal tract. The risk category is usually determined by tumor size and mitotic count, but accurate preoperative diagnosis of GIST is very difficult. The purpose of this study is to evaluate the efficacy of positron emission tomography (PET)-CT for predicting the malignant potential of gastrointestinal stromal tumors.Ten patients with GIST who underwent a preoperative PET-CT examination were divided into two groups by risk category, and various factors were compared between the two groups. The relationships between the maximum standardized uptake value (SUVmax) and GIST parameters were examined.Patients were classified into two groups by their risk category: (low/intermediate-risk or high-risk). The SUVmax was significantly higher in the high-risk group (11.0 ± 3.04) than in the low/intermediate-risk group (2.1 ± 1.5). The Ki67 labeling index was also significantly higher in the high-risk group (8.63 ± 6.2) than in the low/intermediate-risk group (1.75 ± 0.52). There was a significant correlation between the Ki67 labeling index and the SUVmax (p = 0.028) and between the mitotic index and the SUVmax (p = 0.029).PET-CT can predict malignant potential. Cases with a SUVmax of over 5 may have malignant potential.

The role of intratumoral thymidylate synthase (TS) mRNA or protein expression is still controversial and little has been reported regarding relation of them in colorectal cancer.Forty-six patients with advanced colorectal cancer who underwent surgical resection were included. TS mRNA expression was determined by the Danenberg tumor profile method based on laser-captured micro-dissection of the tumor cells. TS protein expression was evaluated using immunohistochemical staining.TS mRNA expression tended to relate TS protein expression. Statistical significance was not found in overall survival between the TS mRNA high group and low group regardless of performing adjuvant chemotherapy. The overall survival in the TS protein negative group was significantly higher than that in positive group in all and the patients without adjuvant chemotherapy. Multivariate analysis showed TS protein expression was as an independent prognostic factor.TS protein expression tends to be related TS mRNA expression and is an independent prognostic factor in advanced colorectal cancer.

Chemo-radiation therapy (CRT) has been used to improve local control and survival in patients with advanced rectal carcinoma. However, a significant proportion of patients shows poor response to adjuvant CRT. We thus investigated the usefulness of RAD51 expressions as a predictive maker of the CRT response.Forty two patients who suffered from lower rectal cancer were investigated. All patients received preoperative CRT consisting of TS-1, concurrent with 40Gy of pelvic irradiation before having curative radical resection. The relationship between pathological responses of the tumors after therapy and expression of RAD51 was evaluated by immunostaining of resected specimen.Positive expression of RAD51 was observed in 24 of 42 patients (57.1%). RAD51 positively expressed in 68.2% (15 of 22 cases) of SD and 42.2% (9 of 20 cases) of PR and CR. There is a tendency of reverse correlation between clinical response and expression of RAD51. Regarding the correlation between pathological response and RAD51 expression, positive expression of RAD51 was recognized in 75.0% (15 of 20 cases) of Grade 1, 47.1% (8 of 17 cases) of Grade 2 and 20.0% (1 of 5 cases) of Grade 3. A significant reverse correlation was recognized between RAD51 expression and pathological responses.RAD51 expression could be one of the most important predictive factors of preoperative CRT for advanced lower rectal cancer.

Our aim was to evaluate the KRAS genotypes of Japanese colorectal cancer (CRC) patients and to assess the effect of these genotypes on clinical outcome. A total of 99 patients with stage I-IV CRC who underwent resection were prospectively studied for KRAS mutations by direct sequencing. KRAS mutations were found in 37 (37.4%) of 99 patients. Of these, 11.1% were the KRAS p.G13D mutation and the remaining 26.2% were other KRAS mutations. The cumulative 5-year survival rates for patients with wild-type KRAS, KRAS 12 and KRAS p.G13D mutations were 81.4, 61.4 and 42.0%, respectively (P=0.0397). The KRAS genotype had no effect on stage IV patient prognosis without anti-epithelial growth factor receptor (EGFR) antibody therapy. However, in stage I-III patients significant or trends in prognostic factors for disease-free survival (DFS) were pathological T stage, lymphatic vessel involvement and KRAS p.G13D. Multivariate analysis identified T4 pathological stage (P=0.0076) and the KRAS p.G13D mutation (P=0.0499) as the most significant independent prognostic factors associated with DFS. In Japanese CRC patients KRAS p.G13D had prognostic impact on DFS in stage I-III disease, while the prognosis of stage IV patients without anti-EGFR antibody therapy was unaffected by KRAS status.

Background/aims Preoperative chemoradiation therapy (CRT) for advanced rectal cancer allows anal sphincter preservation in some patients who would require an abdominoperineal resection. But adequate distal margin in patients with locally advanced rectal cancer requiring preoperative CRT is unclear. The objective was to evaluate necessary distal margin from reduced tumor by preoperative CRT for anal sphincter preservation. Methodology This study included 11 consecutive patients who performed low anterior resection and abdominoperineal resection for rectal cancer after preoperative CRT. Distal margin length from reduced tumor by preoperative CRT to residual viable cancer, tumor grade, lymph-node-metastasis stage and pathological changes of tumors were examined. Results Length from anal side edge of reduced tumor by preoperative CRT to pathological residual tumor ranged from +6 mm to -9 mm. Tumor stages were as follows: T0-2, N0, M0=3, T3, N0, M0=5, T4, N0, M0=1 and T3, N0, M+1=2. Median follow-up was 19 months. Recurrence occurred in one patient and was distant and not local. Pathological examinations showed that no patient had lymph-node-metastasis and residual tumors by preoperative CRT. Conclusions This study suggests that for patients with locally advanced rectal cancer undergoing resection and preoperative CRT, distal margins ≥1 cm from reduced tumor by preoperative CRT seem to compromise pathological outcome.

Liver cirrhosis is characterized by an advanced irreversible fibrotic change in hepatic tissue as a terminal stage of the chronic progressive injury of the liver.(1) The cause of the liver injury is various, and most common causes are chronic viral infection and alcoholism. In non-endemic area of hepatitis B and C virus such as the United States and European countries, the most frequent cause is long-term alcohol consumption. In the endemic area, especially among Asian and African countries including Japan, chronic infection of hepatitis B or C virus is the most common cause of liver cirrhosis.(2-5) Prognosis is not significantly different according to the cause of cirrhosis, such as alcoholic or viral due to hepatitis B or C virus, however, development of hepatocellular carcinoma is more likely to complicate in hepatitis C virus (HCV) infected-patients than in alcoholic patients.(6, 7) Today, HCV infection is spreading worldwide, even in nonendemic area such as the United States or Europe.(8-12) In these non-endemic areas, the main cause of viral infection has been blood transfusion and healthcare-related transmission. But the prevalence of blood test before transfusion and improvement of healthcare environment are decreasing the risk of HCV infection in daily medical practice. However, continuous increase of intravenous drug user and immigration from endemic countries are now bigger risks for HCV infection in these countries. Because HCV is strongly associated with the development of hepatocellular carcinoma, incidence of hepatocellular carcinoma is also increasing all over the world along with the increasing incidence of HCV-related cirrhosis. On the other hand, incidence of lung cancer is still epidemic worldwide.(13-18) In some area of industrialized countries such as the United States, the various effort to educate the public about harmfulness of tobacco and importance of quitting smoking, and another effort to decrease air pollution and exposure of workplace carcinogenetic agents are successfully decreasing the incidence of lung cancer declining in the last decade. However, in the rest majority of the countries, incidence of lung cancer is still increasing especially in the developing countries. Thus, opportunity to encounter patients with lung cancer comorbid with liver cirrhosis will be increasing. These two diseases are both lethal. We will face the difficult question how to treat these patients with the both critical conditions.

A significant prognostic difference exists among metastatic colorectal cancer (CRC) patients despite of any treatments. We identify the specific cytokines related to prognosis of metastatic CRC and assess their prognostic significance.Stage IV CRC patients were divided into two groups according to their prognosis. Difference in serum cytokine level between these groups was determined by the cytokine array. Among the specific cytokines, macrophage inflammatory protein-3 alpha (MIP-3a) was measured using an enzyme-linked immunosorbent assay (ELISA) in the sera of 242 CRC patients.Several cytokines related to prognostic difference in stage IV CRC were identified. The median MIP-3a level (28.2 pg/ml) was used as a cut-off value. Increased MIP-3a was significantly associated with synchronous liver metastases and age. In univariate analysis, high MIP-3a was correlated with poor prognosis (P0.001). Multivariate analysis showed that high MIP-3a was an independent prognostic factor in all CRC patients (P0.001). In subgroup analysis, high MIP-3a was significantly associated with poor survival in patients with stage II, II/III, and IV CRC, respectively.Serum MIP-3a is not only an independent prognostic factor, but also an independent predictive factor for liver metastasis, which may guide the decision making of metastatic CRC patients.

Billroth-I and Roux-en-Y procedures have been applied generally as reconstruction techniques after distal gastrectomy. There have been few reports regarding the physiological differences of these two procedures. We compared gastric emptying after Roux-en-Y procedure with the Billroth-I procedure using the 13C-acetate breath test.Eleven patients who underwent distal gastrectomy, using reconstruction procedures of Billroth- I (B-I group: n=7) and Roux-en-Y (R-Y group: n=6), and 4 healthy volunteers (Control group) were studied. After ingestion of 200mL of liquid diet labelled with 100mg 13C-acetate, breath samples were collected every 5-15 minutes for 3 hours. The analysis of 13C-acetate enrichment was measured using infrared spectrometer.Mean breath-Tmax of B-I group (14.2min) and R-Y group (13.0min) were significantly shorter compared with that of the control group (42.5min). Mean breath-T1/2 of B-I group (76.8min) and R-Y group (80.2min) were significantly shorter compared with that of the control group (133.3min). Mean breath-Cmax of B-I group (60.1min) and R-Y group (59.3min) were significantly higher than that of the control group (27.6min).13C-acetate breath test was useful to evaluate gastric emptying. There were no differences in gastric emptying for both Billroth-I and Roux-en-Y reconstruction.

The feasibility of laparoscopic surgery for clinically staged T3 and T4 rectal cancer has not been clearly defined specifically in cases following preoperative chemoradiation therapy (CRT). Our aim was to investigate the feasibility of laparoscopic surgery after preoperative CRT for clinically staged T3 and T4 rectal cancer.Between May 2003 and June 2009, 57 patients (T3: n = 50, T4: n = 7) who underwent preoperative CRT for rectal cancer were identified. Forty-three patients with laparoscopic surgery (Lap group) were compared with 14 patients who underwent open surgery (Open group). Perioperative data including postoperative morbidity were assessed between the two groups.All patients underwent complete laparoscopic operations, and none was converted to laparotomy. Operating time was longer in the Open group (331 vs 375 min, P0.01). Blood loss was lower in the Lap group (160 vs 316 mL, P0.01). Lymph node harvest and morbidity rate were similar in both groups. The distal tumor margin was negative in all patients. No patients had perioperative mortality associated with surgery after CRT.Laparoscopic surgery after preoperative CRT is a feasible and a safe option for T3 and T4 rectal cancer compared to conventional open surgery.

Subclavian artery aneurysms are comparatively rare in peripheral aneurysms. We experienced a case of intrathoracic aneurysm originating from the proximal part of the right subclavian artery. A 78 year-old man was referred to our hospital with the diagnosis of a right subclavian artery aneurysm. Enhanced computed tomography demonstrated an intrathoracic aneurysm, originating from the right subclavian artery just proximal of its origin. Through a median sternotomy and supra-infraclavicular incision, we reconstructed the brachiocephalic and right common carotid arteries and bypassed to the distal part of the right subclavian artery by using a T-shaped vascular graft and the aneurysm was excluded.

The growth interactions between human cancer cells and primary cultured human fibroblasts, and the effects of suramin on them, were investigated using a double-chamber technique combined with a 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay. Human fibroblasts obtained from various organs resected surgically were cultured in a monolayer and used after the third or fourth passage. In the double-chamber assay, the growth of cancer cells in the top chamber was significantly stimulated by some types of fibroblasts in the bottom chamber in a fibroblast density-dependent manner. Interestingly, the growth of cancer cells was stimulated at 140%-147% by fibroblasts obtained from an organ where cancer cells had developed, the MCF-7 versus mammary fibroblasts, and in LS-180 versus colonic fibroblasts, but not by their fibroblast-conditioned medium. Suramin completely inhibited the growth-enhancing interaction between MCF-7 and mammary fibroblasts, and between SH-101 and lung fibroblasts at a clinical concentration of from 50 micrograms/ml to 300 micrograms/ml. It also reduced the growth of LS-180 co-cultured with colon-fibroblasts, but the inhibitory effect was incomplete. These results suggest that mutual growth reliance exists between human cancer cells and primary cultured fibroblasts by diffusible factors secreted by both cells, and that these enhancing effects are related in part to the growth and metastasis of cancer cells in vivo. Suramin was found to have an inhibitory effect on their interaction at a clinically achievable concentration in vitro.

Background/aims S-1 based chemoradiation is the recommended treatment for rectal cancer; however, the optimal scheduling and dosing are not yet established. A Phase I study was conducted to determine the maximum tolerated dose (MTD) of S-1 with radiotherapy (RT). Endpoints were the toxicity profile of this regimen and to determine the recommended dose (RD). Methodology Conformal RT was given using 4 fields at daily fractions of 2Gy on 5 days per week to a total dose of 40Gy. Concurrently S-1 was given twice daily throughout RT. Eligible patients had a newly diagnosed clinical stage T3-4 N0-2 M0 rectal adenocarcinoma located within 12cm of the anal verge suitable for curative resection. Surgery was performed 6 weeks from completion of preoperative chemoradiotherapy. The dose escalating from S-1 80mg/m2/day (Level 1) to 100mg/m2/day (Level 2). Results Nine patients were valid for safety. In all patients, S-1 was administered. There was no dose-limiting toxicity (DLT) in patients treated at dose Level 1. Six patients were enrolled in the dose-escalation phase. At dose Level 2, two patients developed DLT and this was considered the MTD. Objective response according to RECIST were observed in 5 of 9 patients who had measurable disease (56%). Conclusions The RD of S-1 with concurrent RT was determined to be 80mg/m2/day. Preoperative RT combined with S-1 was feasible and well tolerated.

A 66-year-old man presented with a one month history of hoarseness. Left recurrent nerve palsy and a left upper mediastinal mass were observed by an otorhinolaryngologist who referred the patient to our department. Chest computed tomography showed a superior mediastinal mass, which seemed to involve the left common carotid and left subclavian arteries from the greater curvature of the aortic arch. The innominate vein was compressed, and collateral circulation was well developed. The left upper lobe of the lung was also seemed involved. A mediastinal biopsy conducted via left thoracoscopy revealed a malignant spindle cell tumor. The mediastinum was irradiated (40 Gy), and surgical extirpation was subsequently undertaken 3 weeks later. The tumor was successfully removed without the use of extracorporeal circulation. Because only smooth muscle actin was focally but strongly expressed immunohistochemically, leiomyosarcoma was confirmed. The patient was discharged on day 14. A solitary left pleural metastasis was observed and resected 12 months after the surgery and the patient is well without further recurrence 16 months after the initial surgery.

In gastrointestinal laparoscopic surgery, paraaortic lymphadenectomy is usually performed using a transperitoneal approach (TP), and the use of an extraperitoneal approach (EP) has been scarcely reported. Biopsy of the para-aortic lymph nodes was performed using TP with 3 ports on the patient with esophageal cancer, and EP lymphnode biopsy was performed with 4 ports with malignant lymphoma. The effect of TP vs. EP was evaluated regarding the intraoperative and postoperative complications. TP was difficult for massive biopsy, 1.5cm sized several lymph nodes along the common hepatic artery were biopsied. On the other hand, using EP a 5cm sized paraaortic lymph node was successfully performed. There was no difference between TP and EP in intraoperative blood loss and operation time, respectively, but EP showed great advantage with respect to postoperative complications and length of administration in hospital. Laparoscopic biopsy of para-aortic lymph nodes using EP is a useful method compared with the TP.

The aim of this study was to investigate the primary echocardiographic results of aortic valve replacement using 21- and 19-mm Carpentier-Edwards Perimount Magna bioprosthesis aortic xenografts in patients with small aortic annulus.Twenty patients (mean body surface area 1.63 ± 0.16 m(2)) underwent aortic valve replacement between June 2008 and December 2009. Eight and 12 patients received 21- and 19-mm Magna bioprostheses, respectively. After 12 months, hemodynamic data were obtained by echocardiography to estimate the prosthesis-patient mismatch.At follow-up, significant decreases in peak and mean left ventricular aortic pressure gradients were observed in the 12 patients with aortic stenosis (P 0.05). Regression of the left ventricular mass was observed in all the patients (P 0.05). The mean measured effective orifice area (EOA) and EOA index (EOAI) were 1.61 ± 0.28 cm(2) and 0.99 ± 0.16 cm(2)/m(2), respectively. Prosthesis-patient mismatch (EOAI ≤0.85) was documented in three patients.The primary echocardiographic findings suggested that the hemodynamic performance of the 19- and 21-mm Carpentier-Edwards Perimount Magna bioprostheses was satisfactory in the patients with a small aortic annulus.

Purposes A lot of radiosensitizers have been developed. However, there are few to be available in the clinical setting. Thymidine phosphorylase inhibitor (TPI) regulates the phosphorolysis of thymidine to thymine and 2-deoxy- d -ribose-1-phosphate which is essential for tumor angiogenesis. The aim of this study is to evaluate whether TPI augments the radiotherapy for colorectal cancer in vitro and in vivo studies. Materials and methods The cytotoxicity of TPI with irradiation on HT29 and HCT116 cells was examined using MTT- and colony formation assay. At 10 days post-inoculation, HT29 bearing orthotopic model mice ( n = 28) were divided into four groups and orally treated with TPI- (50 mg/kg/day for 2 weeks), radiation (RT, 2 Gy × 4: Total 8 Gy), their combination or the vehicle. The mechanisms underlying the efficacy were assessed genomically and immunohistochemically. Results Compared to each single treatment, the combination of TPI and RT synergistically inhibited the cell viability in a time- and dose-dependent manner. In the HT-29 bearing mice, the combination of TPI and RT reduced the tumor growth compared with RT alone. Notably, the mRNA levels of VEGF, TGF-β and, Rad51 and the protein expressions of VEGF and CD34 were significantly lower in the combination than the others. Furthermore, the combination markedly increased the TUNEL-positive cells, suggesting that TPI augments the cancer cell death through inhibition of angiogenesis and DNA repair system in the radiotherapy. Conclusions Our study first demonstrated that the combination of TPI and irradiation was effective in colon cancer. TPI would provide a promising therapeutic strategy as a radiosensitizer.

This is the first report of adalimumab-associated pulmonary cryptococcosis. A 56-year-old female with rheumatoid arthritis without a history of pulmonary disease was simultaneously administered adalimumab (40 mg/2 wks), methotrexate (4 mg/wk), and isoniazid (200 mg/day). Five months later, chest radiography revealed a small spiculated pulmonary nodule, and the laboratory test results, including levels of tumor markers and plasma β-D-glucan, were within normal ranges. Since the lesion continued to grow, even after discontinuing adalimumab, it was surgically resected. Grocott staining of the tissue sample revealed black-brown fungi, identified as Cryptococcus neoformans in culture. The patient now remains well, without adalimumab therapy.

Transdiaphragmatic off-pump coronary artery bypass grafting (OPCAB) to the right coronary artery, is an effective way to reduce the risks of second bypass surgery as well as the risk of graft injury after coronary artery bypass grafting (CABG). We report two cases of successful OPCAB as re-do surgery in which the right gastroepiploic artery (RGEA) was grafted to the right coronary artery. The first case was a 58-year-old woman, who underwent CABG 10 years ago. OPCAB (RGEA to right coronary artery) was performed since myocardial perfusion scintigraphy revealed ischemia in the inferior wall. The second case was a 67-year-old man who had hypertension, hyperlipidemia, peripheral arterial disease, and was undergoing dialysis (for 6 years). Six years previously, he developed a mycotic aneurysm of the right coronary artery and underwent open-heart surgery. He often had episodes of angina at night or during dialysis, and then developed congestive heart failure and was hospitalized. Since ischemia was considered to be in the inferior wall, the RGEA was grafted to the right coronary artery.