Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer

BACKGROUND

The area near the left gastric vein (LGV) is a challenging site at which to perform dissection of the lymph nodes during gastrectomy. Therefore, knowledge of the precise location of the LGV is important. The objective of this study was to examine the usefulness of multidetector computed tomography (MDCT) for the identification of the LGV.

METHODS

Eighty-one patients with gastric cancer underwent MDCT, which was performed with contrast media in 76 patients and without contrast media in 5 patients. A 5-mm thin slice of the frontal image was reconstructed. These images were examined preoperatively to detect the location of the LGV. Upon gastrectomy, the LGV was identified and its location compared to that determined by MDCT.

RESULTS

The LGV was identified by MDCT in 76 of the 81 patients (93.8%). The LGV was subsequently located during the operation in all 81 patients. The LGV was located dorsal to the common hepatic artery in 40 patients (49.4%), ventral to the common hepatic artery in 18 patients (22.2%), ventral to the splenic artery in 17 patients (21.0%), dorsal to the splenic artery in 2 patients (2.5%) and in other positions in 4 patients (4.9%). In all patients, the location of the LGV detected using MDCT was consistent with that identified during gastrectomy. In the 4 patients with relatively unusual locations of the LGV, these 4 LGV variants were identified preoperatively by MDCT.

CONCLUSION

MDCT was useful for identifying the location of the LGV prior to gastrectomy.

[A case of curatively resected biliary tract cancer with peritoneal dissemination through effective response to chemotherapy of S-1]

The patient is a 55-year-old woman who has biliary tract cancer with peritoneal dissemination (T3N1P2M0, Stage IV b). Since a curative operation was deemed impossible, we conducted chemotherapy using S-1. S-1 (120 mg/day) was administered for 2 weeks and then chemotherapy was discontinued for 1 week, which was regarded as one course. After 2 courses of the chemotherapy, CT scan showed that the metastatic lymph node and tumor of peritoneal dissemination were reduced in size, and that there was no ascites. Left lobectomy of the liver, cholecystectomy, and partial resection of omentum were carried out. The pathological diagnosis was also curative (pT1, pN0, pP0, Stage I). We think this case shows the possibility of S-1 for patients with unresectable biliary tract cancer.

[A successfully resected case of rectal cancer with liver metastases treated with mFOLFOX6 and bevacizumab]

A sixties-man had complained of melena. Colonoscopy revealed type 2 tumor at rectum. Computed tomography (CT)demonstrated lymph node metastasis in front of sacrum and two low density areas which were suspected metastases in the liver. The patient was diagnosed stageIV rectal cancer and resected primary focus and lymph node metastasis.[ Ra-RS, ant, type 2, moderately differentiated adenocarcinoma, ly1, v3, pSE, pN2, sH1(Grade C), sP0, pM1(No. 270)]without liver resection. It was due to high level of CEA and remote lymph node metastasis. The patient was treated with mFOLFOX6 and bevacizumab after the operation. The level of CEA decreased to normal level and CT revealed a partial response after 4 cycles of systemic chemotherapy. Liver resection was performed safely. Histological response was Grade 2 at liver metastases.

The Fermi Gamma-Ray Space Telescope discovers the pulsar in the young galactic supernova remnant CTA 1

Energetic young pulsars and expanding blast waves [supernova remnants (SNRs)] are the most visible remains after massive stars, ending their lives, explode in core-collapse supernovae. The Fermi Gamma-Ray Space Telescope has unveiled a radio quiet pulsar located near the center of the compact synchrotron nebula inside the supernova remnant CTA 1. The pulsar, discovered through its gamma-ray pulsations, has a period of 316.86 milliseconds and a period derivative of 3.614 x 10(-13) seconds per second. Its characteristic age of 10(4) years is comparable to that estimated for the SNR. We speculate that most unidentified Galactic gamma-ray sources associated with star-forming regions and SNRs are such young pulsars.

Frequent nocturnal vocalization in pure autonomic failure

Nocturnal vocalization is frequent in Parkinson's disease patients with rapid eye movement (REM) sleep behaviour disorder (RBD). We investigated the frequency of nocturnal vocalization and other sleep problems in patients with pure autonomic failure (PAF) and compared the results with idiopathic Parkinson's disease (IPD) and dementia with Lewy bodies (DLB). We interviewed consecutive patient-caregiver pairs with PAF (n = 13), IPD (n = 200) and DLB (n = 19), and ischaemic stroke patients (controls, n = 43). Nocturnal vocalization was similarly frequent in PAF, IPD and DLB. Other dream enactments and vivid dreams also were more frequent in PAF, IPD and DLB compared with controls. Excessive night-time awakenings and daytime sleepiness were frequent in IPD but rare in PAF and controls. Clinical manifestation of sleep disturbances, at least of RBD-like symptoms including nocturnal vocalization and other dream enactments, may occur in PAF, as in IPD and DLB.

Creation of novel chiral synthons with enzymes: application to enantioselective synthesis of antibiotics

Retrosynthesis was carried out to generate, from a target molecule, a symmetric diester in the prochiral or meso form. The symmetric diester was subjected to asymmetric hydrolysis with pig liver esterase to create the corresponding chiral half-ester. The chiral half-ester was converted into the target molecule by organic synthesis. Thus, various types of carbapenem antibiotics, negamycin, showdomycin, 6-azapseudouridine, cordycepin, aristeromycin, neplanocin A, and precursors of fortimicin were efficiently synthesized with the desired absolute configuration. The methods for asymmetric synthesis starting from substrates with sigma-symmetry have been extensively developed.

Detection of cerebrospinal fluid leakage: initial experience with three-dimensional fast spin-echo magnetic resonance myelography

BACKGROUND

The pathogenesis of cerebrospinal fluid (CSF) hypovolemia is supposed to be caused by CSF leakage through small dural defects.

PURPOSE

To compare source three-dimensional (3D) fast spin-echo (FSE) images of magnetic resonance (MR) myelography with radionuclide cisternography findings, and to evaluate the feasibility of MR myelography in the detection of CSF leakage.

MATERIAL AND METHODS

A total of 67 patients who were clinically suspected of CSF hypovolemia underwent indium-111 radionuclide cisternography, and 27 of those who had direct findings of CSF leakage were selected for evaluation. MR myelography with 3D FSE sequences (TR/TE 6000/203 ms) was performed at the lumbar spine for all patients. We evaluated source images and maximum intensity projection (MIP) images of MR myelography, and the findings were correlated with radionuclide cisternography findings. MR myelography of five healthy volunteers was used as a reference. The MR visibility of the CSF leakage was graded as definite (leakage clearly visible), possible (leakage poorly seen), or absent (not shown).

RESULTS

CSF leakage was identified with source 3D FSE images in 22 (81.5%) of 27 patients. Of the 22 patients, 16 were graded as definite and six were graded as possible. For the definite cases, 3D FSE images clearly showed the extent of the leaked CSF in the paraspinal structures. In the remaining five patients with absent findings, radionuclide cisternography showed only slight radionuclide activity out of the arachnoid space.

CONCLUSION

Source 3D FSE images of MR myelography seem useful in the detection of CSF leakage. Invasive radionuclide cisternography may be reserved for equivocal cases only.

Anti-tumor effect of angiogenesis inhibitor TNP-470 and 5-FU combined therapy on human gastric cancer xenograft

BACKGROUND/AIMS

TNP-470, an angiogenesis inhibitor, has already been used in combination with chemotherapy to enhance its antitumor activity. The mechanism of enhanced antitumor activity in combination therapy has not been clarified, however, and few studies have described the combined effect of TNP-470 and 5-fluorouracil (5-FU) on gastric cancer. The present study was conducted to investigate the effect of TNP-470 + 5-FU on gastric cancer cell line MKN-45 in vivo and in vitro.

METHODOLOGY

MKN-45 cells were subcutaneously injected into mice that were divided into 4 groups: a control group, a 5-FU treated group, a TNP-470 treated group, and a 5-FU + TNP-470 treated group. After the inoculation, the volume of subcutaneous tumors was measured. Blood and lymphatic vessels were also analyzed for the assessment of lymphangiogenesis.

RESULTS

Compared with 5-FU or TNP-470 alone, the combined effect of TNP-470 and 5-FU significantly inhibited and suppressed tumor growth in a synergistic fashion. The combined therapy significantly suppressed both angiogenesis and lymphagenesis.

CONCLUSIONS

The study suggests that the combined therapy provides an enhanced antitumor effect on human gastric cancer. The enhanced antitumor activity is explained mainly by the stronger inhibition of angiogenesis.

Thickening of the peritubular capillary basement membrane is a useful diagnostic marker of chronic rejection in renal allografts

In kidney transplantation, the multilayering of the peritubular capillary basement membrane (MLPTC) in electron microscopy (EM) has been recognized as a feature of chronic rejection (CR). In this study, thickening of the peritubular capillary (PTC) basement membrane was evaluated by light microscopy (LM) to determine whether it corresponds to the MLPTC in EM and whether it can be used as a diagnostic marker of CR. Forty-eight patients with late renal allograft were divided into chronic allograft nephropathy (CAN) with CR (Group 1, n = 23), CAN without CR (Group 2, n = 19) and CAN-free (Group 3, n = 6). The thickening of the PTC basement membrane (ptcbm) was scored from grades 0 to 2 (ptcbm score), and the MLPTC thickness was measured in EM. Interobserver agreement on ptcbm scores was statistically significant (Kappa coefficient = 0.63). LM and EM lesions corresponded very well. The ptcbm score was highest in Group 1, and ptcbm2 corresponded closely with CR. Group 1 showed significantly thicker MLPTC than Groups 2 and 3. The results validated the usefulness of the ptcbm score and suggested that the thickening of the PTC basement membrane can be a novel diagnostic marker of CR.

219 COMPARISON OF ESTRUS - OVULATION SYNCHRONIZATION TREATMENTS USING HOLSTEIN HEIFERS AS EMBRYO TRANSFER RECIPIENTS

The Ovsynch system (Pursley et al. 1995 Theriogenology 44, 915–923) has been effectively employed as the synchronization method of recipients for embryo transfer (ET) (Nishisouzu et al. 2004 Reprod. Fertil. Dev. 16, 212–213). To establish the most effective Ovsynch system, we experimentally assessed 3 different protocols by comparing resultant estrus-synchronization rates of Holstein heifers and pregnancy rates of the recipients after ET. Holstein heifers averaging 14–15 months old and weighing over 330 kg were used in this study. They were randomly separated into the following 3 groups: (1) Select-synch (SS) group: an intramuscular (IM) injection of 50 �g GnRH analog was given to heifers at a random stage of the estrus cycle, followed 7 days later by 2 IM injections of 7.5 mg PG analog at an interval of 6 h; (2) Co-synch (CS) group: another IM injection of 50 �g GnRH was given to the SS group at 48 h after the first injection of PG; and (3) Heat-synch (HS) group: an IM injection of 0.75 mg estradiol benzoate was given to the SS group at 24 h after the first injection of PG. Estrus detection was evaluated twice daily by visual observation and use of a Heat Mount Detector. All heifers were additionally injected with 1500 IU hCG 5 days after estrus, to ensure favorable luteal function (Nishigai et al. 2001 J. Reprod. Dev. 47, 283–294). Rectal palpation was used to select acceptable recipients, i.e. those having functional corpora lutea (CL) e17 mm in diameter for 7 days after showing estrus (Nishisouzu et al. 2004 Reprod. Fertil. Dev. 16, 212–213). The size of CL e17 mm was determined by rectal palpation by skillful transferors. Fresh embryos collected from super-ovulated cattle 7 days after estrus were nonsurgically transferred only into acceptable recipients that had functional CL and were properly synchronized, 7–8 days after estrus. Final diagnosis of pregnancy was carried out 60 days after ET. Data were analyzed by the chi-square test. The HS group showed significantly higher (P < 0.01) rates of estrus synchronization (87/89: 98%) at 24–72 h after PG injection, estrus detection (98%), and acceptable suitability as recipients with a functional CL (92%) compared to those of the SS (185/210: 88%, 87%, and 73%, respectively) and CS (68/81: 84%, 74%, and 69%, respectively) groups. The pregnancy rates of heifers that received an embryo were not significantly different among HS, SS, and CS groups (45/82: 55%, 78/153: 51%, and 25/56: 45%, respectively). However, because the yield rate of acceptable recipients in the HS group was higher than in the other groups, the final pregnancy rates (no. pregnant/no. synchronization treatment) of the HS group (50%) was significantly higher than those of the SS and CS groups (37%; P < 0.05, and 31%; P < 0.01, respectively). Taken together, these findings demonstrate that the HS protocol is effective for estrus–ovulation synchronization of Holstein heifers, thus improving the productivity of ET by increasing the yield rates of heifers with a functional CL which leads to acceptable pregnancy results.

Conversion factor for CT dosimetry to assess patient dose using a 256-slice CT scanner

Recent rapid progress in CT technology has yielded equipment with large numbers of detector rows and standard computed tomography dose index (CTDI) is therefore no longer an adequate integration range. An integration range of 300 mm is necessary to accurately measure dose under a nominal beam width of 128 mm due to scattered radiation. However, such a long phantom is inconvenient to use routinely in cone-beam CT patient dose checking. To assess patient dose accurately with standard dosimetry methods, we determined a conversion factor (CF) which was calculated from the weighted dose profile integral (DPI(w)) for the 300 mm integration range with a 300 mm long CTDI phantom using a 300 mm long ionization chamber divided by that for the 100 mm integration range with a standard CTDI phantom (140 mm long) with a 100 mm long chamber. CF values increase with increasing nominal beam width and effective energy in the range from 1.5 to 2.0. CF values can also be adapted for use with other CT systems as their dose profiles are thought to be analogous to those for the 300 mm phantom and are useful in any hospital situation to assess accurate patient doses using standard dosimetry methods.

[Ball thrombus in the right atrium: report of a case]

A 63-year-old man visited our hospital because of intermittent claudication due to an embolic episode in the left femoral artery. He had a long history of arterial fibrillation but had received no anticoagulant therapy. Echocardiography showed a large floating ball-shaped shadow in the right atrium, without any sign of tricuspid stenosis. Pulmonary perfusion scintigram was normal. At the operation, the thrombus which attached to the superior atrial septum with a thin string was removed. The thrombus was 54 x 40 x 25 mm in size and 23.8 g in weight, whose cut surface was in layers. There was neither atrial septal defect nor foramen ovale to suggest possibility of paradoxical embolism. The postoperative course was uneventful and he was discharged on the 9th postoperative day. Although the mechanism of the thrombus formations is unknown, it is considered to be important to continue anticoagulant therapy to avoid reccurence of intracardiac thrombus.

[Quality of life of long-term survivors of surgically treated lung cancer]

Quality of life (QOL) of long-term survivors (more than 3 years after surgery) of primary non-small cell lung cancer was studied. QOL was analyzed using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 30-Item version 3.0 (QLQ-C30) and Hospital Anxiety and Depression Scale (HADS). Sixty of 91 patients (66%) participated in this study 87 +/- 5 (38-172) months postoperatively. In QLQ-C30, calculated scores of physical (84.0 +/- 2.4), role (81.3 +/- 3.6), cognitive (79.7 +/- 2.6), emotional (86.8 +/- 1.9), and social (91.0 +/- 1.9) functioning, and global QOL (72.6 +/- 2.9) were obtained. Calculated HADS A (anxiety) was 3.3 +/- 0.3 and HADS D (depression) was 4.0 +/- 0.4. Postoperative follow-up duration was correlated with financial impact only. QOL of long-term survivors was influenced by gender histology, marital status, employment status, and academic carrier.

Intratumoral heterogeneous expression of thymidylate synthase in gastric cancer

BACKGROUND/AIMS

Thymidylate synthase (TS) is reported to be a predictive factor of survival in gastric cancer patients. Its heterogeneous expression has been observed in various cancerous lesions but has not been assessed intratumorally. The aim of this study was to determine the most pertinent site for investigating intratumoral TS expression for the prediction of survival.

METHODOLOGY

TS staining grade was evaluated at the center (CT), the horizontal edge (HT) and the vertical edge (VT) of the tumor, and TS protein level was determined by ELISA at CT and HT. Proliferating cell nuclear antigen (PCNA) was examined for proliferation markers in all tumor samples.

RESULTS

TS expression at HT and VT was significantly higher than at CT. A positive correlation was observed between TS protein level and PCNA-Labeling Index at HT, but not at CT. The survival rate of the high TS group was poor compared with the low TS group at HT and VT, but not at CT.

CONCLUSIONS

The horizontal edge of the tumor (HT) is the most pertinent site for the evaluation of TS expression in gastric cancer; it could prove especially useful in the presurgical estimation of prognosis through biopsy samples.