Characteristics of electron heat transport of plasma with an electron internal-transport barrier in the large helical device

Associated with the transition from ion root to electron root, an electron internal transport barrier (ITB) appears in the large helical device, when the heating power of electron cyclotron resonance heating exceeds the threshold power. The incremental thermal diffusivity of electron heat transport chi(inc)(e) in the ITB plasma is much lower than that in the plasma with the heating power below the threshold, and the thermal diffusivity chi(e) decreases with increasing of heating power [dchi(e)/d(P/n(e))<0] in helical ITB plasmas.

Surgical management of synchronous hepatocellular carcinoma and gastric cancer

BACKGROUND/AIMS

The improvement of diagnostic modalities and operative techniques has resulted in prolonged survival for cancer patients, but has also led to the diagnosis of an increasing number of patients with synchronous hepatocellular carcinoma (HCC) and extrahepatic primary cancer. It is necessary to determine the optimal surgical strategies for synchronous HCC and gastric cancer.

METHODS

In this retrospective study, clinicopathologic findings, diagnostic methods, treatment and outcome were reviewed in 13 patients who underwent curative surgery for synchronous HCC and gastric cancer.

RESULTS

Twelve of the 13 patients were men older than 60 years. All patients had chronic hepatic disease, and hepatitis viral infection was detected in 9 patients. Examinations of the esophagus to search for esophageal varices before liver resection for HCC, and imaging studies to rule out liver metastasis before gastrectomy for gastric cancer can lead to the incidental finding of a synchronous carcinoma. The most frequent postoperative complication was massive ascites, which occurred in 4 patients who underwent lymph node dissection, 1 of whom died of perioperative hepatic failure. HCC recurred in 7 patients, 4 of whom died of their disease; only 1 patient died of recurrence of gastric cancer.

CONCLUSION

Careful follow-up for recurrence of HCC is necessary because the most common cause of death in patients with synchronous carcinoma is recurrence of HCC.

An HSV amplicon-based helper system for helper-dependent adenoviral vectors

To produce a helper virus-free stock of helper-dependent adenoviral vectors (HDAdVs), we have developed a new helper system in which adenoviral genes for propagation of HDAdVs are delivered into producer cells by a herpes simplex virus-1 (HSV) amplicon-adenovirus hybrid. The hybrid amplicon was constructed to carry the E1 gene (HA-E1) or the entire adenoviral genome except E1 (HA-Ad). E1 expression from the HSV amplicon successfully complemented propagation of an E1-deleted adenoviral vector in a human glioma cell line. HDAdVs were propagated in 293 cells infected with HA-Ad. In addition, HDAdVs were rescued and propagated in a glioma cell line superinfected with both HA-E1 and HA-Ad amplicons, although relatively low titers of HSV amplicon resulted in low propagation efficiency of HDAdVs. Since the HSV amplicon can be easily and completely inactivated by chloroform extraction and/or heat treatment from the HDAdV stock, this helper system might be an alternative method to produce helper virus-free HDAdVs.

Cytokeratin-19 fragments in serum (CYFRA 21-1) as a marker in primary liver cancer

Using an electrochemiluminescence immunoassay, CYFRA 21-1 concentrations were measured in sera from 187 patients with primary liver cancer (164 with hepatocellular carcinoma (HCC) and 23 with intrahepatic cholangiocarcinoma (ICC)) and 87 patients with benign liver diseases. Concentrations of CYFRA 21-1 were significantly higher in patients with ICC (5.0; interquartile range 3.1-10.7 ng ml(-1)) than in those with benign liver disease (1.4; 1.0-1.9; Mann-Whitney U-test, P<0.0001) or HCC (1.7; 1.1-2.7; Mann-Whitney U-test, P<0.0001). Using cutoff values selected for 95% specificity in the benign group (3.0 ng ml(-1)), CYFRA 21-1 showed higher sensitivity for ICC (87.0%) than three commonly used markers including alpha-fetoprotein (17.4%), carcinoembryonic antigen (34.8%), and carbohydrate antigen 19-9 (60.9%). Serum CYFRA 21-1 increased in ICC from stages I/II to IV (Kruskal-Wallis test, P=0.0102). CYFRA 21-1 concentration increased with extent of local invasion, but not nodal status. Serum CYFRA 21-1 represents a useful diagnostic test for ICC that offers high sensitivity. CYFRA 21-1 reflected differences in tumour burden, suggesting applicability to staging and follow-up.

Sawtooth oscillation in current-carrying plasma in the large helical device

Sawtooth oscillations have been observed in current-carrying helical plasmas by using electron-cyclotron-emission diagnostics in the Large Helical Device. The plasma current, which is driven by neutral beam injection, reduces the beta threshold of the sawtooth oscillation. When the central q value is increased due to the plasma current, the core region crashes, and, when it is decreased, the edge region crashes annularly. Observed rapid mixture of the plasma in the limited region suggests that these sawtooth crashes are reconnection phenomena. Unlike previous experiments, no precursor oscillation has been observed.

A new hybrid system capable of efficient lentiviral vector production and stable gene transfer mediated by a single helper-dependent adenoviral vector

To achieve efficient and sustained gene expression, we developed a new lentivirus/adenovirus hybrid vector (LA vector) that encodes sequences required for production of a human immunodeficiency virus-based lentiviral vector (i.e., a lentiviral vector, a gag/pol/rev expression cassette, a tetracycline-inducible envelope cassette, and the tetracycline-inducible transcriptional activator cassette) in a single helper-dependent adenovirus vector backbone. Via either transfection or infection, human cell lines transduced with the LA vector produced a lentiviral vector in a doxycycline-dependent manner at titers up to 10(5) to 10(6) green fluorescent protein transducing units per ml, which are comparable to the titers obtained by conventional multiple plasmid transfection methods. Efficient spread and persistent expression of the transgene were observed in cells maintained in long-term culture that had been infected with the LA vector. Furthermore, when cocultured with adherent cells infected with the LA vector, the human T-cell leukemia cell line was successfully transduced with a marker gene. This LA vector possesses the advantages of efficient gene transfer from an adenoviral vector and stable integration from a lentiviral vector; therefore, it might have potential for a variety of gene therapy applications.

Morphological study of demineralized dentine after caries removal using two different methods

BACKGROUND

Caries-affected dentine is the usual substrate bonded to in everyday clinical practice. The first step for most of the current dentine adhesive systems is etching or conditioning. It is therefore important to understand the effect of etchant/conditioner on caries-affected dentine.

METHODS

Twelve extracted carious permanent molars were examined. Six teeth had caries removed using burs after staining with a caries detector dye, and caries from the other six was removed using Carisolv. After caries removal, three teeth from each group were left untreated. The remaining teeth were sectioned to obtain two normal dentine samples and two caries-affected dentine samples from each tooth. One half of the normal dentine samples and one half of the caries-affected dentine samples were treated with 35 per cent phosphoric acid, and the remaining samples were treated with 20 per cent polyacrylic acid/3 per cent aluminium chloride. The samples were observed using field emission scanning electron microscopy (FE-SEM).

RESULTS

Phosphoric acid treated samples showed more obvious intertubular dentine microporosity and greater depth of demineralization in caries-affected dentine. Polyacrylic acid treated samples showed some residual smear layer. However, the peritubular and intertubular collagen network was easily observed in Carisolv treated dentine. The depth of demineralization was not as distinct as that of the phosphoric treated samples.

CONCLUSIONS

From this study it was shown that etched 'normal' dentine and etched caries-affected dentine had different surface appearances. Furthermore, the two caries removal techniques resulted in different caries-affected dentine surfaces after acid treatment that may influence the longevity of bonds from adhesive restorative materials.

Adenovirus as an integrating vector

Recombinant adenoviral vectors have served as one of the most efficient gene delivery vehicles in vivo thus far. Multiply attenuated or completely gutless adenoviral vectors have been developed to achieve long-term gene expression in animal models by overcoming cellular immunity against de novo synthesized adenoviral proteins. However, since adenovirus lacks native integration machinery, the goal of gene therapy obtaining permanent expression cannot be realized with current adenoviral vector systems. Recent studies have shown that replication-incompetent adenoviral vectors randomly integrate into host chromosomes at frequencies of 0.001-1% of infected cells. To improve the integration frequencies of adenoviral vectors, a variety of hybrid vectors combining the highly efficient DNA delivery of adenovirus with the integrating machinery of retroviruses, adeno-associated viruses, and transposons, have been emerging. These hybrid vectors have shown promise, at least in in vitro systems. Furthermore, adenoviral vectors have shown potential as gene targeting vectors. These developments should eventually lead to more effective gene therapy vectors that can transduce a myriad of cell types stably in vivo.

Randomized clinical trial of long-term outcome after resection of hepatitis C virus-related hepatocellular carcinoma by postoperative interferon therapy

BACKGROUND

Interferon therapy seems to decrease the incidence of recurrence after resection of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC). Effects of postoperative interferon therapy on the survival rate after resection of such HCC are still unclear.

METHODS

A prospective randomized clinical trial of postoperative interferon therapy was performed. Thirty men were allocated randomly after liver resection to an interferon-alpha group (15 patients) or a control group. Patients in the interferon group received interferon-alpha 6 MIU intramuscularly every day for 2 weeks, then three times a week for 14 weeks and finally twice a week for 88 weeks.

RESULTS

The response to interferon was complete in two patients, there was a biochemical response in six patients and no response in seven patients. Interferon administration was not completed in three patients because of adverse events. Liver function did not change or worsened after operation in the control group, and did not change or improved in the interferon group. The cumulative survival rate was higher in the interferon group than in the control group (P = 0.041).

CONCLUSION

Postoperative interferon therapy seems to improve the outcome after resection of HCV-related HCC.

Replication and packaging of helper-dependent adenoviral vectors

A helper-dependent adenovirus vector (HD AdV) that lacks all the coding sequences of viral proteins from the vector backbone was developed to overcome the problem of host cellular immune responses against E1-deleted AdV. One of the limitations of the current HD AdV system is its relatively inefficient propagation compared with that of E1-deleted AdV, which deters application of the HD AdV, especially in large animal models. We hypothesized that the low titers might be due in part to defects in replication and packaging of the vector DNA. We propagated two HD AdVs with similar marker gene cassettes and stuffer sequences, using two different helper viruses, and determined the replication and packaging efficiencies of viral DNA. Our analysis indicated a difference in replication and packaging efficiencies between the two vectors, which resulted in different propagation efficiencies. Furthermore, dl309, which is similar to the wild-type virus, demonstrated superior helper function over that of the loxP-containing helper virus, AdLC8cluc. These findings may have significant implications for the design of improved production systems of HD AdVs.

Resectable pleomorphic giant cell carcinoma of the pancreas

We present a 72-yr-old woman who underwent surgical resection of a large pancreatic tumor. On preoperative imaging, an intratumoral cavity containing necrotic tissue was noted, mimicking the appearance of a cystic tumor. There was no invasion of adjacent organs nor distant metastasis, and histopathologic examination revealed the tumor to be a giant cell carcinoma. Postoperatively, the patient has been followed for 1.5 yr without evidence of recurrence. Giant cell carcinoma generally is associated with a poor prognosis, and patients usually die within months despite intensive multimodality therapy. Some patients with giant cell carcinomas, however, achieve long-term survival when invasion of adjacent organs and distant metastases are absent. Surgical resection is the appropriate treatment for tumors with these favorable characteristics.

Familial Parkinson's disease. Alpha-synuclein and parkin

We have reviewed recent progress in establishing the function of alpha-synuclein and parkin in relation to nigral degeneration in autosomal dominant and autosomal recessive PD. Mutations of alpha-synuclein (Ala53Thr and Ala30Pro) cause a form of autosomal dominant PD with early onset. Parkin is a novel protein expressed in the cytoplasm, including the terminal regions and Golgi apparatus. Mutations of parkin cause a form of autosomal recessive young-onset PD (ARJP). Both proteins appear to be associated with fast axonal transport. In addition, in sporadic PD, normal alpha-synuclein shows an increased tendency to self-aggregate. Thus, altered axonal transport of presynaptic proteins appears to play a crucial role in neurodegeneration in PD.

Island dynamics in the large-helical-device plasmas

In the Large Helical Device plasma discharges, the size of an externally imposed island with mode number ( n/m = 1/1) decreases substantially when the plasma is collisionless ( nu(*)< approximately 1) and the beta is finite ( > approximately 0.1%) at the island location. For the collisional plasmas with finite beta, on the other hand, the size of the island increases. However, there is a threshold in terms of the vacuum island size below which the island enlargement is not seen.

[Clinical significance of interferon therapy in treatments for hepatitis C virus-related hepatocellular carcinoma]

The results of liver resection for hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) are affected by persistent active hepatitis and/or hepatic fibrosis including cirrhosis. In patients infected with HCV, interferon therapy prevents the development of HCC by eradication of HCV and/or the remission of active hepatitis. Although HCCs are found even in some patients treated with interferon, the results of liver resection for such HCCs were satisfactory, especially in patients successfully treated with interferon. Postoperative interferon-alpha therapy decreased recurrence after resection of HCV-related HCC in a randomized controlled trial. Strategies for viral infection as well as the carcinoma can improve the outcome after treatment of HCV-related HCC. Interferon therapy is useful to improve the outcome after treatments for HCV-related HCC.

Large focal nodular hyperplasia of the liver: possible to evade surgical resection

PURPOSE

Although recent advances in diagnostic imaging have allowed a number of patients with focal nodular hyperplasia (FNH) to avoid surgical treatment, the natural course of large FNH is still unknown.

CASE REPORT

A 25-year-old man was admitted because of a large hepatic mass detected on routine examination in June 1998. The only laboratory abnormality was an elevated gamma-GTP. Computed tomography, angiography, positron emission tomography using F-18 fluorodeoxyglucose (FDG-PET), and scintigraphy using technetium-99m-galactosylneoglycoalbumin(99mTc-NGA) demonstrated a spoke-wheel appearance of vessels, normal hepatocytes, and no malignancy. Histologic findings on needle biopsy were consistent with FNH. After informed consent, the patient agreed to observation. Two years after the initial diagnosis, he has no symptoms, and there are no changes in the size or character of the lesion on computed tomography.

DISCUSSION

Careful observation of patients with FNH is required because its natural course is unknown and these lesions can bleed or rupture.

Neuronal changes in the arcuate and hypoglossal nuclei of brain stem induced by head injury

In head injury, assessing the damage not only to the cerebrum and the cerebellum but also to the brain stem is very important. In this paper, we report neuronal changes of the arcuate nucleus (ARC) and the hypoglossal nucleus (HN) in the brain stem. We investigated these changes immunohistochemically with antibodies against microtubule-associated protein 2 (MAP2), muscarinic acetylcholine receptor (mAChR), c-fos gene product (c-Fos), and the 72 kD heat-shock protein (HSP70). We measured the percentage of immunopositive neurons among the total neurons of the ARC and the HN. The investigation of neuronal changes in relation to the type of head injury showed different results. In cases of tonsillar herniation, immunoreactivity to MAP2 and mAChR in the ARC was significantly lower than in the HN (p < 0.01). Moreover, MAP2, HSP70 and c-Fos reactivities in the ARC were significantly lower than in other types of head injuries (p < 0.01). In the HN, diffuse axonal injury produced slightly higher immunoreactivity to mAChR and c-Fos (p < 0.1). Our observations indicate that immunohistochemical examination of brain stem nuclei can provide useful information for estimating damage to the brain stem.

Previous or occult hepatitis B virus infection in hepatitis C virus-associated hepatocellular carcinoma without hepatic fibrosis

We investigated the role of hepatitis B virus infection in development of hepatocellular carcinoma in hepatitis C virus-infected patients without hepatic fibrosis. Of 253 patients, 8 lacked hepatic fibrosis (group 1); group 2 included the remaining 245 patients. Clinicopathologic findings were compared between the groups. Hepatitis B x gene was sought in cancers and adjoining noncancerous liver. Group 1 showed better liver function parameters and milder active hepatitis than group 2. The proportion of patients with anti-hepatitis B virus antibody tended to be higher in group 1 than in group 2. The proportion of patients with hepatitis B x RNA in cancers was significantly higher in group 1 than in group 2. All group 1 patients had previous or occult hepatitis B virus infection. Previous or occult hepatitis B virus infection may be critical in development of hepatocellular carcinomas in hepatitis C virus-infected patients without hepatic fibrosis.

Relationship of the microvascular type to the tumor size, arterialization and dedifferentiation of human hepatocellular carcinoma

Unlike normal liver with the sinusoids, hepatocellular carcinomas (HCCs) possess capillaries. Whether these capillaries derive from the sinusoids remains unclear in human HCCs. This study aimed to examine sinusoidal capillarization in human HCCs and its relationship to the tumor size, arterialization and dedifferentiation. Thirty-eight HCCs with a diameter of 10 - 140 mm were pathologically and angiographically examined. By electron microscopy, the microvasculature of tumors was classified into sinusoidal, intermediate and capillary types, which were all negative, partially positive and all positive, respectively, for four parameters, i.e., endothelial defenestration, continuous basement membrane, lack of Kupffer cells, and lack of lipid-containing hepatic stellate cells. Well-, moderately and poorly differentiated HCCs displayed sinusoidal / intermediate / capillary types, intermediate / capillary types and only capillary type, respectively, suggesting the transition from the sinusoids to capillaries in well-differentiated (and probably moderately differentiated) HCCs. Furthermore, well-differentiated HCCs with a diameter of less than 30 mm often received preferential portal venous blood, while moderately and poorly differentiated ones were all supplied with arterial blood, indicating a relationship between dedifferentiation and arterialization. In contrast, the microvascular type displayed no significant relationship with tumor size or arterialization in well-differentiated HCCs. The present study has demonstrated that sinusoidal capillarization occurs in human well-differentiated HCCs and seems to be related to dedifferentiation of parenchymal tumor cells, but not to tumor size or arterialization.

Treatment of adrenal metastases after hepatic resection of a hepatocellular carcinoma

BACKGROUND

The adrenal gland is a common site of extrahepatic metastases from a hepatocellular carcinoma (HCC). However, treatment of adrenal metastases has not been well characterized.

METHODS

Of 562 patients who underwent hepatic resection for a HCC, 91 developed extrahepatic metastases. We reviewed the medical records of 10 patients with adrenal metastases (9 males and 1 female; mean age 63 years at the time of hepatic resection).

RESULTS

The mean diameter of the primary tumors was 5 cm, and all were located in the right lobe of the liver. The mean interval from hepatic resection to recurrence was 18 months. Seven patients underwent treatment of intrahepatic recurrence. To treat the adrenal metastases, surgical resection was performed in 4 patients, and transcatheter arterial embolization was performed in 1 patient. The patients treated had no other extrahepatic metastases. The mean diameter of the resected adrenal tumors was 6 cm. There was no hospital mortality. With surgical resection, 1 patient has been alive 63 months after recurrence.

CONCLUSIONS

Adrenal metastases from a HCC were often large at the time of diagnosis. Since surgical resection was a safe procedure, and some patients could be alive for a long time, it should be performed whenever possible.

Observation of the "self-healing" of an error field island in the large helical device

It was observed that the vacuum magnetic island produced by an external error magnetic field in the large helical device shrank in the presence of plasma. This was evidenced by the disappearance of flat regions in the electron temperature profile obtained by Thomson scattering. This island behavior depended on the magnetic configuration in which the plasmas were produced.

Drastic up-regulation of Fcepsilonri on mast cells is induced by IgE binding through stabilization and accumulation of Fcepsilonri on the cell surface

It has been shown that IgE binding to FcepsilonRI on mast cells results in increased FcepsilonRI expression, which in turn enhances IgE-dependent chemical mediator release from mast cells. Therefore, prevention of the IgE-mediated FcepsilonRI up-regulation would be a promising strategy for management of allergic disorders. However, the mechanism of IgE-mediated FcepsilonRI up-regulation has not been fully elucidated. In this study, we analyzed kinetics of FcepsilonRI on peritoneal mast cells and bone marrow-derived mast cells. In the presence of brefeldin A, which prevented transport of new FcepsilonRI molecules to the cell surface, levels of IgE-free FcepsilonRI on mast cells decreased drastically during culture, whereas those of IgE-bound FcepsilonRI were stable. In contrast, levels of FcgammaRIII on the same cells were stable even in the absence of its ligand, indicating that FcepsilonRI alpha-chain, but not beta- and gamma-chains, was responsible for the instability of IgE-free FcepsilonRI. As far as we analyzed, there was no evidence to support the idea that IgE binding to FcepsilonRI facilitated synthesis and/or transport of FcepsilonRI to the cell surface. Therefore, the stabilization and accumulation of FcepsilonRI on the cell surface through IgE binding appears to be the major mechanism of IgE-mediated FcepsilonRI up-regulation.

Successful treatment of dissemination of hepatocellular carcinoma to the pleura and diaphragm after percutaneous liver biopsy

BACKGROUND/AIM

Treatment for dissemination of hepatocellular carcinoma to the pleura and diaphragm following percutaneous needle biopsy has not been established.

METHODS

The case of a 57-year-old man who underwent percutaneous needle biopsy for liver tumor is presented.

RESULTS

Ten months after resection of the tumor (moderately differentiated hepatocellular carcinoma), masses in the right pleural cavity and on the diaphragm were detected by computed tomography. Resections of the masses with surrounding tissue and the diaphragm and wedge resection of the right lung were performed. A wide range of the pleura and the diaphragm was coagulated with an argon beam coagulator. The patient is in good health without recurrence 4 years after the operation.

CONCLUSION

Aggressive surgical treatment should be considered for patients with dissemination of hepatocellular carcinoma by needle biopsy when the lesions are limited.

Bifurcation, birooted primary canines: a case report

A rare case of birooted primary canines is reported. A male patient aged 6 years 4 months of age presented with pain and swelling related to the upper right first primary molar. Radiographic examination revealed an incidental finding of bifurcation of the roots of all four primary canines. This represents a rare finding. The prevalence of birooted permanent canines in the Japanese population has been reported, but the prevalence of this abnormality of primary canines in other populations is unknown. This report discusses the findings in the context of the available literature. The possible aetiology, possible inferences for the developing dentition, and the need for careful assessment prior to root canal therapy or extraction are highlighted.

The effect of flexural load cycling on the microleakage of cervical resin composites

Although several in vitro studies have attempted to investigate the microleakage of Class V resin composites under loading, the effect of load cycling on marginal seal is still unclear. This may be due to the fact that axial loads were applied to the specimens. This study investigated the effect of flexural loads on marginal sealing of cervical resin composites. One hundred and fifty cervical wedge-shaped cavities were restored with Clearfil Photo Bond, Clearfil Liner Bond 2, Scotchbond Multi-Purpose with 10% maleic acid, Scotchbond Multi-Purpose with 35% phosphoric acid or Mac-Bond 2 according to the manufacturers' instructions. After the restorations were finished, 10 specimens from each group were immersed in 0.5% basic fuchsin solution to examine microleakage. Prior to dye solution immersion, 20 specimens were subjected to flexural load cycling (1 mm labio-lingual or linguo-labial displacement at the incisal edge, 10,000 cycles, 1 cycle/second). The data were analyzed using the Kruskal-Wallis test and the Mann-Whitney U-test (p<0.05). When the flexural loads were not applied, both the incisal and apical margins showed good marginal sealing, regardless of the adhesive system used. Labio-lingual loading significantly deteriorated the marginal integrity at the incisal enamel margins, except for those restored with Clearfil Photo Bond. However, only Clearfil Photo Bond demonstrated a significant increase in microleakage along the apical dentin margins. Linguo-labial loading had no significant effect on the marginal seal.

Prognostic factors after recurrence of resected hepatocellular carcinoma associated with hepatitis C virus

To clarify the variables related to survival after recurrence of resected hepatocellular carcinoma (HCC) associated with hepatitis C virus (HCV), we studied 17 clinicopathological factors in 99 patients with recurrence of HCC associated with HCV infection after hepatic resection. The 1-, 3-, and 5-year survival rates after first resection in these patients were 91%, 81%, and 49%, while after recurrence they were 81%, 51%, and 29%, respectively. Multivariate analysis showed that the following six variables were independent prognostic factors after recurrence: platelet count, albumin level, bilirubin level, number of hepatic lesions, distant metastasis, and any treatment at recurrence. A correlation between second hepatic resection (SHR) and liver function tests was seen in regard to albumin and total bilirubin values at recurrence. Indeed, hepatic function and progression of intrahepatic tumors at recurrence were significant prognostic factors after recurrence of HCC associated with HCV infection, while any treatment at recurrence was also a significant prognostic factor. Therefore, in order to improve prognosis after recurrence, we should actively treat the recurrent hepatic lesions whenever possible.

Renal pelvic carcinoma producing granulocyte colony-stimulating factor: report of a case

A 69-year-old man was admitted to our hospital because of anorexia and weight loss. Abdominal computed tomography showed an irregularly contoured mass in his left renal pelvis. The patient had a remarkable degree of leukocytosis with no obvious focus of infection. An enzyme immunoassay of the serum revealed a remarkably high concentration of granulocyte colony-stimulating factor (G-CSF). The patient died 6 weeks after admission without a resection of the renal pelvic tumor. At autopsy, the tumor involved the pancreas, stomach, and descending colon. The histopathologic diagnosis was squamous cell carcinoma with sarcomatous change. Immunohistochemical staining using anti-G-CSF antibody demonstrated immunoreactivity in the cancer cells. To our knowledge, this is the first case of renal pelvic carcinoma proven to produce G-CSF reported in English.

Reaction of D-glycals with azidotrimethylsilane

The treatment of 2,3,4,6-tetra-O-acetyl-1,5-anhydro-D-arabino-hex-1-enitol with azidotrimethylsilane by the aid of a catalytic amount of Yb(OTf)(3) afforded 2,4,6-tri-O-acetyl-2,3-dideoxy-alpha-D-erythro-hex-2-enopyranosyl azide in high yield.

Histologic factors affecting prognosis following hepatectomy for intrahepatic cholangiocarcinoma

Long-term survival following hepatectomy for intrahepatic cholangiocarcinoma has been poor, and specific factors influencing survival are unclear. In a retrospective study we sought to determine prognostic factors related to survival in these patients. In 28 patients who underwent hepatic resection for intrahepatic cholangiocarcinoma, we investigated the relations of several histologic factors to patient survival by univariate and multivariate analyses. No deaths occurred during the first 30 days. Median and mean survival times following hepatectomy were 409 and 935 days, respectively. The respective survival rates at 1, 3, and 5 years were 57%, 27%, and 27%. Resection margin status, intrahepatic metastasis, lymph node involvement, and lymphatic invasion were significant predictors of outcome. In a multivariate analysis using the Cox proportional hazards model, only lymphatic invasion independently predicted survival. Curative resection with clear margins was found to prolong survival after surgery. Hepatectomy for intrahepatic cholangiocarcinoma without lymphatic invasion offers hope for long-term survival.

Clinicopathological factors predicting outcome after resection of mass-forming intrahepatic cholangiocarcinoma

BACKGROUND

The prognosis for patients with intrahepatic cholangiocarcinoma differs according to macroscopic type. The identification of clinical and pathological features that predict outcome in patients with mass-forming intrahepatic cholangiocarcinoma is required in order to determine optimal surgical strategies for patients with this type of tumour.

METHODS

The details of 35 patients with resected mass-forming intrahepatic cholangiocarcinomas were analysed retrospectively. Univariate analysis of potential prognostic factors was performed.

RESULTS

The cumulative survival rate at 1, 3 and 5 years after operation was 58, 33 and 33 per cent respectively. Patients with stage II tumours had a better outcome than those with advanced stage tumours. By univariate analysis, lymphatic invasion, lymph node metastasis, intrahepatic satellite lesions and microscopic resection margin involvement were found to be highly significant variables and were identified as possible risk factors for a poor outcome after operation.

CONCLUSION

When frozen-section examination of lymph nodes reveals negative nodal metastasis, extensive anatomical hepatic resection is indicated for mass-forming intrahepatic cholangiocarcinomas. Intraoperative frozen-section examination of the resection margin to confirm the absence of cancer cells is recommended.

Pleural dissemination as a complication of preoperative percutaneous transhepatic biliary drainage for hilar cholangiocarcinoma: report of a case

One potential risk of percutaneous transhepatic biliary drainage is tumor seeding along the catheter tract. A 57-year-old woman with obstructive jaundice due to hilar cholangiocarcinoma underwent an extended left hepatic lobectomy, a regional lymph node dissection, and a right hepaticojejunostomy 2 weeks after percutaneous transhepatic biliary drainage. Multiple right pleural masses were found on a chest radiogram 14 months after the operation. No recurrent lesions were detected in the abdominal cavity. A right panpleuropneumonectomy was performed; however, the patient died of respiratory failure due to tumor recurrence 9 months after the second operation. Preoperative percutaneous transhepatich biliary drainage was considered to have resulted in pleural implantation.

Reduction of ion thermal diffusivity associated with the transition of the radial electric field in neutral-beam-heated plasmas in the large helical device

Recent large helical device experiments revealed that the transition from ion root to electron root occurred for the first time in neutral-beam-heated discharges, where no nonthermal electrons exist. The measured values of the radial electric field were found to be in qualitative agreement with those estimated by neoclassical theory. A clear reduction of ion thermal diffusivity was observed after the mode transition from ion root to electron root as predicted by neoclassical theory when the neoclassical ion loss is more dominant than the anomalous ion loss.

Usefulness of positron emission tomography with fluorine-18-fluorodeoxyglucose for predicting outcome in patients with hepatocellular carcinoma

OBJECTIVES

The present study was designed to assess the usefulness of positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) for predicting outcome in patients with hepatocellular carcinoma.

METHODS

FDG-PET was performed in 48 patients with hepatocellular carcinoma. For quantitative evaluation, a region of interest (ROI) was placed over the area of maximum activity within the lesion. A background ROI was then placed over the nontumor region of the liver. The average activity within each ROI was subsequently corrected for radioactive decay, and the standardized uptake value (SUV) was calculated by dividing the tissue activity by the injected dose of radioactivity per unit body weight. SUV ratio was expressed as the tumor-to-nontumor ratio of the SUV.

RESULTS

The tumor-volume doubling time, as index of the growth rate of hepatocellular carcinoma, correlated significantly with SUV ratio but did not correlate with SUV. On the basis of the SUV ratio, the patients were divided into two groups of similar size: group A, SUV ratio of < or = 1.5; and group B, SUV ratio > 1.5. The cumulative survival rate was significantly lower in group B than in group A. On the basis of the SUV, the patients were divided into two groups of roughly equal size: group C, < or = SUV 2.6; and group D, > SUV 2.6. The cumulative survival rate was similar in these groups. On regression analysis with the Cox proportional hazards model, the SUV ratio and tumor number were significantly related to survival.

CONCLUSIONS

These results suggest that FDG-PET is useful not only for the evaluation of the malignancy of hepatocellular carcinoma but also for the prediction of outcome in patients with hepatocellular carcinoma.

Microleakage of self-etching primers after thermal and flexural load cycling

PURPOSE

To evaluate the adhesive properties of a one-bottle self-etching primer system.

MATERIALS AND METHODS

150 wedge-shaped cervical cavities on bovine teeth were restored with Clearfil Liner Bond 2 (LB), Clearfil Liner Bond 2V (LV) or Clearfil SE Bond (SE), according to the manufacturer's instructions. Twenty specimens of each adhesive system were finished 15 mins after light curing and 30 specimens were finished after a 24-hr storage period in water. From each group, 10 restorations were immediately immersed in 0.5% basic fuchsin solution and kept there for 24 hrs to examine microleakage. The other 10 restorations were thermocycled (5-60 degrees C, 15 s dwell time, 5,000 cycles), and then immersed in the dye solution. The remaining 10 specimens of the 24-hr storage group were subjected to flexural load cycling (0.5 mm labio-lingual displacement at the incisal edge, 10,000 cycles, 1 cps) prior to immersion in the dye solution. The data was analyzed using the Mann-Whitney U-test and the Kruskal-Wallis test. The tensile bond strengths of the adhesive systems to bovine enamel and dentin were also determined. The data was analyzed using the Student's t-test and ANOVA. In addition, SEM examinations were made to evaluate the effects of self-etching primers on enamel and dentin surfaces.

RESULTS

LV and SE showed significantly better marginal sealing than LB (P<0.05). The marginal integrity of SE did not deteriorate even after immediate finishing, thermal stresses or flexural loads. There were no significant differences in bond strengths among the adhesive systems tested. All adhesive systems showed similar bond strengths to enamel and dentin. The enamel etching patterns using LV and SE systems were obscure and difficult to assess. Although the smear plugs were not fully removed, no smear layer was observed on the treated dentin surfaces, regardless of the self-etching primer system used.

CLINICAL SIGNIFICANCE

Clearfil SE bond could possibly improve the clinical performance of cervical cavities.

Virologic and biochemical changes and prognosis after liver resection for hepatitis B virus-related hepatocellular carcinoma

BACKGROUND/AIMS

During the natural course of hepatitis B virus (HBV) infection, clearance of HB e antigen (HBeAg) and HB surface antigen (HBsAg) occurs with remission of liver disease. We investigated the effects of postoperative changes in virologic and biochemical parameters on the prognosis after liver resection for HBV-related hepatocellular carcinoma (HCC).

METHODS

We investigated the relationship between postoperative changes in virologic and biochemical parameters and the incidence of intrahepatic recurrence and the outcome during a 3-year period following surgery in 30 HCC patients with HBsAg.

RESULTS

The incidence of intrahepatic recurrence of HCC was significantly higher in patients with acute postoperative exacerbation of hepatitis (p = 0.0084), a sustained high serum concentration of HBV DNA (> or = 5.0 mEq/ml, p = 0.001), and sustained expression of HBsAg after surgery (p = 0.0421). A high serum concentration of HBV DNA was significantly associated with a shorter survival time (p = 0.0447) and the cause of death was recurrence of HCC.

CONCLUSION

Patients with acute postoperative exacerbation of hepatitis, sustained HBsAg expression, and sustained high serum concentrations of HBV DNA after surgery may require more intensive postoperative monitoring for HCC recurrence.

Effects of long-term postoperative interferon-alpha therapy on intrahepatic recurrence after resection of hepatitis C virus-related hepatocellular carcinoma. A randomized, controlled trial

BACKGROUND

Interferon therapy decreases the incidence of hepatocellular carcinoma in patients with chronic hepatitis C.

OBJECTIVE

To evaluate effects of interferon-alpha on recurrence after resection of hepatitis C virus-related hepatocellular carcinoma.

DESIGN

Randomized, controlled trial.

SETTING

University hospital, medical center, and affiliated hospital in Osaka, Japan.

PATIENTS

30 men were randomly allocated after resection to the interferon-alpha group (n = 15) or the control group (n = 15).

INTERVENTION

Patients in the interferon-alpha group received interferon-alpha, 6 MIU intramuscularly daily for 2 weeks, then three times weekly for 14 weeks, and finally twice weekly for 88 weeks.

MEASUREMENTS

Recurrence rates after resection.

RESULTS

Recurrent tumors were detected in 5 patients in the interferon-alpha group and in 12 control patients. The recurrence rate was significantly lower in the interferon-alpha group than in the control group (P = 0.037).

CONCLUSION

Postoperative interferon-alpha therapy appears to decrease recurrence after resection of hepatitis C virus-related hepatocellular carcinoma.

Tumor-suppressor effect of interferon regulatory factor-1 in human hepatocellular carcinoma

IFN regulatory factor-1 (IRF-1) regulates the IFN system, inhibits cell growth, and has tumor-suppressor activities. p21 is a universal cyclin-dependent kinase inhibitor, the induction of which depends on both p53 and IRF-1 in mouse embryonic fibroblasts. The expression of p21 in hepatocellular carcinomas (HCCs) is regulated by wild-type p53. We examined the expressions of IRF-1 and p21 in 32 HCCs by quantitative reverse transcription-PCR and the mutation p53 gene in 32 HCCs by single-strand conformation polymorphism and direct sequencing. The expression of IRF-1 mRNA in 15 of 32 HCCs was lower than that in adjacent noncancerous tissue. IRF-1 mRNA expression was reduced in 0 of 3 specimens of well-differentiated HCC, 9 of 21 (42%) specimens of moderately differentiated HCC, and 6 of 8 (75%) specimens of poorly differentiated HCC. IRF-1 mRNA expression was significantly lower in tumors with portal thrombus than in those without portal thrombus (P = 0.003). p53 mutations were detected in 7 of 32 HCCS: p21 expression was reduced in 6 of the 7 (86%) HCCs with p53 mutations. In contrast, p21 expression was reduced in 13 of 25 (52%) HCCs with wild-type p53. IRF-1 expression was reduced in 7 of 13 (53%) HCCs with both wild-type p53 and reduced expression of p21. These results suggest that IRF-1 may be a tumor-suppressor gene for HCC and that IRF-1 is related to p21 expression in HCC with wild-type p53.

[Recovery characteristics of propofol anesthesia in pediatric outpatients; comparison with sevoflurane anesthesia]

We compared recovery characteristics of propofol anesthesia with those of sevoflurane anesthesia in pediatric outpatients. One hundred and four children, 3 months to 6 years of age, ASA physical status 1 or 2, were randomly assigned to following four groups; sevoflurane (group S), propofol (group P), sevoflurane with premedication (group MS), or propofol with premedication (group MP). Midazolam 0.5 mg.kg-1 and famotidine 1 mg.kg-1 were administered orally 30 min before the induction in the MS and MP group. Recovery from anesthesia, agitation, and postoperative pain were evaluated. The time intervals from the end of surgery to extubation and to discharge from the hospital were recorded. The incidence of vomiting and use of analgesic drugs were also checked. The emergence from anesthesia was slower with propofol anesthesia than with sevoflurane anesthesia, but the time to discharge from the hospital was not significantly different among the four groups. Incidence of agitation was higher in S group compared with P group, but there were no differences between MS and MP. Postoperative pain was similar among the four groups. There were no differences in the incidence of vomiting. Propofol anesthesia provided slower emergence and less agitation compared with sevoflurane anesthesia.

Peritoneal shunt tube placement performed using an endoscopic threaded imaging port. Technical note

The authors used an endoscopic threaded imaging port that originally was developed for laparoscopy to access the peritoneal cavity, and applied this device to the placement of a peritoneal shunt tube in patients suffering from hydrocephalus. Using this system, the peritoneum can be opened quickly under direct vision by using an endoscope through a small skin incision. The peritoneal cavity is secured by replacing the cannula with a polyvinyl chloride (PVC) tube. At the end of surgery, the terminal end of the shunt tube is inserted through the PVC tube, which serves as a guiding catheter. Only one or two skin stitches are needed for closure. This method has proved to be safe, quick, and less invasive than conventional minilaparotomy.

Clonal analysis of hepatocellular carcinoma and dysplastic nodule by methylation pattern of X-chromosome-linked human androgen receptor gene

To investigate the monoclonality of hepatocellular carcinoma (HCC) and dysplastic nodule (DN) and the origin of multiple lesions, patterns of inactivation of X-linked human androgen receptor gene were studied. Fourteen of 15 patients (93%) were heterozygous in the size of the target, and were informative for clonal analysis. Monoclonal composition was demonstrated in all 17 HCCs and two DNs, whereas all non-cancerous hepatic tissues were polyclonal. Of four patients with more than two lesions of HCC or DN, two patients had two lesions with different patterns of X-chromosome inactivation, indicating that the two lesions were multicentric in origin.

The clinical significance of lymph node metastases in patients undergoing surgery for hepatocellular carcinoma

The frequency of lymph node (LN) metastasis in patients undergoing surgery for hepatocellular carcinoma (HCC) has rarely been studied. We evaluated the clinicopathologic characteristics and outcomes of six patients with nodal metastases from HCC among a total of 504 patients who underwent hepatic resection for HCC in our department over a 16-year period. The nodal metastases were diagnosed preoperatively in two patients. The average diameter of the resected tumors was 7.8 cm and all were confirmed as poorly differentiated HCC. All of the six patients had intrahepatic metastatic nodules and five also had portal vein invasion. One patient underwent limited resection, and the other five underwent bisegmentectomy. All of the regional LNs were removed in one patient, while only enlarged LNs were removed in the other five. One patient died of postoperative liver failure and the others all died later of intrahepatic or nodal recurrence. Our findings suggest that the prognosis of patients with nodal metastasis from HCC is generally poor, even if hepatic resection with regional LN dissection is performed.

Somatic mutation of mitochondrial DNA in cancerous and noncancerous liver tissue in individuals with hepatocellular carcinoma

Unlike other types of cancer, hepatocellular carcinoma (HCC) is usually preceded by chronic inflammation caused by viral infection. The mutation of mitochondrial DNA (mtDNA) in hepatocarcinogenesis associated with viral infection was investigated. Compared with control liver tissue, the frequency of mtDNA mutations was markedly increased in both noncancerous and cancerous liver specimens from individuals with HCC. The accumulation of mtDNA mutations in HCC tissue reflected the degree of malignancy. The frequency of mtDNA mutations in HCC tissue was also greater than that described previously for other types of tumors. These observations suggest that the repeated destruction and regeneration of liver tissue associated with chronic viral hepatitis lead to the accumulation of mtDNA mutations. The genetic instability that results in the high rate of mtDNA mutation in cancerous liver tissue is also consistent with the multicentric hepatocarcinogenesis detected clinically.

Assessment of the effect of revascularization early after CABG using ECG-gated perfusion single-photon emission tomography

When an arterial graft is used, reversible perfusion defects on single-photon emission tomography (SPET) perfusion images are occasionally observed early after coronary artery bypass graft surgery (CABG), owing to the restricted flow capacity. The purpose of this study was to determine whether the functional information obtained with electrocardiography (ECG)-gated perfusion SPET could be helpful in evaluating the effect of revascularization early after CABG. Twenty-three patients (18 men and 5 women, mean age 65+/-9 years) underwent stress/re-injection thallium-201 ECG-gated SPET before and 4 weeks after CABG (13 with exercise and 10 with dipyridamole). Patency of all grafts was confirmed by coronary angiography 1 month after CABG. Cardiac functional data including the left ventricular ejection fraction (LVEF) and the transient ischaemic dilatation (TID) ratio were analysed using a commercially available automated program. The conventional stress and re-injection tomograms were interpreted by means of a five-point scoring system in a nine-segment model. Stress-induced reversible 201Tl perfusion defects were present in 64% of the myocardial segments bypassed by patent arterial grafts, in contrast to 42% of the myocardial segments bypassed by patent venous grafts (chi2=7.8, P=0.005). Of the 23 patients, 12 showed improvement in summed ischaemic scores (group 1), while 11 had no change or deterioration (group 2), although all grafts were patent on postoperative catheterization. The TID ratio improved in both group 1 and group 2 before and after CABG (1.14+/-0.13 vs 0.99+/-0.07, P=0.001 and 1.09+/-0.07 vs 0.94+/-0.05, P=0.002, respectively). However, LVEF did not significantly improve in group 1 or group 2 after CABG (42.5%+/-9.9% vs 47.5%+/-11.8%, and 52.1%+/-7.5% vs 53.1%+/-5.9%, respectively). Perfusion imaging or LVEF assessment is of limited value early after CABG. The TID ratio obtained with ECG-gated perfusion SPET may be a useful marker to evaluate the effect of revascularization early after surgery.

Comparative immunohistochemical study of insulin-like growth factor II and insulin-like growth factor receptor type 1 in pediatric brain tumors

Insulin-like growth factor (IGF)-II is an important growth factor in development of the central nervous system. The purpose of this study was to evaluate expression of IGF-II and IGF receptor type 1 (IGFR1) in various pediatric brain tumors. Immunohistochemistry for IGF-II and IGFR1 was performed on 15 choroid plexus papillomas (CPPs) including 1 atypical CPP, 2 choroid plexus carcinomas (CPCs), 5 anaplastic ependymomas, 7 nonanaplastic ependymomas (simply referred to as "ependymoma"), 5 medulloblastomas, 1 cerebral neuroblastoma, and 1 atypical teratoid/rhabdoid tumor (ATRT) along with 10 non-neoplastic choroid plexus and 3 non-neoplastic ependymal linings. All non-neoplastic choroid plexus, CPPs, CPCs, anaplastic ependymomas, ATRT, 71% of ependymomas, and 67% of non-neoplastic ependymal linings showed cytoplasmic positivity for IGF-II, whereas all medulloblastomas and the cerebral neuroblastoma were negative for IGF-II. In addition to cytoplasmic positivity for IGFR1, membranous positivity was observed in 73% of CPPs, both CPCs, the ATRT, 22% of non-neoplastic choroid plexus, 80% of anaplastic ependymomas, and 29% of ependymomas, but not in any medulloblastoma, cerebral neuroblastoma, or non-neoplastic ependymal lining. IGF-II and IGFR1 may play roles in the pathogeneses of CPP, CPC, anaplastic ependymoma, ependymoma, and ATRT. Immunohistochemical testing for IGF-II and IGFR1 may be useful in differentiating ATRT, CPC, and anaplastic ependymoma from medulloblastoma and cerebral neuroblastoma.