[Malignant pleural mesothelioma]

Malignant pleural mesothelioma carries a poor prognosis, for which no standard therapy has been established. We report 15 cases of malignant pleural mesothelioma experienced since 2000 focusing on their clinical features. They included 14 male and 1 female aged 38 to 81 (62.8 on average) years. All patients were diagnosed by pleural biopsy under thoracoscopic guidance. Histology of the pleural biopsy specimen showed epithelial mesothelioma in 8 patients, biphasic mesothelioma in 3, sarcomatous mesothelioma in 2 and desmoplastic malignant mesothelioma (DMM) in 2. Twelve patients received chemotherapy. Of these, 3 were followed by surgery. In addition to 2 of these 3 patients, 2 underwent extrapleural pneumonectomy (EPP) without adjuvant treatment. Remaining 1 received palliative treatment only. As a result, 6 patients are surviving, 7 died of primary diseases and 2 died of other diseases. The longest survival time with chemotherapy is 41 months in a surviving patient with epithelial mesothelioma and that with EPP is 25 months in a surviving patient with DMM. The 2-year survival rate of the 14 patients was 44.4% and the median survival time in patients with epithelial mesothelioma was 30.6 months.

Practice patterns of Japanese physicians in urologic surveillance and management of spinal cord injury patients

STUDY DESIGN

Analysis of answers to a new questionnaire.

OBJECTIVE

To examine current practice patterns of physicians in the urological surveillance and management of spinal cord injury (SCI) patients in Japan.

SETTING

Nationwide questionnaire survey to physicians in Japan.

METHODS

A Japanese version of the 14-item questionnaire survey carried out in US was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS).

RESULTS

We received answers to our questionnaire from 333 (43.2%) members of JNBS. The responders were all urologists. For surveillance of the upper urinary tract (UUT), 239 (71.8%) respondents preferred abdominal ultrasound. Cystometry was performed routinely by 174 (52.3%) respondents for the evaluation of vesicourethral function. Cystoscopy was carried out in cases of hematuria (88.0%) and bladder stone (55.3%). Surveillance of the urinary tract was performed every year in 154 (46.2%). For detection of bladder cancer, which 119 (37.9%) respondents have experienced, 94.9% physicians perform cystoscopy, 76.3% urinary cytology, and 60.4% ultrasound. For initial treatment of detrusor-sphincter dyssynergia (DSD), 225 (69.2%) respondents chose alpha-blocker, and 94 (28.9%) chose clean intermittent catheterization (CIC) with/without anticholinergic agent(s). For initial treatment of overactive bladder, 245 (74.7%) chose anticholinergic agent(s) only and 63 (19.2%) chose anticholinergic agent(s) with CIC. For initial treatment of areflexic bladder, 233 (73.7%) chose CIC and 63 (19.9%) chose Credé maneuver or tapping.

CONCLUSIONS

This survey shows that there are some differences in urological surveillance and management of SCI patients between Japan and the US. Reasons for the discrepancy should be examined.

Synthesis and Crystal Structure of an Open Capsule-Type Octanuclear Heterometallic Sulfide Cluster with a Linked Incomplete Double Cubane Framework without an Intramolecular Inversion Center

An open capsule-type octanuclear heterometallic sulfide cluster without an intramolecular inversion center [Ru(eta(6)-C(6)Me(6)){P(OMe)(3)}{MoO(mu(3)-S)(3)}(CuI)(2)](2) (5) has been synthesized for the first time by stepwise connection of three mononuclear building blocks, i.e., (i) [RuCl(2)(eta(6)-C(6)Me(6)){P(OMe)(3)}] (1a) as an octahedral terminal building block to control the direction of cluster expansion, (ii) [MoOS(3)](2)(-) as a tetrahedral polydentate building block owing to the strong coordination ability of the S atoms, and (iii) a CuI building block to form a trigonal planar (mu-S)(2)CuI unit or to form a linkage unit of two incomplete cubane-type octanuclear frameworks. The stepwise connection was made in the following order: [RuCl(2)(eta(6)-C(6)Me(6)){P(OMe)(3)}] (1a, mononuclear) --> [Ru(eta(6)-C(6)Me(6)){P(OMe)(3)}{MoOS(mu(2)-S)(2)}] (2a, dinuclear) --> [Ru(eta(6)-C(6)Me(6)){P(OMe)(3)}{MoO(mu(2)-S)(2)(mu(3)-S)}CuI] (3a, butterfly-type trinuclear) --> [Ru(eta(6)-C(6)Me(6)){P(OMe)(3)}{MoO(mu(3)-S)(3)}(CuI)(2)](2) (5). When P(OMe)(3) was replaced by P(OEt)(3), which is more bulky than P(OMe)(3), in the starting ruthenium building block [RuCl(2)(eta(6)-C(6)Me(6)){P(OEt)(3)}] (1b, mononuclear), only the tetranuclear incomplete single cubane cluster [Ru(eta(6)-C(6)Me(6)){P(OEt)(3)}{MoO(mu(3)-S)(3)}(CuI)(2)] (6) was generated, owing to the steric effect of P(OEt)(3).

Carboplatin hypersensitivity induced by low-dose paclitaxel/carboplatin in multiple platinum-treated patients with recurrent ovarian cancer

We report five cases of carboplatin (CBDCA) hypersensitivity after weekly low-dose paclitaxel (60 mg/m2)/CBDCA (area under the concentration curve = 2) therapy in patients with recurrent ovarian cancer receiving multiple platinum-based chemotherapy. Paclitaxel and CBDCA therapy was indicated as second-line chemotherapy in one patient and as third line in four patients with recurrent disease. The range of previously administered total CBDCA was 2582-9589 mg, and the CBDCA area under the concentration curve of the first treatment exhibited appropriate intensity (mean, 1.92 +/- 0.10; range, 1.76-2.10) in all patients. However, one patient exhibited severe hypersensitivity reactions including cardiac arrest and apnea, and another four patients developed eruptions, hypotension, and tachycardia soon after administration of CBDCA. Our report suggested that CBDCA hypersensitivity was correlated with the total dose of previously administered platinum agents and that CBDCA should be excluded in patients who have received multiple platinum-based chemotherapy, even in platinum-sensitive cases, because CBDCA hypersensitivity can occur even with low-dose CBDCA administration.

Carboplatin hypersensitivity induced by low-dose paclitaxel/carboplatin in multiple platinum-treated patients with recurrent ovarian cancer

We report five cases of carboplatin (CBDCA) hypersensitivity after weekly low-dose paclitaxel (60 mg/m2)/CBDCA (area under the concentration curve = 2) therapy in patients with recurrent ovarian cancer receiving multiple platinum-based chemotherapy. Paclitaxel and CBDCA therapy was indicated as second-line chemotherapy in one patient and as third line in four patients with recurrent disease. The range of previously administered total CBDCA was 2582–9589 mg, and the CBDCA area under the concentration curve of the first treatment exhibited appropriate intensity (mean, 1.92 ± 0.10; range, 1.76–2.10) in all patients. However, one patient exhibited severe hypersensitivity reactions including cardiac arrest and apnea, and another four patients developed eruptions, hypotension, and tachycardia soon after administration of CBDCA. Our report suggested that CBDCA hypersensitivity was correlated with the total dose of previously administered platinum agents and that CBDCA should be excluded in patients who have received multiple platinum-based chemotherapy, even in platinum-sensitive cases, because CBDCA hypersensitivity can occur even with low-dose CBDCA administration.

A linear, O-coordinated eta1-CO2 bound to uranium

The electron-rich, six-coordinate tris-aryloxide uranium(III) complex [((AdArO)3tacn)U(III)] [where (AdArOH)3tacn = 1,4,7-tris(3-adamantyl-5-tert-butyl-2-hydroxybenzyl)1,4,7-triazacyclononane] reacts rapidly with CO2 to yield [((AdArO)3tacn)U(IV)(CO2)], a complex in which the CO(2) ligand is linearly coordinated to the metal through its oxygen atom (eta1-OCO). The latter complex has been crystallographically and spectroscopically characterized. The inequivalent O-C-O bond lengths [1.122 angstroms (A) for the O-C bond adjacent to uranium and 1.277 A for the other], considered together with magnetization data and electronic and vibrational spectra, support the following bonding model: U(IV)=O=C*-O- <--> U(IV)-OC-O-. In these charge-separated resonance structures, the uranium center is oxidized to uranium(IV) and the CO2 ligand reduced by one electron.

Synthesis and characterization of N-heterocyclic carbene complexes of uranium(III)

Reaction of [(((Ad)ArO)(3)tacn)U(III)] (1) or [((Me(3)Si)(2)N)(3)U(III)] (3) with tetramethylimidazol-2-ylidene (Me(4)IMC:) yields novel N-heterocyclic carbene complexes [(((Ad)ArO)(3)tacn)U(III)(Me(4)IMC:)] (2) and [((Me(3)Si)(2)N)(3)U(III)(Me(4)IMC:)] (4). Uranium complexes 2 and 4 represent the first examples of compounds with an N-heterocyclic carbene ligand coordinated to a low-valent uranium center. The paramagnetic complexes 1, 2, and 4 were characterized by (1)H NMR, UV-vis-NIR, and EPR spectroscopy as well as SQUID magnetization measurements and X-ray diffraction analyses. DFT studies indicate a significant degree of pi-bonding in the U(III)-carbene entity.

Evidence for Alkane Coordination to an Electron-Rich Uranium Center

A series of five uranium-alkane complexes of the general formula [(ArO)3tacn)U(alkane)].(cy-alkane) has been synthesized and crystallographically characterized. In all cases, X-ray diffraction studies revealed a pseudo-six-coordinate trivalent uranium core structure, [(ArO)3tacn)U], with a coordinated alkane ligand at the axial position. The average U-C bond distance to the bound alkane was determined to be 3.798 A, which is considerably shorter than the sum of the van der Waals radii of the U atom and a CH2 or CH3 unit (3.9 A). In all complexes, the alkane is coordinated in an eta2-H,C fashion.

Clinical application of zygomatic implants for rehabilitation of the severely resorbed maxilla: a clinical report

PURPOSE

A zygomatic implant can be an effective device for rehabilitation of the severely resorbed maxilla. If zygomatic implants are used, onlay bone grafting or sinus augmentation would likely not be necessary. Where an anterior onlay bone graft is required, extension of the graft in the posterior region could be reduced. The results of the application of zygomatic implants in 9 patients and clinical evaluation of this therapy are reported.

MATERIALS AND METHODS

Nine patients received a total of 15 zygomatic implants. Six to 8 months elapsed for healing before second-stage surgery was performed. Six months after prosthetic treatment, patients' opinions were solicited by means of a questionnaire.

RESULTS

No implant was removed at the time of abutment connection surgery or during the follow-up period. In many cases, the zygomatic implant platform was located palatal to the alveolar ridge. However, no patients complained of any continuing speech impediment following superstructure fabrication. Computed tomograms taken before implant placement and 6 months after implant placement showed no sign of sinusitis in any patient.

DISCUSSION

The zygomatic implant allows shorter treatment time and hospitalization. However, there can be some problems in the application of zygomatic implants.

CONCLUSION

It is necessary to investigate long-term clinical prognosis.

Dysferlin mutations in Japanese Miyoshi myopathy: relationship to phenotype

OBJECTIVE

To study dysferlin gene mutations and genotype-phenotype correlations in Japanese patients with Miyoshi myopathy (MM).

BACKGROUND

MM is an autosomal recessive distal muscular dystrophy that arises from mutations in the dysferlin gene. This gene is also mutated in families with limb girdle muscular dystrophy 2B.

METHODS

The authors examined 25 Japanese patients with MM. Genomic DNA was extracted from the peripheral lymphocytes of the patients. The PCR products of each of 55 exons were screened by single strand conformation polymorphism or direct sequencing from the PCR fragments.

RESULTS

The authors identified 16 different mutations in 20 patients with MM; 10 were novel. Mutations in Japanese patients are distributed along the entire length of the gene.

CONCLUSIONS

Four mutations (C1939G, G3370T, 3746delG, and 4870delT) are relatively more prevalent in this population, accounting for 60% of the mutations in this study. This study revealed that the G3370T mutation was associated with milder forms of MM and the G3510A mutation was associated with a more severe form.

A new entry to N-heterocyclic carbene chemistry: synthesis and characterisation of a triscarbene complex of thallium(I)

The synthesis and characterisation of a thallium(I) triscarbene complex of the chelating, tripodal carbene ligand 1,3,5-[tris(3-tert-butylimidazol-2-ylideno)methyl]-2,4,6-trimethylbenzene is reported, in which the thallium ion is coordinated by three N-heterocyclic carbene donors in a distorted trigonal planar environment.

Theoretical study on the excited states of psoralen compounds bonded to a thymine residue

Time-dependent density functional theory calculations have been performed for the excited states of psoralen, 5-methoxypsoralen, and 8-methoxypsoralen in systems and furan and pyrone monoadducts bonded to a thymine residue. The theoretical assignments to ultraviolet (UV) absorption spectra of isolated systems have been performed. The present calculations have clarified that the excitation energies of the first singlet excited (S1) state of monoadducts are blue-shifted compared with the isolated systems. It is shown that, in particular, the S1 excitation energy of the pyrone monoadduct is significantly blue-shifted and, therefore, the pyrone monoadduct is not excited by UV-A light (300-400 nm), which is used in the photochemotherapy.

Basic science and epilepsy: experimental epilepsy surgery

Epilepsy surgery, as is employed for the management of intractable seizures, was performed in animals harboring a seizure focus induced by a local application of kainic acid (KA). Amygdalo-hippocampectomy failed to stop spontaneous seizures in the contralateral hippocampus. Callosotomy inhibited seizure propagation to the contralateral sensori-motor cortex. However, epileptic activity ipsilateral to the focus, including subcortical structures, persisted even after the callosotomy. Multiple subpial transection (MST) around the epileptic cortical focus suppressed the seizure activity of the cortex. However, seizure propagations in subcortical structures remained, even after MST. Nefiracetam (a new nootropic agent) was tested in these models, and its promising effect on the intractable extratemporal epilepsy is reported.

Low-dose mitomycin C, etoposide, and cisplatin for invasive vulvar Paget's disease

We report the effect of low-dose mitomycin C, etoposide, and cisplatin (low-dose MEP) therapy for three patients with invasive vulvar Paget's disease (invasive VPD) who declined radical vulvectomy and skin grafting. One patient achieved a complete response, while the other two showed partial responses (PR) without grade 3 or 4 adverse effects. The two patients with PR were undergone partial vulvectomy and inguinal lymph node dissection. All patients have no sign of recurrence for 10 months after chemotherapy. Our present results suggest that low-dose MEP is an effective and safe chemotherapy for invasive VPD and low-dose MEP may significantly improve postoperative quality of life in patients with invasive VPD by avoiding extensive vulvar resection and skin grafting.