Salvage lymphadenectomy for cervical lymph node recurrence after esophagectomy for squamous cell carcinoma of the thoracic esophagus

Prognosis of patients with recurrent esophageal cancer is usually unsatisfactory. We have successfully treated five patients with cervical node recurrence after esophagectomy with multimodal treatment including salvage lymphadenectomy. In order to clarify the efficacy of salvage surgery for cervical node recurrence, we have reviewed the clinical course and prognosis of these patients. From August 2004 to December 2007, 30 patients with 33 recurrent sites were treated in the Department of Surgery, Iizuka Hospital. Among these patients, there were five patients with recurrence limited within the cervical nodes. Salvage cervical lymphadenectomy was performed for all five patients. Curative resection was achieved in four patients and reduction surgery followed by planned chemoradiotherapy was performed in another patient. All stations including the suspicious node were dissected and a partial sternotomy was added for one patient whose recurrent tumor was located in the right recurrent nerve node. There was no mortality and one minor complication (subcutaneous hemorrhage) was observed. Median duration of hospital stay was 7 days. Adjuvant chemotherapy was performed for all patients. Median follow-up period was 54 months and all patients are alive without relapse of the disease. Salvage cervical lymphadenectomy is a safe and effective treatment for patients with cervical node recurrence after esophagectomy.

Effects of bosentan on nondigital ulcers in patients with systemic sclerosis

BACKGROUND

Bosentan is an oral dual endothelin receptor antagonist, which has been shown to be efficacious for preventing new digital ulcers in patients with systemic sclerosis (SSc) in two high-quality randomized controlled trials. However, its efficacy for nondigital ulcers in SSc remains unknown.

OBJECTIVES

To evaluate the efficacy of bosentan on nondigital ulcers in patients with SSc.

METHODS

Bosentan was administered to five patients with SSc with pulmonary arterial hypertension, who also had nondigital ulcers refractory to conventional treatments. The efficacy of bosentan on nondigital ulcers and its association with clinical features of ulcers were analysed.

RESULTS

The nondigital ulcers refractory to conventional treatments were significantly improved by the administration of bosentan in cases surrounded with severe cyanosis. In contrast, nondigital ulcers without cyanosis were still refractory to bosentan therapy.

CONCLUSIONS

Bosentan may be efficacious for accelerating the healing of nondigital ulcers with severe cyanosis, suggesting that nondigital ulcers caused by severely impaired peripheral circulation are highly responsive to this treatment.

Neuroradiological and neurofunctional examinations for patients with 22q11.2 deletion

Since the neuroradiological features of patients with 22q11.2 deletion syndrome are not well-understood, examinations using functional imaging were performed in this study. Brain magnetic resonance imaging (MRI) and 1H-magnetic resonance spectroscopy (MRS) were performed using a clinical 3-Tesla MR imager in 4 patients with 22q11.2 deletion syndrome (2 boys and 2 girls; aged 2-6 years.) and 20 age- and sex-matched healthy control subjects. Furthermore, interictal 123I-iomazenil (IMZ) single photon emission computed tomography (SPECT) was examined in 2 of the 4 patients. Among the 4 patients with 22q11.2 deletion syndrome, 2 patients showed polymicrogyria and 1 patient showed agyria. Those patients with brain malformations also showed abnormal brain artery patterns and decreased accumulation of IMZ in 123I-IMZ SPECT. Although all 4 patients showed epileptic discharges in their electroencephalograms (EEG), one patient with polymicrogyria had no seizure episodes. Decreases in γ-aminobutyric acid (GABA) corresponding to the areas of polymicrogyria and/or epileptic discharges in EEG were shown in all patients except for the patient with agyria. Although consistent evidence was not seen in patients with 22q11.2 deletion syndrome in this study, brain malformations and disturbances of the GABAergic nervous system would be underlying mechanisms of the neurodevelopmental abnormalities in this syndrome.

Evaluation of a new fiber-grating vision sensor for assessing pulmonary functions in healthy and COPD subjects

Spirometry is practically the only tool to evaluate pulmonary functions. Other automatic systems comparable to spirometry are expected. A fiber-grating (FG) vision sensor is a non-contact respiratory monitoring system to detect changes in volumes by measuring the movement of laser spots on the body surface. We examined the contributions of the FG sensor to evaluating pulmonary functions. The FG sensor showed a linear correlation with spirometry in tidal volumes (TV) obtained from five controls (R = 0.98, P < 0.0001). We also showed agreement of TV between the two devices using Bland-Altman analysis. TV measured by the FG sensor were reproducible and applicable to distinct subjects. To detect airway obstruction, we performed forced expiration in controls (n = 16) and chronic obstructive pulmonary disease (COPD) patients (n = 18) with the FG sensor and spirometry. Forced expiratory volume in 1 s (FEV(1)) and FEV(1)/forced vital capacity in COPD patients were lower than those in controls by the FG sensor. In addition, prolonged expiration in natural breathing by the FG sensor was related to airflow limitation by spirometry. The FG sensor was helpful to measure volume changes and to evaluate pulmonary functions in controls and patients with COPD. Its upcoming clinical applications are promising for simplicity and feasibility.

Effects of Proteolytic Enzyme Inhibitors as Absorption Enhancers on the Transdermal Iontophoretic Delivery of Calcitonin in Rats

The effects of proteolytic enzyme inhibitors, aprotinin, soybean trypsin inhibitor and camostat mesilate as absorption enhancers on the transdermal iontophoretic delivery of salmon calcitonin (SCT) have been examined in rats. The dermal absorption of SCT was evaluated with hypocalcaemic effect. Application of SCT (12·5 int. units/rat) onto abdominal skin did not produce any hypocalcaemic effect. This produced a small hypocalcaemic effect with cationic iontophoresis (drug phase, anode; reference phase, cathode; high frequency pulses of 1 V at 10 kHz, 2h). Furthermore, camostat mesilate (1 Mm) and aprotinin (106 int. units mL−1) enhanced the hypocalcaemic effects on the application of SCT with iontophoresis. These hypocalcaemic effects were highest with the pH 4·0 preparation compared with those of the pH 5·5, pH 7·0 and pH 8·0 preparations. However, soybean trypsin inhibitor did not change the hypocalcaemic effects. This was because the soybean trypsin inhibitor is a relatively high molecular weight peptide (mol. wt 8000) and an anion at used pH, and therefore was not absorbed through rat skins with cation iontophoresis.

Glomerulocystic kidney disease in an adult with enlarged kidneys: a case report and review of the literature

We report the case of a 31-year-old male with enlarged kidneys and glomerulocystic kidney disease (GCKD). The patient had no family history of renal disease or other diseases. On initial presentation he complained of poor eyesight, and hypertensive retinopathy and elevated serum creatinine (5.0 mg/dl) were found at that time. Renal biopsy showed cystic dilatation of Bowman's capsule and atrophy of the glomerular tuft. Thus, an adult case of sporadic GCKD was diagnosed. Based on previous reports, kidney size in patients with adult type GCKD varies from small to large. Our patient's kidneys are the largest ever reported (right kidney was 22 cm×10 cm, left kidney was 19 cm×10 cm). A review of the literature dealing with sporadic adult GCKD suggested that it is difficult to diagnose this disease early in its course.

Chymase as an important target for preventing complications of metabolic syndrome

Chymase plays a crucial role in angiotensin II formation in various tissues. Angiotensin II induces gene expressions of transforming growth factor (TGF)-β and matrix metalloproteinase (MMP)-9, and chymase also converts precursors of TGF-β and MMP-9 to their active forms. All of angiotensin II, TGF-β and MMP-9 are considered to be closely involved in the development and progression of metabolic syndrome and its complications. In a diabetic animal model, chymase induced pancreatic disorganization via attack of oxidative stress induced by augmentation of chymase-forming angiotensin II. In atherosclerotic lesions in patients, accumulation of chymase-positive cells was observed, and chymase inhibition prevented the development of atherosclerosis in an animal model. In Apo E-deficient mice, chymase inhibition prevents the development of angiotensin II-induced abdominal aneurysmal aorta (AAA). In this model, the AAA development on an increase in MMP-9 activities induced by angiotensin II, but the inhibition of MMP-9 activation by chymase inhibitor resulted in attenuation of the AAA development. Cardiac dysfunction after myocardial infarction was also attenuated by chymase inhibition. Steatosis and fiblosis in liver were strongly prevented by chymase inhibition in an animal model with nonalcoholic steatohepatitis which is involved in metabolic syndrome. Therefore, chymase inhibition may be useful for attenuating MMP-9 and TGF-β levels, in addition to reducing angiotensin II formation, and this function may provide powerful preventions of organ damages. In this review, we propose the significance of chymase as a target to prevent complications of metabolic syndrome.

Abstract P3-14-13: Necessity of Confirming the Biological Marker of Distant Metastatic Lesion for Breast Cancer Patients

Background

The systemic management of metastatic breast cancer patients is usually based on biological marker of the primary tumor. However, characteristics of hormone status or HER2 over expression may change with metastatic site due to long term treatment for metastatic cancer with endocrine therapy, chemotherapy or biologic agents. The first purpose of this study was to investigate the concordance in HER2 over expression between primary tumor and distant metastases. The second purpose was to evaluate the efficacy of biologic agents for the patients with positive changes in HER2 status.

Material and methods One hundred forty-one patients had biopsy or operation of their metastatic site from 2000 to December 2009 at the Chiba Cancer Center Hospital. Specimen of operation or biopsies of suspected metastatic site were obtained from breast cancer patients. Specimen were analyzed pathologically to confirm metastatic disease and secondly to evaluate

HER2 by immunohistochemistry or FISH.

Results

Specimen of metastatic site were 67 local lesion (breast or lymph node), 27 brain, 16 liver, 12 bone and 5 others organs (stomach, intestine, ovary or uterus. Negative, positive or no change in HER2 status was observed in 4%, 6%, and 90% respectively. Positive changes of HER2 in metastatic site were 3(4%) local lesion, 3(11%) brain, 1 (7%) lung, 0(0%) liver, 2(17%) bone, and 0(0%) others, respectively. Three patients with positive change in HER2 status of metastatic site were treated to trastuzumab. Two of 3 patients with HER2 positive change were assessed to responded to trastuzumab-based treatment schedules.

Conclusions This study demonstrates the presence of substantial discordance in HER2 overexpression between primary tumor and metastases site.Metastatic tissue confirmation might be considered in patients with suspicious metastatic recurrence or resistance trastuzumab treatment.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-14-13.

Abstract P1-01-24: Is the Dye Method Alone Useful for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer? Prospective Analysis of 1081 Patients after SLN Biopsy

Introduction: Sentinel lymph node biopsy (SLNB) for breast cancer has been established. The objective of this study was to investigate factors which elevate the identification rate employing the dye method (DYm) alone.

Subjects: The subjects were 1,081 cN0 breast cancer patients who underwent preoperative cytology of the axillary lymph nodes at our facility between May 2001 and April 2010.

Methods: In the morning of the operation day, 0.3 ml of technetium phytate was subcutaneously injected immediately above the tumor, and 5 ml of indigocarmine was subcutaneously injected into the para-areolar region on the axillary side immediately before surgery, attempting to identify sentinel lymph nodes (SLN) using the combination method. The rates of identification employing the DYm and RI method (Rim) and false-negative rates were calculated. Regarding SLN in which the highest count was detected by the RIm as the first SLN (fSLN), consistency with that detected using the DYm was investigated.

Results: The mean numbers of SLN identified by the DYm and RIm were 1.36 and 1.90, respectively, showing that significantly more lesions were identified employing the RIm (P&lt;0.05). The identification rates employing the dye, RI, and both methods were 88.7, 98.7, and 99.3%, respectively, and the consistency of fSLN between the DYm and RIm was 78.1%. SLN metastasis detected using the RIm could not be identified employing the dye method in 20 cases. The age, tumor size, and BMI were investigated in these 20 cases, and a significant difference was noted in the tumor size. Conclusion: The identification rate employing the DYm alone was lower than that employing the RIm. The consistency of fSLN between the two methods was 78.1%. Although the RIm may have biopsied excess lymph nodes (LN), its use may be important to complement the DYm. Dye does not readily enter metastatic LN because of the presence of tumor plugs. The application of preoperative axillary LN cytology to cases with large tumors to exclude metastasis-positive cases may elevate the SLN identification rate employing the DYm.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-24.

Increased circulating cell signalling phosphoproteins in sera are useful for the detection of pancreatic cancer

BACKGROUND

Intracellular phosphoprotein activation significantly regulates cancer progression. However, the significance of circulating phosphoproteins in the blood remains unknown. We investigated the serum phosphoprotein profile involved in pancreatic cancer (PaCa) by a novel approach that comprehensively measured serum phosphoproteins levels, and clinically applied this method to the detection of PaCa.

METHODS

We analysed the serum phosphoproteins that comprised cancer cellular signal pathways by comparing sera from PaCa patients and benign controls including healthy volunteers (HVs) and pancreatitis patients.

RESULTS

Hierarchical clustering analysis between PaCa patients and HVs revealed differential pathway-specific profiles. In particular, the components of the extracellular signal-regulated kinase (ERK) signalling pathway were significantly increased in the sera of PaCa patients compared with HVs. The positive rate of p-ERK1/2 (82%) was found to be superior to that of CA19-9 (53%) for early stage PaCa. For the combination of these serum levels, the area under the receiver-operator characteristics curves was showing significant ability to distinguish between the two populations in independent validation set, and between cancer and non-cancer populations in another validation set.

CONCLUSION

The comprehensive measurement of serum cell signal phosphoproteins is useful for the detection of PaCa. Further investigations will lead to the implementation of tailor-made molecular-targeted therapeutics.