Impact of age at diagnosis on clinical features in children with anomalous arrangement of the pancreaticobiliary duct

AIMS

In patients with an anomalous arrangement of the pancreaticobiliary duct (AAPBD), clinical presentations may differ between infants and older children. The optimal timing of surgery remains controversial, particularly in early infancy. The aim of this study was to evaluate the clinicopathological features and clinical outcomes using comparative methods between infants and older cases. MATERIALS AD METHODS: From 1983 to 2007, a total of 85 consecutive children with AAPBD were treated at our institute. They included 46 with the cystic type, 33 with the fusiform type, and 6 with the non-dilatation type. These patients were divided into 2 age groups: "infant" (n=9), <12 months old; and "older", >1 year old (n=76). A retrospective study was performed.

RESULTS

Mean age was 5.2 months (range, 8 days-11 months) in the infant group and 5.2 years (range, 1.2-17.3 years) in the older group. Jaundice was significantly more frequent in the infant group ( P<0.05), whereas abdominal pain was more common in the older group ( P<0.001). Bleeding tendencies such as cranial hemorrhage or bloody stools were noted in only 3 infants. In terms of liver histology, liver cirrhosis was observed in 2 infants, one of whom was a 3-month-old girl with severe jaundice resulting in living-donor liver transplantation, despite bile drainage. A single postoperative death occurred due to an adenocarcinoma arising in a choledochal cyst in a 12-year-old girl.

CONCLUSIONS

Problems characteristic of infantile AAPBD were a severe bleeding tendency and irreversible liver cirrhosis, which could develop as young as 3 months old. The surgical recommendation for infantile AAPBD is thus early surgery before the age of 3 months to prevent liver failure.

Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms

BACKGROUND AND AIMS

Endoscopic submucosal dissection (ESD) provides a high en bloc resection rate with less invasiveness than surgical resection for large or scarring gastrointestinal neoplasms. However, detailed outcomes in colorectal ESD are still lacking. The aim of our study was to elucidate short- and long-term outcomes of colorectal ESD.

PATIENTS AND METHODS

310 consecutive colorectal epithelial neoplasms (146 adenomas, 164 carcinomas), in 290 patients, which fulfilled our indication criteria and were treated with ESD between July 2000 and December 2008 were studied. ESD was done by three skilled endoscopists. As short-term outcomes, rates of en bloc resection, en bloc plus R0 resection, and major complications were analyzed. As long-term outcomes, disease-free and overall survival were assessed in 224 patients.

RESULTS

Rates of en bloc resection and en bloc plus R0 resection were 90.3 % and 74.5 %, respectively. Eight patients underwent additional colectomy due to histopathologically proven possible node-positive cancer. Intraoperative perforations occurred with 14 lesions (4.5 %), which were treated successfully only by endoscopic clipping. Emergent surgery was needed for one case of postoperative perforation. Blood transfusion due to intraoperative massive bleeding was required in 1 case (0.3 %). Postoperative bleeding occurred with four lesions (1.3 %), and was endoscopically managed without blood transfusion. Local recurrence was detected in 4 lesions (4/202 patients, 2.0 %); resection had been piecemeal in all 4. During a median follow-up of 38.7 months (range 12.8 - 104.2), the 3- and 5-year overall/disease-specific survivals were 97.1/100 % and 95.3/100 %, respectively.

CONCLUSIONS

Colorectal ESD showed favorable long-term outcomes. It may largely replace colectomy for node-negative colorectal epithelial neoplasia.

High-temperature optical spectral weight and fermi-liquid renormalization in bi-based cuprate superconductors

The optical conductivity σ(ω) and the spectral weight W(T) of two superconducting cuprates at optimum doping, Bi2Sr2-xLaxCuO6 and Bi2Sr2CaCu2O8, have been first measured up to 500 K. Above 300 K, W(T) deviates from the usual T2 behavior in both compounds, even though σ(ω→0) remains larger than the Ioffe-Regel limit. The deviation is surprisingly well described by the T4 term of the Sommerfeld expansion, but its coefficients are enhanced by strong correlation, as shown by the good agreement with dynamical mean field calculations.

Clinical course of obstructive jaundice associated with operated meconium peritonitis in neonates

BACKGROUND/PURPOSE

Meconium peritonitis (MP) may induce prolonged cholestasis after laparotomy. In this study, we investigated the postoperative clinical course of MP retrospectively and discuss the relationship between MP and the development of obstructive jaundice, including biliary atresia (BA).

PATIENTS AND METHODS

Between 1979 and 2008, 23 infants with MP underwent laparotomy at our institution. Eleven of the 23 infants (47.8%) developed obstructive jaundice postoperatively. The medical charts of these 11 infants were reviewed.

RESULTS

The causative disease underlying MP included jejunoileal atresia in 10 and cloacal anomaly in 1. Of these 11 infants, 4 had acholic stools. Nine of the 11 improved with conservative management including an expectant approach, choleretic agents, and exchange blood transfusion. To differentiate the diagnosis from BA, open cholangiography was required in 2 cases following negative HIDA scintigraphy and a small gallbladder on ultrasonography. One of these 2 cases was diagnosed as BA and underwent hepatic portoeneterostomy simultaneously, after which the infant became jaundice free.

CONCLUSIONS

Postoperative cholestasis after MP was a transient condition in most cases. However, ultrasonography and HIDA scintigraphy should be performed to differentiate BA in infants with MP who show prolonged jaundice with acholic stools.

Formation and stability of oxygen-rich bubbles that shape photosynthetic mats

Gas release in photic-zone microbialites can lead to preservable morphological biosignatures. Here, we investigate the formation and stability of oxygen-rich bubbles enmeshed by filamentous cyanobacteria. Sub-millimetric and millimetric bubbles can be stable for weeks and even months. During this time, lithifying organic-rich laminae surrounding the bubbles can preserve the shape of bubbles. Cm-scale unstable bubbles support the growth of centimetric tubular towers with distinctly laminated mineralized walls. In environments that enable high photosynthetic rates, only small stable bubbles will be enclosed by a dense microbial mesh, while in deep waters extensive microbial mesh will cover even larger photosynthetic bubbles, increasing their preservation potential. Stable photosynthetic bubbles may be preserved as sub-millimeter and millimeter-diameter features with nearly circular cross-sections in the crests of some Proterozoic conical stromatolites, while centrimetric tubes formed around unstable bubbles provide a model for the formation of tubular carbonate microbialites that are not markedly depleted in (13)C.

Concomitant expression of HER2 and HIF-1alpha is a predictor of poor prognosis in uterine cervical carcinoma treated with concurrent chemoradiotherapy: prospective analysis (KGROG0501)

BACKGROUND

In previously reported retrospective analyses of uterine cervical carcinoma cases, HER2 was correlated with poor radiation sensitivity and poor treatment outcomes and HIF-1alpha was found to be an indicator of poor prognosis. To date, no prospective studies have been performed to evaluate the radiation sensitivity and treatment outcomes of patients with uterine cervical carcinoma relative to HER2 and HIF-1alpha expressions. We conducted a prospective evaluation of HER2 and HIF-1alpha in cases of locally advanced uterine cervical carcinoma treated with concurrent chemoradiotherapy.

METHODS

Between June 2005 and April 2008, 25 patients with locally advanced uterine cervical carcinoma were registered in this study, KGROG0501. Their clinical stages were Ib2/IIb/IIIb/IVa in 1/2/22/1 cases, respectively. Nineteen cases had squamous cell carcinoma and six had adenocarcinoma. HER2 expression and HIF-1alpha expression were analyzed using an immunohistochemical kit on pretreatment biopsied specimens. HIF-1alpha expression was studied using another commercial immunohistochemical kit on pretreatment biopsied specimens. The survival rates were compared between patients with and without positive HER2 and HIF-1alpha expressions.

RESULTS

The 20-month survival of HER2(-) and HIF-1alpha(-) cases (n = 6) was 100% and that of HER2(+) and HIF-1alpha(+) cases (n = 4) was 37.5% (p = 0.0032).

CONCLUSIONS

In this first prospective analysis of patients with uterine cervical carcinoma treated with concurrent chemoradiotherapy, concomitant expression of HER2 and HIF-1alpha was suggested to be a strong indicator of poor prognosis. A novel therapy including molecular targeted therapy such as anti-HER2 and anti-HIF-1alpha may be worth considering in patients with concomitant expression of HER2 and HIF-1alpha.

SAR analysis of a re-entrant resonant cavity applicator for brain tumor hyperthermia treatment with a 3-D anatomical human head model

A re-entrant resonant cavity applicator system for non-invasive brain tumor hyperthermia treatments was presented. We have already confirmed the effectiveness of the heating properties of this heating system with cylindrical agar phantoms and with computer simulations.

Heating properties of non-invasive hyperthermia treatment for abdominal deep tumors by 3-D FEM

This paper discusses the heating properties of a new type of hyperthermia system composed of a re-entrant type resonant cavity applicator for deep tumors of the abdominal region. In this method, a human body is placed in the gap of two inner electrodes and is non-invasively heated with electromagnetic fields stimulated in the cavity. Here, we calculated temperature distributions of a simple human abdominal phantom model that we constructed to examine the heating properties of the developed hyperthermia system. First, the proposed heating method and a simple abdominal model to calculate the temperature distribution are presented. Second, the computer simulation results of temperature distribution by 3-D FEM are presented. From these results, it was found that the proposed simple human abdominal phantom model composed of muscle, fat and lung was useful to test the heating properties of our heating method. Our heating method was also effective to non-invasively heat abdominal deep tumors.

Choledochal cyst associated with duodenal atresia: case report and review of the literature

We report a rare case of choledochal cyst (CC) associated with congenital duodenal atresia (DA) and annular pancreas (AP). A girl was born at 37 weeks of gestation weighing 2,974 g with a prenatal diagnosis of DA. She underwent a duodenoduodenostomy for type III DA with an AP 1 day after birth. At 4 years of age, she was admitted for evaluation of cholangitis and pancreatitis. Radiological studies demonstrated a fusiform-type CC with pancreaticobiliary maljunction (PBMJ). Excision of the CC and hepaticojejunostomy were performed. The patient was discharged without complications. Despite the fact that CC, DA, and AP are embryologically closely related entities, to the best of our knowledge, only eight such cases have been documented. We must be aware of the possible combination of CC in the follow-up of the patients with DA associated with AP.

Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms

BACKGROUND AND STUDY AIMS

Although endoscopic submucosal dissection (ESD) is becoming accepted as an established treatment for superficial esophageal squamous cell neoplasms, the risks for developing postoperative stricture have not been elucidated.

PATIENTS AND METHODS

This was a retrospective study at a single institution. From January 2002 to October 2008, 65 patients with high-grade intraepithelial neoplasms (HGINs) or m2 carcinomas treated by ESD were enrolled. Predictors of postoperative stricture were investigated by comparing results from 11 patients who developed strictures with those from 54 patients who did not.

RESULTS

Significant differences between the two groups were observed in longitudinal diameter (45.0 +/- 15.9 mm vs. 31.5 +/- 13.6 mm) and circumferential diameter (37.2 +/- 8.6 mm vs. 26.8 +/- 9.7 mm) of the resected specimens, and the proportion of extension to the whole circumference of the lumen (< 1 / 2/ > 1 / 2/ > 3 / 4 : 2 / 4 / 5 vs. 40 / 13 / 1), histologic depth (HGIN/m2 : 2 / 9 vs. 41 / 13), and procedure time (85.6 +/- 42.8 minutes vs. 53.3 +/- 30.1 minutes). Multivariate analysis revealed that circumferential extension of > 3 / 4 (odds ration [OR]: 44.2; 95 % confidence interval [CI]: 4.4 - 443.6) and histologic depth to m2 (OR: 14.2; 95 %CI: 2.7 - 74.2) are reliable risk factors. Subanalysis for each category by combinations of these risk factors revealed that patients with lesions in > 3 / 4 of the circumferential area were associated with a high rate of postoperative stricture. By contrast, patients with HGIN lesions in < 3 / 4 extension have no probability of postoperative strictures. Additionally, subanalysis of patients with m2 lesions in < 3 / 4 circumferential extension revealed that circumferential diameter can be a reliable predictor for postoperative stricture.

CONCLUSIONS

Circumferential extension and histologic depth are the reliable risk factors for postoperative strictures. In combination with circumferential diameter, we can perform effective and appropriate preventive balloon dilatations after esophageal ESD.

Bioactivation of titanium surfaces using coatings of TiO(2) nanotubes rapidly pre-loaded with synthetic hydroxyapatite

Apatite depositions from simulated body fluid (SBF) have been widely used for the in vitro assessment of the bioactivity of bone- and dental-implant materials. In previous work, we reported that titanium-based implant materials can be coated with an anodic TiO(2) nanotube layer which can significantly stimulate apatite formation. In the present work, we demonstrate that the tubular nature of such coatings makes them highly suitable for the application of a treatment called "alternative immersion method (AIM)", which preloads the coatings with synthetic hydroxyapatite. This treatment is indeed found to additionally promote natural apatite formation significantly. To study the AIM effect, layers of nanotubes with various diameters and crystal structures (amorphous, anatase/rutile) were produced, AIM-treated, and the formation of apatite in SBF10 (10mmol1(-1) HCO(3)(-)) was evaluated. The results show a drastic enhancement of apatite deposition rates (in some cases >20-fold acceleration) for AIM-treated TiO(2) nanotube layers in comparison with non-treated TiO(2) surfaces.

Far-infrared absorption and the metal-to-insulator transition in hole-doped cuprates

By studying the optical conductivity of Bi(2)Sr(2-x)La(x)CuO(6) and Y(0.97)Ca(0.03)Ba(2)Cu(3)O(6), we show that the metal-to-insulator transition in these hole-doped cuprates is driven by the opening of a small gap at low T in the far infrared. Its width is consistent with the observations of angle-resolved photoemission spectroscopy in other cuprates, along the nodal line of the k space. The gap forms as the Drude term turns into a far-infrared absorption, whose peak frequency can be approximately predicted on the basis of a Mott-like transition. Another band in the midinfrared softens with doping but is less sensitive to the metal-to-insulator transition.

Long-term outcome after endoscopic resection in patients with hypopharyngeal carcinoma invading the subepithelium: a case series

Patients with early stage hypopharyngeal carcinoma can be treated with endoscopic resection. However, strict indication for endoscopic resection in cases of hypopharyngeal carcinoma is unclear. In this paper, we evaluated the long-term outcome after endoscopic resection in patients with hypopharyngeal carcinoma invading the subepithelium. Among 16 patients with hypopharyngeal carcinoma who underwent endoscopic resection, eight patients who were histologically confirmed to have tumors with shallow invasion of the subepithelium were studied. Depth of tumor invasion in the subepithelium in those patients ranged from 300 to 720 microm (mean +/- SD, 490 +/- 140 microm). During a median follow-up period of 40 months, none of the eight patients had local recurrence or metastasis. Kaplan-Meier estimates of relapse-free survival rates at 5 years in the eight patients were 100 %. The results of this study suggest that hypopharyngeal carcinoma with slight invasion to the subepithelium can be successfully treated by endoscopic resection.

Effects of preoperative administration of omeprazole on bleeding after endoscopic submucosal dissection: a prospective randomized controlled trial

BACKGROUND AND AIMS

The effectiveness of preoperative administration of proton pump inhibitors (PPIs) for the prevention of bleeding after endoscopic submucosal dissection (ESD) is unclear. Our aim was to evaluate the benefit of starting PPI treatment 1 day before ESD to prevent bleeding after the procedure.

PATIENTS AND METHODS

This was a prospective randomized controlled trial. Data for 155 patients who underwent ESD (preoperative administration group: N = 81; postoperative administration group: N = 74) were analyzed. All patients received standard ESD using an insulation-tipped knife. Patients in the preoperative group were administered omeprazole from the day before ESD, and patients in the postoperative group received omeprazole after ESD. Follow-up endoscopy was performed on day 1, day 7, and day 28. Intragastric pH was measured from samples of gastric juice. The primary endpoint of this study was major bleeding related to ESD, and the secondary endpoint was minor bleeding.

RESULTS

Major bleeding occurred in one patient from the postoperative group who had hematemesis. Minor bleeding occurred on day 1 in six patients from the preoperative group and five patients from the postoperative group (7.7 % vs. 7.4 %). There was no significant difference between major and minor bleeding ratios in the two groups. Intragastric pH at ESD in the postoperative group was lower than that in the preoperative group ( P < 0.05).

CONCLUSIONS

Preoperative administration of omeprazole offers no additional benefit over postoperative administration alone in the prevention of bleeding after ESD among elderly Japanese people.

Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria

BACKGROUND AND STUDY AIMS

Endoscopic submucosal dissection (ESD) is a novel, promising endoscopic technique for gastrointestinal neoplasms. We aimed to elucidate the feasibility of ESD as curative treatment for intestinal-type early gastric cancer (EGC) potentially without lymph-node metastases.

PATIENTS AND METHODS

For the short-term analysis, 276 consecutive, intestinal-type EGCs, which fulfilled the criteria for node-negative EGC in 231 patients who had undergone ESD from January 2000 to March 2007, were retrospectively investigated. For the long-term analysis, 212 lesions checked by endoscopy later than 1 year or recurrence within 1 year after ESD were assessed for local recurrence, and 208 patients followed for over 1 year or to death within 1 year after ESD were assessed for metastases and survival. All lesions/patients were divided into three groups: intramucosal cancer without ulcerative findings (M-Ul[-]); intramucosal cancer with ulcerative findings, < or = 3 cm (M-Ul[+]); and slight invasive cancer into submucosa (< 500 microm), < or = 3 cm (SM1).

RESULTS

En bloc and complete resection rates were 96.7 % and 91.7 %, respectively. During a median follow-up of 36 months (range 2 - 93 months), two local recurrences occurred (0.9 %), which were detected at 2 and 6 months after ESD, respectively. During a median follow-up of 38 months (range 6 - 97 months), the 5-year overall and disease-specific survival rates were 96.2 % and 100 %, respectively, with neither lymph node nor other-organ metastasis; one patient died due to other disease 6 months after ESD. No disease-related death occurred. No significant differences were found between the groups in short- and long-term analyses.

CONCLUSIONS

The prognostic analyses demonstrated the validity of the criteria of node-negative intestinal-type EGC as curability criteria for ESD. ESD can be proposed as an alternative method to gastrectomy for the treatment of these EGCs.