[Complete response obtained by preoperative chemotherapy in a case of T4 rectal cancer]

A 48-year-old man, who had presented with anal pain and cloudy urine, was referred to our hospital. Colonoscopy showed a type 2 circular tumor at the higher rectum, and a diagnosis of well-differentiated adenocarcinoma was made by biopsy. CT demonstrated increased thickness of the rectum wall, an equivocal boundary between the rectum and the bladder, and abnormal gas production in the bladder. Following diagnosis of T4 rectal cancer, preoperative chemotherapy was initiated with the aim of downstaging the tumor and avoiding total pelvic exenteration. After 5 courses of mFOLFOX+bevacizumab, the tumor showed a partial response on CT, which enabled the tumor to be resected without sacrificing the bladder. The whole tumor was resected by performing low anterior resection (D3) and partial resection of the bladder. Subsequent pathological examination of the resected specimen indicated complete response to chemotherapy due to the absence of malignant cells. Because higher response rate is reported for modern chemotherapy, including targeted therapy, preoperative intensive chemotherapy is an option for the local treatment of advanced rectal cancer. Downstaging chemotherapy is expected to enhance the role of function-preserving surgery for T4 rectal cancer.

[Current status and treatment results of combined modality therapy for locally recurrent rectal cancer]

PURPOSE

The aim of this study was to clarify the current status of combined modality therapy for locally recurrent rectal cancer.

METHODS

Between 2000 and 2011, 43 patients(26 men and 17 women; mean age, 60 years) developed local pelvic recurrence after curative surgery. The recurrence pattern was almost equally distributed as 53% (23/43) pelvic, and 47% (20/43) pelvic and metastatic disease. Regarding the form of local recurrence, localized type and lateral spread type were present in 25 and 18 patients, respectively. In all, 24 patients underwent surgical resection for recurrent disease, and 87% of these patients underwent potentially curative surgery. The 3- and 5-year overall survival rates for patients who were treated with surgical resection were 42% and 29%, respectively. These results were significantly favorable when compared to the non-surgical group of patients who were treated with chemoradiotherapy or chemotherapy. Localized type recurrence is a statistically significant prognostic factor for improved survival compared to lateral spread type recurrence.

CONCLUSIONS

Preoperative chemoradiotherapy and surgical resection should be a standard treatment option for patients with localized type recurrence, and chemoradiotherapy is better indicated for patients with lateral spread type recurrence.

[A case of recurrent intestinal GIST with long-term survival-beneficial effect of multimodality therapy using high-dose imatinib and surgery]

Treatment of recurrent GIST is often difficult. Here, we report a case of recurrent intestinal GIST with long-term survival. A 67-year-old woman underwent surgical resection of a GIST of the jejunum. Recurrence was observed 2 years after the operation: a tumor was found in the abdominal wall and imatinib therapy was started at a daily dose of 400 mg. However, a new metastatic nodule was noted 2 months later. Because a duplication mutation in KIT exon 9 was found in the primary tumor, we decided to increase the dose of imatinib to 800 mg/day. The tumors presented with PR-SD thereafter. About 3 years after the first surgery, a new lesion was found. We assessed the tumor as resectable and performed resection. About 10 months after the second surgery, however, a new lesion was detected. Imanitib therapy was re-started at a dose of 800 mg/day, and the tumor has remained PR-SD to date. She continues to be an outpatient 7 years and 5 months after the first operation. The multimodality therapy of high-dose imatinib and surgery is beneficial for the control of recurrent intestinal GIST.

Does planned intravenous sedation affect preoperative anxiety in patients?

Dental surgery generally causes stress and fear, which may affect patient physiology and increase perioperative anxiety. Dental anxiety is considered to be an important factor in determining the need for intravenous sedation. One of the gold standards for measuring preoperative anxiety is Spielberger's State-Trait Anxiety Inventory (STAI). The authors have previously assessed preoperative anxiety using STAI and recommended that intravenous sedation be performed for patients whose anxiety level is high. The intravenous cannulation necessary for sedation and sedation itself may increase anxiety. The authors carried out this study to examine whether planning intravenous sedation before surgery increases preoperative anxiety. The subjects were patients who planned to undergo wisdom teeth extraction under local anaesthesia in the authors' hospital. They were divided into two groups on the basis of the planned intravenous sedation. STAI scores were compared between the initial visit and just before surgery. There were no significant differences in the state and trait anxiety scores between the initial visit and the day of the surgery in the two groups. Planned intravenous sedation based on the evaluation of anxiety levels using STAI is effective for promoting a safe operation without aggravating preoperative anxiety.

Potential pitfalls in volume reduction for the treatment of Proteus syndrome

Proteus syndrome is a rare congenital hamartomatous condition that is characterised by a wide range of malformations. Skin and skeletal developmental malformations are common and may manifest as significant physical anomalies. However, few reports have discussed surgical treatment. A 37-year-old woman presented with disproportionate enlargement of the right buttock, which required volume reduction. The overgrown tissue was combined with vascular malformations, which in our patient were extremely thick. The patient experienced massive blood loss during the procedure, due to which a blood transfusion was performed. Pathological findings revealed partial lipohyperplasia with venous malformations. Thus, during operations including incomplete excision, massive bleeding is always a possibility, but is not commonly described in these instances.

Resection of the second portion of the duodenum sacrificing the minor papilla but preserving the pancreas for a recurrent duodenal adenocarcinoma: report of a case

Duodenal adenocarcinoma is a relatively rare malignancy and pancreaticoduodenectomy would be a standard procedure to achieve curative resection. We report a case of resection of the 2nd portion of the duodenum with nodal dissection preserving the pancreas. The patient was a 75-year-old man with right-sided paresis suffering from early cancer in the 2nd portion of the duodenum. Despite 3 times of endoscopic mucosal resections, mucosal local recurrence was found. The depth of the tumour involvement continued to be limited within the mucosal layer. We performed segmental duodenal resection with nodal dissection sacrificing the minor papilla, while preserving the pancreas and the major papilla. The pathological diagnosis was primary intramucosal adenocarcinoma; the surgical margin was negative for cancer and there was no nodal metastasis. This procedure can be an alternative to pancreaticoduodenectomy in patients with earlystage adenocarcinoma in the 2nd portion of the duodenum when the major papilla can be spared, especially in high-risk patients.

Reduction of ion thermal diffusivity inside a magnetic island in JT-60U tokamak plasma

A peaked ion temperature profile is observed inside the magnetic island during mode locking after the back transition from H mode to L mode in JT-60U. The thermal diffusivity evaluated inside the magnetic island is 0.1 m(2)/s, which is much smaller than that outside the magnetic island by an order of magnitude. The present experiment gives clear evidence that ion heat transport inside a magnetic island can bifurcate and the transport level can be suppressed to the very low level associated with the strong flow shear at the boundary.

Contrast-enhanced intraoperative ultrasonography using perfluorobutane microbubbles for the enumeration of colorectal liver metastases

BACKGROUND

Intraoperative ultrasonography (IOUS) is considered the standard for the identification of liver metastases. Use of lipid-stabilized perfluorobutane microbubbles as an ultrasound contrast agent may improve this. The value of contrast-enhanced IOUS (CE-IOUS) in enumerating colorectal liver metastases was studied here.

METHODS

CE-IOUS was performed in consecutive resections for colorectal liver metastases in 2007-2010. All patients underwent preoperative computed tomography. Magnetic resonance imaging was not carried out routinely. Conventional intraoperative examination including IOUS, and CE-IOUS with peripherally injected contrast were performed. The histopathological findings and 6-month follow-up images were used as the reference standard.

RESULTS

The study group of 102 patients had a total of 315 lesions identified on preoperative imaging (2·4 lesions per operation; 129 operations). Conventional intraoperative examination including IOUS identified 350 lesions (2·7 per operation). CE-IOUS identified 370 lesions (2·9 per operation). The sensitivity, specificity and accuracy of CE-IOUS were 97·1, 59·1 and 93·2 per cent respectively. The CE-IOUS findings altered the surgical plan in 19 operations (14·7 per cent).

CONCLUSION

CE-IOUS provided additional information to that obtained using contemporary preoperative imaging and conventional intraoperative examinations.

Poly[[dodeca-aqua-(μ(4)-benzene-1,4-dicarboxyl-ato)(μ(2)-4,4'-bipyridine-κ(2)N:N')dicerium(III)] bis-(benzene-1,4-dicarboxyl-ate)]

The asymmetric unit of the title compound, {[Ce₂(C₈H₄O₄)(C₁₀H₈N₂)(H₂O)₁₂](C₈H₄O₄)₂}_n, consists of half a Ce^III cation, a quarter of a coordinated benzene-1,4-dicarboxyl­ate (bdc²⁻) dianion, a quarter of a 4,4′-bipyridine (bpy) mol­ecule, three water mol­ecules and a half of an uncoordinated benzene-1,4-dicarboxyl­ate dianion. The Ce^III ion is located on a twofold rotation axis and exhibits a distorted trigonal prism square-face tricapped coordination geometry. The coordinated and uncoordinated bdc²⁻ ions and the bpy mol­ecule lie about special positions of site symmetries 2/m, m and 2/m, respectively. The Ce^III ions are bridged by the bdc²⁻ and bpy ligands, giving a sheet structure parallel to the ac plane. The uncoordinated bdc²⁻ dianion exists between the sheets and links the sheets by inter­molecular O—H⋯O hydrogen bonds between the uncoordinated bdc²⁻ and coordinated water mol­ecules. A π–π stacking inter­action between the uncoordinated bdc²⁻ dianion and the bpy ligand [centroid–centroid distance = 3.750 (4) Å] is also observed.

Indication of reactor ν(e) disappearance in the Double Chooz experiment

The Double Chooz experiment presents an indication of reactor electron antineutrino disappearance consistent with neutrino oscillations. An observed-to-predicted ratio of events of 0.944±0.016(stat)±0.040(syst) was obtained in 101 days of running at the Chooz nuclear power plant in France, with two 4.25 GW(th) reactors. The results were obtained from a single 10 m(3) fiducial volume detector located 1050 m from the two reactor cores. The reactor antineutrino flux prediction used the Bugey4 flux measurement after correction for differences in core composition. The deficit can be interpreted as an indication of a nonzero value of the still unmeasured neutrino mixing parameter sin(2)2θ(13). Analyzing both the rate of the prompt positrons and their energy spectrum, we find sin(2)2θ(13)=0.086±0.041(stat)±0.030(syst), or, at 90% C.L., 0.017<sin(2)2θ(13)<0.16.

Thrombotic microangiopathy after living-donor liver transplantation

Thrombotic microangiopathy (TMA) is an infrequent but severe life-threatening disorder in solid organ transplant recipients. Few studies of TMA in living donor liver transplant (LDLT) recipients, however, have been reported. We investigated the clinical characteristics and prognostic factors of TMA after LDLT. Among 393 adult LDLT recipients, 30 patients (7.6%) were identified to have TMA. The 1-, 3- and 5-year survival rates of these patients were lower (60.6%, 52.5% and 47.7%, respectively) than those of patients without TMA (93.0%, 89.0% and 87.3%, respectively). Multivariate analysis confirmed that reduced administration of fresh frozen plasma and sensitization against HLA are closely related with TMA (odds ratio [OR]: 2.6 and 16.1, respectively). However, a review of the cases revealed that individual responses to treatment varied considerably and the main etiologies were difficult to determine. A comparison of the clinical factors suggested that late onset (>30 days), poor response to treatment and delayed diagnosis and/or treatment are associated with a poor outcome. Because the prevention of TMA in LDLT patients is difficult, early diagnosis and initiation of intensive therapies may be crucial to improve the prognosis.

Status of ion sources at National Institute of Radiological Sciences

The National Institute of Radiological Sciences (NIRS) maintains various ion accelerators in order to study the effects of radiation of the human body and medical uses of radiation. Two electrostatic tandem accelerators and three cyclotrons delivered by commercial companies have offered various life science tools; these include proton-induced x-ray emission analysis (PIXE), micro beam irradiation, neutron exposure, and radioisotope tracers and probes. A duoplasmatron, a multicusp ion source, a penning ion source (PIG), and an electron cyclotron resonance ion source (ECRIS) are in operation for these purposes. The Heavy-Ion Medical Accelerator in Chiba (HIMAC) is an accelerator complex for heavy-ion radiotherapy, fully developed by NIRS. HIMAC is utilized not only for daily treatment with the carbon beam but also for fundamental experiments. Several ECRISs and a PIG at HIMAC satisfy various research and clinical requirements.

[Long-term clinical effects of preoperative radiotherapy on anal function after intersphincteric resection]

BACKGROUND

The aim of this study was to determine whether preoperative radiotherapy had an influence on the anal function of patients having an intersphincteric resection (ISR).

METHODS

We evaluated a long-term outcome and postoperative anal function in 22 patients having undergone ISR for low rectal cancer.

RESULTS

There was no significant difference between the irradiated and nonirradiated group in the postoperative complications and oncological outcome. After a median follow-up of 6 .8 years, the number of bowel movements per 24 hours in patients with and without radiation was 4 .5 and 2 .7, respectively. Poor anal function assessed by Wexner incontinence score and Kirwan classification were significantly associated with preoperative radiotherapy.

CONCLUSION

Preoperative radiotherapy was identified as a risk factor with the greatest negative impact on anal function after ISR.

[A case of lung metastases after surgery for colon cancer demonstrating complete response for more than six years after treatment with UFT/LV]

A 54-year-old female with cecal cancer underwent Rt. hemicolectomy in December 2000. The lesion was mod, ss, p1(+), n1, stage IV. The level of CEA increased around August 2002. Abdominal CT revealed a recurrent tumor in the RLQ in July 2003, peritoneal dissemination was suspected. In December 2003, we performed a partial resection of the ileum and transverse colon including initial anastomosis. Lung metastases were found by chest CT in right S4, S5, S9 and S3, S8 in February 2004. Because of experience of severe side effect of intravenous chemotherapy, UFT/LV was administered from February 2004. Chest CT revealed the disappearance of tumor in September 2004, and no signs of recurrence were observed for 65 months.

[Anal squamous cell carcinoma-a report of 6 cases]

In Japan, surgical therapy is utilized as the main treatment modality for anal squamous cell carcinoma (SCC). Subjects were 6 patients with anal SCC treated at our hospital from 2000-2010, and a study was made on the treatment. In the early 3 cases (Stage IIIA, IIIB, IIIB), chemoradiotherapy (CRT) was used as adjuvant therapy on the premise of surgery. All of them were considered as stable disease, and they all experienced postoperative complications. The average length of the hospital stay was 45 days. Two cases are still surviving without recurrence, but the other one developed a distant metastasis. In contrast, we selected CRT with curative intent in the late 3 cases(Stage II, IIIA, IIIB). Two cases were considered as complete response (CR), and the other one considered as partial response (PR) was performed a salvage operation. Two cases are still surviving without recurrence, but the other case metastasized to the internal iliac lymph nodes. CRT with curative intent for anal SCC demonstrated a good antitumor effect. Salvage operation was safely performed, and showed a good prognosis.

Bulk and surface magnetization of Co atoms in rutile Ti(1-x)Co(x)O(2-δ) thin films revealed by x-ray magnetic circular dichroism

We have studied magnetism in Ti(1-x)Co(x)O(2-δ) thin films with various x and δ by soft x-ray magnetic circular dichroism (XMCD) measurements at the Co L(2, 3) absorption edges. The estimated ferromagnetic moment by XMCD was 0.15-0.24 µ(B)/Co at the surface, while in the bulk it was 0.82-2.25 µ(B)/Co, which is in the same range as the saturation magnetization of 1.0-1.5 µ(B)/Co. These results suggest an intrinsic origin of the ferromagnetism. The smaller moment of the Co atom at the surface is an indication of a magnetically dead layer of a few nanometers thick at the surface of the thin films.

Modeling of Neptunium(V) Sorption Behavior onto Iron-Containing Minerals

Sorption behaviors of neptunium (V) on naturally-occurring magnetite (Fe3O4) and goethite (α-FeOOH) in 0.1M NaN03electrolyte solution under aerobic conditions were interpreted using the surface complexation model (SCM). The surface properties of these materials were experimentally investigated by C02-free potentiometric titration, and SCM parameters for the constant capacitance model, such as protonation/deprotonation constants of the surface hydroxyl group, were determined. The number of negatively charged sorption sites of goethite rapidly increased with the increase of the bulk solution pH compared with that of magnetite and this tendency was similar to the pH dependence of neptunium sorption. This implies that the neptunyl cation, NpO2+, plays a dominant role in possible sorption reactions. Assuming that the dominant surface complex is XO-NpO2, modeling by means of SCM was carried out, and the results were found to agree with experimental data.

Influence of Humic Acid on Sorption of Neptunium(V) onto Soil

The pH dependence of the stability constant of Np(V)-humate and the sorption of Np(V) onto soil was studied to clarify the influence of dissolved organic carbon on the migration behavior of Np(V) in soil layer. The stability constant of Np(V)-humate was expressed by logβ1=(0.35 ±0.03)pH+0.04±0.01 in the pH region from 5.3 to 8.7, and the intrinsic stability constant by logβ*1=3.66±0.05.

The sorption of Np(V) increased with pH up to pH 7, and tended to reach maximum, about 95%, at pH 9 in the absence of humic acid. In the presence of humic acid more than 140mg/l, the sorption of Np(V) was lower than that in the absence of humic acid above pH 7, while any influence of humic acid on the sorption of Np(V) onto soil was not observed below pH 7. The sorption behavior of Np(V) onto soil was explained by reversible sorption of NpO2+ and sorption of NpO2CO3- and/or NpO2OH. Further, the influence of the size distribution of Np(V) on the sorption onto soil was examined and discussed.

20 FACTORS THAT AFFECT PURITY AND YIELD OF BOVINE SEX-SORTED SPERM

The purposes of these studies were to examine the influence on the yield of sex-sorted sperm by the different size of sorting gate and to evaluate factors that affect the purity of sex-sorted sperm. As the sorting gate was expanded, so the yield of bovine sex-sorted sperm using flow cytometry was increased. At the same time, the purity of sex-sorted sperm became low. In addition, though the sorting gates were the same size, the purity of sex-sorted sperm differed among trials. These observations indicated the existence of factors that affect purity besides the size of sorting gate. To examine the yield of sex-sorted sperm, X-bearing sex-sorted sperm from 4 Holstein bulls were produced repeatedly 34 times by 3 flow cytometers. The sizes of sorting gates were fixed at 40–42%, 44%, and 46%. Each yield of sorting gate at 40–42%, at 44% and at 46% was compared. To evaluate factors that affect purity, X- or Y-bearing sex-sorted sperm were produced by one flow cytometer. These trials were repeated 160 times for the sorting of X-bearing sperm and 45 times for the sorting of Y-bearing sperm. Stepwise multiple regression analysis was used to analyse the relationships between the purity of sex-sorted sperm and the following sorting conditions, the percentage of oriented sperm, the percentage of dead sperm, degree of separation between X-bearing and Y-bearing sperm, the size of sorting gate, event rate, drop drive frequency, drop delay value and drop delay accuracy. The highest yield was acquired by sorting gate at 44%. The number of sex-sorted sperm was increased as sorting gate was expanded, however, the purity became low. The purities of the sperm by some trials using sorting gate at 46% were less than our acceptable lowest purity that was 90%. So that those sperm must be discarded. Therefore the yield of sorting gate at 44% was greater than sorting gate at 46%. Stepwise multiple regression analysis revealed that the factors for increasing purity of X-bearing sex-sorted sperm were the percentage of oriented sperm (P < 0.001), the degree of separation between X-bearing sperm and Y-bearing sperm (P < 0.001), the drop delay accuracy (P < 0.001), the event rate and the drop drive frequency, and the factor for decreasing purity of X-bearing sex-sorted sperm was the size of sorting gate (P < 0.001). On the other hand, the factors for increasing purity of Y-bearing sex-sorted sperm were the percentage of oriented sperm (P < 0.01), the degree of separation between X-bearing sperm and Y-bearing sperm (P < 0.01) and the event rate (P < 0.05), and the factor for decreasing purity of Y-bearing sex-sorted sperm was the size of sorting gate (P < 0.01). From these results, it can be concluded that the purity of sex-sorted sperm was not depend on simply by size of sorting gate but was more completely explained by other sorting conditions.

Extended right hemihepatectomy for gallbladder carcinoma involving the hepatic hilum

BACKGROUND

Major hemihepatectomy for advanced gallbladder carcinoma remains controversial as it is associated with serious postoperative complications and poor prognosis.

METHODS

All those who underwent extended right hemihepatectomy were identified from a database of patients with gallbladder carcinoma who had surgical resection between 1999 and 2009. The clinicopathological data for these patients were analysed retrospectively.

RESULTS

A total of 126 patients underwent surgical resection, 35 of whom had extended right hemihepatectomy. There were no deaths, but 16 patients had complications. The mean(s.d.) duration of operation and blood loss were 564(206) min and 1472(1268) ml respectively. No blood transfusions were needed in 28 patients. Tumour stage (International Union Against Cancer, sixth edition) was IIA in four, IIB in four, III in 15 and IV in 12 patients. The overall 5-year survival rate was 17 per cent with a median survival of 2·2 years. Three patients survived more than 5 years. The presence of hepatic metastases and gallbladder carcinoma originating from the cystic duct were indicators of poor prognosis.

CONCLUSION

Extended right hemihepatectomy for gallbladder cancer is safe and may contribute to long-term survival in selected patients.

Potassium-benzene interactions on Pt(111) studied by metastable atom electron spectroscopy

Electron emission spectra obtained by thermal collisions of He(∗)(2(3)S) metastable atoms with C(6)H(6)/Pt(111), C(6)H(6)/K/Pt(111), and K/C(6)H(6)/Pt(111) were measured in the temperature range of 50-200 K to elucidate the adsorption/aggregation states, thermal stabilities of pure and binary films, and local electronic properties at the organic-metal interface. For C(6)H(6)/Pt(111), the He(∗)(2(3)S) atoms de-excite on the chemisorbed overlayer predominantly via resonance ionization followed by Auger neutralization and partly via Penning ionization (PI) yielding weak emission just below the Fermi level (E(F)). We assigned this emission to the C(6)H(6) π-derived states delocalized over the Pt 5d bands on the basis of recent density functional calculations. During the layer-by-layer growth, the C(6)H(6)-derived bands via PI reveal a characteristic shift caused by the final-state effect (hole response at the topmost layer). C(6)H(6) molecules chemisorb weakly on the bimetallic Pt(111) (θ(K)=0.1) and physisorb on the K multilayer. In both cases, the sum rule was found to be valid between the K 4s and C(6)H(6)-derived bands. The band intensity versus exposure plot indicates that the C(6)H(6) film grows on the K multilayer by the Volmer-Weber mechanism (island growth), reflecting the weak K-C(6)H(6) interactions. In case of K/C(6)H(6)/Pt(111), the K atoms are trapped on the topmost C(6)H(6) layer at 65 K, forming particlelike clusters. The surface plasmon satellite was identified for the first time and the loss energy increases with increasing cluster size. The K clusters are unstable above ∼100 K due to thermal migration into the C(6)H(6) film. When the cluster coverage is low, the K 4s band extends below and above E(F) of the Pt substrate and the anomaly is discussed in terms of vacuum level bending around the cluster.

Observation of a complex multistage transition in the JT-60U H-mode edge

A complex multistage transition of the edge radial electric field is observed in JT-60U H-mode phase without edge localized mode. An interesting feature is that the poloidal rotation velocity of the carbon impurity ions changes in the later H-phase without a comparable change in the main ion pressure gradient, indicating a change in the parallel momentum (and particle) balance channel.

[Bevacizumab in combination with mFOLFOX6 or FOLFIRI for previously treated metastatic colorectal cancer]

We retrospectively investigated the safety and efficacy on outpatient chemotherapy including bevacizumab(BV)as secondline therapy for inoperable metastatic colorectal cancer. Analytical subjects were thirty patients treated with chemotherapy including BV as second-line therapy after first disease progression. All patients were treated with BV 5mg/kg. Concurrent therapy was given mFOLFOX6(2 patients)and FOLFIRI(28 patients). The BV treatment frequency and all course treatment frequency including the prior regimens averaged 20 and 37 times, respectively. The overall response rate was 24. 1%(PR, 7 patients; SD, 17 patients; PD, 5 patients), and the median duration of progression-free survival was 8. 0 months. The median duration of survival after addition of BV was 20. 3 months. The adverse events were 84%(>grade 3, 9%), BV-associated adverse events were GI perforation(1 patient), GI hemorrhage(1 patient), grade 3 hypertension(1 patient)and grade 2 epitaxis(2 patient). Although it is necessary to be careful about GI hemorrhage and GI perforation, we could safely continue the treatment with BV on outpatient chemotherapy. We confirmed that the chemotherapy including BV as second-line therapy had high antitumor effect and patient benefit.