Intranuclear paracrystals observed in striated muscle specific LIM protein-deficient mouse cardiomyocytes

A paracrystalline structure was observed within left ventricular cardiomyocyte nuclei of MLP(-/-) mice. The paracrystal possessed cross lines, approximately 8.0 micro m long and 0.3 micro m wide, with a slender spindle shape and a periodicity of 13 nm. Paracrystals were best observed along the longitudinal orientation of myofibrils and were detected in less than 10% of the nuclei observed. One dimension of the protein unit forming the paracrystal was 8.5 nm long. The electron density of the paracrystal appeared to be slightly higher than that of heterochromatin, suggesting that RNA-associated proteins are constituents of the paracrystal. This is the first report of intranuclear paracrystals in cardiomyocytes, which appear to be unique to MLP(-/-) mice.

Estrogen-Receptor-Alpha-Positive Extramammary Paget’s Disease Treated with Hormonal Therapy

The patient was an 80-year-old man with scrotal and penile extramammary Paget's disease and prostate cancer. Both diseases were in advanced stages. Tumor cells of extramammary Paget's disease strongly expressed estrogen receptor alpha. The patient was concurrently treated with two kinds of hormonal therapy: the anti-estrogen tamoxifen (20 mg/day orally) for extramammary Paget's disease and the anti-androgen bicalutamide (80 mg/day orally) for prostate cancer. The toxicity of the therapy was mild. All of the metastatic lesions remained stable for 2 months after initiation of dual hormonal therapy. During a follow-up period of 22 months, performance status was well maintained for 17 months. Hormonal therapy may be an alternative for selected cases of advanced extramammary Paget's disease.

Efficacy of systemic chemotherapy (CT) for the patients (pts) with unresectable liver metastasis (LM) of colorectal cancer (CRC)

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Background: Surgical resection of colorectal LM is the only treatment which provides long-term survival for pts with advanced disease confined to the liver. However, most of LM are initially unresectable. The aim of this retrospective study was to evaluate the efficacy of systemic CT for the pts with initially unresectable LM from CRC. Methods: Subjects of this study were advanced CRC with unresectable LM treated by systemic CT at our institution between Aug ’92 and Dec ’03, and fulfilled the following criteria; Age ≤ 75, PS ≤ 2, histologically confirmed colorectal adenocarcinoma, no extrahepatic disease, no prior CT and no serious complication. Results: A total of 349 pts with metastatic CRC were managed by systemic CT between the period. Among these, there were 47 pts who met the recruitment criteria. Their characteristics were; male/female: 32/15, median age (range): 59 (34–75), PS 0/1/2: 33/12/2, primary tumor: colon/rectum: 26/21, sinchronous/metachronous: 26/21, number of LM: 4 ≥ / 5 ≤: 9/38. Regimens of CT were; 5FU/5FU+LV/CPT-11+5FU/CPT-11+5FU+LV/Others: 4/11/7/18/7. In all 47 pts, response rate was 53%, median survival time and 3-year survival rate were 14.6 month and 14.6%, respectively, at a median follow-up of 43.4 month. Seven of 47 (15%) could be secondarily resected after response to CT and all had R0 resection. Estimated 3-year survival rates in resected and non-resected pts were 57.1% and 0%, respectively. Prior CT before liver resection was CPT-11+5FU+LV (IFL)/CPT-11 alone: 6/1. Of the 7 resected pts, 2 pts are alive with no evidence of disease for 38 and 40 month after initiation of CT. Five of 7 pts relapsed (liver 3, liver and lung 2) and all treated with systemic CT for recurrence. Although recurrent disease is persisting, 2 of 5 are still alive for 34 and 48 month by continuing CT. Conclusions: Effective systemic CT allows some pts with unrsectable colorectal LM to be rescued by hepatic resection and provides a chance of long-term survival.

No significant financial relationships to disclose.

Haplotype structures of the UGT1A gene complex in a Japanese population

Genetic polymorphisms of UDP-glucuronosyltransferases (UGTs) are involved in individual and ethnic differences in drug metabolism. To reveal co-occurrence of the UGT1A polymorphisms, we first analyzed haplotype structures of the entire UGT1A gene complex using the polymorphisms from 196 Japanese subjects. Based on strong linkage disequilibrium between UGT1A8 and 1A10, among 1A9, 1A7, and 1A6, and between 1A3 and 1A1, the complex was divided into five blocks, Block 8/10, Block 9/6, Block 4, Block 3/1, and Block C, and the haplotypes for each block were subsequently determined/inferred. Second, using pyrosequencing or direct sequencing, additional 105 subjects were genotyped for 41 functionally tagged polymorphisms. The data from 301 subjects confirmed the robustness of block partitioning, but several linkages among the haplotypes with functional changes were found across the blocks. Thus, important haplotypes and their linkages were identified among the UGT1A gene blocks (and segments), which should be considered in pharmacogenetic studies.

Vertebroplasty in the treatment of spine disease

SUMMARY

We report our experience in the treatment of thoracic and lumbosacral spinal pain due to vertebral bone fractures. This pathology can be related to osteoporosis but also to metastatic disease and less frequently vertebral haemangioma. From April 2001 through December 2004 we treated 238 patients for a total of 455 vertebral bodies. 175 patients had osteoporosis, 70 had metastasis and 13 had vertebral haemangioma. Sacroplasty was performed in six patients to obtain a cement filling of sacral metastasis. The procedures were mostly performed under fluoroscopy and only in cases of metastasis or sacroplasty was CT/fluoroscopy guidance preferred for optimal filling of the area of osteolysis. We evaluated the results at six and 18 months follow-up and analysed the incidence of new vertebral fractures, vascular and disk leakage and the incidence of major and minor complications. Biopsy was performed only in doubtful cases. We obtained different results considering the etiology of the disease. We obtained a 92% success rate at six months follow-up and 89% success at 18 months follow-up in osteoporosis, a 77% and 72% success rate at six and 18 months follow-up in metastastic patients, and no change at six and 18 months follow-up in patients with vertebral haemangioma in which the success rate was of 95%. We noted extravertebral leakage in 41% of vertebral bodies of which 31% were treated at the level of the vascular space and only 10% at the level of the disk space, and symptomatic in only two cases (acute compressive radiculitis, medically treated and resolved within a month). Six patients presented new fractures in the adjacent vertebral body and 30% had a partial recovery in the height of the vertebral body with kyphosis curve reduction. Vertebroplasty is a good technique to obtain spine pain relief and has a low incidence of side effects. Good quality equipment is important to obtain these results.

Percutaneous vertebroplasty: indications, contraindications, technique, and complications

Percutaneous vertebroplasty is emerging as one of the most promising new interventional procedures for relieving (or reducing) painful vertebra, with the injection of surgical polymethylmethacrylate or cement into vertebral bodies. This imaged-guided technique, originally used to treat vertebral hemangioma, has recently been extended to the treatment of metastases, osteoporotic compression fractures, and vertebral myeloma. It is increasingly being accepted as a main treatment of choice in the management of resistant back pain due to vertebral compression fractures, especially in the elderly individual who is not a candidate for surgery. In this article, we review indications, contraindications, technique, and complications of percutaneous vertebroplasty.

A rare case of the cutaneous form of adult T-cell leukaemia/lymphoma: assessment of remission by PCR for clonal T-cell receptor gamma gene rearrangements in an electron beam-irradiated cutaneous lesion

Adult T-cell leukaemia/lymphoma is a lymphoproliferative disorder aetiologically associated with human T-cell lymphotropic virus type I infection. A cutaneous lesion often develops in the disease, and in rare cases, is even the only manifestation. Here we report a rare case of 'cutaneous' adult T-cell leukaemia/lymphoma with neither atypical cells in the peripheral blood nor lymph node involvement. All nodular lesions were completely eliminated after local electron beam irradiation (20 Gy/nodule in total). To evaluate whether or not there were residual lymphoma cells in the skin, we performed PCR to detect clonal T cell receptor gamma gene rearrangements. The sample from the nodule before irradiation showed evidence of a rearranged band, which was not detected at the same site after treatment nor in any peripheral blood. The findings suggest that this procedure is useful for the evaluation of therapeutic effects and the early detection of lymphoma recurrence.

Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study

BACKGROUND AND STUDY AIMS

A newly developed narrow-band imaging (NBI) technique, in which modified optical filters were used in the light source of a video endoscope system, was applied during colonoscopy in a clinical setting. This pilot study evaluated the clinical feasibility of the NBI system for evaluating colorectal lesions.

PATIENTS AND METHODS

A total of 43 colorectal lesions in 34 patients were included in the study. The quality of visualization of colorectal lesions and the accuracy of differentiation between neoplastic and non-neoplastic lesions using the NBI system were evaluated in comparison with results from conventional colonoscopy and with chromoendoscopy.

RESULTS

For pit pattern delineation, NBI was superior to conventional endoscopy (P < 0.001), but inferior to chromoendoscopy (P < 0.05). NBI achieved better visualization of the mucosal vascular network and of the hue of lesions than conventional endoscopy (P < 0.05). However there was no significant difference between NBI and chromoendoscopy in differentiating neoplastic from non-neoplastic lesions (both techniques had a sensitivity of 100 % and a specificity 75 %). This was better than the results of conventional colonoscopy (sensitivity 83 %, specificity 44 %; P < 0.05 for specificity).

CONCLUSIONS

These results suggest that in the examination of colonic lesions the NBI system provides imaging features additional to those of both conventional endoscopy and chromoendoscopy. For distinguishing neoplasms from non-neoplastic lesions, NBI was equivalent to chromoendoscopy.

Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygen-ozone (O2-O3) injection

MATERIAL

We report our experience between May 1996 and May 2003 with 2200 patients affected by low back pain or sciatica due to herniated disk treated by intradiscal and intraforaminal oxygen-ozone injection. The patients received medical and physical therapy before treatment for at least 2 months; the patients with conus-cauda syndrome and hyperalgesic sciatica were excluded. We never performed discography before the treatment that was performed under CT guidance or fluoroscopy. CT provided monitoring of gas distribution in the disk and epidural space.

RESULTS

No side effects were recorded at short and long-term follow-up. Clinical results were evaluated with the modified McNab method showing an 80% success rate and 20% failure rate in 1750 patients followed up to 6 months while the success rate dropped down at 75% and failure increased at 25% in 1400 followed up to 18 months. CT showed reduction in the size of the herniated disk in only 63% of the followed patients (420 patients). The failure has been mostly related to: calcified herniated disk; spinal canal stenosis; recurrent herniated disk with epidural fibrosis; small descending herniated disk at the level of the lateral recess.

Enhanced electron-capture decay rate of 7Be encapsulated in C60 cages

The decay rate of 7Be electron capture was measured in C60 and Be metal with a reference method. The half-life of 7Be endohedral C60 ((7)Be@C(60)) and 7Be in Be metal (Be metal (7Be)) is found to be 52.68+/-0.05 and 53.12+/-0.05 days, respectively. This amounts to a 0.83% difference in electron-capture decay half-life between (7)Be@C(60) and Be metal (7Be). Our result is a reflection of the different electron wave functions for (7)Be@C(60) inside C60 compared to the situation when 7Be is in a Be metal.

Clinical and mycological study of occult tinea pedis and tinea unguium in dermatological patients from Tokyo

An epidemiological investigation was conducted to determine the prevalence and circumstances of untreated, unsuspected tinea pedis and tinea unguium, morbid conditions that could be termed occult athlete's foot, in patients visiting a dermatology clinic in Tokyo, Japan, for the first time, for other complaints. All subjects completed a questionnaire covering comprehensive anamnestic details, and were examined for disposition of toes, presence of signs suggestive of tinea pedis, other diseases of the foot, score of clinical signs and symptoms, potassium hydroxide (KOH) test, severity score, and mycological culture. The results showed that the prevalence of occult athlete's foot was 25%, and that 59% of those cases were complicated by tinea unguium. The characteristics of patients with occult athlete's foot included a higher proportion of men and a tendency toward a low clinical score together with a high severity score. In the patient background, a strong correlation was observed between a positive KOH test result and characteristics such as age, disposition of toes, and predisposing disease.

Sequential methotrexate and 5-fluorouracil therapy for gastric cancer patients with peritoneal dissemination: a retrospective study

BACKGROUND

Most gastric cancer patients with peritoneal dissemination have been excluded from clinical studies because they usually have no measurable lesions. They also have a high risk of toxicity because of complications such as intestinal obstruction and ascites. We conducted a retrospective analysis to evaluate the efficacy and feasibility of sequential methotrexate (MTX) and 5-flurorouracil (5FU) therapy for this population.

METHODS

This analysis was based on 56 consecutive chemotherapy-naive patients with confirmed peritoneal dissemination of gastric cancer who were being treated with sequential MTX/5FU. The therapy comprised a weekly schedule of MTX 100 mg/m2, given as a bolus infusion 3 h prior to a bolus infusion of 5FU 600 mg/m2. Leucovorin 10mg/m2 was administered six times, every 6h, starting 24h after MTX administration.

RESULTS

Evidence of peritoneal dissemination was confirmed by laparotomy in 16 patients, by cytologic examination of ascites in 11 patients, and by clinical imaging in 29 patients (15 with ascites, 13 with intestinal obstruction; in 10 of the 29 patients, detection was by barium enema or computed tomography [CT] scan). Neutropenia of grade 3 or worse and anemia were observed in 8 (14%) and 10 (18%) of the 56 patients, respectively. There was one treatment-related death due to neutropenic sepsis. Of the 26 patients with measurable lesions, 9 showed a response (36%). The median survival time and median time to treatment failure were 259 days and 167 days, respectively. Objective improvement of ascites was seen in 13 of 26 patients (50%), including 5 with showed complete disappearance of ascites. Seven of the 15 patients (47%) with intestinal obstruction showed resolution, and 8 of the 21 patients (38%) who needed nutritional support before the treatment were free of that support for a median duration of 220 days after the completion of the treatment. Forty-seven of the 56 patients (84%) could be treated at outpatient clinics.

CONCLUSIONS

This regimen may be of clinical benefit for patients with peritoneal dissemination of gastric cancer.

Combination chemotherapy of irinotecan plus cisplatin for advanced gastric cancer: efficacy and feasibility in clinical practice

BACKGROUND

A previous phase II study showed that a combination of irinotecan (CPT-11) with cisplatin (CDDP) was effective for advanced gastric cancers, but was associated with substantial neutropenia and diarrhea. The aim of this retrospective study was to evaluate the efficacy and feasibility of the combination in clinical practice.

METHODS

The subjects comprised 65 patients with advanced gastric cancer treated with CPT-11 (70mg/m2, day 1, day 15) and CDDP (80mg/m2, day 1) as first-line chemotherapy between April 1993 and March 1999. Patient backgrounds, response rates, response durations, times to progression, and survival rates were investigated retrospectively.

RESULTS

The overall response rate and the response rates for measurable metastatic lesions and primary sites were 43% (28/65), 48% (31/64), and 24% (10/42). Leucopenia of grade 4 and diarrhea of grade 3 or 4 were observed in 6 (9%) and 5 (8%) patients, respectively. Among the 19 patients with peritoneal metastasis, leucopenia of grade 4 and diarrhea of grade 3 or 4 were observed in only 1 of the 18 patients who received sufficient oral intake (6%). There were no treatment-related or early deaths within 30 days from the last treatment day. The median survival times of all patients, patients with an intestinal type of adenocarcinoma, and patients with a diffuse type were 365, 472, and 291 days, respectively. Multivariate analysis showed that the histological type of cancer was a significant independent prognostic factor (P = 0.0169).

CONCLUSION

This retrospective study confirmed the efficacy and feasibility of this combination therapy in clinical practice.

Successful treatment of non-segmental vitiligo: systemic therapy with sex hormone-thyroid powder mixture

We previously reported a patient with generalized vitiligo improved by oral administration of the drug for menopausal syndrome (sex hormone-thyroid powder mixture). In this study, we reevaluated the efficiency of this drug for vitiligo, and examined its pharmacological action in melanogenesis.

A semi-immobilization of a partial auricle induces hypertrophy and ultrastructural alteration of cardiomyocytes

Semi-immobilization of a partial area of the ventral edge, lateral epicardium of the left auricle (ventrolateral of left auricle), by using quick adhesion glue induces moderate hypertrophy of myocytes with an average increase of 34% in cross-sectional area. Intercellular connective tissues increased, and cellular sizes varied markedly. The ultrastructure of immobilized (semi-immobilized) myocytes commonly exhibited degenerating features in myofibrils, various cytoplasmic organelles including mitochondrial cristae and sarcoplasmic reticulum (SR) were disrupted, and T-tubules disappeared. Z-line streaming and widening (hypertrophic Z-line, rod bodies) and increase of metabolic particle deposition are typical phenomena in addition to intercalated disc (Id) disorganization. The results suggest that semi-immobilization of the auricle induces hypertrophy of myocytes in association with degeneration and disruption of myofibrils and other cytoplasmic organelles, and an increase of intercellular connective tissues, rather than increase of myofibril mass. This is the first study to immobilize only a part of the heart rather than the whole animal. Our results using artificial immobilization of cardiac myocytes were extremely significant since the structural alterations obtained were similar to that observed in cardiomyopathies. This suggests that myocytes progressing to heart failure are also subjected to inhibition of movement. Therefore, this experiment may prove very useful as a model for studying the functional effect of heart failure observed in cardiomyopathy.

Loricrin keratoderma: a cause of congenital ichthyosiform erythroderma and collodion baby

A group of hereditary palmoplantar keratodermas due to heterozygous mutation in the loricrin gene has recently been identified. Of five reported pedigrees, four presented as mutilating keratoderma with ichthyosis (variant Vohwinkel syndrome), and one as progressive symmetric erythrokeratoderma. We report a new Japanese pedigree of loricrin keratoderma. A 14-year-old male and his 11-year-old female sibling had both been born as collodion babies and were initially diagnosed as having non-bullous congenital ichthyosiform erythroderma, but later developed palmoplantar keratoderma with pseudoainhum. Their father was similarly affected. Direct sequencing of genomic DNA revealed a G residue insertion at codon 230-231 of the loricrin gene. Antibody studies confirmed the presence of mutant loricrin in the retained nuclei. We conclude that loricrin gene mutation may present as congenital ichthyosiform erythroderma, and should be included in the differential diagnosis of collodion baby.

Routine endoscopy using electronic endoscopes for gastric cancer diagnosis: retrospective study of inconsistencies between endoscopic and biopsy diagnoses

To clarify the actual conditions and problems encountered in the diagnosis of gastric cancer during routine endoscopic examinations using electronic endoscopes, a retrospective study of cases that had shown inconsistencies between the endoscopic and biopsy diagnoses was conducted. The subjects were 5,640 patients who had undergone gastric biopsies. They were selected from among 18,248 patients in whom upper gastrointestinal endoscopy had been performed between July 1992 and July 1997 at the National Cancer Center Hospital East. The study was conducted focusing on macroscopic type, size, location, and pathologic findings of the lesions. Cases showing inconsistencies between the endoscopic and biopsy diagnoses comprised 2.7% of all biopsy cases (150 of 5,640). Most of these inconsistently diagnosed lesions were less than 20 mm in diameter. The frequency of inaccurate diagnosis for depressed lesions in the areas of upper and middle thirds of the stomach from the lesser curvature to the posterior wall was significantly higher in the inconsistent group, compared with the accurate diagnoses from the control group. In diagnostic reviews of depressed lesions, 46.0% (46 of 100) were diagnosed accurately, but cases with fewer malignant indices were recognized. These results indicate that diagnostic accuracy must be enhanced through objective biopsy-implementation standards and the use of image processing in using diagnostic methods that employ electronic endoscopes.