Arsenic trioxide inhibits DNA methyltransferase and restores methylation-silenced genes in human liver cancer cells

In the present study, we investigated methylation status of the CpG islands of some major tumor suppressor genes both in human hepatocellular carcinoma and liver cancer cell lines and examined whether demethylation by arsenic trioxide (As2O3) could restore their expression in the cell lines. HepG2 and Huh-7 cells were treated with 2 to 10 micromol/L of AS2O3 and/or 1 micromol/L of 5-aza-2'-deoxycytidine for 24, 48, and 72 hours. The methylation status of the CpG island around the promoter regions of p161NK4a, RASSF1A, E cadherin, and GSTP1 was detected by a methylation-specific polymerase chain reaction (MSP). The messenger RNA (mRNA) and protein levels of these genes were determined by quantitative real-time reverse transcriptase-polymerase chain reaction, Western blot, and immunohistochemical analyses. The DNA methyltransferase (DNMT) mRNA levels and enzyme activity were also examined. The hypermethylated status of the promoter regions of p16INK4a, RASSF1A, E cadherin, and GSTP1 was observed in 10 (40%), 14 (56%), 6 (24%), and 12 (48%) of 25 patients with hepatocellular carcinoma, respectively. CpG methylation of the p16INK4a, RASSF1A, E cadherin, and GSTP1 genes was correlated to the reduction of mRNA levels in the cell lines, and mRNA expression of these 4 genes were indeed restored by low concentrations (2-6 micromol/L) of As2O3 through demethylation, as well as 1 micromol/L of 5-aza-2'-deoxycytidine. Western blot and immunohistochemical analyses confirmed that each protein was markedly enhanced after treatment with a low concentration of As2O3. In contrast, As2O3 at a high concentration (10 micromol/L) damaged cell membranes and remarkably suppressed these 4 protein levels. As2O3 decreased the mRNA expression of DNMT 1 and also dose-dependently inhibited DNMT activity. In conclusion, a low concentration of As2O3 induces CpG island demethylation of tumor suppressor genes by inhibition of DNMT and reactivates the partially/fully silenced genes in liver cancer cells.

Video-assisted living donor hemihepatectomy through a 12-cm incision for adult-to-adult liver transplantation

OBJECTIVES

There has been remarkable progress in recent technical innovations for laparoscopic hepatectomy. However, a laparoscopic procedure rarely has been indicated for donation of the liver in living-related liver transplantation (LRLT). Here, we described the technique and the outcome of video-assisted donor hepatectomy (VADH) for adult-to-adult LRLT.

METHODS

For 13 donors in adult-to-adult LRLT, 3 types of major hepatectomy--right hemihepatectomy (3), and left hemihepatectomy, with or without the caudate lobe (10)--were performed through video-assisted procedures; surgical manipulation via ports or via a 12-cm incision and viewing through a laparoscope or through incision were combined and used.

RESULTS

VADH was completed in 13 donors, with a median operation time of 363 +/- 33 minutes and a median blood loss of 302 +/- 191 mL. No complications specific to video-assisted procedures, postoperative bile leak, or bleeding were observed. The restoration of the liver function was smooth, and the use of an analgesic (median: 1.2 times) was reduced, compared with the historical control (median: 3.8 times) that underwent a standard donation of the liver. Currently, all donors are healthy and have returned to their previous activities. The grafts have been functioning well, excluding 3 recipients who succumbed to serious complications unrelated to the video-assisted procedure.

CONCLUSION

We have shown a new method of VADH through a 12-cm laparotomy for adult-to-adult LRLT. This technique is as feasible as standard open donor hepatectomy, with less pain and with improved postoperative symptoms.

An inguinal hernia sac tumor of extrahepatic cholangiocarcinoma origin

Background

Metastatic hernia sac tumor from biliary malignancy is extremely rare with only one such case previously reported. We herein report an additional case of extrahepatic cholangiocarcinoma presenting as a hernia sac tumor.

Case presentation

A 78-year-old man presented with an irreducible right inguinal hernia associated with a firm tumor, 2.0 cm in diameter. A computed tomography scan demonstrated a soft tissue density mass with heterogeneous enhancement within the right inguinal canal. The patient underwent a hernia repair and the hernia sac tumor was resected. Histological examination of the tumor revealed a metastatic adenocarcinoma suggesting the tumor was of pancreato-biliary origin. Further investigation using imaging studies disclosed a primary tumor in the upper bile duct. The patient died of the disease nine months after the resection.

Conclusion

Hernia sac tumors should be considered when an irreducible, growing mass appears within an inguinal hernia. Computed tomography may be useful for the early detection of hernia sac tumors from undiagnosed intra-abdominal malignancies.

Effects of protein kinase inhibitors on thein vitrogrowth ofBabesia bovis

Staurosporine, Ro-31-7549, and KN-93, which are inhibitors of serine/threonine protein kinase, protein kinase C, and calcium-modulin kinase, respectively, were tested for their effects on thein vitrogrowth ofBabesia bovis. Staurosporine was the most effective inhibitor, completely clearing the parasitaemia as early as the first day of exposure at a concentration of 100 μM. Moreover, staurosporine caused a significant increase in the percentage of extracellular merozoites, most likely due to the inhibition of erythrocyte invasion by the parasite. Although 5 mMRo-31-7549 and KN-93 had a suppressive action, this was not enough to destroy the parasite. Interestingly, concentrations of 0·5 to 5 mMKN-93 influenced the parasitic development within the infected erythrocytes. The present study suggests thatB. bovisrequires, to a certain extent, the phosphorylations mediated by parasite- or host erythrocyte-protein kinases, in particular, for the processes of successful invasion of erythrocytes and intraerythrocytic development.

Long-term outcomes of hepatectomy vs percutaneous ablation for treatment of hepatocellular carcinoma ≤ 4 cm

AIM: To determine which treatment modality - hepatectomy or percutaneous ablation - is more beneficial for patients with small hepatocellular carcinoma (HCC) (≤ 4 cm) in terms of long-term outcomes.

METHODS: A retrospective analysis of 149 patients with HCC ≤ 4 cm was conducted. Eighty-five patients underwent partial hepatectomy (anatomic in 47 and non-anatomic in 38) and 64 underwent percutaneous ablation (percutaneous ethanol injection in 37, radiofrequency ablation in 21, and microwave coagulation in 6). The median follow-up period was 69 mo.

RESULTS: Hepatectomy was associated with larger tumor size (P < 0.001), whereas percutaneous ablation was significantly associated with impaired hepatic functional reserve. Local recurrence was less frequent following hepatectomy (P < 0.0001). Survival was better following hepatectomy (median survival time: 122 mo) than following percutaneous ablation (median survival time: 66 mo; P = 0.0123). When tumor size was divided into ≤ 2 cm vs > 2 cm, the favorable effects of hepatectomy on long-term survival was seen only in patients with tumors >2 cm (P = 0.0001). The Cox proportional hazards regression model revealed that hepatectomy (P = 0.006) and tumors ≤ 2 cm (P = 0.017) were independently associated with better survival.

CONCLUSION: Hepatectomy provides both better local control and better long-term survival for patients with HCC ≤ 4 cm compared with percutaneous ablation. Of the patients with HCC ≤ 4 cm, those with tumors > 2 cm are good candidates for hepatectomy, provided that the hepatic functional reserve of the patient permits resection.

Impact of 16-slice computed tomography in percutaneous coronary intervention of chronic total occlusions

The main reason for failure of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is because the calcified plaque prevents the guide wire crossing the occlusion. We aimed to identify the route, and characterize plaque components within CTO, using 16-slice computed tomography (MSCT). Twenty three angiographic CTO in 22 patients (mean age 69 +/- 5 years, 17 males) were included. All patients had undergone MSCT prior to PCI. Images were analyzed for lesion visibility and plaque characteristics of CTO. The presence and location of calcified plaque within the CTO were systematically assessed. Each lesion was classified as a noncalcified, moderately calcified, or exclusively calcified plaque. Procedural failure was defined as the inability to cross a guide wire through the occlusion. All coronary routes of CTO segment were visualized. MSCT revealed three markedly bent CTO segments (13.0%), which could not be identified by coronary angiography only. Calcified plaques were detected in 30 lesions of 19 CTO segments (82.6%), but were not detected in the other four. The majority of calcified plaque was located in the proximal lesion, or both proximal and distal lesions. Fifteen out of 30 calcified lesions (50.0%) were exclusively calcified plaques. Overall procedural success was obtained in 21 CTOs (91.3%). MSCT can accurately identify the route of the CTO segment and evaluate both distribution and amount of the calcified plaque within it. Even with the complicated and/or calcified lesions, PCI success rate was excellent under MSCT guidance. MSCT should become a useful tool in PCI of CTO.

Accuracy and Efficiency of Left Ventricular Ejection Fraction Analysis, Using Multidetector Row Computed Tomography Effect of Image Reconstruction Window Within Cardiac Phase, Slice Thickness, and Interval of Short-Axis Sections

BACKGROUND

The aim of the present study was to assess the accuracy and efficiency of left ventricular ejection fraction (LVEF) analysis by multidetector row computed tomography (CT).

METHODS AND RESULTS

The CT data of 21 patients were analyzed by semi-automated software on a workstation. In analysis of LVEF using systolic volumes in the 6 phases (30-55%), systolic images of 10% interval (35, 45, 55%) were underestimated with a mean measurement error of -0.4% and the standard error of the estimate (SEE) of 0.6%, compared with the LVEF using images of 5% interval. In analysis of LVEF using 3-slice thicknesses of axial images (1, 2, and 3 mm), and 3-slice numbers of short-axis sections (10 14, and 30 slices), there was no significant difference between the SEE of the intraobserver reproducibility and that of the analysis with 30 short-axis sections using axial images of 1-, 2- and 3-mm thickness, and that with 14 short-axis sections using axial images of 1- and 2-mm thickness. The mean analysis times were 96.9 s, 119.8 s, and 227.0 s for the analysis with 10, 14, and 30 short-axis sections, respectively.

CONCLUSION

The proper selection of the reconstruction interval in the cardiac phase, the slice thickness of the axial images, and the number of short-axis sections reduces the analysis time, maintaining the accuracy of LVEF analysis. This will be acceptable for practical use at present, although more accurate analysis is preferable.

Radiation Exposure to Patient's Skin During Percutaneous Coronary Intervention for Various Lesions, Including Chronic Total Occlusion

BACKGROUND

Radiation skin injuries have been reported as a result of various procedures, so in the present study the patients' entrance skin dose (ESD) during percutaneous coronary intervention (PCI) was evaluated.

METHODS AND RESULTS

ESDs were assessed during 97 procedures (13 for chronic total occlusion (CTO), 14 for multivessel stenoses, 22 for single-vessel multiple stenoses, and 48 for single stenosis). The patients wore jackets that had 48 or 52 radiosensitive indicators placed on the back during the PCI procedures, with 8 other indicators placed on both upper arms. After the procedure, the color of the indicators was analyzed with a color measuring instrument, and the patients' ESDs were calculated from the color difference of the indicators. The average maximum ESDs of the patients were 4.5 +/- 2.8 Gy (median: 4.6 Gy) for CTO, 2.3 +/- 0.7 Gy (median: 2.4 Gy) for multivessel stenoses, 1.8 +/- 1.0 Gy (median: 1.5 Gy) for single-vessel multiple stenoses, and 1.4 +/- 0.9 Gy (median: 1.2 Gy) for single stenosis.

CONCLUSIONS

Skin injury can occur during PCI, especially for CTO, so it is important to estimate each patient's ESD and attempt to reduce it.

Evaluation of coronary stents in vitro with CT angiography: effect of stent diameter, convolution kernel, and vessel orientation to the z-axis

BACKGROUND

The aims of the present study were to assess the effect of the stent diameter, convolution kernel, and vessel orientation to the z-axis on the evaluation of coronary stents, in vitro with computed tomography (CT) angiography.

METHODS AND RESULTS

Seven vascular models (2 models without stenosis, 2 with obstruction, and 3 with stenosis) with an approximate inner diameter of 3 or 4 mm, filled with contrast material (79 or 330 HU) were scanned with a 16-detector CT. The diameter measurement of the stent lumen and stenosis evaluation were both done in an orientation parallel to the z-axis of the scanner using 4 convolution kernels. The measured diameters of the stented lumen were 47-57% and 36-45% smaller than the actual inner diameter of the 3- and 4-mm diameter models, respectively. The diameter measurement of the stent lumen and visualization of the in-stent stenosis were improved by using convolution kernels with higher spatial resolution. The in-stent artifacts were evaluated in 4 orientations (0 degrees , 30 degrees , 60 degrees , 90 degrees ) to the z-axis. The artifact was the minimum in 0 degrees to the z-axis, and the maximum in 90 degrees .

CONCLUSION

Visualization of the lumen of a stent by CT is affected by its diameter, convolution kernel, and vessel orientation to the z-axis, and these factors should be taken into consideration in the stent evaluation.

Few-electron molecular states and their transitions in a single InAs quantum dot molecule

We study electronic configurations in a single pair of vertically coupled self-assembled InAs quantum dots, holding just a few electrons. By comparing the experimental data of nonlinear single-electron transport spectra in a magnetic field with many-body calculations, we identify the spin and orbital configurations to confirm the formation of molecular states by filling both the quantum mechanically coupled symmetric and antisymmetric states. Filling of the antisymmetric states is less favored with increasing magnetic field, and this leads to various magnetic field induced transitions in the molecular states.

Narrow portion of the terminal choledochus is a cause of upstream biliary dilatation in patients with anomalous union of the pancreatic and biliary ducts

AIM

To clarify the pathogenesis of biliary dilatation associated with anomalous union of the pancreatic and biliary ducts (AUPBD).

METHODS

Direct cholangiopancreatograms of 350 adult patients with or with suspicion of hepatobiliary or pancreatic disorders were reviewed. AUPBD was diagnosed cholangiopancreatographically, when the pancreaticobiliary ductal union was located above the narrow distal segment of the bile duct, which represents the action of the sphincter of Oddi. The narrow portion of the terminal choledochus was defined as symmetrical stricture of the common bile duct just above the pancreaticobiliary ductal union.

RESULTS

AUPBD was found in 36 patients. Among cholangiopancreatographic features, the narrow portion of the terminal choledochus was the most pathognomonic for AUPBD (accuracy, 98%); it was present in 29 (81%) patients with AUPBD, but was not found in any patients without AUPBD. Among patients with AUPBD, biliary dilatation (>10 mm) was more frequent in those with the narrow portion of the terminal choledochus (23/29) than in those without (2/7; P=0.018) AUPBD. Among the patients with both AUPBD and the narrow portion of the terminal choledochus, there was a strong negative correlation between the minimum diameter of the narrow portion and the maximum diameter of the choledochus (r=-0.78, P<0.001), suggesting that the degree of biliary narrowing at the narrow portion correlates with that of upstream biliary dilatation.

CONCLUSION

The narrow portion of the terminal choledochus, a pathognomonic radiologic feature of AUPBD, may be a cause of biliary dilatation in patients with AUPBD.

Increased risk of cholelithiasis after esophagectomy

BACKGROUND/PURPOSE

Truncal vagotomy enhances gallstone formation. As esophagectomy involves truncal vagotomy, it was hypothesized that esophagectomy would increase the risk of cholelithiasis. This study was intended to test this hypothesis and to elucidate factors influencing the incidence of cholelithiasis after esophagectomy.

METHODS

The study was a retrospective analysis of 136 patients with esophageal carcinoma who had survived for 5 years or longer after esophagectomy. Eight patients (5.9%) had cholelithiasis before esophagectomy. Of the remaining 128 patients, 113 underwent abdominal ultrasonographic examination for cholelithiasis twice a year after esophagectomy; the median follow-up time was 89.5 months (range, 60-117 months).

RESULTS

Gallstones developed in 26 (23%) of the 113 patients undergoing regular ultrasonographic examination. The cumulative incidence of cholelithiasis reached a plateau of 34% at 10 years after esophagectomy. Reduction of body mass index after esophagectomy was the strongest independent predictor of gallstone formation after esophagectomy ( P = 0.0001, log-rank test; P = 0.0003, Cox's proportional hazards model). The prevalence of cholelithiasis at 5 years after esophagectomy (18/113; 16%) was significantly higher than that before esophagectomy (8/136; 5.9%; P = 0.012, Fisher's exact test).

CONCLUSIONS

Esophagectomy yields an increased risk of the development of cholelithiasis. Truncal vagotomy and postsurgical malnutrition may contribute to this increased gallstone formation after esophagectomy.

Low preoperative platelet counts predict a high mortality after partial hepatectomy in patients with hepatocellular carcinoma

AIM: To assess the validity of our selection criteria for hepatectomy procedures based on indocyanine green disappearance rate (KICG), and to unveil the factors affecting posthepatectomy mortality in patients with hepatocellular carcinoma (HCC).

METHODS: A retrospective analysis of 198 consecutive patients with HCC who underwent partial hepatectomies in the past 14 years was conducted. The selection criteria for hepatectomy procedures during the study period were KICG ≥ 0.12 for hemihepatectomy, KICG ≥ 0.10 for bisegm-entectomy, KICG ≥ 0.08 for monosegmentectomy, and KICG ≥ 0.06 for nonanatomic hepatectomy. The hepatectomies were categorized into three types: major hepatectomy (hemihepatectomy or a more extensive procedure), bisegmentectomy, and limited hepatectomy. Univariate (Fisher’s exact test) and multivariate (the logistic regression model) analyses were used.

RESULTS: Postoperative mortality was 5% after major hepatectomy, 3% after bisegmentectomy, and 3% after limited hepatectomy. The three percentages were comparable (P = 0.876). The platelet count of ≤ 10104/mL was the strongest independent factor for postoperative mortality on univariate (P = 0.001) and multivariate (risk ratio, 12.5; P = 0.029) analyses. No patient with a platelet count of >7.3104/mL died of postoperative morbidity, whereas 25% (6/24 patients) of patients with a platelet count of ≤ 7.3104/mL died (P<0.001).

CONCLUSION: The selection criteria for hepatectomy procedures based on KICG are generally considered valid, because of the acceptable morbidity and mortality with these criteria. The preoperative platelet count independently affects morbidity and mortality after hepatectomy, suggesting that a combination of KICG and platelet count would further reduce postoperative mortality.

Clinical significance of Ki-67 proliferation index in disease progression and prognosis of patients with resected colorectal carcinoma

BACKGROUND

The prognostic role of proliferation markers in patients with colorectal neoplasia is inconclusive. The aim of this study was to evaluate proliferation markers in patients with colorectal carcinoma, to relate these to standard clinicopathological findings and to investigate their potential role in the prediction of long-term survival.

METHODS

Archived formalin-fixed, paraffin-embedded tissue samples from a cohort of 106 patients who underwent curative resection for colorectal carcinoma were analysed to determine a Ki-67 (MIB-1)-derived proliferation index (PI) using a double immunostaining technique. The relationship between PI and standard clinicopathological variables was assessed and its association with long-term survival evaluated.

RESULTS

A significant association was found between PI and tumour (T) status (P = 0.001), lymph node (N) involvement (P = 0.0098), the presence of distant metastases (P < 0.010) and advanced stage of disease (P < 0.001). On multivariate analysis, PI was shown to be an independent prognostic factor for long-term survival (hazard ratio 2.1 (95 per cent confidence interval 1.1 to 4.1); P = 0.032).

CONCLUSION

Cell proliferation is significantly associated with tumour progression and may be used to identify patients with a predicted adverse outcome after resection of colorectal carcinoma.

Jaundice at presentation heralds advanced disease and poor prognosis in patients with ampullary carcinoma

Jaundice is a common manifestation of ampullary carcinoma. The aim of this study was to evaluate the correlation between jaundice at initial presentation and the degree of tumor spread and to determine the prognostic significance of jaundice in patients with ampullary carcinoma. Fifty-nine patients who had undergone curative resection for ampullary carcinoma were analyzed retrospectively. Jaundice was defined as a total bilirubin serum concentration of > or = 3 mg/dl. The median follow-up time was 106 months. Jaundice was noted at the time of initial presentation in 43 (73%) patients. Jaundice at presentation correlated with lymph node metastasis (p < 0.0001), lymphatic vessel invasion (p < 0.0001), invasion into the pancreas (p = 0.0007), and vascular invasion (p = 0.0487). Pancreatic invasion was absent in patients without jaundice. Superior mesenteric nodal involvement was more frequent in patients with jaundice (15/43) than in those without (0/16) (p = 0.0062). The survival of patients with jaundice (median survival 48 months; cumulative 10-year survival rate 39%) was worse than for patients without jaundice (median survival time not available; cumulative 10-year survival rate 86%) (p = 0.0014). In conclusion, jaundice at presentation predicts advanced-stage ampullary carcinoma and a poor prognosis. Pancreatic invasion and superior mesenteric nodal involvement were not observed in nonjaundiced patients.

[Cardiac rupture caused by myocardial infarction in the diagonal branch area: evaluation by cardiac multislice computed tomography: a case report]

A 75-year-old woman was admitted to the emergency room because of hypotension and loss of consciousness induced by cardiac tamponade. Electrocardiography revealed ST elevation and laboratory data showed elevation of serum creatine kinase and troponin I. The patient was referred to the cardiology department 5 days later. Cardiac catheterization revealed ventricular aneurysm in the anterior wall, significant stenosis (75%) in the left anterior descending coronary artery and subtotal stenosis (99%) in the diagonal branch. Cardiac multislice computed tomography suggested that the ventricular pseudoaneurysm was probably due to cardiac rupture caused by myocardial infarction in the diagonal area. Subsequently, aneurysmectomy and coronary artery bypass graft surgery were performed. Cardiac multislice computed tomography is useful for evaluating coronary artery and cardiac rupture.

[Pharmacokinetic modulating chemotherapy highly effective for colorectal carcinoma metastases to multiple organs]

AIMS

Pharmacokinetic modulating chemotherapy (PMC) is designed to boost high serum 5-fluorouracil (5-FU) concentrations through modulation by uracil. The therapeutic efficacy of PMC and the sensitivity of metastatic lesions to 5-FU were evaluated in advanced colorectal cancer patients.

METHODOLOGY

Thirteen patients with colorectal carcinoma metastases to multiple organs were enrolled. PMC was initiated with a combination of 400 mg of uracil-tegafur daily and 24-hour continuous intravenous infusion of 600 mg/m2 of 5-FU once weekly. The 5-FU dose was escalated when the disease progressed. When PR was achieved, serum 5-FU concentrations were monitored in order to evaluate the chemosensitivity of each metastatic lesion to 5-FU.

RESULTS

PR in the target lesion was observed in 7 of 11, 6 of 10, 2 of 2, and 2 of 4 patients with metastatic lesions to the liver, lungs, peritoneum and lymph nodes, respectively. The area under the concentration-time curve (AUC ng x hr/ml) of the 5-FU sufficient to induce PR in pulmonary lesions, 3528 to 9684, was significantly higher than for hepatic lesions, 2413 to 6323 (p = 0.028). The median survival was 13 months.

CONCLUSIONS

PMC, having a chronomodulating nature, is highly effective in treating colorectal carcinoma metastases with a superior safety profile. Pulmonary metastases are more resistant to 5-FU than hepatic metastases, as they require a higher 5-FU AUC to respond.

Host serum modifies the drug susceptibility of Babesia bovis in vitro

Babesia parasites generally require a defined percentage of serum in the culture medium for their in vitro growth. In this study, we attempted to culture Babesia bovis in a serum-free condition. The growth pattern and morphology of B. bovis in serum-free (plain) GIT medium were unaltered as compared to those of the standard growth condition containing 40% bovine serum in M199. When exposed to the test drugs, the parasite in plain GIT medium showed clearly lower IC50 values than those in 40% serum-containing G IT medium, indicating that several serum components may interfere with the drug bio-availability. Therefore, the serum-free culture system is useful for standardizing drug test protocols and understanding the roles of serum factors in the drug test.

Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma

BACKGROUND

The current study was performed to clarify whether the presence of residual carcinoma in situ at ductal resection margins differs prognostically from residual invasive ductal lesions in patients undergoing surgical resection for extrahepatic cholangiocarcinoma.

METHODS

A retrospective analysis of 84 patients with extrahepatic cholangiocarcinoma who underwent surgical resection was conducted. The ductal resection margin status was classified as negative (n = 64 patients), positive with carcinoma in situ (n = 11 patients), or positive with invasive carcinoma (n = 9 patients). The median follow-up period was 105 months.

RESULTS

Ductal margin status was found to be a strong independent prognostic factor by both univariate (P = 0.0002) and multivariate (P = 0.0039) analyses. The outcome after surgical resection was comparable between patients with negative ductal margins (median survival time of 45 months; cumulative 10-year survival rate of 40%) and those with positive ductal margins with carcinoma in situ (median survival time of 99 months; cumulative 10-year survival rate of 23%; P = 0.4742). In patients with positive ductal margins, the outcome was found to be significantly better in patients with residual carcinoma in situ than in those with residual invasive carcinoma (median survival time of 21 months; cumulative 5-year survival rate of 0%; P = 0.0003). Of 11 patients with residual carcinoma in situ, 4 died of tumor recurrence and the initial site of the disease recurrence was local. All 9 patients with residual invasive carcinoma died of disease recurrence (local recurrence with or without distant metastases) within 40 months after surgical resection.

CONCLUSIONS

After surgical resection for extrahepatic cholangiocarcinoma, invasive carcinoma at ductal resection margins appears to have a strong adverse effect on patient survival, whereas residual carcinoma in situ does not.

Observation of the effects of radially sheared electric fields on the suppression of turbulent vortex structures and the associated transverse loss in GAMMA 10

Vortexlike turbulent structures in hot-ion mode plasmas with several keV are observed in the case with a radially produced weak shear of electric fields E(r). However, a strong E(r) shear formation due to a high ion-confining potential phi(c) production clears up these vortices together with plasma-confinement improvement and disappearance of both drift-wave and turbulencelike Fourier spectral signals. These findings are based on three-time progress in phi(c) in comparison to phi(c) attained 1992-2002. The significant advance of phi(c) is well extended in line with proposed potential-formation physics scalings.

[Pharmacokinetic modulating chemotherapy for rectal carcinoma metastases to the liver and lung--a case report]

Pharmacokinetic modulating chemotherapy (PMC) is a new therapeutic regimen for advanced colorectal carcinoma, in which high serum 5-FU concentrations are attained through the inhibition of 5-FU degradation by simultaneously administered uracil. A 67-year-old woman, presented with unresectable multiple hepatic and pulmonary metastases following abdominoperineal resection of rectal carcinoma, was successfully treated by the PMC. The patient was initially treated by 600 mg/m2/day of 5-FU infusion, once a week, and subsequently 5-FU doses were increased to 750 mg/m2/day and then to 1,200 mg/m2/day. Hepatic metastases responded at the dose of 750 mg/m2/day and pulmonary metastases responded at the dose of 1,200 mg/m2/day. The patient remains partial response (>21 months). 5-FU serum concentrations were higher at night time and the peak concentration of 5-FU was obtained at 3 a.m. 5-FU Cmax of 600 mg/m2/day, 750 mg/m2/day and 1,200 mg/m2/day were 254, 329, 531 ng/ml, respectively. The experience of this case, together with literature review, suggests that pulmonary metastases are more resistant to 5-FU than hepatic metastases in patients with colorectal carcinoma. The high serum 5-FU concentrations at night suggest the chronomodulating nature of PMC and are effective for metastatic colorectal carcinoma.

Left ventricular myocardial mass determination by contrast enhanced colour Doppler compared with magnetic resonance imaging

OBJECTIVE

To assess the feasibility of using contrast enhanced colour Doppler echocardiography to determine left ventricular (LV) mass and to compare its accuracy with LV mass obtained by magnetic resonance imaging (MRI).

METHODS

Images were acquired in the short axis plane of the heart, derived from coronal and sagittal scout views and double oblique angulation. The LV mass was calculated by two methods: Simpson's rule and the area-length method. Levovist (Schering AG, Berlin, Germany) 2.5 g was given by slow intravenous bolus or infusion over about 45 seconds for contrast imaging. LV images were captured in the apical two chamber, four chamber, and three chamber views. Each contrast harmonic colour Doppler image was converted to a cavity-only image by simple image mathematics.

RESULTS

27 (77.1%) of the patients (mean (SD) age 66.2 (8.9) years) were men. There was a mean (SD) interval of 6.6 (8.6) days (range 0-27 days) between echocardiography and MRI. The mean (SD) LV mass determined by MRI Simpson's rule method was 171.0 (52.4) g (range 105.1-318.7 g). The mean LV mass (SD) determined by the echocardiographic Simpson's rule method was 178.2 (47.0) g (range 112.6-307.6 g). The mean (SD) MRI area-length LV mass was 187.3 (64.5) g (range 109.0-393.6 g). The linear regression correlation between LV mass determined by MRI Simpson's and echocardiographic Simpson's methods was excellent (y = 1.022x, R2 = 0.986) with a mean (SD) difference of 7.20 (20.9) g. The linear regression correlation between the MRI area-length LV mass and MRI Simpson's LV mass was excellent (y = 1.101x, R2 = 0.989) with a mean (SD) difference of 16.3 (22.3) g.

CONCLUSIONS

LV mass may be obtained reliably by contrast enhanced colour Doppler and two dimensional echocardiography. The contrast Doppler method accurately determines LV mass with excellent agreement with the MRI technique.

Intravascular Ultrasound Analysis of the Radial Artery for Coronary Artery Bypass Grafting

BACKGROUND

The radial artery has become a popular conduit for coronary artery bypass surgery. However, limited information has been provided regarding the atherosclerotic nature of this artery, which may affect both the immediate intraoperative difficulties and long-term graft patency.

METHODS

We examined intravascular ultrasound (IVUS) images of the radial artery in patients with coronary artery diseases. Cross sections of the radial artery were assessed using the following factors: lumen diameter, lumen area, vessel diameter, vessel area, plaque area, percent plaque area, and extent of calcium deposition.

RESULTS

The IVUS images were obtained from radial arteries of 58 patients (47 men, average 67 +/- 9 years) during transradial procedures; ie, transradial coronary angiography and/or transradial coronary intervention. Mean luminal diameter was 3.28 +/- 0.69 mm and 3.00 +/- 0.70 mm at the proximal and distal segments, respectively, and 2.58 +/- 0.73 mm at the minimal lumen cross section. A percent plaque area greater than 50% was seen in five radial arteries (8.6%) whose average plaque length was 26.4 +/- 30.8 mm. Of these, one showed a plaque length greater than 50 mm, and another showed vessel caliber less than 2.0 mm. Five of 58 radial arteries (8.6%) showed calcium deposition, two of which showed diffuse calcification (> 50 mm). Thus, among 58 radial arteries, four (6.9%: one with diffuse arteriosclerosis, one small radial artery, two with diffuse calcification) were considered unsuitable for bypass conduit.

CONCLUSIONS

Preoperative evaluation of the radial artery is recommended in order to prevent unnecessary exploration of the forearm and to improve graft patency.